Weigelt L(1), Hartmann R(1), Pfirrmann C(2), Espinosa N(3), Wirth SH(1). Example of understaging of the cartilage defect of an OCL on MRI compared to CBCT arthrography. Coronal (a) fat suppressed T2-WI show adjacent BME (white asterisk) at the superolateral aspect of the talar dome. 5. Skeletal Radiol. • Goh GSH et al. The articular cartilage layer of the talocrural joint is indicated in blue. Journal of the Belgian Society of Radiology 101 (S2): 1. Lateral radiograph shows the normal skeletal anatomy of the foot and ankle. Osteochondral Lesions of the Knee: Differentiating the Most Common Entities at MRI. 3 . Glossary of terms for musculoskeletal radiology. In particular cases also alternative diagnoses can be made on basis of CBCT (Figure 11). Modification of the Outerbridge classification of cartilage defects. The purpose of our study was to investigate the performance of MRI findings to predict instability of osteochondral lesion of the talus (OLT) in children and the association between skeletal maturity and lesion stability. MRI coronal PD fat suppressed image (1.5 Tesla equipment) of the talocrural joint (c) with normal appearance of the thin cartilage layer (arrows) of intermediate signal, low signal of subchondral bone and homogenous bone marrow signal (stars). 17 Osteochondral Lesions of the Talus MARK E. EASLEY, STEVEN D. SIDES, AND ALISON P. TOTH Treatment of symptomatic focal talar osteochondral defects has undergone a dramatic evolution over the past decade. 1991; 7(1): 101–4. The overlying cartilage is intact at the talus, whereas there is subtle cartilage lesion at the distal tibia (arrow). Presentation. The cartilage at the talar dome is slightly irregularly delineated (white arrow). Treatment principles of osteochondral lesions of the talus are based on debridement of the chondral component and attempts to stimulate revascularization of the necrotic osseous component of the lesion. This term covers a wide spectrum of pathologies including (sub)chondral contusion, osteochondritis dissecans, osteochondral fracture and osteoarthritis resulting from longstanding disease. The talus is the 3rd most common site (after the knee and elbow) of osteochondral lesions. CT arthrography visualizes tissue growth of osteochondral defects of the talus after microfracture. 2003; 19(4): 353–9. Osteochondral lesions are relatively common in children and adolescents, and the incidence is increasing. Art. Shell osteochondral allografts of the knee: comparison of mr imaging findings and immunologic responses. As such, the term encompasses a variety of pathologies, including: osteochondritis dissecans, osteochondral defects, and osteochondral fractures. Eur Radiol. Check for errors and try again. Although Conventional Radiography (CR) is still the initial diagnostic modality used for evaluation of ankle pain, later studies showed that 30–43% of talar OCL diagnosed on MRI were invisible on CR [5]. Journal of the Academy of Chiropractic Orthopedists. Moreover, despite several modifications of the staging systems on MRI, not all combination of the degree of involvement of the cartilage and subchondral bone are included and therefore these classification systems remain uncomprehensive, complicated and less valuable for use in daily routine. (2020) Skeletal Radiology. Osteochondral lesions are injuries to the talus (the bottom bone of the ankle joint) that involve both the bone and the overlying cartilage. Cartilage damage may have a variable imaging appearance ranging from a small fissure, a distinct defect, flap formation or delamination. Furthermore, cartilage lesions may be isolated (one defect), complex (one lesion with variable depth of the lesion) or multifocal (involving multiple areas of the talus or tibia). Useful MR scoring parameters include lesion location, lesion size in 3 planes, subchondral bone marrow edema, subchondral cyst formation and/or sclerosis, status of the overlying cartilage, contour depression of the articular bone plate. Although Magnetic Resonance Imaging (MRI) at 1.5 Tesla is the leading cross-sectional modality for detection and staging of OCL, lack of spatial resolution hampers accurate assessment of thin articular cartilage. We report the outcome of a nonoperative treatment for symptomatic OCL. Coronal computed tomographic (CT) scan (a) and sagittal T1-weighted magnetic resonance (MR) image (b) demonstrate the normal skeletal anatomy of the foot and ankle. Dr. Ebraheim’s educational animated video describes Osteochondral Lesions of the Talus. With the advent of MRI, this grading system was further revised including evaluation of structures invisible on conventional radiology, such as the integrity of the cartilage and presence of BME. This joint permits much of the up (dorsiflexion) and down (plantarflexion) motion of the foot and ankle. comments powered by Radiology. DOI: https://doi.org/10.2106/00004623-198971080-00004, Lee, KB, Bai, LB, Park, JG and Yoon, TR. DOI: https://doi.org/10.1007/s00330-006-0446-4, El-Khoury, GY, Alliman, KJ, Lundberg, HJ, Rudert, MJ, Brown, TD and Saltzman, CL. Patient Data. They are most commonly associated with ankle trauma and wh… Compared to the articular cartilage of the knee, cartilage of the ankle joint is very thin and the spatial resolution of MRI may be insufficient for detection of small lesions. Author information: (1)Department of Orthopedic Surgery, Konkuk University School of Medicine, 4-12 Hwayang-dong, Gwangjin-gu, Seoul, 143-729, Republic of Korea. Diagnostic value of CT arthrography for evaluation of osteochondral lesions at the ankle. DOI: http://doi.org/10.5334/jbr-btr.1377. Background and purpose - The frequency of progression of osteoarthritis and persistence of symptoms in untreated osteochondral lesion of the talus (OCL) is not well known. Figure 1. They may also be called osteochondritis dessicans or osteochondral fractures. Purpose: The purpose of our study was to investigate the performance of MRI findings to predict instability of osteochondral lesion of the talus (OLT) in children and the association between skeletal maturity and lesion stability. Jung HG(1), Kim NR(2), Jeon JY(3), Lee DO(4), Eom JS(1), Lee JS(1), Kim SW(1). Sirlin CB, Brossmann J, Boutin RD et-al. 1, pp. Example of improved visualization of communication of subchondral cysts with the joint through deep articular cartilage lesions on CBCT arthrography. Ankle Platform is for Orthopedic Surgeons with special interest in Ankle and Hindfoot. Articular cartilage covering the articular surfaces (blue), cortical bone (black), normal bone marrow (yellow) and ligaments (brown). DOI: https://doi.org/10.1177/107110079902001206, Ferkel, RD, Zanotti, RM, Komenda, GA, Sgaglione, NA, Cheng, MS, Applegate, GR, et al. Background: Osteochondral lesions of the talus (OLT) are rela-tively uncommon but may be a cause of significant pain and disability. Outcomes are favorable after arthroscopic treatment of osteochondritis dissecans of the talus. There is slight irregular delineation of the cartilage (white arrow). Conventional radiography, Mortise View (b). Most classification systems are based on lesion descriptions by Berndt and Harty ( 2 ): Example of accurate staging of the status of the articular cartilage in paediatric OCL. Schematic drawing shows the basic anatomy of the talocrural joint (Figure 2a). Osteonecrosis can develop when the lesion’s vascularity is disrupted. 2017. William Palmer, Laura Bancroft, Fiona Bonar, Jung-Ah Choi, Anne Cotten, James F. Griffith, Philip Robinson, Christian W.A. DOI: https://doi.org/10.1177/0363546508316773, Dipaola, JD, Nelson, DW and Colville, MR. Characterizing osteochondral lesions by magnetic resonance imaging. Kaplan P. Musculoskeletal MRI. Purpose: The purpose of our study was to investigate the performance of MRI findings to predict instability of osteochondral lesion of the talus (OLT) in children and the association between skeletal maturity and lesion stability. • Emre et al. Radiology: Volume 252: ... drilling of osteochondral lesions of the talus with MR guidance. Location of the OCL according to the mechanism of trauma. The majority of those lesions occur in active patients and are related to trauma. Schematic drawing of the normal talocrural joint (a). 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. 2008; 16(11): 1047–51. DOI: https://doi.org/10.2106/00004623-195941060-00002, Hepple, S, Winson, IG and Glew, D. Osteochondral lesions of the talus: A revised classification. Arthroscopy. Staging of Osteochondral Lesions of the Talus: MRI and Cone Beam CT. Journal of the Belgian Society of Radiology, 101(S2), 1. S2 (2017): 1. Radiology. Sanders TG, Paruchuri NB, Zlatkin MB. 1 ) and anterolateral (46%) talar dome ( 1 ). Arthroscopy. Management strategies for symptomatic osteochondral lesions of the talus are primarily surgical. • Emre et al. We describe ten patients with an osteochondral lesion of the talus who underwent ACI using cartilage taken from the knee and were prospectively reviewed with a mean follow-up of 23 months. Osteochondral lesion(s) of the talus (OLT) is an all-encompassing term for any injury involving both the subchondral bone and the articular cartilage of the talar dome, including bone bruise (contusion), osteochondritis dissecans, and osteochondral fracture. cartilage injury with associated subchondral fracture but without detachment 2016; 2016: 3594253. Lesion size, location, chronicity, and characteristics such as displacement and the presence of subchondral cysts help dictate the appropriate treatment … Clinical management of these lesions is based on whether or not the fragments are attached. Osteochondral lesions (OCL) of the talus are defined as any damage involving both articular cartilage and subchondral bone of the talar dome. 1999; 20(12): 789–93. Osteochondral injury staging system for MRI attempts to grade the stability and severity of osteochondral injury and is used to plan management.. stage I. injury limited to articular cartilage; MRI findings: subchondral edema; x-ray findings: none; stage II. Treatment depends on the location and size of the defect as well as the presence of secondary degenerative changes. Foot Ankle Surg 2012;51:556-60. Open mosaicplasty in osteochondral lesions of the talus: a prospective study. The diagnosis and investigation of such lesions have been greatly enhanced by modern high resolution magnetic resonance imaging capabilities, which have provided far greater detail of the pathological anatomy. A comparison of arthroscopic and MRI findings in staging of osteochondral lesions of the talus. The overlying cartilage is difficult to assess on MRI. How the lesion condition or stage is affected by the presence of lateral instability in medial osteochondral lesions of the talus (OLT) is unclear. 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