You and your foot and ankle orthopaedic surgeon can discuss these treatment options and decide which one is best. Thanks Dr. Throughout this article, these injuries will be referred to as osteochondral lesions of the talus (OLT). After having a little incident with one of my left toes, I was really scared and in pain and the first person I thought of was Dr. Lopez. 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. Osteochondral lesions of the talus (OLTs) are a difficult pathologic entity to treat. Most treatments require a period of immobilization and restricted weightbearing that can range from several weeks to several months. Arthroscopy uses a camera and small instruments to view and work within the joint through small incisions. Goals may range from removal of a loose fragment to securing a larger fragment anatomically. Osteochondral lesions if left untreated can cause significant pain and discomfort during weight bearing activities, swelling, dull aching pain, locking or clicking, instability and giving way of the knee joint. The talar dome has no direct muscle attachments(2); during norm… With this type of injury, a section of the talus surface may impact another part of the ankle joint (tibia or fibula) and injure the talus. The talus is the bottom bone of the ankle joint. Powered by FranFlight. They can also occur following severe trauma to the knee such as a skiing accident where the meniscus/cartilage is damaged. He was thorough, patient and comforting from the beginning. Dr. Lopez and staff are awesome! Imaging is necessary to confirm the diagnosis. The goals of ankle surgery are to restore the normal shape and gliding surface of the talus to re-establish normal mechanics and joint forces. X-rays are taken, and often an MRI or other advanced imaging tests are ordered to further evaluate the lesion and extent of the injury. The need for treatment of concomitant cartilage lesions during patella instability surgery will be discussed in a later section. Physical therapy may also include techniques to reduce pain and swelling. Surgery may be done arthroscopically depending on the size or location of the lesion. What is osteochondral repair of talus? The site navigation utilizes arrow, enter, escape, and space bar key commands. Osteochondral Allograft Transfer (i.e., Cadaver): A bone and cartilage plug may also be obtained from a cadaver and transplanted into the OLT. Miami Beach, FL 33140, South Miami Appropriate treatment of this disorder remains controversial. The diagnosis of cartilage damage (osteochondral lesion, also known as talar dome) is often done with x-rays and/or an MRI. Osteochondral Lesion. Osteochondral defects (OCDs) are very localised areas of joint damage which can occur in a number of different joints , not just the ankle. In the management of large cartilage defects, the two classically utilized cartilage restoration procedures are osteochondral allograft (OCA) transplantation and cell therapy, or autologous chondrocyte implantation (ACI). for professional medical advice, diagnoses or treatments. Otherwise, for the majority of cases of PF chondral/osteochondral lesion(s) and/or underlying malalignment, failure of up to 6 … Suite #940 They can start as bone bruising that develops into an osteochondral lesion. Osteochondral lesions are injuries to the talus (the bottom bone of the ankle joint) that involve both the bone and the overlying cartilage. Often treated with benign neglect, this condition is a potential sport-ending injury for an athlete, with long-term sequel of degenerative arthritis. Left and right arrows move across top level links and expand / close menus in sub levels. Osteochondral lesions of the talus are uncommon sources of ankle pain in athletes that can occur after traumatic ankle sprains.They are often found incidentally on ankle x-rays obtained for ankle sprains or to rule out ankle fractures.In patients and athletes with pain in the ankle joint from a presumed ankle sprain but with persistent symptoms, x-rays, CT scans, or MRIs can reveal the diagnosis. Diagram shows the classic four signs of instability in an OCD lesion: 1, high signal intensity rim at the interface between the fragment and the adjacent bone on T2-weighted MR images; 2, fluid-filled cysts beneath the lesion; 3, a high-signal-intensity line extending through the articular cartilage overlying the lesion; and 4, a focal osteochondral defect filled with joint fluid. More involved procedures that include bone grafting or cartilage transfer may require a longer period of recovery. This is referred to as an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). I feel great, minimal scarring etc... every week we had a follow up appointment carefully monitoring the healing process. Surgical options are lesion excision, excision and curettage, excision combined with curettage and microfracturing, filling the defect with autogenous cancellous bone graft, antegrade (transmalleolar) drilling, retrograde drilling, fixation and techniques such as osteochondral transplantation [osteochondral autograft transfer system (OATS)] and autologous chondrocyte implantation (ACI). This joint permits much of the up (dorsiflexion) and down (plantarflexion) motion of the foot and ankle. A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. Treatments may include debridement (removing injured cartilage and bone), fixation of the injured fragment, microfracture or drilling of the lesion, bone grafting the bone cyst below the cartilage, and/or transfer or grafting of bone and cartilage. Infection 2. In general, the best results can be expected for smaller lesions. Immobilization: Depending on the type of injury, the leg may be placed in a cast or cast boot to protect the talus. Physical therapy: Range-of-motion and strengthening exercises are beneficial once the lesion is adequately healed. Had surgery and I couldn’t be happier he did a great job and was always there if I needed him. My toe is recuperating nicely thanks to his care. Using small incisions, microsurgery instruments can be used to repair damaged bone and cartilage in your ankle after an osteochondral lesion. Miami Beach Recovery: Average recovery time after undergoing surgery to repair an osteochondral lesion of the talus ranges from four to six weeks. Crutches are usually prescribed for about six weeks, and you should rest as much as possible with your ankle elevated above your heart level. Occasionally, regular X-rays can show an OLT but frequently additional imaging is needed, such as a CT scan or an MRI. All surgeries come with possible complications, including the risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots. Foot and ankle orthopaedic surgeons diagnose OLTs with a combination of clinical and special studies. Oral medications: Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be helpful in reducing the pain and inflammation. Surgery may involve removal of the loose bone and cartilage fragments within the joint and establishing an environment for healing. Initial x-rays are taken to check the alignment of the foot and ankle, as well as look for any bone damage. This has been shown to no longer be true. If the lesion is considered stable but large, surgery may also be … Alternatively, the primary objective may be to create an environment amenable to fibrocartilaginous proliferation or resurfacing with hyaline cartilage. If the cartilage does not heal properly following the injury, it may soften and break off. 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. Suite #101, Pembroke Pines, FL 33028, Aventura It was once believed that all OLTs progress and worsen with time. A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. The American Orthopaedic Foot & Ankle Society (AOFAS) offers information on this site as an educational service. Ankle sprains are a common cause of OLTs. I’m walking again in less than three months when most said it would be 6-9 months. Swelling of the joint can also be a symptom. It helps to move the ankle joint to help determine if there is pain, clicking or limited motion within that joint. Hemorrhage or formation of blood clots (risk for thrombosis or pulmonary embolism) 6. Surgery is more commonly prescribed for adult patients. The pain is usually worsened by activity. Sign & Symptoms: Unless the injury is extensive, it can take up to months, a year, or even longer for symptoms to develop. The high incidence of good outcome in our series indicates that the one-step BMDCT could be a valid option for the treatment of this rare type of lesions. With an MRI, the ligament structures, tendons and cartilage of the ankle can be examined and analyzed. There are still doubts about the best treatment for these injuries that require surgery. OSTEOCHONDRAL LESIONS TREATMENTS . This is to be taken into consideration for osteochondral lesions (articular cartilage) and is aimed at its repair. I’m grateful and extremely appreciative for the care and service I received. Recovery: Average recovery time after undergoing surgery to repair an osteochondral lesion of the talus ranges from four to six weeks. One can drill and inject these lesions. Purpose: The purpose of this study was to compare outcomes of chondroplasty versus microfracture versus osteochondral autologous transplantation (OAT) in patients with osteochondral lesions of the talus (OLT).Methods: After prospective sample size analysis, patients with symptomatic, recalcitrant Ferkel class 2b, 3, and 4 OLT were randomized to chondroplasty, microfracture, or OAT … These are the complications that can occur in patients who have undergone a surgical procedure for the osteochondral lesion: 1. Lesion size, location, chronicity, and characteristics such as displacement and the presence of subchondral cysts help dictate the appropriate treatment … for professional medical advice, diagnoses or treatments. The content is not intended to substitute 601 N. Flamingo Road The talar dome is a trapezoid-shaped protuberance of the talus, 2.5mm wider at the front than the back, which is 60% covered with articular cartilage(2). Treating osteochondral lesions of the talus can pose challenges and delayed diagnosis due to late presentation after an ankle sprain. He guided me thru the journey all the way up until surgery. American Orthopaedic Foot & Ankle Society, The American Orthopaedic Foot & Ankle Society (AOFAS) offers information on this site as an educational service. Bone marrow aspirate, PRP and amniotic cells are good additions to your treatment protocol. More complex procedures with an open surgical approach or bone or cartilage transfer may have additional risks. Although wearing a brace or cast may ease the discomfort of an osteochondral lesion, they are usually not enough to remedy the problem permanently, except in children, who can respond well to non-surgical treatment. I had an unfortunate incident, breaking my leg, dislocating my ankle and rupturing all of my tendons in my left foot. These injuries may include softening of the cartilage layers, cyst-like lesions within the bone below the cartilage, or fracture of the cartilage and bone layers. Recovery after OLT treatment varies depending upon the nature of the lesion and the treatment. Ankle brace: Wearing an ankle brace may help protect the patient from reinjury if the ankle is unstable. Together with the newer techniques OATS and ACI, BMS was identified as an effective treatment strategy for OCD of the talus. The hope is to minimize symptoms and limit the risk of developing arthritis. Often, there may be several treatment options. Osteochondral lesions (OCLs) are focal articular injuries of the subchondral bone and the cartilage with a multifaceted cause (trauma, ligament instability, ischemic necrosis, malalignment, endocrine diseases, and others). Osteochondral lesions of the talus (OLT) are those that affect the chondral and subchondral areas of the talus. An osteochondral cyst can also be present following surgery. I would highly recommend Dr. Lopez and his team. The content of FootCareMD, including text, images, and graphics, is for informational purposes only. Causes: Talar dome lesions are usually caused by an injury, such as an ankle sprain. Surgery may involve removal of the loose bone and cartilage fragments within the joint and establishing an environment for healing. Patients who have osteochodral lesions typically will have pain in the involved joint. The knee and the ankle joint are the most commonly involved joints for OCLs in the lower extremity. Common symptoms include prolonged pain, swelling, catching, and/or instability of the ankle joint. The ankle joint is composed of the bottom of the tibia bone (shin) and the top of the talus bone (ankle). For adults, such a condition usually requires surgery. 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