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. • Emre et al. 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. Home MRI Musculoskeletal MRI Musculoskeletal radiology Osteochondral Defect. Sirlin CB, Brossmann J, Boutin RD et-al. J Bone Joint Surg Am. CBCT, which was first introduced for preoperative evaluation of dental implants, is currently also used for musculoskeletal applications. The main reason for that is the fact that we need images with high spatial resolution to detect early changes of articular cartilage of the ankle joint. Osteochondral lesions ... radiology, and sports medicine literature. Biomed Res Int. 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. It uses a conical X-ray beam and flat-panel detector collecting all volumetric data in one rotation of the gantry. The recognized sites of osteochondral defects are: Osteochondral injuries are graded according to the stability and location of the fragment and presence of secondary degenerative changes (see: osteochondral injury staging). This chapter is adapted from Chao W, Freeland E, Dedini R: Osteochondral Lesions of the Talus in Chou LB, ed: Orthopaedic… 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). CT arthrography visualizes tissue growth of osteochondral defects of the talus after microfracture. Staging of Osteochondral Lesions of the Talus: MRI and Cone Beam CT. Journal of the Belgian Society of Radiology, 101(S2), 1. Additional CBCT-Arthrography is, however, very useful for more accurate cartilage staging and should be considered in those clinical scenarios where arthroscopic treatment of the lesion is considered. Disqus. MRI of osteochondral defects of the lateral femoral condyle: incidence and pattern of injury after transient lateral dislocation of the patella. DOI: http://doi.org/10.5334/jbr-btr.1377, Posadzy, Magdalena, Julie Desimpel, and Filip M. Vanhoenacker. Dr. Ebraheim’s educational animated video describes Osteochondral Lesions of the Talus. Besides the limitations of MRI in this field, it is still considered the most comprehensive imaging modality of the ankle because of its capability to assess soft tissue and bone marrow abnormalities on a single examination. 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. 1, pp. Weigelt L(1), Hartmann R(1), Pfirrmann C(2), Espinosa N(3), Wirth SH(1). The first system of classification has been reported by Berndt and Harty in 1959 [4], including four stages based on their radiological appearance. Most classification systems are based on lesion descriptions by Berndt and Harty ( 2 ): Characterizing osteochondral lesions by magnetic resonance imaging. Many of these lesions are first diagnosed by plain film. 2017;101(S2):1. 1 ) and anterolateral (46%) talar dome ( 1 ). The red arrow indicates the direction of the applied force. Unable to process the form. Autologous Matrix-Induced Chondrogenesis for Osteochondral Lesions of the Talus: A Clinical and Radiological 2- to 8-Year Follow-up Study. [7], who correlated MR imaging with arthroscopic appearance. Osteochondral Defect Monday, September 15, 2008 MRI, Musculoskeletal MRI, Musculoskeletal radiology. Recht MP, Kramer J. MR imaging of the postoperative knee: a pictorial essay. MRI is the most sensitive method to depict this stage without any correlating signs on CR or CBCT with injection of intraarticular contrast. DOI: http://doi.org/10.5334/jbr-btr.1377. Radiology: Volume 252: ... drilling of osteochondral lesions of the talus with MR guidance. 1. Osteochondral lesion of talus. Electronic databases from January 1966 to December 2006 were systematically screened. Subchondral bone involvement can be manifested by bone marrow edema (BME), fracture, sclerosis and/or cyst formation. 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. {"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"}. Page 6 of 19 talar dome in the ankle joint. Osteochondral lesions of the talus present a numerically small but therapeutically significant problem to the foot surgeon. The majority of those lesions occur in active patients and are related to trauma. 2015; 44(8): 1111–7. Radiology. 3 c Department of Radiology, Asan Medical Center, College of Medicine , University of Ulsan , Seoul , Republic of Korea. For staging of OCL of the talus several grading systems have been proposed. Osteochondral injury staging system for MRI attempts to grade the stability and severity of osteochondral injury and is used to plan management. Large uncontained lesions are usually painful as the structure of the talus is threatened. Osteochondral lesions of the talus Few patients require surgery Sang Gyo SEO 1, Jin Soo KIM , Dong-Kyo SEO 2, You Keun KIM 1, Sang-Hoon LEE 3, and Ho Seong LEE 1 Department of Orthopedic Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul; 2 Department of Orthopedic Surgery, Sagittal PD fat suppressed MRI image (a) showing BME (star) at the posteromedial part of the talar dome. J Bone Joint Surg Am. Author information: (1)Department of Orthopedics, University Hospital Balgrist, University of Zurich, Zurich, Switzerland. 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. We aimed to examine whether CLAI is associated with the size and staging of medial OLT on radiographs, … Journal of the Belgian Society of Radiology 101, no. Commonly, this is achieved by drilling the subchondral bone (6 – 12). 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. Staging of Osteochondral Lesions of the Talus: MRI and Cone Beam CT. Journal of the Belgian Society of Radiology, 101(S2), p.1. The frequency of progression of osteoarthritis and persistence of symptoms in untreated osteochondral lesion of the talus (OCL) is not well known. Osteochondral lesions of the talus are relatively uncommon but may be a cause of significant pain and disability in symptomatic patients. 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. The purpose of this study was to investigate tissue growth after arthroscopic microfracture of OLTs using computed tomography arthrography (CTA) and to identify the relationship between CTA findings and clinical outcomes. An alternative MRI staging system has been proposed by Mintz [8] et al. S2, 2017, p. 1. 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. How the lesion condition or stage is affected by the presence of lateral instability in medial osteochondral lesions of the talus (OLT) is unclear. Morrison, et al.Osteochondral lesions of the talus: localization and morphologic data from 424 patients using a novel anatomical grid scheme. Osteochondral lesions are relatively common in children and adolescents, and the incidence is increasing. Posadzy M, Desimpel J, Vanhoenacker FM. 2008; 16(11): 1047–51. Members receive the 'Picture of the week', new operative techniques and can submit their problem cases for an expert opinion. DOI: https://doi.org/10.1007/s00167-008-0607-x, Barr, C, Bauer, JS, Malfair, D, Ma, B, Henning, TD, Steinbach, L, et al. The talus is the bottom bone of the ankle joint. This retrospective IRB-approved and HIPPA-compliant study included children with OLT, who underwent an ankle MRI examination between March 1, 2011, and May 31, 2018. Articular cartilage lining remains homogenous without any signal changes (Figure 7). 5. 1. 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. • Goh GSH et al. This term covers a wide spectrum of pathologies including (sub)chondral contusion, osteochondritis dissecans, osteochondral fracture and osteoarthritis resulting from longstanding disease. 1999; 20(12): 789–93. In addition, factors Isolated lesions of cartilage or subchondral bone are not considered an OCD 6. Unstable lesions – if left untreated – predispose for early osteoarthritis. 2006;187 (5): 1332-7. 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. (2020) Skeletal Radiology. At earlier stages (stage 1 to 4), a number of options exist including: The knee is a complex synovial joint that can be affected by a range of pathologies: ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Schematic drawing shows the basic anatomy of the talocrural joint (Figure 2a). and Dr. Arthemizio Antônio Lopes Rocha M.D. 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. Osteochondral lesions of the talus (OLT) bring the challenges both of articular cartilage healing and a constrained area of access in the ankle joint. A comparison of arthroscopic and MRI findings in staging of osteochondral lesions of the talus. They require a strong plan. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. DOI: https://doi.org/10.1016/j.fas.2013.10.005, https://doi.org/10.2106/00004623-198668060-00007, https://doi.org/10.1007/s00256-015-2127-3, https://doi.org/10.2106/00004623-195941060-00002, https://doi.org/10.1177/107110079902001206, https://doi.org/10.1016/0749-8063(91)90087-E, https://doi.org/10.2106/00004623-198971080-00004, https://doi.org/10.1007/s00167-008-0607-x, https://doi.org/10.1007/s00330-006-0446-4, https://doi.org/10.1148/radiol.2333031921. Due to the widespread use of fluid-sensitive sequences on MRI, even subtle foci of BME may be seen adjacent to a cartilage defect, particularly in acute or subacute OCL lesions. Planning of the pathway and adjustment of the targeting device were performed outside the operating room. 2016; 2016: 3594253. The most common sites are the posteromedial (53%) ( Fig. Epub 2009 Jun 30. 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]. Most classification systems are based on lesion descriptions by Berndt and Harty ( 2 ): Osteochondral lesions are injuries to the talus (the bottom bone of the ankle joint) that involve both the bone and the overlying cartilage. Osteochondral lesion of the talus in children: Are there MRI findings of instability? 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. Materials and method: This retrospective IRB-approved and HIPPA-compliant study included children with OLT, who underwent an ankle MRI examination between March … 1, pp. You JY(1)(2), Lee GY(1)(3), Lee JW(1), Lee E(1), Kang HS(1). focal injuries to the talar dome with variable involvement of the subchondral bone and cartilage resulting in osteochondral lesion of the talus (OLT) may be caused by … Coronal proton density (b) shows focal hypointense thickening of the talar dome (arrow). • Emre et al. Pain in right ankle joint. On CBCT arthrographic images, the contrast separating the OCL fragment from the talar dome can be evaluated with more confidence (Figure 8). Both x-rays and CT are able to detect displaced defects with ease. Dr. Ebraheim’s educational animated video describes Osteochondral Lesions of the Talus. 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. It is often used synonymously with osteochondral injury/defect and in the pediatric population. 2004; 233(3): 768–73. This condition is also known as osteochondritis dissecans (OCD) of the talus or a talar osteochondral lesion (OCL). 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. DOI: https://doi.org/10.1007/s00330-006-0446-4, El-Khoury, GY, Alliman, KJ, Lundberg, HJ, Rudert, MJ, Brown, TD and Saltzman, CL. Point loading and loose bodies cause a synovitis, and the mechanics of the joint are altered. 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