Talar dome lesions usually occur from an injury, such as an ankle sprain. 6 However, … Because the history and physical examination findings are often nonspecific and the differential diagnosis includes multiple other entities such as tendonitis, instability, impingement lesions, neurological causes such as neuroma or tarsal tunnel syndrome, subtalar symptoms including os trigonum, a careful physical examination must be performed to assess these possibilities. Depending on the type of injury, the leg may be placed in a … In these cases, the most affected area is the posteromedial talar dome (see Table 71-1). Medial talar dome lesions are typically found in the central to posterior aspect of the talar dome and are therefore often inaccessible to arthroscopic procedures and techniques. Talar dome lesions are usually caused by an injury, such as an ankle sprain. 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. Smaller diameter cysts would not accommodate the arthroscopic tools. lesions and 70% of medial lesions are associated with trauma based on Flick and Gould’s7 review of more than 500 documented talar dome lesions. Conservative treatment of osteochondral lesions of the talus (OLTs) should be attempted first, whenever possible. The diagnosis of cartilage damage (osteochondral lesion, also known as talar dome) is often done with x-rays and/or an MRI. An osteochondral injury to the talar dome produces pain at the ankle and you will find walking and other weight bearing activities difficult. 2 Historical treatment recommendations, however, have been based on expert opinion and lower quality studies. 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 ]. “Osteo” means bone and “chondral” refers to cartilage. 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. suggested internal fixation of the lesion if it is larger than one third of the size of talar dome while Stone et al. Patients tend to present with more chronic symptoms of ankle pain, rather than acute injury. If the lesion doesn’t heal correctly, the cartilage can break down, and sometimes, a fragment of cartilage can break away and “float” nearby. There is no universally accepted treatment algorithm for osteochondral lesions of the talar dome. The simplest treatment is to place the patient in a cast to keep the ankle joint from moving and allowing the defect to heal. Routine views include anteroposterior (AP), lateral, and mortise views. If the cartilage doesn’t heal properly following the injury, it softens and begins to break off. There is a slight male predominance in incidence of injury, [4-6] Treatment of these lesions has been reported extensively previously, but as stated by Dahmen et al. Procedure selection is generally based on lesion size, location on the talar dome and/or a history of prior failed surgical management. 1. soft tissue massage 2. J Bone Joint Surg Br. The result is a persistent deep pain in the ankle and recurrent swelling with activity. Verhagen RA, Struijs PA, Bossuyt PM, van Dijk CN. Medial lesions tend to be deeper and cup shaped. Kelberine F, Frank A. Arthroscopic treatment of osteochondral lesions of the talar dome: a retrospective study of 48 cases. We have reviewed charts and radiographs in 13 cases of OCL in children, examined at follow-up as adults. Newer techniques such as osteochondral autograft, osteochondral allograft, and autologous chondrocyte transplantation are promising; however, long term results are unknown. Arthroscopy. 2003;8(2):233-42. Osteochondral lesions of the talus (OLTs) are a difficult pathologic entity to treat. It is also called an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). These incidents can be a singular, acute macrotraumatic incident, or a repet-itive, cumulative microtrauma-induced event. Lateral lesions tend to be thinner and more wafer shaped. Plain radiographs are indicated in the evaluation of any patient with acute or chronic ankle pain. 2, No. Surgical: The preferred surgical treatment of talar osteochondral lesions is using a local osteochondral talar autograft. 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. In 2007, MRIs of 428 ankles with OLTs were studied. Talar dome lesions do occur with no history of trauma. Depending on the type of injury, the leg may be placed in a cast or cast boot to protect the talus. 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. Treatment decisions are based upon the site of the lesion, the size of the lesion, the skeletal maturity of the patient, the quality of the articular cartilage, and the quality of the associated bone fragment. Introduction The patient presented with a history of a medial talar dome osteochondral lesion (OCL) for over five years prior to her first microfracture surgery in 2008. 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. 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. Clinical testing by a health professional is unable to detect talar dome lesions. What is a Talar Dome Lesion? This condition is also known as either osteochondritis dissecans (OCD) of the talus or as a talar osteochondral lesion (OCL). A variety of surgical techniques is available to accomplish this. Autologous cartilage was then reimplanted arthroscopically. Sixteen patients (16 ankles) with symptomatic osteochondral lesions of the medial talar dome were treated arthroscopically with percutaneous retrograde drilling through the sinus tarsi. Osteochondral lesion (OCL) of the talar dome is rare in children. 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 most often result from an injury, such as a sprain. Depending on the type of injury, the leg may be placed in a cast or cast boot to protect the talus. Treatment depends on the severity of the talar dome lesion. Assessment of Treatment* Rating Pain Function Exam X-ray Good None No restriction on Normal Normal activities Fair Occasionally with Some limitation of Mild swelling; slight Minimal change activity activities … It is also called an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). His initial observation was that they were loose osteocartilaginous bodies that … Treatment depends on the severity of the talar dome lesion. Robinson DE, Winson IG, Harries WJ, Kelly AJ. It was determined that the midmedial zone was the most common location (53%). Options for surgical treatment of osteochondral talar dome lesions include drilling of intact lesions, internal fixation of intact or separated lesions, bone grafting, and fragment excision followed by curettage, abrasion, or drilling of the base of the lesion. Swelling is commonly found in acute injuries, although it may be absent in chronic cases especially with medial lesions. debridement of lesion to create stable cartilage rim, subchondral bone exposed. Treatment for these complications is best directed by a foot and ankle surgeon and may include one or more of the following: Nonsteroidal or steroidal anti-inflammatory medications Physical therapy Bracing Surgical intervention Treatment may comprise: Find a physiotherapist in your local area who can treat an osteochondral lesion of the talar dome. They may complain of generalized pain, weakness, swelling, stiffness and/or limited ankle range of motion with catching or locking. Alexander AH, Lichtman DM. 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. 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.” The arthroscopic treatment of these lesions was first described by Parisien and Pritsch et al. Pain with weight bearing and a sensation of giving way are more common but nonspecific complaints. However, medial lesions are more common than lateral OCLs. 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. Talar dome lesions generally involve either the superomedial or superolateral corners of the talus. 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