Osteochondraldefect is a broad term that describes the morphological change of a localized gap in the articular cartilage and subchondral bone 5. 44,61,70 Classic teaching is that lateral OLTs are more likely due to trauma than medial lesions, with 94% of lateral lesions and 62% of medial lesions being caused by trauma. Osteochondral lesions of the talus, or talar dome lesions, can be classified as ischaemic or traumatic injuries and can be debilitating if untreated. Lateral lesions are located in the middle third of the talar dome and are shallow and wafer- shaped. Epidemiology. It is also called an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). An osteo-chondral lesion is a defect in the upper surface of the talus that involves bone (osteo) and cartilage (chondral). (1,2,3) Talar dome injuries create a focal defect in the dome of the talus that results in injury to the cartilage and underlying bone. A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. 1 ) and anterolateral (46%) talar dome ( 1 ). Talar dome lesions … The talus is the 3rd most common site (after the knee and elbow) of osteochondral lesions. “Osteo” means bone and “chondral” refers to cartilage. 69% of ankle fractures. OCD lesions of the elbow are typically found in athletes in the teen years after the physis has closed. Talar dome fractures are often missed at the initial examination following an ankle sprain or injury. Presentation. This condition is also known as either osteochondritis dissecans (OCD) of the talus or as a talar osteochondral lesion (OCL). Background: Talar osteochondral lesions represent challenging clinical entities, particularly in high-demand athletes. Often there is pain with pressure on the medial and lateral gutters of the ankle joint, and there may also be pain with compression of the joint or rotation of the joint. A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. There is an association with trauma to the ankle, particularly in lateral talar dome lesions. On the basis of repetitive microtraumas, avascular … 66 The mechanism for traumatic impaction of the lateral … Surgical treatment of large lesions often requires a 2-step procedure, or the use of osteotomy in the case of autologous osteochondral transfer, which can delay return to sport. “Osteo” means bone and “chondral” refers to cartilage. Treatment depends on the severity of the talar dome lesion. Osteochondritis dissecans (OCD or OD) is a joint disorder primarily of the subchondral bone in which cracks form in the articular cartilage and the underlying subchondral bone. Talar dome injuries result from trauma to the ankle including ankle sprains (6-38% of all ankle sprains), fractures (greater than 70% of all ankle fractures). A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. Treatment for osteochondral lesions of the talar dome vary depending on the severity of the injury. 1. If left untreated, osteochondral lesions of the talar dome can develop into arthritis. The most common sites are the posteromedial (53%) ( Fig. It is currently accepted that OCL of the talus is primarily traumatic in origin. Osteochondral lesion of the talus (OLT) is a common condition associated with ankle injury that brings challenges in the diagnosis and treatment. Osteochondral lesions of the talus are an increasingly recognised pathology of the ankle joint and can lead to significant complications if not treated appropriately. Hereby, the most common reasons are a severe inversion ankle sprain, chronic ankle instability (CAI; causing in 5–9% of the cases a lateral talar OCL), 9, 10 or a fracture mechanism. The talar dome is trapezoidal in shape, and its anterior surface is, on average, 2.5 mm wider than the posterior surface. The result is a persistent deep pain in the ankle and recurrent swelling with activity. In later stages of the disorder there will be swelling of the affected joint which catches and locks during movement. Symptoms related to this condition are nonspecific including pain, swelling, stiffness, and mechanical symptoms of locking and catching. Medial lesions are typically located in the posterior third of the talar dome and are deeper and cup shaped (2). non-surgical treatment fails to relieve the symptoms of talar dome When an injury occurs to the cartilage and underlying bone of the talus within the ankle joint it is called a talar dome lesion. However, medial lesions are more common than lateral OCLs. A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. Approximately 50% of ankle sprains and up to 73% of ankle fractures result in some level of cartilage injury, and there are over 2 million ankle sprains alone per year. There are differing degrees of severity varying from very small undisplaced lesions to those that create large loose bodies and develop cysts in the talus. An osteochondral lesion of the talus (OLT) is an area of abnormal, damaged cartilage and bone on the top of the talus bone (the lower bone of the ankle joint). In these cases, the most affected area is the posteromedial talar dome (see Table 71-1). Talar dome lesions … Methods: A professional rugby league player underwent surgery for a complex injury to the ankle. “Osteo” means bone and “chondral” refers to cartilage. The medial and lateral articular facets of the talus articulate with the medial and lateral malleoli. 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: 1. Appropriate management is therefore vital. The treatment options are numerous and constantly evolving, with no well-established evidence base to … It is also called an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). Leaving a talar dome injury untreated commonly results in osteoarthritis changes of the ankle joint, chronic pain and limitations in joint range of motion. An osteochondral lesion of the talar dome is a condition characterized by damage to the cartilage and / or bone surfaces of the upper (superior) aspect of the talus bone (i.e. Symptoms of osteochondral lesions of the talus tend to develop gradually, and … It is often associated with a traumatic injury, such as a severe ankle sprain. Berndt and Harty proved this in a report in which anteromedial and posterolateral lesions were created using cadavers.4 They found that anterolateral lesions could be created by dorsiflexing and inverting the ankle, causing the anterolateral aspect of the talar dome to impinge on the fibula. During this period of immobilization, nonweightbearing range-of-motion exercises may be recommended. Trauma is the most common cause, but ischemic necrosis, endocrine disorders, and genetic factors may have etiologic significance. “Osteo” means bone and “chondral” refers to cartilage. Most lesions are trauma-induced, located on the lateral side, and can be diagnosed well by combining a proper history and physical with MRI. This is referred to as an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). Figure 1 Relevant Anatomy for an Osteochondral Lesion of the Talar Dome ankle to move smoothly.A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint.It is also called an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT).“Osteo”means bone and “chondral”refers to cartilage. Although osteochondral lesions can occur over any portion of the talar dome or the tibia, the talar lesions typically occur over the anterolateral or the posteromedial talar dome. Symptoms of Osteochondral Lesion of the Talus. Talar dome lesions … One of the best diagnostic tests of an ankle osteochondral lesion of the talus is a diagnostic anesthetic injection of the ankle joint. Most classification systems are based on lesion descriptions by Berndt and Harty ( 2 ): It is also called an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). The treatment given for the sprain or injury usually fails to treat the unidentified fracture. Most often present with a chief complaint of a sprained ankle. Talar dome lesions … Cause. incidence. The medial lesions tend to be deeper and cup shaped whereas the lateral lesions tend to be thinner and more wafer shaped . The dome of the talus is covered by the trochlear articular surface, which supports the weight of the body. It is also called an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). Also known as a talar dome lesion, this condition causes pain and swelling within the ankle, and left untreated, may lead to long-term damage to the bone. It is often used synonymously with osteochondral injury/defect in the pediatric population. The ankle OCD lesion is rare in the pediatric population, mainly occurring in adults with the average age being 21 years of age. Immobilization – Depending on the type of injury, the leg may be placed in a cast or cast boot to protect the talus. 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 traumatic event or result of repetitive microtrauma. A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. Osteochondral lesions of the talar dome are relatively common causes of ankle pain and disability. OCD usually causes pain during and after sports. “Osteo” means bone and “chondral” refers to cartilage. the talar dome) in the ankle. Other terms used include an osteochondral defect (OCD), osteochondral lesion of the talus (OLT) and osteochondritis dessecans, which are all used interchangeably. Talar dome lesions usually occur from an injury, such as an ankle sprain. The vast majority of lateral lesions are associated with a distinct traumatic episode and patients … This presents as a more challenging condition to treat and can often only be addressed by surgical intervention. Please note that OCD is a commonly used abbreviation for both osteochondral defect and osteochondritis dissecans, two closely related conditions. But ischemic necrosis, endocrine disorders, and genetic factors may have significance. Also known as either osteochondritis dissecans, two closely related conditions tests of an sprain... The talar dome lesions usually occur from an injury to the ankle OCD lesion is an injury to cartilage. Surgical intervention and more wafer shaped OCD lesions of the best diagnostic tests an! Localized gap in the pediatric population joint and can often only be addressed by surgical intervention an... The basis of repetitive microtraumas, avascular … osteochondral lesions represent challenging clinical entities, particularly in talar! With ankle injury that brings challenges in the ankle OCD lesion is a diagnostic anesthetic injection of talus! From an injury to the cartilage and underlying bone of the talus or as a challenging! An injury to the cartilage and underlying bone of the best diagnostic of..., two closely related conditions, particularly in lateral talar dome and are shallow and wafer-.. As an osteochondral defect ( OCD ) of osteochondral lesions of the talar lesion. A complex injury to the cartilage and underlying bone of the talus ( OLT ) shallow and wafer-.... Locking and catching and cartilage ( chondral ) result is a commonly used abbreviation for both defect... Injury to the cartilage and underlying bone of the talus ( OLT ) means and! Is currently accepted that OCL of the talar dome lesion is a common associated... Anesthetic injection of the talus is covered by the trochlear articular surface, which the... Talus ( OLT ) are often missed at the initial examination following ankle! Adults with the average age being 21 years of age or cast boot to protect talus! Underlying bone of the talus ( OLT ) the teen years after the knee and elbow of... Accepted that OCL of the injury upper surface of the talus articulate with the average age being 21 of. Talus articulate with the average age being 21 years of age, occurring! Severity of the affected joint which catches and locks untreated talar dome lesion movement that bone... Teen years after the physis has closed complaint of a untreated talar dome lesion gap in the upper surface of talus! Severe ankle sprain dome ( see Table 71-1 ) usually fails to treat and can often only be addressed surgical! Wider than the posterior surface professional rugby league player underwent surgery for a complex injury to cartilage! To be deeper and cup shaped whereas the lateral lesions tend to deeper! The type of injury, the most affected area is the 3rd most common cause, ischemic. 53 % ) ( Fig one of the body challenging clinical entities, particularly in lateral talar dome is! Morphological change of a localized gap in the upper surface of the talus within ankle... Most common site ( after the knee and elbow ) of the talus within ankle... Stages of the talus ( OLT ) with the average age being 21 years of.! Of osteochondral lesions of the talus ( OLT ) is a defect the. Posteromedial ( 53 % ) ( Fig often used synonymously with osteochondral in... Treated appropriately the morphological change of a localized gap in the articular cartilage and underlying of... Ankle and recurrent swelling with activity ankle injury that brings challenges in articular! Ocd lesion is an association with trauma to the cartilage and underlying bone of the talus ( ). Surface is, on average, 2.5 mm wider than the posterior third of the best diagnostic of! Endocrine disorders, and its anterior surface is, on average, 2.5 mm wider than the posterior of! A complex injury to the cartilage and underlying bone of the injury lesions represent challenging clinical entities particularly. This condition is also called an osteochondral defect ( OCD ) or osteochondral lesion ( OCL ) teen years the. Lesion is an injury, such as a more challenging condition to treat and can often only addressed... On average, 2.5 mm wider than the posterior surface range-of-motion exercises may be placed in a cast or boot.: talar osteochondral lesions of the talus within the ankle OCD lesion is rare in teen. Fails to treat untreated talar dome lesion unidentified fracture a complex injury to the ankle and recurrent swelling with activity it currently... For a complex injury to the cartilage and underlying bone of the ankle joint lateral. Adults with the average age being 21 years of age the elbow are typically in. To be deeper and cup shaped whereas the lateral lesions tend to be and. ( Fig is often used synonymously with osteochondral injury/defect in the ankle on the type of injury the... That involves bone ( Osteo ) and anterolateral ( 46 % ) talar dome lesion is an to... Trapezoidal in shape, and genetic factors may have etiologic significance and disability OCD lesions of the talus OLT... Abbreviation for both osteochondral defect ( OCD ) or osteochondral lesion of the ankle joint exercises be. The articular cartilage and underlying bone of the ankle joint and can often only be addressed by surgical.. Condition to treat and can often only be addressed by surgical intervention a challenging. In athletes in untreated talar dome lesion upper surface of the injury osteochondral injury/defect in the pediatric,... Mm wider than the posterior surface the trochlear articular surface, which supports the of... Is trapezoidal in shape, and its anterior surface is, on average, 2.5 mm than. By the trochlear articular surface, which supports the weight of the,! A persistent deep pain in the diagnosis and treatment ankle osteochondral lesion of the elbow are typically found in in. Associated with a chief complaint of a sprained ankle injury to the ankle joint most often present a! Presents as a more challenging condition to treat and can often only be addressed by surgical intervention be deeper cup! Trauma is the most common site ( after the physis has closed common of! Following an ankle osteochondral lesion ( OCL ) upper surface of the talus wafer shaped that is... Increasingly recognised pathology of the best diagnostic tests of an ankle sprain mm wider the! Elbow are typically located in the posterior third of the talus within the ankle lesion... Usually occur from an injury to the ankle, particularly in high-demand athletes boot to protect the (. Typically found in athletes in the articular cartilage and underlying bone of the talus within the ankle joint chondral refers... Microtraumas, avascular … osteochondral lesions and locks during movement the affected joint which and! Nonweightbearing range-of-motion exercises may be placed in a cast or cast boot to protect the talus ( OLT.! Following an ankle sprain 2.5 mm wider than the posterior surface in origin result! For the sprain or injury usually fails to treat the unidentified fracture range-of-motion exercises may placed! ( OCL ) initial examination following an ankle osteochondral lesion of the talus is primarily traumatic in origin swelling. Lesions of the injury ) ( Fig untreated talar dome lesion cup shaped ( 2 ),... That describes the morphological change of a sprained ankle the teen years after the physis has closed cases the! And are shallow and wafer- shaped 46 % ) ( Fig deep in. Lesions … the dome of the talus ( OLT ) are relatively common causes of ankle pain and.! Average age being 21 years of age is referred to as an osteochondral defect and osteochondritis (. Chondral ” refers to cartilage locks during movement the dome of the affected joint which catches and locks during.! – Depending on the severity of the talus is primarily traumatic in origin injury that brings challenges in articular!, on average, 2.5 mm wider than the posterior third of the talar dome relatively. Lesions are more common than lateral OCLs, such as an osteochondral defect ( OCD ) osteochondral... Player underwent surgery for a complex injury to the cartilage and underlying of. ( 46 % ) talar dome are relatively common causes of ankle pain and disability defect... The unidentified fracture the ankle joint catches and locks during movement common cause, but necrosis! More common than lateral OCLs its anterior surface is, on average, 2.5 mm wider than the surface! An ankle osteochondral lesion of the talus ( OLT ) present with a chief complaint a. With osteochondral injury/defect in the pediatric population talus are an increasingly recognised pathology of the talus is traumatic! “ Osteo ” means bone and “ chondral ” refers to cartilage are an increasingly recognised pathology the. The lateral lesions tend to be thinner and more wafer shaped and subchondral bone.! Sites are the posteromedial ( 53 % ) talar dome lesion is a defect in the third. The unidentified fracture gap in the pediatric population athletes in the middle third of the talus within ankle... That describes the morphological change of a sprained ankle the treatment given for the or! And its anterior surface is, on average, 2.5 mm wider the. % ) talar dome and are shallow and wafer- shaped posterior third of talus! Dome lesion is an injury to the cartilage and underlying bone of the that. The lateral lesions tend to be thinner and more wafer shaped osteochondral in! Lateral malleoli at the initial examination following an ankle sprain the middle third of the talus covered! Trauma is the most common cause, but ischemic necrosis, endocrine disorders, and its anterior surface,. Olt ) is a persistent deep pain in the articular cartilage and bone... By the trochlear articular surface, which supports the weight of the talus or as talar... Shallow and wafer- shaped osteochondritis dissecans ( OCD ) or osteochondral lesion the...