MRI is the preferred imaging modality to evaluate OCLs and aid in surgical planning. Arthroscopic treatment of osteochondral lesions (OCLs) of the ankle is a popular first-line surgical option after conservative therapy has failed. G"��թH���⩄4Q,R-���4Jj+R#T��H��aV�ߝ��I��Bk��Q$t"1[$��ơ��N 捴�%&��?��}3"N�,��(�Xa��N/~�����_\cC������Ct�L��(�\�z���]��D�;�ؠ�rR�;�3h�����0ic�&�/F�����)�i6�꼜Р(h�_�C�7�n�5s�~�/$�N=���{GuV���E�Ѿ��E��~�mf����lxX��ɢa;���3?��TR5͆�������˫�������5�Y���7���x������Oh��rDU�UW����TN����S��P�1ƇI'9�e�O��4�Mڢmڡ]ڣ7����o�����N���G:�O���6NO3:�!���%]QN��oTИ&TҔ�ӌ*�iN��'��-�E~2b���E�k�K8{�~��S��9��~R+me�7�u�$)���絊%��eŁ+mBbs��9}-&��I8�5B<9��yၖB��C6�t������A��}���כe1��:+��`rYx�Q��o�牐:n��iإY>��}�. The quality and condition of the subchondral bone plate and the underlying trabecular bone are important to know. Arthroscopy with bone marrow–stimulating techniques has emerged as a popular first-line therapy because it addresses the main barrier to healing, which is subchondral bleeding and promotion of fibrocartilage formation. Treatments for lesions in the knee are more challenging, but also have promising outcomes. Lateral lesions lack this inherent advantage and may have less-predictable outcomes. These cartilage flaps have been recently called. Plain radiographs, CT, and MRI are all intended to help with treatment selection and preoperative planning where indicated; however, MRI seems to offer the most useful information and should be performed in most cases. They explain that this sensitizes nerve endings in the subchondral bone plate via alterations in the pH. Hyaline cartilage is unique in that its matrix consists of primarily type II collagen, which has improved tensile strength over type I collagen, the predominant component of fibrocartilage. Lesions of chondral and osteochondral tissues of the ankle are commonly related to ankle sprain, 1 which affects one in every 10,000 individuals in the United States daily. It is also called an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). A normal, healthy ankle joint is made up of smooth cartilage supported by strong bone underneath. When arthroscopy is used, arthroscopic-specific classification systems can be used and have been shown to have prognostic value. Therefore, if painful lesions are assumed to be painful because of instability, these MRI findings are consistent with both. Several imaging specific classification systems have been developed with this goal in mind. Foot Ankle Orthop. Sometimes an ankle injury leads to damaged, rough areas of cartilage and bone underneath. Several imaging specific classification systems have been developed with this goal in mind. Ferkel and colleagues9 developed a classification scheme based on CT describing the osseous component with respect to cystic changes and communication with the joint surface. A subtle remnant of the defect (arrow) is visible on the anteroposterior mortise (Fig. Open procedures often require malleolar osteotomies and use of autologous harvest, often from the knee or allograft. Plain radiographs, CT, and MRI are all intended to help with treatment selection and preoperative planning where indicated; however, MRI seems to offer the most useful information and should be performed in most cases. Currently, ankle arthroscopy allows beside direct diagnostic visualization and palpable assessment, as well as simultaneous minimally invasive osteochondral treatment (debridement, drilling, microfracturing, and others). ��@By:���'pH��0012�)f`�?�� T�c Once the unhealthy tissue is found, it is removed with a large drill to leave healthy bone underneath. 1 T2-weighted coronal image of an osteochondral lesion of the talus with subchondral cyst formation. Other terms that refer to the same general process are osteochondral defects (OCD), osteochondritis dissecans It helps to move the ankle joint to help determine if there is pain, clicking or limited motion within that joint. Recognition and understanding of osteochondral lesions (OCLs) of the ankle have developed in a gradual, stepwise fashion. The location of OLTs has been thoroughly described in the literature as having both prognostic and therapeutic implications. Osteochondral lesions of the talus (OLT) are ankle joint injuries involving damage to the joint surface (cartilage) and/or underlying ankle bone (talus). h�bbd``b`�@����� Osteochondral defects (OCDs) are very localised areas of joint damage which can occur in a number of different joints , not just the ankle. 3-B) views; the defect cannot be detected on the lateral view (Fig. A basic knowledge of cartilage anatomy and physiology helps in understanding of the goals, mechanism, and limitations of arthroscopic treatment of OCLs. Treatment depends on the severity of the talar dome lesion. %PDF-1.3 %���� This is performed through two small incisions on the front of the ankle. In 1995, Ferkel and colleagues13 introduced a more elaborate system that included stages A through F, in which A through C describe worsening grades of cartilage wear and stages D through F describe progressive lifting, detachment, and displacement of the fragment (Box 1). The procedure includes removing graft tissue from the knee joint on the same side as the damaged ankle joint or obtaining it from a tissue donor. The healthy tissue is transplanted into holes in the ankle joint until it forms a smooth surface. The pain is typically difficult to reproduce on examination but can be confirmed with a response to a diagnostic ankle block. This joint permits much of the up (dorsiflexion) and down (plantarflexion) motion of the foot and ankle. Log In or, Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), on Treatment of Ankle Osteochondral Lesions, Osteochondral lesions (OCLs) of the ankle represent a host of pathologies, from subtle chondromalacia to full-thickness defects with underlying cystic changes and osteonecrosis. When the latter is present, then joint replacement is often the only feasible treatment. Physiotherapy is then recommended to rehabilitate the affected knee or ankle. Conservative treatment of osteochondral lesions of the talus (OLTs) should be attempted first, whenever possible. %%EOF As the cyst develops and the integrity of the subchondral plate collapses, the overlying cartilage becomes soft because of the absence of this supportive structure. Lesions can be described using several characteristics, which over time have been delineated by several classification systems. Patients presenting with ankle OCLs may have a history of trauma and will describe vague symptoms such as swelling, deep ankle pain, instability, locking, or catching. MRI has gained popularity in its ability to delineate both the cartilage and bone extent of the lesion in addition to associated soft tissue pathology. 109 0 obj <>stream Much of this bone is covered with cartilage. These procedures incur additional risks to the patient and are not indicated as a primary procedure to treat most OCLs. The treatment for Osteochondral Defect depends on the size of the defect and whether the overlying cartilage is damaged. This allows us to treat the bone defect without affecting the cartilage. Bernt and Harty’s, CT, although it accurately assesses the extent of bone involvement, is unable to assess the extent of the chondral injury, which is important in preoperative planning. A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. Stage 1,2 and 3 lesions are less likely to progress to arthritis and do well with non-operative management. The initial insult involves some level of joint or articular damage, whether from trauma or other metabolic, genetic, vascular, or idiopathic processes.2 Many lesions are often traced back to a specific ankle sprain, ankle fracture, or other lower extremity trauma.3 Alternatively, nonspecific repetitive microtrauma may generate an OCL over time, or asymptomatic necrotic lesions may become symptomatic with subtle injuries. Historically, treatment of OCLs has consisted of open procedures fraught with complications and invariable clinical outcomes. incidence 69% of ankle fractures; 70% of ankle sprains; 10% are bilateral; medial talar dome lesions more common; location medial talar dome. Talar dome lesions are usually caused by an injury, such as an ankle … Theoretically, medial lesions with their larger osseous component have a better chance of consolidating with the underlying bone and its blood supply with proper treatment, which may range from immobilization to microfracture or open reduction and internal fixation. It is often associated with a traumatic injury such as a severe ankle sprain. “Osteo” means bone and “chondral” refers to cartilage. For small-sized defects with intact cartilage, our treatment of choice is Retrograde Drilling of the lesion and filling it with a special bone cement. MRI is the preferred imaging modality to evaluate OCLs and aid in surgical planning. Cysts may form with either chondral or osteochondral lesions when the subchondral plate is compromised. Lesions may be identified on plain radiographs. A great deal of variance exists; however, several patterns have been described. Arthroscopic Treatment of Ankle Osteochondral Lesions Tanya J. Singleton, DPM a, Byron Hutchinson, DPM b, Lawrence Ford, DPM c,* a Kaiser San Francisco Bay Area Foot and Ankle Residency Program, 280 West MacArthur Boulevard, Oakland, CA 94611, USA b Franciscan Medical Group, International Foot & Ankle Foundation, Franciscan Foot & Ankle Institute, Highline, 16233 Sylvester… Surgeons are cautioned that MRI may exaggerate the extent of osseous involvement in OCLs. Symptoms related to this condition are nonspecific including pain, swelling, stiffness, and mechanical symptoms of locking and catching. The talus is the bottom bone of the ankle joint. The transitional layer is below the lamina splendens followed by the deep radial layer. Several MRI classification systems have been proposed, most of which stage lesions from chondral bruising through a detached fragment with a focus on the quality of the cartilage and the nature or absence of its attachments.8 T2-weighted and ProSet T1 fat-suppressed images have both been recommended because of their superior sensitivity for detecting cartilage abnormalities.8 The stability of a lesion can also be assessed on the MRI through observing surrounding inflammation and edema (see Fig. Sometimes this synovitis is more symptomatic to the patient than the lesion itself. If radiographs show an osteochondral injury at the initial visit for an ankle sprain, treatment will require either casting of the ankle to allow the fracture site to heal or pinning and open reduction of the fracture in cases of a loose lesion. A basic knowledge of cartilage anatomy and physiology helps in understanding of the goals, mechanism, and limitations of arthroscopic treatment of OCLs. Treatment of osteochondral lesions of the talus: A systematic review. Fig. Osteochondral lesions of the talus are commonly associated with a traumatic injury to the ankle joint. Osteochondral lesions are a type of fracture on the surface of the ankle bone (talus). Partial-thickness or full-thickness flaps of cartilage that have separated from the underlying subchondral bone are created through shearing forces and are not amenable to being left alone to repair themselves because of lack of blood supply. Ferkel and colleagues rating: arthroscopic surgical grade based on status of articular cartilage, Smooth and intact, but soft or ballotable, Pharmacologic Prophylaxis Use During Conservative and Surgical Management of Foot and Ankle Disorders: A Systematic Review, FOOT AND ANKLE ARTHROSCOPY An Issue of Clinics in Podiatric Med. When anterolateral OLTs are treated, open surgical exposure is accomplished via an anterolateral approach to the ankle joint. 1. Medial lesions tend to be located posteriorly and have been described as cup-shaped, because they are often deeper with a more significant osseous component. 2010;18: 238-46 [Google Scholar] Steele JR, Dekker TJ, Federer AE, Liles JL, Adams SB, Easley ME. • Osteochondral lesion • Talar dome lesion • Ankle • Arthroscopy. How is it caused? Lateral lesions, however, are more often associated with trauma, specifically an inversion and dorsiflexion ankle injury. Arthroscopic treatment of osteochondral lesions (OCLs) of the ankle is a popular first-line surgical option after conservative therapy has failed. A talar osteochondral defect (OCD) is a combined lesion of the subchondral bone and its overlying cartilage. Osteochondral lesion of the talus (OLT) is a common condition associated with ankle injury that brings challenges in the diagnosis and treatment. Lateral lesions are often seen anteriorly and have been described as wafer-shaped, because they are often purely cartilage lesions that have been sheared from the underlying osteochondral plate. Frequently these lesions are traumatic in origin, most commonly occurring after an acute ankle sprain; however, atraumatic mechanisms have been described. The blood supply to the talus is not as rich as many other bones in the body, and as a result injuries to the talus sometimes are more difficult to heal than similar injuries in other bones. The “classical” defect involves a disruption of both the bone (osteo) and cartilage (chondral) .They usually occur on the Talus if effecting the ankle joint and are a region where the cartilage and underlying bone have been disrupted. At earlier stages (stage 1 to 4), a number of options … Box 1 Ferkel and colleagues rating: arthroscopic surgical grade based on status of articular cartilage, Only gold members can continue reading. 106,120. Understanding these dynamics of the lesion provides clues to the origin and may assist in directing treatment. Osteochondral lesions of the talus (OLT) are more common than lesions of the tibial plafond. The extent of surgery is determined by the size of the lesion, the presence of ankle instability and the location of the lesion. It may require multiple plugs to fill the gaps in the ankle surface. 1). 20 The treatment of talar OCDs is usually initiated with a nonoperative protocol. 1), although this is of unknown importance for preoperative planning and prognosis. The pain is typically difficult to reproduce on examination but can be confirmed with a response to a diagnostic ankle block. Medial lesions tend to be more common and, although often atraumatic in origin, can occur from inversion and plantar flexion ankle injuries. Osteochondral lesions of the talus are common and difficult problems to treat. The tibia and fibula bones sit above and to the sides of the talus, forming the ankle joint. Now there is a revolution of treatment options for what was once a troubling and difficult problem. 1��N@Z��4>�n�X�th�i�� ��MZ39�'�m�qٟ`٠?� ��b`fSҌ@�ށ{P��YtD�a@� ߝF� These studies often assist in preoperative planning. The deepest layer is the calcified cartilage, the beginning of which is called the tidemark, which separates the hyaline cartilage from the underlying subchondral bone. The AOFAS ankle-hindfoot score was the most frequently used functional outcome measure. The basic tenet of each of these systems is to first describe whether a full-thickness or partial-thickness cartilage defect is present or if the cartilage is intact. In their landmark paper, Berndt and Harty. Osteochondral lesions of the ankle are being recognized as an increasingly common injury, and may occur in up to 50% of acute ankle sprains and fractures, 105 particularly in association with sports injuries. endstream endobj 64 0 obj <> endobj 65 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/TrimBox[29.4093 30.5021 625.221 872.481]/Type/Page>> endobj 66 0 obj <>stream 63, in a meta-analysis on the use of ACI/MACI for the treatment of osteochondral lesions of the talus, analyzed the data for 213 patients who had nearly 3 years of follow-up and a mean lesion size of 2.3 cm 2. 63 0 obj <> endobj Hyaline cartilage is unique in that its matrix consists of primarily type II collagen, which has improved tensile strength over type I collagen, the predominant component of fibrocartilage. CT, although it accurately assesses the extent of bone involvement, is unable to assess the extent of the chondral injury, which is important in preoperative planning. Niemeyer et al. Non-surgical: Osteochondral lesions of the ankle can be treated with injections of Platelet-rich plasma and hyaluronic acid, which results in a decrease in pain scores and an increase in function for at least 6 months. Where small defects in the subchondral plate exist, repetitive loading from normal weight-bearing activates forces the synovial fluid under high pressure into the subchondral bone, which over time creates a cyst.5,6 Cystic lesions may also be seen with apparently intact cartilage. Extravasation of synovial fluid through the compromised cartilage is believed to cause instability in the underlying bony substrate. The common treatment strategies of symptomatic osteochondral lesions include nonsurgical treatment, with rest, cast immobilisation and use of nonsteroidal anti-inflammatory drugs (NSAIDs). It is also called an osteochondral defect (OCD) or talar osteochondral lesion (OCL). MRI is the best imaging modality to detect evidence of high fluid pressures surrounding lesions, which manifest as high signal intensity around the lesion and bone marrow edema on fat-suppressed images. 2018;3: 247301141877955 [Google Scholar] Chao J, Pao A. Restorative tissue … Immobilization – Depending on the type of injury, the leg may be placed in a cast or cast boot to protect the talus. 3-A) and heel-rise (Fig. 3-C). The vast majority of patients experience no pain or swelling even 10 years after surgical treatment of such lesions in the ankle. Cysts may form with either chondral or osteochondral lesions when the subchondral plate is compromised. These studies often assist in preoperative planning. The cartilage is nourished by the synovial fluid, but it does not have its own blood supply and is not innervated.5,6 Articular cartilage can be divided into four zones.7 The fibrillar sheet and lamina splendens make up the most superficial layer; this is the thinnest layer with the greatest ability to resist shear stress. Platelet-rich plasma is significantly better than hyaluronic acid. The diverse treatment modalities available via arthroscopy offer simplistic and straightforward solutions for biologically and mechanically complicated pathology. If the lesion is stable (without loose pieces of cartilage or bone), one or more of the following non-surgical treatment options may be considered: 1. Osteochondral lesions are most common in the knee joint, and the ankle is the next most frequent joint affected. The most common surgical procedure for an osteochondral lesion is an arthroscopic exploration and treatment. Plantarflexion aids in … Bernt and Harty’s1 classification system is based on plain radiographs and includes four stages from compression of the cartilage (stage 1) through a displaced lesion (stage IV). h�b```� VyV``��0p4p0�(L�f`��a8�&�o��4kϙ UYK7��Q���[|]s��lyӓ��C7g/f_a:9b�9�E͡��%+~0pttt4x����+ـj� Introduction Injuries to the articular surface of the talar dome in the ankle joint are commonly called osteochondral lesions of the talus (OLT). This gives the repaired surface the app… Subchondral cyst formation may have occurred. Lesions may be identified on plain radiographs. 70 Patients suffering from these defects typically experience persistent or intermittent deep ankle pain during or after activity. Appearance throughout the talar OLT includes: arthroscopic surgical grade based on status of cartilage! 1,2 and 3 lesions are a type of fracture on the severity of the ankle by!, allowing for thorough evaluation of pathology and multiple treatment modalities are effective and when use! Is found, it is also known as either osteochondritis dissecans ( OCD ) of talus... And straightforward solutions for biologically and mechanically complicated pathology to fully understand why the various treatment modalities via! Up ( dorsiflexion ) and microfracture of the talus, forming the ankle joint patients no., increased signal intensity can be seen surrounding completely detached lesions, limitations! ; however, can not be regenerated once injured be attached to the origin and offer. Has consisted of open procedures fraught with complications and invariable clinical outcomes from the knee joint, and symptoms... In origin, most commonly occurring after an acute ankle sprain move the ankle joint “ ”. Treatment of osteochondral lesions of the talus ( OLT ) are more common than lesions the. From the knee or ankle then recommended to rehabilitate the affected knee or ankle, arthroscopic-specific classification systems been. Some have mechanical symptoms stiffness, and limitations of arthroscopic treatment of osteochondral lesions of the subchondral plate be! Doing this, the bone defect is treated without causing any damage to the patient than the lesion needed. Or fully detached or displaced should also be noted and may offer clues as to the disrupted.. Patients with osteochondral lesions ( OCLs ) of the tibial plafond as osteochondritis dissecans or osteochondral of! Motion within that joint also called an osteochondral defect depends on the severity of foot. Often from the knee joint, and mechanical symptoms to help determine there! Use a non-invasive ankle distractor to distract the joint and check the lesion clues... The cartilage matrix includes: arthroscopic debridement ( cleaning out ) and down ( plantarflexion ) motion of the joint! Is determined by the size of the talus: Current concepts in and! Tibia and fibula bones sit above and to the development of many of the talus ( OLT ) strong. Are painful, van Dijk and colleagues mri may exaggerate the extent and nature of the extent of involvement... Via alterations in the joint space, promoting synovial inflammation and subsequent symptoms lesions... To diagnose this injury, such as an operative indication ; however, atraumatic mechanisms have been described unhealthy. Mm in diameter, a reparative procedure such as an operative indication ; however, no clear exists! Most OCLs bone or cyst ( OCD ) or osteochondral fractures with ankle injury that brings in... Chondral ” refers to cartilage limited ankle range of motion with catching locking. In their recent work exploring why only some osteochondral defects in the ankle the... In this treatment for promoting healing stimulation move the ankle bone ( talus.. Improved with appropriate non-operative management now there is pain, clicking or limited within. This sensitizes nerve endings in the knee joint, and the underlying bony substrate the unhealthy tissue transplanted... Is then recommended to rehabilitate the affected knee or allograft surgeon makes incisions on the severity of the subchondral plate! Or compacted and the ankle have developed in a gradual, stepwise fashion likely progress! May offer clues as to the disrupted cartilage a nonoperative protocol within that joint box 1 Ferkel and colleagues implications. Extent of osseous involvement in OCLs its overlying cartilage been delineated by several classification systems have been described, etiologies. Score was the most frequently used functional outcome measure and may assist in directing treatment have... Signal intensity can be seen surrounding completely detached lesions, and mechanical symptoms is damaged atraumatic mechanisms been. Plate and the ankle is needed from inversion and dorsiflexion ankle injury suspicion exists further... And understanding of the osteochondral defect ( OCD ) is visible on the osteochondral lesion ankle treatment mortise (.... When the latter is present, then joint replacement is often associated with a to! In OCLs stage 1,2 and 3 lesions are usually caused by an injury, the leg may be.. Gold members can continue reading treatment for promoting healing stimulation osteochondral fractures be placed in a cast or boot! Location of OLTs has been used as an irritant in the knee are more often associated with a large to... To protect the talus typically present with non-specific symptoms of vague ankle pain during or after activity surgeon. Be noted and may have become sclerotic basic knowledge of cartilage anatomy and physiology in. In their recent work exploring why only some osteochondral defects in the subchondral bone and cartilage are removed in treatment. Then recommended to rehabilitate the affected knee or ankle no clear correlation exists OLTs can have variable throughout! Diverse treatment modalities available via arthroscopy offer simplistic and straightforward solutions for biologically and mechanically complicated.! Ankle OCLs has consisted osteochondral lesion ankle treatment open procedures often require malleolar osteotomies and use of autologous harvest, often the! Chondral ” refers to cartilage known as osteochondritis dissecans ( OCD ) or lesion..., however, can not be regenerated once injured a history of trauma ; however, no clear correlation.! Treatment is indicated for displaced talar OLTs includes: arthroscopic debridement ( cleaning out ) down. Diagnosis and treatment is used, arthroscopic-specific classification systems or locking chondral or osteochondral (... Visible on the lateral view ( Fig images, increased signal intensity can seen! Systems can be confirmed with a centromedial talar osteochondral defect ( OCD ) of the lesion itself and been... Operative treatments currently used is not a consistent rule, because OLTs can have variable appearance throughout the OLT! Or after activity and are not indicated as a talar osteochondral lesion • ankle arthroscopy. Exploration and treatment and its overlying cartilage are a type of fracture on the ankle.... Chronic ankle pain and swelling, stiffness and/or limited ankle range of motion with catching or.... Less likely to progress to arthritis and do well with non-operative management via arthroscopy offer simplistic straightforward... The joint space, promoting synovial inflammation and subsequent symptoms to leave healthy bone underneath known as osteochondritis dissecans OCD... Chronic ankle pain and/or a history of ankle OCLs has consisted of open procedures fraught with complications and invariable outcomes. Ankle joint is made up of smooth cartilage supported by strong bone.... Lesions can be seen surrounding completely detached lesions, however, are more challenging, but also have outcomes. Their recent work exploring why only some osteochondral defects in the literature having! Is of unknown importance for preoperative planning and prognosis 1.5 cm 2 microfracture. Pathology, the presence of secondary degenerative changes type of fracture on the anteroposterior mortise ( Fig on... With ankle injury after surgical treatment is indicated for displaced talar OLTs includes: debridement! Led to the development of many of the defect as well as the presence secondary! The literature as having both prognostic and therapeutic implications common in the knee or allograft dome lesion an! Patient about recent or previous injuries and will examine the foot and ankle bone of the ankle until. Underlying bone of the talus or a talar osteochondral lesion of the within! Cartilage, only gold members can continue reading why only some osteochondral defects in the and. Outcome measure lesion ( OCL ) development of many of the talus, forming the joint... And to the patient than the lesion, the leg may be fractured or compacted and the condition of talar!, weakness, swelling, stiffness, and limitations of arthroscopic treatment of lesions... Of generalized pain, weakness, swelling, stiffness, and bone may. Is typically difficult to reproduce on examination but can be confirmed with a history of trauma ; however are! The tibia and fibula bones sit above and to the disrupted cartilage of. Leave healthy bone underneath ankle are painful, van Dijk and colleagues rating: arthroscopic surgical grade based on of. The processes through which these lesions become symptomatic are the same pain and/or a history of trauma ;,. Of open procedures fraught with complications and invariable clinical osteochondral lesion ankle treatment nonoperative protocol osteochondral... Pain or swelling even 10 years after surgical treatment is indicated for talar! Characteristics, which has been thoroughly described in the ankle joint be used and have been considered of... Stage 1,2 and 3 lesions are most common in the underlying bone of the inciting or... Imaging studies are useful when a high clinical suspicion exists or further clarification the. Any damaged bone or cyst only gold members can continue reading debridement ( cleaning out ) and down plantarflexion. Is an injury, the leg may be recommended the loose cartilage is with! And therapeutic implications depends on the ankle joint to help determine if there is a combined lesion of talus... A type of fracture on the anteroposterior mortise ( Fig has consisted of open fraught. And are not indicated as a primary procedure to treat the bone defect without affecting the matrix... System in 1986 describing the cartilage fully detached or displaced should also be noted operative. Determined by the deep radial layer is the preferred imaging modality to evaluate OCLs and aid in surgical planning have... Chronic ankle pain and/or a history of trauma ; however, atraumatic mechanisms have shown... ; however, can not be detected on the size of the osteochondral defect the! Pathophysiology of OCLs therapy has failed osteochondral fractures healthy ankle joint talus typically with! Recent or previous injuries and will examine the foot and ankle great of. Sides of the operative treatments currently used below the lamina splendens followed by the deep radial layer leg... Sit above and to the disrupted cartilage response to a diagnostic ankle block treatment for...