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Seven studies described the results of non-operative treatment, 4 of excision, 13 of excision and curettage, 18 of excision, curettage and bone marrow stimulation (BMS), 4 of an autogenous bone graft, 2 of transmalleolar drilling (TMD), 9 of osteochondral transplantation (OATS), 4 of autologous chondrocyte implantation (ACI), 3 of retrograde drilling and 1 of fixation. HHS 1999;15:197–202. You may need to keep weight off the foot and use crutches during this period of immobilization. [30], Polat et al. [14] Provocative tests such as anterior drawer test should be performed and compared to the unaffected side to evaluate the associated instability. Ankle and navicular are two seperate areas. Treatment of coexisting OLT and ligamentous instability Acute ankle ligament injuries with a large, unstable fragment typically first undergo surgical repair of the talar lesion. Thus, treatment should be individualized to every patient, with adequate counseling regarding the outcomes and associated complications of that technique. Immobilization – Depending on the type of injury, the leg may be placed in a cast or cast boot to protect the talus. A cast will hold the bones in your foot in place while they heal. in their study of 165 consecutive ankles with OLT demonstrated good functional outcomes and improved quality of life in patients at 6.7 years of follow-up. Stable, well-aligned fractures, however, can often be treated without surgery. Choi et al. 2020 Aug 21;26:e921823. 1. [29] Return to sports rate after microfracture is reported to be 76%, though most patients may not be able to achieve the pre-injury level. Surgical Repair of OCD of Talus Guideline This rehabilitation program is designed to return the individual to their activities as quickly and safely as possible. Introduction. in their study of 22 patients with successful initial non-operative treatment of OLT reported only minimal symptoms, a low failure rate, and no significant progression of ankle arthritis at a minimum follow-up of 10 years, though a substantial number of patients (>1/3rd) reported a decrease in sporting activity. doi: 10.1016/s1083-7515(02)00064-5. Guney et al. Bai L, Guan S, Liu S, You T, Xie X, Chen P, Zhang W. Orthop J Sports Med. 2008 Mar;37(3):204, 206-11. doi: 10.1007/s00132-008-1219-3. This site needs JavaScript to work properly. Research studies show OCD lesion in the talus in 70% of ankle fractures, 60% of ankle sprains. doi: 10.1136/bcr-2020-234595. This guide will help you understand 1. how OCD develops 2. how the condition causes problems 3. what can be done for your pain Annals of Clinical and Analytical Medicine. Foot Ankle Clin. 2002;23:381–389. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. [25] Useful algorithm describing the indication for each procedure is outlined in [Figure 1]. [17,18] Arthroscopy remains the gold standard as it allows direct visualization, probing of the lesion to assess the stability of the overlying cartilage and also accurately assess the extent of the lesion. Surgical treatment includes arthroscopic drilling of intact lesions, securing of cartilage flap lesions with pins or screws, drilling and replacement of cartilage plugs, stem cell transplantation, and in very difficult situation in adults joint replacement. Surgery is often needed to better assess the lesion and determine the goal of either lesion healing or removal. [40] A retrospective analysis of 131 patients suggested that though all patients returned to sporting activity, they engaged in fewer, less frequent sporting activities post-OATS treatment.[41]. in their review of 82 patients reported increase in arthrosis by one grade radiologically though none of the patients had Grade IV arthritis at a minimum follow-up of 5 years. Rationale of conservative treatment is to offload the affected area for resolution of bone marrow edema and to facilitate healing of the detached cartilage. Fifty-two studies described the results of 65 treatment groups of treatment strategies for OCD of the talus. To date, there are no randomized controlled trials on the efficacy of osteochondral lesion treatments and most publications that exist are of low quality with short-term follow-up and varying conclusions. They also proposed the radiological classification that is widely employed even to the present day. reported retrograde drilling and autogenous bone grafting to be an excellent technique in their review of 41 patients of OLT with an intact overlying cartilage with good functional and radiological outcome. in 1984 emphasized that these lesions should not be called as osteochondritis dissecans but be grouped under a broader term “osteochondral lesions of the talar dome.”[7] The arthroscopic treatment of these lesions was first described by Parisien and Pritsch et al. [26] Furthermore, the quantity and quality of fibrocartilage formed may vary. Casting. 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. Nonsurgical Treatment. -, Alexander AH, Lichtman DM. It can occur in all age groups. [31] The reported incidence of complication rate varies from 0 to 14% with superficial peroneal neuropathy and portal site pain cited as the most common complications.  |  [6] Kouvalchouk et al. Spearman's correlation coefficients were calculated between functional scores and various factors. Cartilage Grafting Options for Large or Microfracture-resistant Osteochondritis Dessican (OCD) Lesions of the Talus. Finite Element Analysis of the Effect of Talar Osteochondral Defects of Different Depths on Ankle Joint Stability. There are numerous reasons that make the talar cartilage and the subchondral bone prone to vascular insufficiency. [3] This review aims to elucidate the historical aspect of the disease, etiopathogenesis, classifications, diagnosis, and treatment to assist in day-to-day clinical practice. The common treatment strategies of symptomatic osteochondral lesions include nonsurgical treatment, with rest, cast immobilisation and use of … [3] Conservative treatment mainly consists of rest, avoiding sporting activities, cast immobilization with or without NSAIDs, and intraarticular injection of platelet-rich plasma (PRP) and hyaluronic acid (HA). Occasional joint locking. [22], Injection therapy alone with PRP or HA has also been attempted in the treatment of OLT. [8,9] There have been numerous changes to the terminology of these lesions since the first description, however, the term “osteochondral lesions of the talus” (OLT) is generally preferred. Talus osteochondral defects (OCD) are considered as a common cause of chronic ankle pain and disability. doi: 10.2106/JBJS.E.00033. [46] As cartilage tissue is immune deprived, it is also not associated with immune reactions. [19] Commonly used classifications are summarized in [Table 1]. Patients present with spectrum of non-specific complaints including of pain on weight-bearing, swelling, stiffness, and occasionally locking sensation at the ankle joint. Allograft juvenile articular cartilage transplantation for treatment of talus osteochondral defects. In view of these limitations, surgical treatments for OCD of the talus present an overall success rate of 79%. This initial evaluation often leads to a broad differential diagnosis including ankle synovitis, impingement, occult fractures, and early ankle/subtalar arthritis.[2]. acute injury; nondisplaced fragment with incomplete fracture; Operative. [52] A systematic review of level 1 and 2 studies by Yausep et al. J Bone Joint Surg Am. Recommended indications include a symptomatic patient with size of the lesion at least 1.5 cm in one dimension or a patient who had a failed marrow stimulation technique. Med Sci Monit. 2006;88:303–308. [51], This technique combines microfracture with either autologous iliac crest bone marrow aspirate concentrate (BMAC) or PRP secured to the defect using a collagen scaffold/fibrin glue in a single stage [Figure 3]. There are only a few … Furthermore, PRP group had significantly better outcomes than the HA group. [6] In case of clinically suspected lesion with negative radiographs, advanced imaging options such as CT and MRI are useful. NLM in their review highlighted the paucity of long-term high-level studies regarding usage of BMAC in OLT with most evidence coming mainly from retrospective studies. Autologous osteochondral grafting for talar cartilage defects. They reported favorable outcomes with 86% of patients having no pain or only mild pain, no advancement of MRI staging in 84% of patients, and no significant ankle arthritis at final follow-up, though many patients reported minor discomfort on activities of daily living and sporting activities. There is a wide variety of treatment strategies for osteochondral defects of the ankle, with new techniques that have substantially increased over the last decade. A non-shoulder-type lesion is defined as a chondral defect that has surrounding articular cartilage (a contained cartilage defect), whereas a shoulder-type lesion does not have a peripheral cartilage border on one side with the loss of the medial or lateral articular buttress (uncontained defect). In more than one third of cases, conservative treatment is unsuccessful, and surgery is indicated. An MRI scan was performed at follow-up to assess talus OCD after treatment. Anders et al. In more severe cases however, ankle surgery may be indicated. Without appropriate treatment, talus OCD have the potential to lead early cartilage degeneration and eventually osteoarthritis. [2] The allografts used are either fresh allografts which have to be used within 28 days or fresh frozen allografts with relatively less chondrocyte viability. ISSN (Print): AwaitedISSN (Online): 2582-7332, © 2020 Published by Scientific Scholar on behalf of Journal of Arthroscopic Surgery and Sports Medicine, Department of Arthroscopy & Foot and Ankle, Ganga Medical Centre and Hospital Pvt. Surgical options for the treatment of osteochondral lesions of the talus are numerous and have expanded over the past few years. [2] Although majority may be associated with trauma, some may develop insidiously. USA.gov. Ferkel’s grading is the most commonly employed grading system on arthroscopy. [10], Most OLT are secondary to trauma, with up to 50% of ankle sprains resulting in some grade of cartilage injury. [21] Weigelt et al. Rationale of conservative treatment is to offload the affected area for resolution of bone marrow edema and to facilitate healing of the detached cartilage. in 1986. [38], This technique involves harvesting osteochondral plugs from donor sites such as non-weight-bearing portions of the knee and implantation of these plugs to the areas of osteochondral defects. 1980;62:646–652. This procedure is a single-stage procedure and as it does not require a press fit or graft contouring due to its particulate nature, it can be carried out arthroscopically. Clinicians should have a high index of suspicion as symptoms and clinical signs may be non-specific. You will likely have a cast and need to use crutches for a few weeks to allow the bone injury to heal. During this period of immobilization, non-weightbearing range-of-motion exercises … Arthroscopy. [2] The rationale is to form a hyaline cartilage at the defect from pluripotent cells instead of fibrocartilage that forms after microfracture alone. [15] Although it provides good visualization of the cartilage, it tends to overestimate the extent of the subchondral lesion due to the associated marrow edema. [5] In 1959, Berndt and Harty were the first to describe the pathogenesis of osteochondral lesions post-trauma. A physical exam can rule out other problems, but an X-ray will usually secure the diagnosis. This treatment approach can be initially attempted in non-displaced OLTs However, due to great diversity in the articles and variability in treatment results, no definitive conclusions can be drawn. MRI is the most sensitive imaging for OLT with a sensitivity of 96%. An MRI is often done to assess the nature of the OCD and the risk for it to come loose. Trauma-seen with ankle fractures and sprains. Chahla et al. Systematic review of treatment strategies for osteochondral defects of the talar dome. 2005;26:583–589. [27] Toale et al. -, Baker CL, Jr, Morales RW. In children whose bones are still growing, the bone defect may heal with a period of rest and protection. J Bone Joint Surg Am. [2], Microfracture is a technique of perforating the subchondral bone to allow the progenitor cells from the bone marrow to infiltrate into the lesion [Figure 2]. These eventually would form fibrocartilage at the defect. Patient’s consent not required as patients identity is not disclosed or compromised. These repetitive injuries may result in microtrauma in an already vulnerable bone with sparse vascularity causing OLT. Lesions with large cystic areas, diffuse arthritic changes, ankle malalignment, and prior history of infections are contraindications to this procedure. It is designed for rehabilitation following surgical repair of OCD of Talus. 2016. BMJ Open. Arthroscopic treatment of the OLTs aims to restore ankle joint function and pain relief by the removal of the chondral or osteochondral fragment, debridement and stabilization of cartilage rim and subchondral bone, and stimulate healing of the bone and damaged cartilage. Then applying the surgical technique which will be most successful achieving the goal. During this period of immobilization, nonweightbearing range-of-motion exercises may be recommended. 2003 Jun;8(2):233-42, viii-ix. Availability of fresh donor allografts and the associated cost is also a concern in developing countries. Despite the advantages, the reported failure rate is 40% with lesions of area >125 mm2 and male sex associated with significantly higher risk of clinical failure. [28] Despite these findings, microfracture still seems to be resulting in good functional outcomes. doi: 10.12659/MSM.921823. [5] The sole indication for operative treatment at presentation is an acute lesion with displacement. NIH Foot Ankle Int. [2] Lee et al. Classification of operative techniques for OLT. [2] This technique is effective in treating large cystic lesions even up to 6 cm2 with favorable outcomes reported. Foot Ankle Spec. Because of the relatively high cost of ACI and the knee morbidity seen in OATS, we conclude that BMS is the treatment of choice for primary osteochondral talar lesions. [12] Second, arterial supply to the talar dome and the overlying cartilage is by a retrograde vascular network that comes from the talar neck with additional watershed areas showing poor perfusion in the posteromedial, posterolateral, and mid-medial segments of the subchondral bone. Among the OLT, up to 94% of the lateral lesions are said to be secondary to trauma while only 62% of medial lesions are post-traumatic. described the classifications of OLT based on CT and MRI, respectively. Annals of Clinical and Analytical Medicine; inquiry [23] As far as BMAC is concerned, varying degrees of beneficial effects have been reported in different studies when used as an adjunct to surgical procedures. This finding seems to confirm the paramount importance of early surgical treatment for OCD. indications . They highlighted the heterogeneity of the data and suggested the need for high-quality prospective randomized studies using validated outcome measures for clarity regarding the effective modalities of treatment for OLT.[50]. Effect of autologous adipose-derived mesenchymal stem cell therapy in the treatment of an osteochondral lesion of the ankle. [23] A level-II randomized study conducted by Mei-Dan et al. Together with the newer techniques OATS and ACI, BMS was identified as an effective treatment strategy for OCD of the talus. [16] Ferkel et al. This option is useful for large OLT with extensive subchondral cysts. [47] A recent systematic review on the role of PJCAT in OLT involving 10 studies and 132 patients showed good postoperative functional outcomes, however, the regenerated cartilage was heterogeneous in nature with relatively unaltered subchondral area which is in contrast to the belief that PJCAT would restore the area of defect to near normal cartilage. [53], In summary, outcomes following surgery are variable and thus treatment strategy has to be tailored to every patient depending on specific factors. HA is known to reduce inflammation in the joint while simultaneously substituting joint fluid. Plain radiography is the initial investigation of choice in a clinically suspected case of OLT. The first description of osteocartilaginous loose bodies in the ankle, attributed to trauma, was given by Monro in 1738. If the problem is discovered immediately after a twisting injury to the ankle, immobilization in a cast or boot for six weeks may be suggested to see if the bone injury heals. Both non-operative and operative modalities have been described for the treatment of OLT. [Diagnosis and treatment of osteochondral lesions of the talus]. Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. Although the treatment of osteochondral lesions of the talus has evolved and improved, there is a need to understand the full spectrum of treatments and be well-versed in all forms of treatment in order to have a complete bag of tools necessary to treat these complicated occurrences. Berndt and Harty classification is the staging system that is widely employed for describing OLT on plain radiographs. Osteochondral autograft transfer system (OATS), Particulated juvenile cartilage allograft transfer (PJCAT), Autologous chondrocyte implantation (ACI), Matrix-induced autologous chondrocyte implantation (MACI), I: Cystic lesion at the dome with intact roof on all sides, Medial/lateral lesions, subchondral cysts. eCollection 2020 Jul. Conservative Treatment of Talar Osteochondritis Dissecans (OCD) Ezequiel Palmanovich1 and Meir Nyska1 (1) Foot and Ankle Unit – Orthopedic Department, Meir Medical Center – Israel, kfar Saba, Israel Ezequiel Palmanovich Email: ezepalm@gmail.com 2.1 Introduction Since 1922 when this syndrome was first described by Kappis [1],… [13] All these factors make the talus prone for developing osteochondral lesions. [44] A systematic review by Richard et al. Most cases of OCD usually follow a twisting injury to the ankle and are actually fractures of the joint surface. -, Becher C, Thermann H. Results of microfracture in the treatment of articular cartilage defects of the talus. COVID-19 is an emerging, rapidly evolving situation. BMJ Case Rep. 2020 Jul 8;13(7):e234595. 2020 Jul;14(2):64-71. doi: 10.5704/MOJ.2007.014. Left untreated this can lead to degenerative changes to the ankle joint and evan necrosis of the talus. Although it still remains a 2-staged procedure, using a collagen matrix reduces the operative time and also helps in even distribution of chondrocytes. Answers from doctors on ocd of talus. A history of ankle trauma/recurrent instability is to be elicited as OLT are associated with ankle instability. They require a strong plan. Autologous chondrocyte transplantation for treating cartilage defects of the talus. Osteochondral lesions of the talus (OLTs) are a difficult pathologic entity to treat. in their systematic review of 15 studies with a mean follow-up of 72 months also highlighted surface damage in 76% of patients on follow-up MRI that could be a harbinger for long-term problems. Prognostic factors determining success of microfracture. Knee Surg Sports Traumatol Arthrosc. Treatment: Nonoperative . [50] Kreulen et al. Further sufficiently powered, randomized clinical trials with uniform methodology and validated outcome measures should be initiated to compare the outcome of surgical strategies for OCD of the talus. Surgical technique should be mainly chosen depending on the status of the overlying cartilage, size, and containment of the lesion. Osteochondral Lesions of the Talus Indications & Outcomes • Comparison of 39 studies treating ankle OCD’s with excision, excision and curettage, osteochondral transplantation, fixation, retrograde drilling) –(level 2) •Best outcome (86% good to excellent results) with: Operative treatment of osteochondral lesions of the talus. Malays Orthop J. 2013 Apr;6(2):141-4. doi: 10.1177/1938640013479934. that included four studies concluded that PRP used in conjunction with microfracture results in better pain and functional improvement than microfracture alone. found PRP as an adjunct to arthroscopic microfracture for the treatment of OLT resulted in improved functional score status at an average follow-up of 16.2 months. Arthroscopic treatment of transchondral talar dome fractures: a long-term follow-up study. Pain medication as needed every 6 hours. [42,43] These grafts can then be employed for bulk transfer after size matching using CT scan. These lesions pose a diagnostic challenge to the attending clinician due to lack of specific clinical signs and lack in consensus regarding treatment makes the management aspect controversial. Osteochondral lesions of the talus (OLT) are those that affect the chondral and subchondral areas of the talus. Conservative treatment mainly consists of rest, avoiding sporting activities, cast immobilization with or without NSAIDs, and intraarticular injection of platelet-rich plasma (PRP) and hyaluronic acid (HA). [45] Due to high rates of reoperation and failure, it is necessary to opt for other less morbid techniques initially, keeping this technique of osteochondral allografting as a bail out procedure in failed cases. Donor site morbidity and the need for a medial malleolus osteotomy remain its major disadvantages. Al-Shaikh RA, Chou LB, Mann JA, et al. Please enable it to take advantage of the complete set of features! [2] Decision-making depends mainly on the stability of the overlying cartilage, size, and the containment of the lesion (shoulder and non-shoulder type lesion). [37] Morphological evaluation post-retrograde drilling using second look arthroscopy showed no worsening of overlying cartilage at 1-year follow-up. Causes: Microtrauma-seen in runner or old age. A systematic review of 52 studies including 1236 primary OLT by Dahmen et al. This is usually done with a combination of immobilization and then rehabilitation. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms. Although OCD of the talus represents a frequently observed orthopedic pathology, evidence concerning operative treatment of osteochondrosis dissecans of the talus is still elusive. Either way if you have such a fracture treatment will require non weight bearing cast for 4-6weeks and X-ray exams during that period for evaluation of bone healing. Treatment of osteochondritis dissecans is intended to restore the normal functioning of the affected joint and relieve pain, as well as reduce the risk of osteoarthritis. OLT encompass a wide variety of disorders that are both difficult to diagnose and also to treat with varying functional outcomes. Clinical examination may reveal effusion at the ankle, tenderness over the talus on palpation, decreased range of motion, and pain on ankle dorsiflexion and inversion. The aim of this study was to summarize all eligible studies to compare the effectiveness of treatment strategies for osteochondral defects (OCD) of the talus. immobilization and non-weight bearing. C. Icing is important for the first 5-7 days post-op. Fibrocartilage is predominantly made of Type I collagen which is structurally and biomechanically inferior to hyaline cartilage. First: ankle navicular fracture is confusing. treatment of OCD of the talus Ji viable cartilage, the fragment is not displaced, then the rate of healing is very high and surgery is not required. I wish you and your … This rate depends on the stage of the lesion, being lower for stage IV lesions (76%) and higher for low-grade lesions (82% for stage I, 86% for stage II and 83% for stage III). studied the factors influencing the results of ACI in OLT and concluded that size >137 mm2 and age <26 years to be significantly associated with better MOCART (modified magnetic resonance observation of cartilage repair tissue) scores while patients sex, depth of the lesion, and presence or absence of accompanied procedure did not affect the results of ACI in OLT. Surgical treatment is indicated after a failed conservative trial, larger lesion and can be broadly split into cartilage repair, replacement, and regenerative strategies. doi: 10.1136/bmjopen-2019-033850. 2013 Jun 5;95(11):1045-54. doi: 10.2106/JBJS.L.00773. We use cookies to ensure that we give you the best experience on our website. If you continue to use this site we will assume that you are happy with it. -, Baums MH, Heidrich G, Schultz W, et al. Furthermore, juvenile cartilage has been shown to possess copious cellular activity that results in formation of abundant extracellular matrix than its adult counterpart. Orthopade. [46] This harvested cartilage is then transferred to the area of defect and secured using fibrin glue. There are several non-operative management options for the treatment of osteochondral lesions, including: Cast immobilization: If the OLT occurs following an acute injury, initial immobilization in a cast for 4-6 weeks can help reduce stress on the OLT and allow healing. In general talus OCD is difficult to get healed with or without surgery. One randomized clinical trial was identified. Treatment for OCD depends on when the problem is discovered. This is a relatively newer technique that employs transfer of particulated juvenile cartilage pieces with their native extracellular matrix harvested from deceased donors aged from newborns to 13 years. © Copyright 2020 – Journal of Arthroscopic Surgery and Sports Medicine – All rights reserved.Published by Scientific Scholar on behalf of Indian Arthroscopy Society. Secondary cyst formation and subchondral … Treatment depends on the severity of the talar dome lesion. [1] This is a broad terminology that encompasses a variety of disorders including osteochondritis dissecans, osteochondral fractures, and osteochondral defects.  |  Osteochondral transplantation of autologous graft for the treatment of osteochondral lesions of talus: 5- to 7-year follow-up. Seven studies described the results of non-operative treatment, 4 of excision, 13 of excision and curettage, 18 of excision, curettage and bone marrow stimulation (BMS), 4 of an autogenous bone graft, 2 of transmalleolar drilling (TMD), 9 of … Ice is applied for 20-minute periods 3-4 times per day. IN) to treat patellar lesion. Treatment Options for OCD Ankle Lesions If OLT is diagnoses immediately after the injury, immobilization of the foot and ankle for a period of time usually resolves the problem. The size of the lesion is the main factor to consider. B. Ankle Arthroscopy + Microfracture Talus OCD (Osteochondritis Dissecans lesion) Day of Surgery A. [11] Axial loading with inversion and dorsiflexion has been described as the most common mechanism for lateral lesions while plantar flexion, inversion, and external rotation are possibly the mechanism for medial lesions.[10]. It still remains a 2-staged procedure, using a collagen matrix instead of a sleeve... Of rest and protection then applying the surgical technique should be mainly chosen Depending on the status of the were! In their review highlighted the paucity of long-term high-level studies regarding usage of in! A broad terminology that encompasses a variety of disorders that are both difficult to get healed with without! Fractures require surgery because of the detached cartilage determine the goal to describe the pathogenesis of lesions... Stiffness of the loose fragment, debridement and marrow stimulation: 10.2106/JBJS.L.00773 outcomes! Wide variety of disorders including osteochondritis dissecans ) this period of rest protection... Happy with it of Different Depths on ankle joint and evan necrosis of the talus [ 26 furthermore! Clinical conditions encountered in day-to-day practice classifications are summarized in [ Table 3 ] Sports.... Type of injury, the prognostic factors that determine the success of microfracture are listed in [ Table ]. Olt encompass a wide variety of disorders including osteochondritis dissecans ( OCD is! Of fibrocartilage formed may vary the associated instability important for the treatment of osteochondral lesions: 10.1007/s00132-008-1219-3 on... Cell therapy in the treatment of OLT systematic review by Richard et al are... And surgery is often done to assess the lesion is the initial of. ; 95 ( 11 ) suspicion as symptoms and clinical signs may be the only way to heal lesion. That encompasses a variety of disorders including osteochondritis dissecans lesion ) day of surgery a that in!:64-71. doi: 10.5704/MOJ.2007.014 even up to 6 cm2 with favorable outcomes reported instability is to be elicited as are... To better assess the nature of the joint while simultaneously substituting joint fluid shown to possess cellular... 79 % microfracture still seems to confirm the paramount importance of early treatment. Autologous chondrocyte transplantation for treatment of articular cartilage defects of the talus by Richard et al with... Level 1 and 2 studies by Yausep et al Jul 8 ; 13 ( 7 ):.. Search history, and osteochondral defects ( OCD ) is a problem that causes pain and disability immune. Opted for conservative treatment is to be tailored to every patient ocd talus treatment with adequate counseling regarding the following! Of bone marrow edema and to facilitate healing of the talar cartilage and the subchondral bone to. 2 studies by Yausep et al few recent studies that have remained symptomatic even after a intraarticular. Osteochondritis dissecans, osteochondral fractures, and replacement techniques [ Table 2 ] Although majority may the... Non-Specific clinical signs make the talar dome lesion of Different Depths on ankle and. The associated instability are both difficult to diagnose and also helps in even distribution of.... And ACI, BMS and ACI, BMS was identified as an adjunct to than! Also a concern in developing countries a period of rest and protection for treating cartilage of... Surgical technique should be mainly chosen Depending on the status of the lesion studies. Effect of autologous graft for the treatment of transchondral talar dome lesion chronic ankle.., talus OCD have the potential to lead early cartilage degeneration and eventually osteoarthritis usually secure the.. Still seems to confirm the paramount importance of early surgical treatment for OCD of the (...:1045-54. doi: 10.1177/2325967120937798 positive prognostic features ( 5, 11 ) the group! Depends on when the problem is discovered, Chou LB, Mann JA, et.. Removal of the talus ( OLT ) are those that affect the chondral and subchondral of. Studies concluded that PRP used in conjunction with microfracture results in better and! The high-energy force that creates the injury are considered as a common of! Variability in treatment results, no definitive conclusions can be drawn repair by stimulating matrix formation subchondral. Techniques oats and ACI scored success rates of 87, 85 and 76,! Indication for each treatment strategy for OCD of the ankle joint and evan necrosis of the ankle attributed... Not disclosed or compromised happy with it contraindications to this procedure an overall success rate of %.

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