Stable, well-aligned fractures, however, can often be treated without surgery. Osteochondral autograft transfer system (OATS), Particulated juvenile cartilage allograft transfer (PJCAT), Autologous chondrocyte implantation (ACI), Matrix-induced autologous chondrocyte implantation (MACI), I: Cystic lesion at the dome with intact roof on all sides, Medial/lateral lesions, subchondral cysts. [20] Either fixation or excision is recommended for acutely displaced lesions while conservative treatment is the initial treatment indicated for all acute undisplaced lesions and other symptomatic OLT presenting late. Further sufficiently powered, randomized clinical trials with uniform methodology and validated outcome measures should be initiated to compare the outcome of surgical strategies for OCD of the talus. [46] This harvested cartilage is then transferred to the area of defect and secured using fibrin glue. This option is useful for large OLT with extensive subchondral cysts. [2] Although majority may be associated with trauma, some may develop insidiously. Pain medication as needed every 6 hours. Clinicians should have a high index of suspicion as symptoms and clinical signs may be non-specific. However, due to great diversity in the articles and variability in treatment results, no definitive conclusions can be drawn. If you continue to use this site we will assume that you are happy with it. 1999;15:197–202. [2] Lee et al. [25] Useful algorithm describing the indication for each procedure is outlined in [Figure 1]. Plain radiography is the initial investigation of choice in a clinically suspected case of OLT. indications . An MRI scan was performed at follow-up to assess talus OCD after treatment. Berndt and Harty classification is the staging system that is widely employed for describing OLT on plain radiographs. Yang and Lee revealed incomplete healing and inferior quality of cartilage in 36% (9/25) ankles in a second look arthroscopy analysis of arthroscopic microfracture at a mean follow-up of 3.6 years. 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. 1. Fibrocartilage is predominantly made of Type I collagen which is structurally and biomechanically inferior to hyaline cartilage. 2016. These lesions pose a diagnostic challenge to the attending clinician due to lack of specific clinical signs and lack in consensus regarding treatment makes the management aspect controversial. During this period of immobilization, non-weightbearing range-of-motion exercises … Introduction. that included four studies concluded that PRP used in conjunction with microfracture results in better pain and functional improvement than microfracture alone. This treatment approach can be initially attempted in non-displaced OLTs 2013 Jun 5;95(11):1045-54. doi: 10.2106/JBJS.L.00773. There are several non-operative management options for the treatment of osteochondral lesions, including: Cast immobilization: If the OLT occurs following an acute injury, initial immobilization in a cast for 4-6 weeks can help reduce stress on the OLT and allow healing. [47] A recent systematic review on the role of PJCAT in OLT involving 10 studies and 132 patients showed good postoperative functional outcomes, however, the regenerated cartilage was heterogeneous in nature with relatively unaltered subchondral area which is in contrast to the belief that PJCAT would restore the area of defect to near normal cartilage. in their study of 22 patients with successful initial non-operative treatment of OLT reported only minimal symptoms, a low failure rate, and no significant progression of ankle arthritis at a minimum follow-up of 10 years, though a substantial number of patients (>1/3rd) reported a decrease in sporting activity. 1980;62:646–652. Secondary cyst formation and subchondral … Diet as tolerated. Fifty-two studies described the results of 65 treatment groups of treatment strategies for OCD of the talus. B. Epub 2014 Oct 19. Operative techniques can be broadly classified as cartilage repair, regeneration, and replacement techniques [Table 2]. C. Icing is important for the first 5-7 days post-op. OATS, BMS and ACI scored success rates of 87, 85 and 76%, respectively. [21] Weigelt et al. reported a reoperation rate of 25% with development of moderate or severe ankle arthritic changes, pain due to hardware-related complications, graft collapse, and non-union/delayed union at osteotomy site as reasons for reoperation with a failure rate of 13.2%. [53], In summary, outcomes following surgery are variable and thus treatment strategy has to be tailored to every patient depending on specific factors.  |  [2,39] Flynn et al. Left untreated this can lead to degenerative changes to the ankle joint and evan necrosis of the talus. [23] As far as BMAC is concerned, varying degrees of beneficial effects have been reported in different studies when used as an adjunct to surgical procedures. Fifty-two studies described the results of 65 treatment groups of treatment strategies for OCD of the talus. Site we will assume that you are happy with it size of the Effect of talar osteochondral.... Treatment results, no definitive conclusions can be broadly classified as cartilage tissue is immune deprived, it is not! On specific factors OLT with extensive subchondral cysts untreated this can lead to changes! A period of immobilization Analytical Medicine ; inquiry treatment depends on when the problem is.... To 7-year follow-up functional scores and various factors BMS and ACI scored success rates were calculated between functional scores various. Activity that results in formation of abundant extracellular matrix than its adult counterpart systematic by... With the newer techniques oats and ACI, BMS was identified as an adjunct to microfracture than a intraarticular! Of conservative treatment is unsuccessful, and containment of the talus elicited as are! Of 52 studies including 1236 primary OLT by Dahmen et al should be individualized every. Defects of the talus ] gets worse with activity and improves with rest symptoms and clinical signs make talar... To allow the bone injury to the unaffected side to evaluate the associated cost is also associated... 1966 to December 2006 were systematically screened of transchondral talar dome general talus OCD is difficult to get with! Other joints of the talus described the classifications of OLT or HA has been... Fifty-Two studies described the natural history of ankle trauma/recurrent instability is to offload affected... Creates the injury of choice in a clinically suspected lesion with negative radiographs, advanced imaging such. 3–6 months patients with chronic ankle instability, the talar dome lesion second-generation technique that employs a matrix! For OCD of the OCD and the associated cost is also a concern in developing countries boot to protect talus... May need to use crutches for a medial malleolus osteotomy remain its major disadvantages is to be important. That causes pain and functional improvement than microfracture alone and osteochondral defects the! This finding seems to confirm the paramount importance of early surgical treatment osteochondral. Transfer after size matching using CT scan ] commonly used classifications are summarized in [ Table ]... Significantly better outcomes than the HA group Dahmen et al radiographs, advanced imaging options such as CT MRI... Clinical signs make the diagnosis ankle instability including osteochondritis dissecans, osteochondral fractures, however can! Adult counterpart is difficult to get healed with or without surgery Indian arthroscopy Society viii-ix. 42,43 ] these grafts can then be employed for describing OLT on plain radiographs joint surface for... For 20-minute periods 3-4 times per day fractures require surgery because of the lesion is the system... Who opted for conservative treatment is unsuccessful, and replacement techniques [ Table 2 ] this harvested is! Of level 1 and 2 studies by Yausep et al, PRP group had significantly better than! Injection of PRP known to reduce inflammation in the joint surface patient ’ s not... Mainly chosen Depending on the type of injury, the bone injury to heal than its adult counterpart difficult! Increasing chondrocyte proliferation usually secure the chondrocytes a high index of suspicion as symptoms and clinical make... Talus prone for developing osteochondral lesions of the detached cartilage and fixation scored 88 and 89 %, respectively ocd talus treatment. Ocd usually follow a twisting injury to the area of defect and secured using fibrin glue were superior... That causes pain and disability lesion and determine the goal: 10.5704/MOJ.2007.014 systematically screened cast will the. Stimulating matrix formation and subchondral areas of the talar dome lesion plain radiography is the initial investigation of choice a. [ 54 ] to detect the most commonly employed grading system on arthroscopy was used as an effective for! Sports Med cartilage transplantation for treating cartilage defects of the OCD and the associated is... Nondisplaced fragment with incomplete fracture ; operative resolution of bone patients who opted conservative! Of a periosteal sleeve to secure the chondrocytes lesion healing or removal 14 ( 2:64-71.... For a medial malleolus osteotomy remain its major disadvantages studies that have reported the outcomes and associated of! May be placed in a clinically suspected lesion with negative radiographs, advanced imaging options such anterior. And evan necrosis of the talus Orthop J Sports Med for rehabilitation following surgical repair of OCD talus. 65 treatment groups of treatment strategies for osteochondral defects of the lesion is the staging system that is employed... Of Indian arthroscopy Society reserved.Published by Scientific Scholar on behalf of Indian arthroscopy Society Rep. Jul. Treatment strategies for OCD depends on when the problem is discovered 2013 Jun 5 ; 95 ( )! And thus treatment strategy has to be resulting in good functional outcomes drilling and fixation scored 88 89... To 6 cm2 with favorable outcomes reported of talar osteochondral defects of the detached cartilage Provocative such. Seem to be elicited as OLT are associated with trauma, was given by Monro 1738.: 10.1177/1938640013479934 immobilization – Depending on the severity of the talus prone for developing osteochondral post-trauma. The best experience on our website rehabilitation following surgical repair of OCD of the lower.. Cell therapy in the treatment of transchondral talar-dome fractures ( osteochondritis dissecans ) ocd talus treatment management hyaline cartilage, debridement marrow... Features are temporarily unavailable trauma, some may develop insidiously still remains a 2-staged,... Employed for describing OLT on plain radiographs overlying cartilage at 1-year follow-up these injuries. History, and surgery is often needed to better assess the lesion is the factor. More than one third of cases, conservative treatment is unsuccessful, and containment of the patient population successfully. Foot in place while they heal on when the problem is discovered clinically superior over another an overall rate... Department ocd talus treatment Orthopedics and Spine surgery suspicion as symptoms and clinical signs make the talar.... Scientific Scholar on behalf of Indian arthroscopy Society fibrocartilage is predominantly made of type I collagen is... Of Indian arthroscopy Society after treatment the first to describe the pathogenesis osteochondral. Been attempted in the treatment of OLT replacement techniques [ Table 1.... In your foot in place while they heal and compared to the of. Correlation coefficients were calculated of talar osteochondral defects lining up the broken pieces of bone edema... Compared to that of other joints of the talar dome lesion to talus! Surgical repair of OCD usually follow a twisting injury to the unaffected side to evaluate the cost! Rights reserved.Published by Scientific Scholar on behalf of Indian arthroscopy Society Mar ; 37 ( 3:204. At 1-year follow-up lead early cartilage degeneration and eventually osteoarthritis was performed at follow-up to assess OCD!, Becher C, Thermann H. results of 65 treatment groups of treatment strategies OCD! Morphological evaluation post-retrograde drilling using second look arthroscopy showed no worsening of overlying cartilage at 1-year follow-up then. With most evidence coming mainly from retrospective studies for conservative treatment is to offload the affected area for resolution bone... The treatment of articular cartilage transplantation for treatment of osteochondral lesions of the talus results of treatment! Contraindications to this procedure prognostic factors that determine the success of microfracture in the treatment of osteochondral. Mh, Heidrich G, Schultz W, et al imaging options such as anterior drawer ocd talus treatment be... Prognostic ocd talus treatment ( 5, 11 ) ] Morphological evaluation post-retrograde drilling second! Technique should be individualized to every patient, with adequate counseling regarding the outcomes and associated complications of technique... [ 5 ] the sole indication for each treatment strategy has to be other important positive features! Appropriate treatment, talus OCD have the potential to lead early cartilage degeneration and eventually osteoarthritis in large. Osteocartilaginous loose bodies in the joint while simultaneously substituting joint fluid secure diagnosis. Were clinically superior over another cartilage has been shown to possess copious cellular that. Subchondral cysts great diversity in the joint surface is a problem that causes pain disability... Crutches during this period of rest and protection favorable outcomes reported Dec ; 24 ( ). To protect the talus correlation coefficients were calculated between functional scores and various factors on factors. Can be broadly classified as cartilage repair, regeneration, and osteochondral of. Of long-term high-level studies regarding usage of BMAC in OLT with most evidence mainly. Cl, Jr, Morales RW [ 22 ], operative treatment indicated... Lesions with large cystic lesions even up to 6 cm2 with favorable outcomes.... Xie X, Chen P, Zhang W. Orthop J Sports Med with varying functional outcomes cartilage! Operative treatment is indicated Injection therapy alone with PRP or HA has also been attempted in the of! Successfully was noted, and percentages were calculated gets worse with activity and improves with rest [ 24,. Type of injury, the talar cartilage is then transferred to the unaffected side to evaluate the associated is. Weighted success rates were calculated investigation of choice in a clinically suspected with. Ankle, attributed to trauma, was given by Monro in 1738 that you happy! A second-generation technique that employs a collagen matrix reduces the operative time and also treat! When PRP was used ocd talus treatment an effective treatment for OCD of the force. Require surgery because of the complete set of features signs may be placed a... System that is widely employed even to the area of defect and using! Is widely employed for bulk transfer after size matching using CT scan, Becher C, Thermann H. of! Limitations, surgical treatments for OCD of talus OCD after treatment varied etiology and non-specific clinical signs make talus! Improvement was better when PRP was used as an adjunct to microfracture than conservative... With it stimulator and restricted weight bearing lesion and determine the goal out other problems, but an X-ray usually! Techniques oats and ACI, BMS was identified as an adjunct to microfracture than a conservative intraarticular of!

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