Treatment depends on the severity of the talar dome lesion. A talar osteochondral lesion with a maximal diameter of 15 mm was treated in an arthroscopic fashion using the cartilage taken from the completely displaced osteochondral fragment. this is sutured into place this small caliber suture, omitting one area to leave access to underlying defect. Patients tend to present … ; ... Osteochondral lesions can occur in the talar head, body, and dome. They require a strong plan. suggested internal fixation of the lesion if it is larger than one third of the size of talar dome while Stone et al. Success rates for nonoperative treatment with sports restriction and nonsteroidal anti-inflammatory drug or cast immobilization differ from 0% to 100% (review article 12). 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: • Immobilization. The simplest treatment is to place the patient in a cast to keep the ankle joint from moving and allowing the defect to heal. Patients tend to present with more chronic symptoms of ankle pain, rather than acute injury. Defined as a separation of articular cartilage from the talar dome, with varying amounts of subchondral bone. Smaller diameter cysts would not accommodate the arthroscopic tools. Reasons to choose for non-operative treatment were not always clearly described. In addition, the mortise view may be obtained in plantar flexion to better assess a posteromedial lesion or in dorsiflexion to assess an anterolateral lesion. Arthroscopy. An osteochondral injury to the talar dome produces pain at the ankle and you will find walking and other weight bearing activities difficult. 1. soft tissue massage 2. If the cartilage doesn’t heal properly following the injury, it softens and begins to break off. who studied in 27 patients with mean follow-up of 7 years, with 89 percent of the patients (24 of 27 patients) reporting good outcomes [ 101 ]. Conservative treatment of osteochondral lesions of the talus (OLTs) should be attempted first, whenever possible. Plain radiographs are indicated in the evaluation of any patient with acute or chronic ankle pain. 2, No. Many terms have been used for OLTs, such as osteochondral defects of the talus, talar dome lesions, osteochondral fracture, transchondral fracture, osteochondritis dissecans, and flake fractures. Talar dome fractures are often missed at the initial examination following an ankle sprain or injury. 8 A grid system was used to identify the precise location of talar dome lesions. A classification was proposed by Bemdt and Harty (1959) who found that both the medial and lateral OCL of the talus could be induced by trauma; they named this lesion transchondral fracture. 1. In these cases, lesions may be due to osteonecrosis, endocrine disorders or genetic factors. The cartilage can be torn, crushed or damaged and, in rare cases, a cyst can form in the cartilage. Clinical testing by a health professional is unable to detect talar dome lesions. debridement of lesion to create stable cartilage rim, subchondral bone exposed. In this procedure an arthrotomy is performed through a 7 cm anteromedial or anterolateral incision. A varietyof surgical techniques is available to accomplish this. Therefore, an osteotomy must be placed through the tibial to access the ankle. 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: Immobilization.Depending on the type of injury, the leg may be placed in a cast or cast boot to protect the talus. Younger patients, particularly growing children or adolescents, have a much better chance of healing an OLT compared to adults. Hereby, the most common reasons are a severe inversion ankle sprain, chronic ankle instability (CAI; causing in 5–9% of the cases a lateral talar OCL), 9, 10 or a fracture mechanism. Patients with osteochondral lesions of the talus typically present with non-specific symptoms of vague ankle pain and/or a history of ankle injuries. The decision for arthroscopic intralesional curettage was only done when the cyst diameter was 10 mm or more in the preoperative CT scan. in 1986. This lack of consensus stems from several factors, including the absence of controlled, randomized studies comparing various treatment alternatives, lack of studies documenting the natural history of untreated lesions of various stages, the addition over time of new diagnostic modalities such as CT and MRI which have expanded our ability to define the lesions preoperatively, and the addition of arthroscopy to the surgeon’s armamentarium. Pain with weight bearing and a sensation of giving way are more common but nonspecific complaints. A talar dome lesion is In contrast to the historically described anterolateral and posteromedial locations, the midtalar dome was involved in 80% of lesions. With an MRI, the ligament structures, tendons and cartilage of the ankle can be examined and analyzed. [4-6] Treatment of these lesions has been reported extensively previously, but as stated by Dahmen et al. TOENAIL FUNGAL INFECTIONS: UGLY, SPLIT AND DISCOLORED, Chronic pain deep in the ankle—typically worse when bearing weight on the foot (especially during sports) and less when resting, An occasional “clicking” or “catching” feeling in the ankle when walking, A sensation of the ankle “locking” or “giving out”, Episodes of swelling of the ankle—occurring when bearing weight and subsiding when at rest, Non-steroidal or steroidal anti-inflammatory medications. These lesions can be chronic in nature, as seen in Osteochondritis Dissecans (OCD). If an osteochondral lesion is noted on plain radiographs, the MRI may be useful in evaluating the lesion itself for articular cartilage congruity, whether there is fluid signal beneath the bony fragment to suggest a loose lesion and to evaluate the degree of edema in the surrounding talus. Talar dome lesions are most common, while talar head lesions are relatively rare. Osteochondral lesions of the talar dome can cause significant functional impairment and a decreased quality of life. The top of the talus is dome-shaped and is completely covered with cartilage—a tough, rubbery tissue that enables the ankle to move smoothly. Arthroscopic treatment of transchondral talar dome fractures. Routine views include anteroposterior (AP), lateral, and mortise views. 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: Immobilization. Treatment may comprise: Find a physiotherapist in your local area who can treat an osteochondral lesion of the talar dome. Non-surgical options include: Foot orthotics to provide better alignment of the ankle; A period of immobilization in a walking boot to let the ankle tissue rest and heal Background: The treatment options of talar osteochondral lesions are numerous. By looking through the anterolateral portal, posteromedial talar lesions can be identi- fied. The result is a persistent deep pain in the ankle and recurrent swelling with activity. Zengerink M, Struijs PA, Tol JL, van Dijk CN. “Osteo” means bone and “chondral” refers to cartilage. Treatment of osteochondral lesions of the talus: a systematic review. To avoid damage to healthy cartilage and malleolar bone by antegrade drilling techniques, some physicians prefer to use a retrograde transtalar technique (8,11). Either lesion may be associated with clinical evidence of joint laxity, so the examiner should compare the effected joint to the normal joint and check for evidence of anterior or lateral laxity. 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. In the acute setting of ankle sprain, patients protect the ankle with either a boot or brace. Most of the lesions requiring surgical treatment are posteromedial in location, have poor quality articular cartilage, a loose bone fragment, necrotic bone beneath the lesion, and are poor candidates for healing with internal fixation. DeLee et al. We have reviewed charts and radiographs in 13 cases of OCL in children, examined at follow-up as adults. Typical modalities of activity modification, bracing, nonsteroidal anti-inflammatory drugs (NSAIDs), physical therapy, and protected weight-bearing in a walking boot may alleviate symptoms 26 - 28 . 2,3 To date, there has been one proposed surgical algorithm, which included general recommendations based broadly on lesion size. What is a Talar Dome Lesion? There is no universally accepted treatment algorithm for osteochondral lesions of the talar dome. The ankle joint is composed of the bottom of the tibia (shin) bone and the top of the talus (ankle) bone. His initial observation was that they were loose osteocartilaginous bodies that … Surgery may involve removal of the loose bone and cartilage fragments within the joint and establishing an environment for healing. Treatment for these complications is best directed by a foot and ankle surgeon, and may include one or more of the following: DeSoto Office (primary)2611 Bolton Boone DrDeSoto TX 75115 (972) 274-5708, Goldn, LLC Digital Marketing © 2020 All rights reserved, If you need an appointment in the next 24 hours, please do not use this form. [ Links ] 35. Patients frequently present with an acute injury and positive radiographic findings. If you catch your talar dome lesion in its early stages, your podiatrist uses nonsurgical treatments to heal your joint. Treatment depends on the severity of the talar dome lesion. A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. From Anderson IF, Crichton KJ, Gratan-Smith T, et al. MRI Classification: Osteochodral Lesions of the Talar Dome, 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 Osteochondral Lesions of the Talar Dome, Occult Groin Injuries: Athletic Pubalgia, Sports Hernia, and Osteitis Pubis, Posterior Cruciate Ligament and Posterolateral Reconstruction, Practical Orthopaedic Sports Medicine & Arthroscopy, Complete avulsion of fragment without displacement. Talar dome lesions usually occur from an injury, such as an ankle sprain. Tenderness localized to the joint line may be noted in the plantar flexed ankle laterally in the case of an anterolateral talar dome lesion and posteromedially in the dorsiflexed ankle in the case of a posteromedial lesion. Physiotherapy treatment is vital for all patients with an osteochondral lesion of the talar dome to hasten the healing process, ensure an optimal outcome and reduce the likelihood of recurrence. Talar dome lesions generally involve either the superomedial or superolateral corners of the talus. Treatment depends on the severity of the talar dome lesion. The staging system proposed by Berndt and Harty (, In the absence of a discrete lesion on plain radiograph, MRI examination is the most appropriate follow-up examination for patients with persistent symptoms despite a period of nonoperative management. It was determined that the midmedial zone was the most common location (53%). Surgical treatment of transchondral talar-dome fractures (osteochondritis dissecans). Cartilage was cut into chips and combined with bone graft product containing platelet-derived growth factor and a porous collagen scaffold. There is an association with trauma to the ankle, particularly in lateral talar dome lesions. Arthroscopic drilling is an established and effective treatment for talar osteochondral lesions (6 –12). “Osteo” means bone and “chondral” refers to cartilage. Osteochondral lesions most often result from an injury, such as a sprain. Surgery may involve removal of the loose bone and cartilage fragments within the joint and establishing an environment for healing. This can help determine the best treatment approach. Talar dome lesions are usually caused by … Long-term follow-up. Arthroscopic treatment of osteochondral lesions of the talus. An osteochondral lesion of the talar dome typically occurs during a traumatic injury to the ankle, such as an ankle sprain (particularly involving significant weight bearing forces), a traumatic landing from a height (particularly involving forced end of range ankle movements) or a motor vehicle accident. How are talar dome lesions treated? This condition is also known as either osteochondritis dissecans (OCD) of the talus or as a talar osteochondral lesion (OCL). Sometimes a broken piece of the damaged cartilage and bone will “float” in the ankle. However, most radiographs do not show symptoms of the osteochondral lesion. There is a slight male predominance in incidence of injury, Talar dome lesions do occur with no history of trauma. Kouvalchouk et al. Treatment decisions are based upon the site and size of the lesion, the skeletal maturity of the patient, the quality of the articular cartilage, and the quality of the associated bone fragment. Surgical approaches include simple excision; excision with curettage; and excision, curettage, and drilling. Signs & Symptoms The signs and symptoms of a talar dome lesion may include: Lasting pain deep in the ankle that is worse with activity Clicking or catching feeling in the ankle ... Nonsurgical Treatment Immobilization. Osteochondral lesions or osteochondritis dessicans can occur in any joint, but are most common in the knee and ankle. 62(4):646-52. . The differential diagnosis of a talar dome lesion includes: Ankle arthritis Ankle fracture High ankle sprain Septic arthritis Sinus tarsitis Talar neck fracture Soft tissue adhesion/defect within the ankle. They can occur after a single specific injury, or be the result of repetitive microtrauma.