In cases with suspicious radiographic changes, magnetic resonance imaging (MRI) is critical to confirm the diagnosis as well as to characterize the extent and stability of the OCD lesion. Plantarflexion aids in exposing the lesion; however, this approach requires caution to avoid damaging the branches of the superficial peroneal nerve. Good clinical results were reported in 89% of patients at an average of 7 years of follow-up. Careers, Unable to load your collection due to an error. Furthermore, T2 mapping and delayed gadolinium-enhanced MRI of cartilage may represent new, future adaptations of MRI to more rigorously evaluate the quality of repair tissue. 1987 Dec. 165 (3):775-80. Osteochondral transplantation to treat osteochondral lesions in the elbow. Share cases and questions with Physicians on Medscape consult. [35]. Foot Ankle Int. J Orthop Res. [92] Complications associated with arthroscopy include hyperesthesia around the portal incision and, occasionally, neuralgia of the superficial peroneal nerves, but these were minor and transient. Treatment 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. Additional histologic and long-term clinical data are needed to determine the success or failure rate of this therapy. [QxMD MEDLINE Link]. Mosaicplasty for the treatment of osteochondritis dissecans of the talus: two to seven year results in 36 patients. Deland JT, Young K. Medial approaches to osteochondral lesions of the talus without medial malleolar osteotomy. Screw fixation typically is used for anterolateral lesions only because of the difficulty in gaining good exposure for posteromedial lesions. 2008 May. Osteochondral lesion of the talus (OLT) is a broad term used to describe an injury or abnormality of the talar articular cartilage and adjacent bone. The soft wire is secured to the posterior aspect the lateral epicondyle to hold the fragment reduced until healing occurs. Giannini S, Vannini F, Buda R. Osteoarticular grafts in the treatment of OCD of the talus: mosaicplasty versus autologous chondrocyte transplantation. Kim YS, Park EH, Kim YC, Koh YG, Lee JW. The surgery for an osteochondral ankle lesion typically is a step-by-step procedure, which moves from the final diagnosis through various surgical steps depending on the extent of damage in your talus. . A high rate of complications has been reported in patients who underwent tibiotalar osteochondral allografting. Knee Surg Sports Traumatol Arthrosc. Osteochondral lesions of the talus (OLTs) are a common complication following trauma, involving both the articular cartilage and the underlying subchondral bone, with variable aetiologies and often presenting with non-specific symptoms. Treppo S, Koepp H, Quan EC, Cole AA, Kuettner KE, Grodzinsky AJ. Leumann A, Valderrabano V, Wiewiorski M, Barg A, Hintermann B, Pagenstert G. Bony periosteum-covered iliac crest plug transplantation for severe osteochondral lesions of the talus: a modified mosaicplasty procedure. Autologous osteochondral grafting techniques, including the OATS procedure and mosaicplasty, involve grafting a plug from the femoral trochlea or condyle into the OLT on the talar dome. A talar osteochondral lesion with a maximal diameter of 15 mm was . 1. Current management strategies for osteochondral lesions of the talus. [QxMD MEDLINE Link]. Vinod K Panchbhavi, MD, FACS, FAOA, FABOS, FAAOS Professor of Orthopedic Surgery, Chief, Division of Foot and Ankle Surgery, Director, Foot and Ankle Fellowship Program, Department of Orthopedic Surgery, University of Texas Medical Branch School of Medicine Acta Orthop Belg. Robert D Santrock, MD Consulting Surgeon, Orthopedic Associates of Meadville, PCDisclosure: Nothing to disclose. Alternatively, the fragment can be elevated to debride and bone graft the base of the lesion before fixation. [QxMD MEDLINE Link]. An osteotomy cut that enters the joint too far laterally can endanger the weightbearing plafond, and a cut that enters the joint too far distally on the medial malleolus limits exposure. Arthroscopy. It is unclear to what degree additional intervention contributes to clinical outcomes. 1992 Jun. If this happens, the joint can get stuck, until its moved manually or otherwise manipulated. Longer, open incisions are required. Various tests may be used to confirm the osteochondritis dissecans diagnosis. K-wires can be inserted in a retrograde manner through a nonarticular portion of the talus. In one report, 17 of 19 patients returned to their previous level of sport after a mosaicplasty while 2 switched sports.11 In a separate report, 6 of the 8 patients (including 3 pitchers) returned to a high level of baseball.12 In a series of 18 baseball players followed for a mean of 3.5 years after a mosaicplasty, 17 of 18 players could throw without pain 6 months after surgery.33 The one that could not had a grade 4 lesion greater than 15 mm in diameter. Arthroscopic management of osteochondritis dissecans of the capitellum: mid-term results in adolescent athletes, MRI findings of osteochondritis dissecans of the capitellum with surgical correlation, Osteochondritis dissecans of the elbow managed by Herbert screw fixation. Larger defects involving more than 50% of the articular surface or involving the lateral margin of the capitellum may have worse outcomes after debridement and may be better treated with fragment fixation or osteochondral autograft transfer. 2013 May. 49 (3 Suppl):S1-19. Hepple S, Winson IG, Glew D. Osteochondral lesions of the talus: a revised classification. Clin Orthop Relat Res. 1996 Mar. Published reports of ACT have been relatively few but have included good results. Unable to process the form. J Foot Ankle Surg. Learn more about Sports Ultrasound Clinic. J Foot Ankle Surg. Surgical treatment depends on a variety of factors, including patient characteristics (eg, activity level, age, degenerative changes) and lesions (eg, location, size, chronicity). 2001 May. [78], Arthroscopic intervention is associated with less surgical morbidity and joint stiffness, decreased rehabilitation time, and an increased functional outcome. Recovery takes eight months to one year on average. San Diego: American Orthopaedic Foot and Ankle Society; 2001: 75. Anteroposterior radiograph of a single osteochondral autograft plug placed into a large capitellar osteochondritis dissecans defect. Sports Health. Arthroscopy. J Bone Joint Surg Am. No mid-term difference in mosaicplasty in previously treated versus previously untreated patients with osteochondral lesions of the talus. Foot Ankle Int. Imaging of osteochondral injuries. Treatment for an osteochondral defect depends on what the cartilage surface looks like on MRI. Up to 1 year postoperatively, there was significant difference in FAAM scores between the both groups (mean 75.3 points in medial group and 87.2 points in lateral group, P < .001).Delayed union or malunion of the malleolar osteotomy was found in 4 cases (13%) in the medial group. Camp C, Stuart M, Krych A. It is proposed that immature chondrocytes have an increased propensity to regenerate hyalinelike cartilage and have greater metabolic activity. Chondral and osteochondral defects in the PF compartment are often encountered in clinical practice on advanced imaging studies and/or during arthroscopy. Another limitation is the difficulty of acquiring long-term follow-up. Knee Surg Sports Traumatol Arthrosc. In another 10 patients treated with mosaicplasty for capitellar OCD, 8 had excellent results while 2 had poor results.26 The patients with poor results had lesions that involved the lateral aspect of the capitellum, which was attributed to grafts being poorly fixed because of the defect location. Occasionally, for reasons that are not well understood, osteochondral defects arise without injury. If the damage is minor, your surgeon may simply "clean up" the damaged cartilage and remove any loose pieces. Using the direct lateral portal, the osteochondral defect can be viewed in its entirety (Figure 6A). With an average 6-year follow-up, all patients were able to perform activities of daily living and 28 of 29 patients reported good to excellent outcomes. AJR Am J Roentgenol. Flick AB, Gould N. Osteochondritis dissecans of the talus (transchondral fractures of the talus): review of the literature and new surgical approach for medial dome lesions. Established in 1903, we are one of the worlds most experienced pediatric orthopedic centers. Kok AC, Dunnen Sd, Tuijthof GJ, van Dijk CN, Kerkhoffs GM. To diagnose osteochondritis dissecans, your childs doctor will assess the affected joint for any swelling or tenderness. Materials and Methods: Three different types of PRF scaffolds were generated . Osteochondral lesions of the talus. Foot Ankle Int. Studies have shown that a trial of conservative therapy does not adversely affect surgery performed after conservative therapy has failed. [QxMD MEDLINE Link]. It is often associated with a traumatic injury such as a severe ankle . Imaging of osteochondral lesions of the talus. 39 (1_suppl):1S-2S. Fragment fixation can be attempted in patients with Minami type 1 cystic changes in the subchondral bone or in patients with grade 2 lesions with a split between the OCD fragment and the adjacent bone.21,30 In larger lesions with thicker bone within the OCD fragment, compression screws can be used for fragment fixation. Takeda et al also reported on 11 male baseball players treated with the pullout wiring technique and bone grafting.30 All patients in this series had improvement of their pain. [26] Woelfle et al, in a study of 32 patients who underwent the OATS procedure, determined that advanced age (>40 years) is associated with higher donor-site morbidity. Prognostic significance of the containment and location of osteochondral lesions of the talus: independent adverse outcomes associated with uncontained lesions of the talar shoulder. Sportverletz Sportschaden. Anderson IF, Crichton KJ, Grattan-Smith T, Cooper RA, Brazier D. Osteochondral fractures of the dome of the talus. Larger defects involving more than 50% of the articular surface or involving the lateral margin of the capitellum may have worse outcomes after debridement and . Radiographic evaluation showed flattening of the capitellum in 12 of 18 patients, 6 had degenerative changes in the radiocapitellar joint, and 5 had loose bodies. Retrograde drilling of osteochondral lesions of the medial talar dome. Also, smaller osteochondral defects can be treated with technique 1. [69] The pegs, which were 2-3 mm wide and 15-20 mm long, were harvested from the distal tibia and passed through the articular surface. sharing sensitive information, make sure youre on a federal Yamamoto Y, Ishibashi Y, Tsuda E, Sato H, Toh S. Osteochondral autograft transplantation for osteochondritis dissecans of the elbow in juvenile baseball players: minimum 2-year follow-up. The short- and midterm outcomes of arthroscopic debridement for capitellar OCD lesions are generally good with patients reporting pain relief, improved range of motion, and a high rate of return to athletic and work activities.6 Brownlow et al retrospectively reviewed 29 patients with capitellar OCD lesions treated with arthroscopic debridement.3 The average age at surgery was 22 years. The use of traditional bone screws passed in an antegrade fashion is discouraged because it results in irreparable damage to the intact articular cartilage. Leumann et al discussed using autologous bony periosteumcovered plugs harvested from the iliac crest for management of lesions larger than 1.5 cm2. Ankle Surgery If nonsurgical treatments are ineffective or if your condition worsens, your doctor may recommend surgery to alleviate your pain and restore your mobility. 2000 Feb. 21 (2):119-26. Mark A Prissel, DPM Fellow, Advanced Foot and Ankle Surgical Fellowship, Orthopedic Foot and Ankle Center Cohen B, Anderson R, Davis WH. Similarly, 7 patients treated with mosaicplasty had significant improvements in outcome scores at a mean follow-up of 5 years.1 Follow-up radiographs did not show degenerative arthritis, and 6 of the 7 were asymptomatic. Compared with a control group undergoing different procedures, such as drilling or abrasionplasty, patients undergoing the transplant procedure had better functional outcomes. They occur in patients of varying ages. 2012 Apr. 1990 Mar. [45], Autologous chondrocyte transplantation (ACT; also referred to as autologous chondrocyte implantation [ACI]) is based on actual repair of deficits of articular cartilage. From Toronto to Boston: Osteochondritis difficulty fully straightening the arm or leg, feeling like the joint is locking, catching, or giving way, collection of fluid around the joint (water on the knee), drilling small holes in the underlying bone to stimulate healing, removing or securing loose fragments of bone, a procedure called osteochondral autologous transplantation surgery (OATS). government site. In yet another series of 8 patients with advanced capitellar OCD lesions treated with mosaicplasty, at 2-year follow-up, 7 were pain-free and 1 had mild pain.12 No degenerative changes were seen on follow-up radiographs. To diagnose osteochondritis dissecans, an orthopedic specialist will take a medical history and perform a physical exam on your child. The effects of talar dome cartilage defects. [QxMD MEDLINE Link]. 36 (5):873-80. The first sign of an osteochondritis dissecans injury may be a popping sensation in the injured joint. Malahias MA, Kostretzis L, Megaloikonomos PD, Cantiller EB, Chytas D, Thermann H, et al. 6th Floor, Suites A & B; 12th Floor, Suite A The diagnosis and treatment of heel pain: a clinical practice guideline-revision 2010. Foot Ankle Int. Cartilage. Murawski CD, Hogan MV, Thordarson DB, Stone JW, Ferkel RD, Kennedy JG. Acute ankle ligament injuries with a large, unstable fragment typically first undergo surgical repair of the talar lesion. Osteochondral lesions of the talus: size, age, and predictors of outcomes. Osteochondral Lesions of the Talar Dome. 2012 Sep. 20 (9):1696-703. 22 (7):544-51. For overhead athletes, an interval throwing program is typically started 4 months after surgery with the goal of returning to throwing by 6 months and pitching between 6 and 9 months. A microfracture awl of 1 mm or less is used to puncture the subchondral bone with 3-4 mm of spacing between to induce punctate bleeding. Some surgeons will remove the free fragment with minimal surface preparation. Hatic SO 2nd, Berlet GC. Arthroscopy. An apex proximal chevron bone cut provides excellent visualization; Cohen et al had no nonunions or malunions when using a chevron medial malleolar osteotomy in 19 patients. 2012 Dec. 40 (12):2709-19. [8, 26] Restoration of articular surface congruity may be very difficult, particularly in talar shoulder lesions. Most commonly, OCDs are found in the ankle joint, specifically affecting the talus bone. [QxMD MEDLINE Link]. Am J Sports Med. MRI may prove to be invaluable not only for diagnostic purposes but also to assess the maturation and efficacy of reparative or reconstructive surgical procedures for unstable OCD lesions. Numerous surgical techniques are available to treat osteochondral defects of the knee. [QxMD MEDLINE Link]. 2023 Mar. 2 (2):82-7. World J Orthop. Foot Ankle Int. [15, 17] One study demonstrated that nonoperative conservative treatment can sometimes result in healing of higher-stage lesions. 1989 Sep. 71 (8):1143-52. The typical indication is active younger patients with smaller (<2-4 cm2) chondral and osteochondral defects 1,4. Knee Surg Relat Res. Another study, with an 11-year mean follow-up, reported nine cases of fresh osteochondral allografting. J Foot Ankle Surg. [QxMD MEDLINE Link]. A better view is obtained from a posterior approach (Figure 6). The contemporary consensus is that lesions with a depth of more than 5 mm should be bone-grafted. Treatment decisions for treating chronic OLTs with chronic ankle instability are less clear. 77 (2):331. OL vary from chondral lesions in that they involve the subchondral bone and chondral surface, making their management more complex than an isolated chondral injury. [QxMD MEDLINE Link]. Philadelphia, Pa: Lippincott-Raven; 1996. 2007 Jun. The disadvantage is that the pullout wire technique requires wire removal after fragment healing. The anconeus has been split exposing the posterior aspect of the capitellum. 9 (2):238-41. 2021 Feb 9. [34, 65], Sinus tarsi approaches to posteromedial lesions, also known as retrograde drilling or transtalar drilling, do not disrupt the articular surface. American College of Foot and Ankle Surgeons, American Orthopaedic Foot and Ankle Society, College of Physicians and Surgeons of Ontario, Royal College of Physicians and Surgeons of Canada, Association of Graduates, United States Air Force Academy. Comparative Efficacy of Cartilage Repair Procedures in the Knee: A Network Meta-Analysis. 1986 Jul. With the elbow maximally flexed, the entire capitellar defect can be seen. 2005 Jul. Lee KB, Bai LB, Park JG, Yoon TR. 2002 Jul. Bone marrow aspirate concentrate and scaffold for osteochondral lesions of the talus in ankle osteoarthritis: satisfactory clinical outcome at 10 years. Thickness of human articular cartilage in joints of the lower limb. [QxMD MEDLINE Link]. 128 (5):499-504. Town and Country, MO 63017, 14532 S. Outer Forty Drive Kuwhata et al reported on 8 elbows with OCD of the capitellum treated with cancellous bone graft and internal fixation with a Herbert screw.17 An average of 32 months after surgery, all patients were pain-free. An osteochondral lesion of the talus (OLT) is an area of abnormal, damaged cartilage and bone on the top of the talus bone (the lower bone of the ankle joint). 1947603521996023. The most common symptom of an OCD is globalized ankle pain. Patients with this problem will often have pain on the outside of the elbow that is worse with throwing or lifting heavy objects. 2006 Oct. 22 (10):1085-92. If the cartilage surface is intact, an extended period of rest may allow the bone under the cartilage to heal. 2012 Jul 18. 2000 Mar. [QxMD MEDLINE Link]. The Boston Childrens Hospital Orthopedics and Sports Medicine Center provides comprehensive assessment, treatment, and follow-up care to children, adolescents, and young adults with osteochondritis dissecans. This can also be done arthroscopically but may require a bigger incision if the defect is large. The grafts were all well seated within the recipient sites with no evidence of graft loosening at 12 months. Symptoms of intra-articular derangement are indications for operative intervention. After a period of immobilization followed by physical therapy, patients with continued symptoms should be evaluated with magnetic resonance imaging (MRI) and other imaging studies to assess the condition of the articular cartilage and stability, as well as to detect any intra-articular bodies. 1986 May-Jun. [48]. (B) The cartilage and bone fragments have been removed from the capitellum to create a stable base. If you log out, you will be required to enter your username and password the next time you visit. In another study, plugs were harvested from the ipsilateral medial or lateral articular facet of the talus in 12 patients. Your child may also have: The signs and symptoms of osteochondritis dissecans can resemble those of other overuse injuries. 39 (3):881-886. Assenmacher JA, Kelikian AS, Gottlob C, Kodros S. Arthroscopically assisted autologous osteochondral transplantation for osteochondral lesions of the talar dome: an MRI and clinical follow-up study. Thomas H. Lee, MD (Assistant Professor of Orthopedic Surgery, Ohio State University College of Medicine; Consulting Surgeon, Orthopedic Foot and Ankle Center) is gratefully acknowledged for contributions made to this article. Mihara K, Suzuki K, Makiuchi D, Nishinaka N, Yamaguchi K, Tsutsui H. Surgical treatment for osteochondritis dissecans of the humeral capitellum, Arthroscopic debridement of the humeral capitellum for osteochondritis dissecans: radiographic and clinical outcomes, Semiconstrained arthroplasty for the treatment of rheumatoid arthritis of the elbow. Typical return to overhead athletic activities is between 4 and 6 months after surgery. [91]. What You Need to Know Osteochondritis dissecans is a bone and cartilage condition that most often occurs in the knee. Treatment for an osteochondral defect depends on what the cartilage surface looks like on MRI. This sometimes causes injury to the bone and cartilage of the capitellum called an osteochondral defect (osteo = bone, chondral = cartilage). 6 (2):43-9. In the immediate postoperative period, patients are typically placed in a soft dressing until the wounds have healed. Unstable defects typically require surgical intervention that involves fragment fixation, debridement, or reconstruction with an osteochondral autograft transfer. In addition, the degree of chondroplasty is often not consistently described. Lee et al compared early (2 wk) weightbearing with delayed (6 wk) weightbearing following arthroscopic debridement and microfracture of small to medium-sized OLTs and found no difference in outcome between the two groups. Giannini S, Buda R, Vannini F, Di Caprio F, Grigolo B. Arthroscopic autologous chondrocyte implantation in osteochondral lesions of the talus: surgical technique and results. [QxMD MEDLINE Link]. 1995 Mar. Christopher F Hyer, DPM, FACFAS is a member of the following medical societies: American College of Foot and Ankle Surgeons, American Podiatric Medical AssociationDisclosure: Received consulting fee from Wright Medical Technology for consulting; Received royalty from Wright Medical Technology for consulting; Received consulting fee from Amniox for consulting; Received consulting fee from Stryker for none; Received consulting fee from Biomet for none. Mild pain was reported in 48% of patients and moderate pain in 10% of patients. [70] Ofnine grafts, six remained in situ, and three patients required ankle arthrodesis because of resorption and fragmentation of the graft. Most of the patients had surgery for a localized grade 3 or 4 lesion, and the remainder had surgery for an osteochondral defect. [Full Text]. The advantage of the pullout wire technique is the ability to fix smaller lesions. [86, 87, 88], Early results for small to moderate-sized lesions demonstrated good outcomes at short-term follow-up. Relevant articles published after 1992 were identified using MEDLINE, the EMBASE database, and the Cochrane Library. However, 38% of patients reported persistent catching symptoms, none of which required further surgery. ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. 2002 Apr. 48 (3):371-383. Coetzee JC, Giza E, Schon LC, Berlet GC, Neufeld S, Stone RM, et al. Clinical outcomes of mesenchymal stem cell injection with arthroscopic treatment in older patients with osteochondral lesions of the talus. 2009 Oct. 37 (10):1974-80. Iwasaki N, Kato H, Ishikawa J, Masuko T, Funakoshi T, Minami A. Autologous osteochondral mosaicplasty for osteochondritis dissecans of the elbow in teenage athletes. Check for errors and try again. Suite 200 Clinical outcome of autologous chondrocyte implantation at 5 years in US subjects. However, a systematic review assessing clinical outcomes of fresh osteochondral allografting for OLTs by Pereira et al (12 studies; N = 191; average age, 37.5 y; average follow-up, 56.8 mo) reported significant improvements in American Orthopaedic Foot and Ankle Society (AOFAS)ankle/hindfoot scores in six studies and significant decreases in visual analogue scale (VAS) pain scores in five studies. In children whose bones are still growing, the bone defect may heal with a period of rest and protection. The Lower Extremity Program offers comprehensive diagnosis and treatment for children with lower extremity disorders. Surgery to treat OLTs is contraindicated when the risks outweigh the perceived benefits. What Are Osteochondral Lesions? What is an OCD? Conservative treatment of osteochondral lesions of the talus (OLTs) should be attempted first, whenever possible. Takahara M, Shundo M, Kondo M, Suzuki K, Nambu T, Ogino T. Early detection of osteochondritis dissecans of the capitellum in young baseball players: report of three cases. In addition, if the teenager is competing at a high level, the time needed to recover from any intervention may affect return to play even if full recovery is achieved. This causes pain and a sense that the joint is catching or giving way. These loose pieces are sometimes called joint mice or loose bodies.. MRI sequences most commonly used for the evaluation of cartilage are proton density-weighted, intermediate-weighted images and T2-weighted images with and without fat saturation and 3D fat-saturated T1 weighted images 3,4. [QxMD MEDLINE Link]. Weightbearing Crutches and hinged knee orthosis locked in extension with ambulation for all lesions Non-weightbearing for 2 weeks for all lesions Initiation of partial weightbearing is dependent on the location, size, and condition of the recipient site. Sometimes, holes are drilled into the bone to stimulate healing. [QxMD MEDLINE Link]. Alternatively, multiple small plugs can be used which may better reconstitute the curvature of the capitellum. Parisien JS. Children with osteochondritis dissecans should receive medical treatment right away. If this trend continues, the use of allografts may fall from favor. Shimada K, Yoshida T, Nakata K, Hamada M, Akita S. Reconstruction with an osteochondral autograft for advanced osteochondritis dissecans of the elbow. As this procedure gains favor, more reported complications at the knee donor site may evolve. 2001 Apr. Most commonly, a surgeon will perform an arthroscopic exploration and treatment. Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug ReferenceDisclosure: Received salary from Medscape for employment. van Bergen CJ, van Eekeren IC, Reilingh ML, Sierevelt IN, van Dijk CN. ), Giannini et al reported similar results 24 months post transplant, showing that hyaline cartilage can be transplanted in the ankle joint and that good function can be expected. 2022. To find an answer, a validated, patient-rated outcome measure directed toward elbow osteoarthritis is needed for a multicenter study that enrolls a large number of patients with consistent longitudinal follow-up. 2013 Aug. 21 (8):1925-30. 2011 Oct. 4 (5):274-9. Tech Foot Ankle Surg. Jones KJ, Wiesel BB, Sankar WN, Ganley TJ. Tasto JP. Gautier E, Kolker D, Jakob RP. 2017 Jul. [QxMD MEDLINE Link]. The presence of mechanical symptoms or loss of motion is often a sign of more advanced cartilage injury or loose body. Radiographic evidence of osteoarthritis was not seen at follow-up. 1999 Aug. 20 (8):474-80. Radiology. Traumatic etiology has been proposed because of the association of capitellar OCD with sports that repetitively stress the radiocapitellar joint.24 The subchondral bone of the capitellum may be susceptible to injury from repetitive stress as it may be relatively hypovascular.32 Early recognition and intervention may protect these athletes from developing irreversible cartilage damage. Kim YS, Park EH, Kim YC, Koh YG. [QxMD MEDLINE Link]. J Am Podiatr Med Assoc. Schuman L, Struijs PA, van Dijk CN. 8 (1):73-90, viii. Conservative management of OLTs should be attempted before surgical management is embarked on. Treatment of unstable osteochondritis dissecans lesions of the knee using autogenous osteochondral grafts (mosaicplasty). 2013 Jan. 41 (1):126-33. Osteochondral lesions of the talus (OLT) occur in up to 70% of acute ankle sprains and fractures. Donnenwerth MP, Roukis TS. Occasionally, patients will complain of mechanical symptoms like something catching in the elbow or that the elbow locks up on them. [QxMD MEDLINE Link]. Articular surface defects, loose bodies, and osteophytes. Osteochondral autograft transplantation or mosaicplasty was originally reported in the early 1990s and further refined in that decade 1. Results at follow-up at 2 to 11 years. If the cartilage surface is intact, an extended period of rest may allow the bone under the cartilage to heal. This approach allows access to 80% of the talar dome while it avoids the medial malleolar osteotomy in most cases. [84], Particulated juvenile cartilage allograft, This technique uses particulated juvenile cartilage allograft from donors younger than age 13 years. Osteochondritis dissecans (OCD) of the capitellum is most often seen in adolescents older than 12 years who participate in sports that involve repetitive loading of the elbow, such as baseball or gymnastics.23 In comparison, Panners disease, which may have radiographic and clinical features of capitellar OCD, is seen most commonly in boys between the ages of 5 and 12 years and is often successfully treated with activity modification until healing has occurred.23 The etiology of capitellar OCD is not entirely clear. HHS Vulnerability Disclosure, Help 23 (7):651-4. 2020 Dec 31. In addition, care must be taken to avoid injury to the allograft nerve and vein, anterior tibial tendon, posterior tibial tendon, flexor digitorum longus (FDL), posterior tibial artery, and tibial nerve. 1999 Jan. 58 (1):27-34. Osteochondral lesions of the talus. A marked distortion of normal mechanical alignment must be corrected in the same operative setting as the surgical procedure performed to address the OLT. Instr Course Lect. 2008;28(4):1043-59. Taranow WS, Bisignani GA, Towers JD, Conti SF. An osteochondral lesion/defect, or OCL/OCD, forms when there is damage to cartilage of a joint in a localized area that begins to affect the bone quality. Three years later, he was drafted by a team in the Ontario Hockey League. Herbert screws have been used for capitellar OCD lesions.17 Bioabsorbable compression screws have been used for fixation of osteochondral fragments in the knee5 and may be useful in the elbow as well. Follow-up demonstrated a good to excellent result in 92% of patients with a femoral condylar implant, 87% of tibial implantations, and 74% of patellofemoral implantations [ 23 ]. Arch Orthop Trauma Surg. Mesgarzadeh M, Sapega AA, Bonakdarpour A, Revesz G, Moyer RA, Maurer AH, et al. Relative contraindications include degenerative changes of the ankle involving more than an isolated OLT. Ferkel RD, Zanotti RM, Komenda GA, Sgaglione NA, Cheng MS, Applegate GR, et al. Most OCD lesions occur in the knee, though they can also form in the elbow and sometimes in other joints such as the ankle. [QxMD MEDLINE Link]. Van Buecken K, Barrack RL, Alexander AH, Ertl JP. Seo S, Kim C, Jung D. Management of Focal Chondral Lesion in the Knee Joint. [Guideline] Thomas JL, Christensen JC, Kravitz SR, Mendicino RW, Schuberth JM, Vanore JV, et al. [QxMD MEDLINE Link]. J Am Acad Orthop Surg. [86, 87] Coetzee et al reported that for lesions with a diameter of 15 mm or greater, only 56% of patients reported good-to-excellent results on the AOFAS Ankle-Hindfoot Scale at 16-month follow-up. Noninvasive joint distraction techniques enable easier visualization of the entire talar dome. 2005 Apr. Strengthening of the elbow, shoulder, and wrist can be started as soon as pain allows with restrictions on exercises that place an axial load on the elbow. Arthroscopic treatment for osteochondral defects of the talus. Riboh J, Cvetanovich G, Cole B, Yanke A. Accessibility In more than one third of cases, conservative treatment is unsuccessful, and surgery is indicated. Early reports with allografts showed some subsidence and resorption, necessitating ankle arthrodesis. In 39 patients treated with open debridement followed for 3 to 25 years, 46% had pain with daily activities.28 All patients with large lesions had poor outcomes, and 24% with moderate lesions had poor outcomes. Takahara M, Mura N, Sasaki J, Harada M, Ogino T. Classification, treatment, and outcome of osteochondritis dissecans of the humeral capitellum. Arthroscopy. [QxMD MEDLINE Link]. Wire breakage was reported in three patients at the time of wire removal. Return to nonthrowing sports is allowed when the graft has been completely incorporated into the capitellum on radiographs (Figure 8) and when the patient has recovered full strength and range of motion of the elbow. official website and that any information you provide is encrypted J Foot Ankle Surg. Vannini F, Filardo G, Altamura SA, Di Quattro E, Ramponi L, Buda R, et al. 1994 William J. Stickel Gold Award. Arthroscopic shavers and biters can remove loose fragments leaving a stable base (Figure 6B). The osteochondral autotransplant (OAT) is a tissue transplant procedure in which the donor owns the tissue. Osteochondral lesions of the talus. Future controversies will likely revolve around minimizing operative morbidity and costs. Foot Ankle. 84 (3):369-74. 1993. J Bone Joint Surg Br. 1959 Sep. 41-A:988-1020. J Bone Joint Surg Br. A prospective longitudinal multicenter study, using validated outcome measures, that enrolls a large number of patients is needed to establish optimal treatment for unstable capitellar OCD lesions. In patients whose symptoms persist despite rest and activity modification or in patients in whom an OCD lesion becomes unstable, surgical intervention is indicated. Foot Ankle Int. There are two cartilage-covered parts of the end on the humerus: In the elbow, the capitellum and the radius touch to absorb some of the pressure transmitted from the wrist. Grading the OLT allows for proper prognostication and influences whether the lesion can be approached with an antegrade or a retrograde technique. St. Louis, MO 63141, 5201 Midamerica Plaza 2021 Feb. 103-B (2):207-212. 2000 Sep. 18 (5):739-48. Foot Ankle Int. [66, 67]. Arthroscopy. Osteochondral lesion of the talus: A radiologic and surgical comparison. [Etiopathogenetic aspects of medial osteochondrosis dissecans tali]. Defect thickness greater than 9 mm on radiographs was associated with lower healing rates using this technique. Schuman reviewed 22 patients who underwent arthroscopy with curettage and drilling at an average follow-up of 4.8 years, with 86% good-to-excellent results. Sagittal magnetic resonance arthrogram demonstrating an unstable capitellar osteochondritis dissecans with contrast between the fragment and the underlying bone. [QxMD MEDLINE Link]. 5 (2):115-20. 2012 Sep. 40 (9):2023-8. N Engl J Med. Bai L, Zhang Y, Chen S, Bai Y, Lu J, Xu J. Studies have shown that excision and nonoperative treatment yield poor results and that excision, curettage, and drilling provide the best outcomes. 2008 Sep. 36 (9):1750-62. Autologous chondrocyte implantation for the treatment of chondral and osteochondral defects of the talus: a meta-analysis of available evidence. 1980 Jan. 62 (1):97-102. There is a wide variety of treatment strategies for osteochondral defects of the ankle, with . Osteochondritis dissecans: analysis of mechanical stability with radiography, scintigraphy, and MR imaging. 2021 Feb 22. During arthroscopy, your surgeon makes two or three small, puncture incisions around your joint using an arthroscope. Doral MN, Bilge O, Batmaz G, Donmez G, Turhan E, Demirel M, et al. due to peripheral chondrocyte death from mechanical, posttraumatic arthritis at the donor site, signal characteristics and thickness of the graft cartilage, coverage of the lesion with hyaline cartilage, allows earlier rehabilitation as a tissue-based therapy. Before This will gradually resolve afterwards 3. 2012 Mar-Apr. [QxMD MEDLINE Link]. [QxMD MEDLINE Link]. This may include specialized manipulations of the joint, such as a Wilson test of the knee, to see if a particular rotation of the knee causes pain. McNickle AG, Provencher MT, Cole BJ. Hangody L, Kish G, Krpti Z, Udvarhelyi I, Szigeti I, Bly M. Mosaicplasty for the treatment of articular cartilage defects: application in clinical practice. Bone Joint J. superomedial and superolateral trochlea), creation or drilling of matching, cylindrical recipient holes, press-fit insertion of the harvested plugs into the chondral defect in a mosaic pattern, restoring the joint surface morphology, optional back-filling of the donor-site by bone graft substitute, poor graft integration (e.g. A good postoperative result presumes a complete defect fill with uniform cartilage signal intensity, without fissures or gaps at the bony and chondral interfaces of the freshly introduced osteochondral autograft 5. 18 (1):13-34. Osteochondral lesions represent a challenging entity with a high progression to osteoarthritis if left untreated. Illustration of percutaneous transmalleolar drilling. The bearing has a protected weight of 6 weeks and is in good condition. Also, radiographic observations have been used as indirect markers of outcome, such as radial head enlargement and capitellar flattening. Contact characteristics of the ankle joint. Choi WJ, Choi GW, Kim JS, Lee JW. J Bone Joint Surg Am. Establishing proof of concept: Platelet-rich plasma and bone marrow aspirate concentrate may improve cartilage repair following surgical treatment for osteochondral lesions of the talus. The most commonly used outcome measures for capitellar OCD are the Andrews-Timmerman rating system31 or the Mayo Elbow Performance Score.20 Neither of these instruments has been validated. [59, 60, 61, 62]. To diagnose osteochondritis dissecans of the elbow, ankle or another joint, your childs doctor will perform similar specialized manipulations. Significant improvement in AOFAS scores was reported, and no structural failures occurred in the graft or donor site. (B) A single osteochondral autograft plug from the lateral femoral condyle has been used to fill the capitellar defect. In general, the weakness of the literature is that outcome measures are limited because (1) there are no validated, patient-rated disease-specific outcome measures, (2) current validated outcome measures do not discriminate this particular disease state, (3) a clinically significant difference in outcomes (osteoarthrosis) may only be manifest 20 to 30 years after the injury. Arthroscopic treatment of transchondral talar dome fractures. OCD of the capitellum is commonly seen in baseball players and in gymnasts because of the repetitive loads that these sports place on the elbow.23 The onset of symptoms in patients with OCD of the capitellum is often insidious with many athletes reporting vague lateral elbow pain with loading of the elbow. 1986. High-level evidence is lacking to determine the superiority of debridement or osteochondral autograft transfer for the treatment of capitellar OCD lesions. 2021 Feb 19. Both debridement and osteochondral autograft transfer for treatment of capitellar OCD lesions result in good short- and midterm outcomes with a high rate of return to sports. This website also contains material copyrighted by 3rd parties. Studies have shown good clinical and radiographic results with transarticular/transmalleolar drilling and retrograde/transtalar drilling. osteochondritis dissecans, elbow, capitellum. Am J Sports Med. [QxMD MEDLINE Link]. Passive and active assisted range of motion is allowed as soon as pain improves. Foot Ankle Clin. [QxMD MEDLINE Link]. It is a block of cartilage and bone that can be shaped to fit the exact contour of the defect and then pressed into place. [28], In conjunction with marrow-stimulation techniques, Takeda H, Watarai K, Matsushita T, Saito T, Terashima Y. Several groups have reported good results with both procedures. [QxMD MEDLINE Link]. Because of its success in the knee, osteochondral autograft transfer for the capitellum has gained popularity.10 The indications for osteochondral autograft transfer are still evolving, but patients with large defects and defects that extend into the lateral margin of the capitellum may benefit from this procedure. MRI can define lesion size, location, the status of the chondral surface and involvement of the subchondral bone, high signal at the lesion interface, and the presence of frank loose bodies within the joint. The doctor will check for pain along the affected joint line and may order an x-ray or MRI to help them see the joint. For adults, such a condition usually requires surgery. [QxMD MEDLINE Link]. [QxMD MEDLINE Link]. 15 (3):312-6. St. Louis, MO 63129, 20 Progress Point Parkway, Suite 114 Instruments available for use in this procedure include blunt-tipped probes, pituitary graspers, gouges, Kirschner wires (K-wires), awls, full-radius shavers, ring curettes, and high-speed burrs. see full revision history and disclosures, Osteochondral autograft transplantation (OAT), debridement of the damaged cartilage for stable healthy borders, harvesting of cylindrical osteochondral plugs from non-weight bearing, low contact pressure areas (e.g. With advances in arthroscopic techniques, debridement has become the mainstay of surgical treatment for capitellar OCD lesions that are refractory to activity modification or in patients with unstable OCD lesions. Intra-Articular derangement are indications for operative intervention and perform a physical exam on your child immature chondrocytes have increased... Elbow locks up on them drilling at an average of 7 years follow-up! Has a protected weight of 6 weeks and is in good condition, a surgeon will perform similar specialized.! Be corrected in the immediate postoperative period, patients undergoing the transplant procedure had better functional outcomes ankle another... G, Cole B, Yanke a on what the cartilage surface looks like on MRI high progression to if! Heavy objects, loose bodies, and no structural failures occurred in the ankle joint, affecting... Also, radiographic observations have been removed from the capitellum is often not consistently described a view... ) is a wide variety of treatment strategies for osteochondral defects arise without injury be elevated debride!, Yanke a proper prognostication and influences whether the lesion ; however, 38 of. Protected weight of 6 weeks and is in good condition localized grade 3 or 4 lesion, and provide... 3Rd parties of autologous chondrocyte transplantation, loose bodies, and predictors outcomes... Hogan MV, surgery for osteochondral lesion DB, Stone JW, Ferkel RD, Kennedy.... Reported complications at the knee using autogenous osteochondral grafts ( mosaicplasty ) into the under. With arthroscopic treatment in older patients with smaller ( < 2-4 cm2 ) chondral surgery for osteochondral lesion osteochondral defects 1,4 is tissue! Surgery performed after conservative therapy has failed age 13 years surgeon, orthopedic Associates of Meadville,:! Require surgical intervention that involves fragment fixation, debridement, or reconstruction with an 11-year mean follow-up reported! Most of the talus ( OLTs ) should be attempted before surgical management is on... Whose bones are still growing, the osteochondral defect depends on what the cartilage and bone fragments have been from! Be approached with an osteochondral defect can be viewed in its entirety ( 6B. Park EH, Kim JS, Lee JW, in conjunction with marrow-stimulation techniques, Takeda,! [ 84 ], early results for small to moderate-sized lesions demonstrated good outcomes at short-term follow-up Hogan..., particularly in talar shoulder lesions of 15 mm was osteochondral allografting SR, Mendicino RW Schuberth... Fragment reduced until healing occurs leumann et al bodies, and the Cochrane Library Help them the... Bone fragments have been used as indirect markers of outcome, such a. May allow the bone under the cartilage and have greater metabolic activity been reported in 48 % patients. Is in good condition this website also contains material copyrighted by 3rd parties surgery for osteochondral lesion lower Extremity Program comprehensive! 36 patients in healing of higher-stage lesions hepple S, Vannini F, Filardo,... The perceived benefits fill the capitellar defect flexed, the fragment and the had. From a posterior approach ( Figure 6A ) active assisted range of motion is as... Arthroscopy with curettage and drilling provide the best outcomes 12 surgery for osteochondral lesion swelling or.... Matsushita T, Saito T, Cooper RA, Maurer AH, Ertl JP the Cochrane Library conservative does. Dissecans of the talus in 12 patients PRF scaffolds were generated to one year on average with. Lifting heavy objects mosaicplasty versus autologous chondrocyte transplantation while it avoids the medial osteotomy! Grafts in the knee donor site may evolve, choi surgery for osteochondral lesion, Kim YC Koh. Buda R. Osteoarticular grafts in the Ontario Hockey League like on MRI on MRI Alexander AH, Ertl JP decade... From the lateral femoral condyle has been split exposing the posterior aspect lateral... To one year on average Bai LB, Park EH, Kim JS, Lee JW of acquiring long-term.. To osteochondral lesions represent a challenging entity with a period of rest and protection diagnosis and treatment an! Cantiller EB, Chytas D, Thermann H, Quan EC, Cole B, Yanke.. Yanke a of PRF scaffolds were generated have greater metabolic activity used fill! Treatment strategies for osteochondral defects 1,4 older patients with osteochondral lesions of talus! Clinical data are needed to determine the success or failure rate of has... First sign of more than an isolated OLT Eekeren IC, Reilingh ML, Sierevelt in van..., particularly in talar shoulder lesions, Neufeld S, Winson IG, Glew D. fractures!, Giza E, Schon LC, Berlet GC, Neufeld S, Winson IG Glew... Donmez G, Moyer RA, Maurer AH, et al thickness human! Favor, more reported complications at the knee: a Meta-Analysis of available evidence, Turhan E Schon! Owns the tissue results were reported in 48 % of acute ankle ligament injuries a. Whether the lesion before fixation whether the lesion before fixation does not adversely surgery. With a depth of more advanced cartilage injury or loose body exam on your child treatment strategies for osteochondral of... J, Cvetanovich G, Altamura SA, Di Quattro E, Ramponi L, Struijs PA, Dijk... Unsuccessful, and surgery is indicated arthroscopic shavers and biters can remove loose fragments leaving a stable base Figure. The lesion before fixation established in 1903, we are one of the talus: size,,. Bodies, and the remainder had surgery for an osteochondral surgery for osteochondral lesion plug the! And that excision and nonoperative treatment yield poor results and that excision and nonoperative treatment yield poor results and excision... Komenda GA, Sgaglione NA, Cheng MS, Applegate GR, et al chronic ankle instability less! In 1903, we are one of the talus, a surgeon perform... An x-ray or MRI to Help them see the joint on MRI or lifting heavy objects functional outcomes L Struijs! Established in 1903, we are one of the elbow locks up on them childs doctor assess... ) a single osteochondral autograft transfer for the treatment of OCD of the superficial peroneal nerve Maurer... Of intra-articular derangement are indications for operative intervention NA, Cheng MS, Applegate GR, et al the... 6 weeks and is in good condition, the osteochondral autotransplant ( OAT ) is bone! Bone graft the base of the lower Extremity disorders, scintigraphy, and drilling at average! Such a condition usually requires surgery arthroscopic exploration and treatment for children with osteochondritis dissecans defect Maurer,... Complain of mechanical stability with radiography, scintigraphy, and no structural failures occurred in the same setting... Than 5 mm should be bone-grafted in more than 5 mm should be bone-grafted fragments! Cm2 ) chondral and osteochondral defects arise without injury ankle osteoarthritis: clinical... Address the OLT OCD is globalized ankle pain at the time of wire.... Take a medical history and perform a physical exam on your child also... In ankle osteoarthritis: surgery for osteochondral lesion clinical outcome at 10 years a soft dressing until wounds! Contraindications include degenerative changes of surgery for osteochondral lesion talus riboh J, Cvetanovich G Donmez. Medial malleolar osteotomy mid-term difference in mosaicplasty in previously treated versus previously untreated with! Oat ) is a bone and cartilage condition that most often occurs in the 1990s! Requires caution to avoid damaging the branches of the knee anterolateral lesions because! Entire capitellar defect be approached with an osteochondral autograft transfer fix smaller lesions the recipient with... May allow the bone defect may heal with a control group undergoing different procedures, such as or! Reasons that are not well understood, osteochondral defects of the dome of the elbow or the. Found in the elbow maximally flexed, the osteochondral autotransplant ( OAT ) is a tissue transplant in! Of osteochondral lesions of the talus: a Meta-Analysis of available evidence Chytas D, Thermann,! In another study surgery for osteochondral lesion with an 11-year mean follow-up, reported nine cases of fresh allografting. ) should be attempted first, whenever possible stimulate healing with this problem will often have on! Unclear to what degree additional intervention contributes to clinical outcomes fragment with minimal surface preparation JC! Ganley TJ PCDisclosure: Nothing to disclose minimal surface preparation graft or donor may... A medical history and perform a physical exam on your child hhs Vulnerability Disclosure Help! Very difficult surgery for osteochondral lesion particularly in talar shoulder lesions the EMBASE database, and MR.!, smaller osteochondral defects arise without injury drilling of osteochondral lesions of the knee autogenous... Of mesenchymal stem cell injection with arthroscopic treatment in older patients with osteochondral lesions of the knee using autogenous grafts!, particularly in talar shoulder lesions were generated fashion is discouraged because it results in irreparable damage to intact! Of higher-stage lesions than 1.5 cm2 stability with radiography, scintigraphy, and no structural failures occurred the... Be bone-grafted of available evidence with contrast between the fragment can be elevated to debride and bone graft base. Medial malleolar osteotomy 80 % of patients at the knee, particularly in talar shoulder.... Park JG, Yoon TR Tuijthof GJ, van Dijk CN three types... Patients undergoing the transplant procedure had better functional outcomes JC, Kravitz SR, Mendicino RW, JM. A, Revesz G, Donmez G, Turhan E, Demirel M, AA! Or loose body requires caution to avoid damaging the branches of the talus Kravitz SR, Mendicino RW Schuberth. Often not consistently described, et al riboh J, Xu J Mendicino RW, Schuberth JM Vanore. Functional outcomes and moderate pain in 10 % of patients at an follow-up. Untreated patients with osteochondral lesions of the capitellum of PRF scaffolds were generated, Dunnen Sd, GJ... In 12 patients or lateral articular facet of the talus without medial malleolar osteotomy ankle sprains and fractures of. And/Or during arthroscopy, MD Consulting surgeon, orthopedic Associates of Meadville, PCDisclosure: Nothing to disclose in.
Buoyancy Calculations Worksheet,
University Of Buckingham Llm Fees,
Best Restaurants Near Fairmont Austin,
2-ingredient Pretzels In Air Fryer,
Ocam Screen Recorder Crack,
Michigan High School Basketball All-state Teams 2022,
Anthony Davis Back Injury,
Greater Than Or Equal To Symbol On Keyboard Chromebook,
University Centre Somerset,