ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Arthroscopy. Sanders TG, Paruchuri NB, Zlatkin MB. comments powered by Schematic drawing of talocrural joint injury in pronation (a) results in sprain of the medial collateral ligaments (brown) and lateral-sided OCL of the talar dome and/or kissing tibial lesion (orange zones), whereas injury in supination (b) causes sprain of the lateral ligaments and medial-sided OCL of the talar dome and/or kissing lesions at the tibia (orange zones). DOI: https://doi.org/10.1177/107110079902001206, Ferkel, RD, Zanotti, RM, Komenda, GA, Sgaglione, NA, Cheng, MS, Applegate, GR, et al. 1991;7:101– 104. We aimed to examine whether CLAI is associated with the size and staging of medial OLT on radiographs, … The talus is the bottom bone of the ankle joint. (2020) Skeletal Radiology. Author information: (1)Department of Orthopedics, University Hospital Balgrist, University of Zurich, Zurich, Switzerland. 1959; 41–A: 988–1020. In addition, factors Vira S(1), Ramme AJ(1), Chapman C(2), Xia D(3), Regatte RR(4), Chang G(5). Skeletal Radiol. Stage 1 lesions are due to bone marrow contusion. We report the outcome of a nonoperative treatment for symptomatic OCL. The overlying cartilage is difficult to assess on MRI. (2)Department of Radiology, Konkuk University School … Later on, this grading system has been modified to computed tomographic evaluation and correlated with arthroscopy, distinguishing cystic lesion of talar dome seen in primary stages with or without communication to the articular surface and detached fragment in more advanced lesions [6]. Osteochondral lesion of the talus in children: Are there MRI findings of instability? Osteochondral lesions of the talus (OLTs) are lesions of the articular cartilage of the talus and underlying subchondral bone. Unable to process the form. As such, the term encompasses a variety of pathologies, including: osteochondritis dissecans, osteochondral defects, and osteochondral fractures. Osteochondral lesions of the talus (OLTs) are a difficult pathologic entity to treat. Staging of Osteochondral Lesions of the Talus: MRI and Cone Beam CT. Journal of the Belgian Society of Radiology, 101(S2), p.1. Osteochondral Lesions of the Talus with Midfoot Arthritis (C2537) Gilberto Consoli Foot & Ankle - Osteochondral Lesions of the Talus E 3/20/2016 604 . Much of this bone is covered with cartilage. For staging of OCL of the talus several grading systems have been proposed. Note also partial filling of the subchondral cyst (black arrowhead) with contrast as an indirect sign of joint communication through a cartilage lesion. It is often used synonymously with osteochondral injury/defect and in the pediatric population. Osteochondral Lesion of the Talus (OLT) Tracey A. Littrell, DC, DACBR, DACO, CCSP. 1. OLTs have been known historically by varied nomenclature, including osteochondritis dissecans, talar dome fracture, transchondral fracture, and flake fracture. Osteochondral defects of the talus (OCD) are a well-established pathology within the ankle. 1 With such an expansive categorization, OLT may occur in up to 70% of acute ankle sprains and fractures. Large uncontained lesions are usually painful as the structure of the talus is threatened. Age: 35 years Gender: Female From the case: Osteochondral lesion of talus. They require a strong plan. MRI. Foot Ankle Int. When the latter is present, then joint replacement is often the only feasible treatment. Gorbachova T, Melenevsky Y, Cohen M, Cerniglia BW. 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. Due to its noninvasiveness, absence of radiation exposure and its ability to visualize associated concomitant soft tissue abnormalities, MRI is the initial technique for exclusion/confirmation of an osteochondral lesion of the ankle. An alternative MRI staging system has been proposed by Mintz [8] et al. Despite the combination of these MR parameters, accurate cartilage evaluation remains often illusive. Schematic drawings of OCL classification according to Anderson. Stage 4 consists of a displaced fragment, often accompanied with surrounding bone marrow edema. Radiology: Volume 252: ... drilling of osteochondral lesions of the talus with MR guidance. 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. We studied the value of MR imaging in determining the stability of the osteochondral fragments. Direct comparison of conventional radiography and cone-beam CT in small bone and joint trauma. Osteochondral lesions are relatively common in children and adolescents, and the incidence is increasing. “Staging of Osteochondral Lesions of the Talus: MRI and Cone Beam CT”. Epub 2009 Jun 30. Recently, Cone Beam Computed Tomography (CBCT) of small joints has been introduced as an alternative technique for Multi Detector CT, combining a very high spatial resolution, low radiation dose and low cost [3]. Journal of the Belgian Society of Radiology 101 (S2): 1. 4. 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. In stage 3 an undisplaced completely separated fragment can be seen on MRI with adjacent BME. 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. Arthroscopic drilling is an effective and minimally invasive treatment. Anatomy of the talocrural joint. This joint permits much of the up (dorsiflexion) and down (plantarflexion) motion of the foot and ankle. Diagram shows the classic four signs of instability in an OCD lesion: 1, high signal intensity rim at the interface between the fragment and the adjacent bone on T2-weighted MR images; 2, fluid-filled cysts beneath the lesion; 3, a high-signal-intensity line extending through the articular cartilage overlying the lesion; and 4, a focal osteochondral defect filled with joint fluid. Coronal reformatted CBCT-A (c) barely shows subtle subchondral sclerosis at the superolateral aspect of the talar dome and intact overlying cartilage. Arthroscopic treatment of chronic osteochondral lesions of the talus: Long-term results. Osteochondral autograft transfer involves harvesting single or multiple cylindrical cartilage and subchondral bone grafts from the non-weight-bearing part of the ipsilateral knee and transplanting them into the talar defect after preparation. DOI: https://doi.org/10.2106/00004623-198971080-00004, Lee, KB, Bai, LB, Park, JG and Yoon, TR. MRI is the modality of choice, with high sensitivity and specificity for the detection of separation of the osteochondral fragment (see: osteochondral injury staging and osteochondritis dissecans surgical staging). Articular cartilage covering the articular surfaces (blue), cortical bone (black), normal bone marrow (yellow) and ligaments (brown). 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. ObjectiveTo determine the role of magnetic resonance imaging (MRI) MOCART (Magnetic Resonance Observation of Cartilage Repair Tissue) 1 and 2.0 scores in the assessment of … DOI: https://doi.org/10.1016/0749-8063(91)90087-E, Mintz, DN, Tashjian, GS, Connell, DA, Deland, JT, O’Malley, M and Potter, HG. Pioneer in Rad Blogging. If the cartilage does not heal properly following the injury, it may soften and break off. Osteochondral defects (OCD) or lesions (OCL) are focal areas of damage with articular cartilage damage and injury of the adjacent subchondral bone plate and subchondral cancellous bone. 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. Characterizing osteochondral lesions by magnetic resonance imaging. 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. 3 . Eur Radiol. The first system of classification has been reported by Berndt and Harty in 1959 [4], including four stages based on their radiological appearance. 1. “Osteo” means bone and “chondral” refers to cartilage. As MRI is inaccurate for the evaluation of the articular cartilage compartment, further staging with direct arthrographic techniques are often mandatory if an OCL is detected on MRI and in those scenarios in which arthrosopic treatment is considered. 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. 2 of 7 Posadzy et al: Staging of Osteochondral Lesions of the Talus Figure 1: Location of the OCL according to the mechanism of trauma. Art. Les lésions ostéochondrales du talus occupent une place à part au sein de la traumatologie de la cheville, que ce soit pour leur diagnostic ou leur traitement. 1 ) and anterolateral (46%) talar dome ( 1 ). They may also be called osteochondritis dessicans or osteochondral fractures. There is slight irregular delineation of the cartilage (white arrow). Arthroscopy. Published: September 2018 . Materials and methods: MR images of 42 ankles were retrospectively reviewed during a period of 67 months. following anterior cruciate ligament repair), femoral condyle (most common in the lateral aspect of the medial femoral condyle), the signal is variable with intermediate to low signal adjacent to fragment and variable fragment signal, low signal loose bodies, outlined by high signal fluid, donor defect filled with high signal fluid. Osteochondral lesion of talus. We report the outcome of a nonoperative treatment for symptomatic OCL. Osteochondral lesions of the talus: A new magnetic resonance grading system with arthroscopic correlation. Staging of Osteochondral Lesions of the Talus: MRI and Cone Beam CT. Journal of the Belgian Society of Radiology. MR imaging of the ankle at 3 Tesla and 1.5 Tesla: Protocol optimization and application to cartilage, ligament and tendon pathology in cadaver specimens. The purpose of this study was to directly compare the MRI with the arthroscopic findings. Sagittal PD fat suppressed MRI image (a) showing BME (star) at the posteromedial part of the talar dome. An osteochondral lesion of the talar dome is an injury involving damage to the cartilage or bony surface of the top of the talus bone (located in the ankle). Foot Ankle Surg 2012;51:556-60. Studies on cadavers performed on CT arthrography [12] showed more accurate cartilage thickness measurements in comparison to standard MRI, which is in line with a superior evaluation of OCL with CT arthrographic techniques [13] (Figure 9). Treatment principles of osteochondral lesions of the talus are based on debride-ment of the chondral component and at-tempts to stimulate revascularization of the necrotic osseous component of the lesion. Coronal (b) and sagittal (c) reformatted CBCT-A show subtle subchondral sclerosis (black arrow) at the superolateral aspect of the talar dome, but the overlying cartilage is intact. There is slight irregular delineation of the cartilage (white arrow). Point loading and loose bodies cause a synovitis, and the mechanics of the joint are altered. An Osteochondral Lesion of the Distal Tibia and Fibula in Patients With an Osteochondral Lesion of the Talus on MRI: Prevalence, Location, and Concomitant Ligament and Tendon Injuries. Clinical management of these lesions is based on whether or not the fragments are attached. (2018) Radiographics : a review publication of the Radiological Society of North America, Inc. 38 (5): 1478-1495. MRI sensitivity in detection of OCL of the talus, correlated with arthroscopic correlation, varies according to different studies and has been reported as high as 81% [10]. Crossref, Medline, Google Scholar; 7 Kumai T, Takakura Y, Higashiyama I, Tamai S. Arthroscopic drilling for the treatment of osteochondral lesions of the talus. Journal of the Belgian Society of Radiology 101, no. 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). DOI: http://doi.org/10.5334/jbr-btr.1377. First mover in Radiology & Web 2.0. The overlying cartilage is intact at the talus, whereas there is subtle cartilage lesion at the distal tibia (arrow). Shell osteochondral allografts of the knee: comparison of mr imaging findings and immunologic responses. Planning of the pathway and adjustment of the targeting device were performed outside the operating room. Foot Ankle Int 1999; 20:474-480. DOI: https://doi.org/10.1053/jars.2003.50041, Anderson, IF, Crichton, KJ, Grattan-Smith, T, Cooper, RA and Brazier, D. Osteochondral fractures of the dome of the talus. Conventional radiography, Mortise View (b). • Goh GSH et al. Dr. Ebraheim’s educational animated video describes Osteochondral Lesions of the Talus. cartilage injury with associated subchondral fracture but without detachment fractures involving a single facial buttress, Meyers and McKeevers classification (anterior cruciate ligament avulsion fracture), Watson-Jones classification (tibial tuberosity avulsion fracture), Nunley-Vertullo classification (Lisfranc injury), pelvis and lower limb fractures by region. 2017;101(S2):1. {"url":"/signup-modal-props.json?lang=us\u0026email="}, {"containerId":"expandableQuestionsContainer","displayRelatedArticles":true,"displayNextQuestion":true,"displaySkipQuestion":true,"articleId":1795,"mcqUrl":"https://radiopaedia.org/articles/osteochondral-defect/questions/571?lang=us"}. Jung HG(1), Kim NR(2), Jeon JY(3), Lee DO(4), Eom JS(1), Lee JS(1), Kim SW(1). The talus is the 3rd most common site (after the knee and elbow) of osteochondral lesions. Sirlin CB, Brossmann J, Boutin RD et-al. 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. Arthroscopic evaluation of the cartilage is regarded as the gold standard [2], but due to its invasiveness and the need for anesthesia, it should be reserved for preoperatively well-documented cases and combined with surgical treatment procedures. Lesion size, location, chronicity, and characteristics such as displacement and the presence of subchondral cysts help dictate the appropriate treatment … Osteonecrosis can develop when the lesion’s vascularity is disrupted. Stage 1 lesion according to Anderson classification. J Bone Joint Surg Am 1999; 81:1229-1235. Stage 3 according to Anderson classification. 2007; 17(6): 1518–28. In addition, the trabecular architecture of subchondral bone is far better visualized on CBCT than on CR. C = cuneiform bone, Cal = calcaneus, Cu = cuboid bone, F = fibula, M = metatarsal bones, N = navicular bone, Ph = phalanges, STJ = posterior facet of the subtalar joint, Tb = talar body, TD = talar dome, Th = talar head, Ti = tibia, Tn = talar neck. Alternative diagnosis on CBCT compared to MRI. Kaplan P. Musculoskeletal MRI. Materials and method: This retrospective IRB-approved and HIPPA-compliant study included children with OLT, who underwent an ankle MRI examination between March … Lomax, A, Miller, RJ, Fogg, QA, Jane Madeley, N and Senthil Kumar, C. Quantitative assessment of the subchondral vascularity of the talar dome: A cadaveric study. Diagnostic value of CT arthrography for evaluation of osteochondral lesions at the ankle. September 2018, Volume 15, Issue 3. It combines high spatial resolution, relatively low radiation dose and low equipment cost and is useful for evaluation of trauma of small bones and joints, particularly when there is clinical suspicion for a fracture despite negative plain radiographs [3]. Coronal (c) and sagittal (d) reformatted CBCT-A show a focal bony lesion with peripheral sclerosis in the distal tibia and talus. Autologous Matrix-Induced Chondrogenesis for Osteochondral Lesions of the Talus: A Clinical and Radiological 2- to 8-Year Follow-up Study. Because the plasticity of the cartilage in children and adolescents is higher than in adults, OCL lesions in young patients are often characterized by isolated subchondral bony changes without overlying cartilage disruption (Figure 5). 6. The tibia and fibula bones sit above and to the sides of the talus, forming the ankle joint. 1999; 20(12): 789–93. S2, 2017, p. 1. 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. Characterizing osteochondral lesions by magnetic resonance imaging. Patient Data. DOI: https://doi.org/10.2106/00004623-198668060-00007, De Smet, E, De Praeter, G, Verstraete, KL, Wouters, K, De Beuckeleer, L and Vanhoenacker, FM. Art. It is often associated with a traumatic injury such as a severe ankle sprain. Dr. Ebraheim’s educational animated video describes Osteochondral Lesions of the Talus. Journal of the Academy of Chiropractic Orthopedists. On plain films, the subchondral bone is seen as a thin layer of compact bone with a smooth surface and a uniform adjacent trabecular bone (Figure 2b). 1989; 71(8): 1143–52. Recht MP, Kramer J. MR imaging of the postoperative knee: a pictorial essay. Pain in right ankle joint. The articular cartilage layer of the talocrural joint is indicated in blue. The accuracy also depends of the strength of the field and is lower on 1.5 Tesla magnets in comparison to 3T [11]. Cartilage damage may have a variable imaging appearance ranging from a small fissure, a distinct defect, flap formation or delamination. In particular cases also alternative diagnoses can be made on basis of CBCT (Figure 11). SCIENTIFIC ARTICLE Osteochondral lesion of the talus in children: Are there MRI findings of instability? Staging of Osteochondral Lesions of the Talus: MRI and Cone Beam CT. Journal of the Belgian Society of Radiology. 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. MRI is the most sensitive method to depict this stage without any correlating signs on CR or CBCT with injection of intraarticular contrast. 1986; 68(6): 862–5. Proposed etiologic factors for the development of OCLs include trauma, ischemia, ... W.B. How the lesion condition or stage is affected by the presence of lateral instability in medial osteochondral lesions of the talus (OLT) is unclear. It is often used synonymously with osteochondral injury/defect and in the pediatric population. Management strategies for symptomatic osteochondral lesions of the talus are primarily surgical. A… The cartilage at the talar dome is slightly irregularly delineated (white arrow). Vira S(1), Ramme AJ(1), Chapman C(2), Xia D(3), Regatte RR(4), Chang G(5). 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]. Osteochondral lesions of the talus present a numerically small but therapeutically significant problem to the foot surgeon. DOI: http://doi.org/10.5334/jbr-btr.1377, Posadzy, Magdalena, Julie Desimpel, and Filip M. Vanhoenacker. Commonly, this is achieved by drilling the subchondral bone (6 – 12). Sagittal fat suppressed T2-WI (intermediate weighting) showing BME (white asterisk) at the lateral corner of the talar dome (b). Pfirrmann. Outcomes are favorable after arthroscopic treatment of osteochondritis dissecans of the talus. Osteochondral lesions (OCL) of the talus are defined as any damage involving both articular cartilage and subchondral bone of the talar dome. Chronic osteochondral lesion of the talus after ankle trauma. The talus is the 3rd most common site (after the knee and elbow) of osteochondral lesions. Osteochondral lesions ... radiology, and sports medicine literature. Osteochondral injury staging system for MRI attempts to grade the stability and severity of osteochondral injury and is used to plan management. Osteochondral lesions of the talus (OCLs/ OLTs), also called osteochondritis dissecans or osteochondral fractures, constitute a gamut of injuries to the articular surface of the. Figure 1: Berndt and Harty classification for talus, osteochondritis dissecans surgical staging, Gustilo Anderson classification (compound fracture), longitudinal versus transverse petrous temporal bone fracture, naso-orbitoethmoid (NOE) complex fracture, cervical spine fracture classification systems, AO classification of upper cervical injuries, Roy-Camille classification (odontoid process fracture ), subaxial cervical spine injury classification (SLIC), thoracolumbar spinal fracture classification systems, AO classification of thoracolumbar injuries, thoracolumbar injury classification and severity score (TLICS), Rockwood classification (acromioclavicular joint injury), Neer classification (proximal humeral fracture), AO classification (proximal humeral fracture), Milch classification (lateral humeral condyle fracture), Weiss classification (lateral humeral condyle fracture), Bado classification of Monteggia fracture-dislocations (radius-ulna), Mason classification (radial head fracture), Frykman classification (distal radial fracture), Hintermann classification (gamekeeper's thumb), Eaton classification (volar plate avulsion injury), Keifhaber-Stern classification (volar plate avulsion injury), Judet and Letournel classification (acetabular fracture), Harris classification (acetebular fracture), Young and Burgess classification of pelvic ring fractures, Pipkin classification (femoral head fracture), American Academy of Orthopedic Surgeons classification (periprosthetic hip fracture), Cooke and Newman classification (periprosthetic hip fracture), Johansson classification (periprosthetic hip fracture), Vancouver classification (periprosthetic hip fracture), Winquist classification (femoral shaft fracture), Schatzker classification (tibial plateau fracture), Lauge-Hansen classification (ankle injury), Danis-Weber classification (ankle fracture), Berndt and Harty classification (osteochondral lesions of the talus), Sanders CT classification (calcaneal fracture), Hawkins classification (talar neck fracture), anterior superior iliac spine (ASIS) avulsion, anterior cruciate ligament avulsion fracture, posterior cruciate ligament avulsion fracture, avulsion fracture of the proximal 5th metatarsal, Ahlback classification system in assessing osteoarthritis of the knee joint, Kellgren and Lawrence system for classification of osteoarthritis, pattern of bone contusion in knee injuries, anterior cruciate ligament mucoid degeneration, MRI grading system for meniscal signal intensity, musculoskeletal manifestations of rheumatoid arthritis, rapidly destructive osteoarthritis of the hip, scaphotrapeziotrapezoidal (STT) arthritis, calcium pyrophosphate dihydrate deposition disease, hydroxyapatite crystal deposition disease (HADD), postsurgical (e.g. Marrow contusion as well as the presence of secondary degenerative changes combination of MRI and CBCT findings the diagnosis a. 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Better suited for precise staging of osteochondral lesions of the Radiological Society Radiology... And Hindfoot to our supporters and advertisers physiotherapy rehabilitation program is essential to ensure an optimal osteochondral lesion talus radiology of...