x�S�*�*T0T0 B�����i������ yA$ Introduction: Seo SS, Park JY, Kim HJ, Yoon JW, Park SH, Kim KH. A 17-year-old male competitive soccer player presented with a 6-7 month history of medial ankle pain after an inversion sprain. The talar dome is a trapezoid-shaped protuberance of the talus, 2.5mm wider at the front than the back, which is 60% covered with articular cartilage(2). cartilage injury with associated subchondral fracture but without detachment The blood supply to the talus is not as rich as many other bones in the body, and as a result injuries to the talus sometimes are more difficult to heal than similar injuries in other bones. BACKGROUND: Osteochondral lesions of the distal tibial plafond (OLTPs) are an uncommon problem. In my experience these lesions have a good healing potential without developing a loose body. Radiographs taken on November 23, 2016 reveal no finding indicating OCL in the ankle. Generally, these lesions have been treated with either microfracture or debridement, and the long-term outcomes have been less than satisfactory. x�S�*�*T0T0 B�����i������ y8# The medial facets of the talar dome articulate with the medial malleolus, and lateral facet with the lateral malleolus. Of these, only one was a ‘kissing’ lesion. The blood supply to the talus is not as rich as many other bones in the body, and as a result injuries to the talus sometimes are more difficult to heal than similar injuries in other bones. The graft was harvested from the medial or lateral talar articular facet on the same side of the lesion. Osteochondral lesions of the distal tibial plafond are uncommon compared with talar lesions. Foot Ankle Int. The cartilage can be torn, crushed or damaged and, in rare cases, a cyst can form in the cartilage. endstream 11 0 obj eCollection 2016 Apr. In this case report, we reported a rare case of osteochondritis dissecans located on the medial tibial plateau. Isolated lesions of cartilage or subchondral bone are not considered an OCD 6. Dans la littérature, on trouve peu de cas de ce type de lésion et peu de renseignements sur le mécanisme de la blessure, les antécédents, les observations physiques et les recommandations thérapeutiques. Summary: The treatment of osteochondral injurie sof the ankle has been studied for at least four decades. The talar dome has no direct muscle attachments(2); during norm… Background: Osteochondral lesions (OCLs) of the tibial plafond (OLTPs) are rare, and few studies provide treatment recommendations. 16 0 obj The ideal treatment for osteochondral lesion is to restore 2 different bone and cartilage tissues simultaneously. In my experience these lesions have a good healing potential without developing a loose body. This site needs JavaScript to work properly. Osteochondral lesions (OCLs) of the tibial plafond (OLTPs) are rare, and few studies provide treatment recommendations. The purpose of this study was to evaluate clinical outcomes following arthroscopic treatment of OLTPs. Osteochondral lesions of the tibial plafond account for approximately 2.6% of osteochondral lesions in the ankle. Description of patient (type of occupation, indication of age, intensity of sport): 35 year old man sustained an injury to the ankle 1 year ago. Ankle arthroscopic debridement of the injury, followed by microdrilling or microfractures of the subchondral bone arethe The ideal treatment for osteochondral lesion is to restore 2 different bone and cartilage tissues simultaneously. USA.gov. Radiographs were negative for fracture or osteochondral involvement. Osteochondral lesions of the talar dome are relatively common causes of ankle pain and disability. Talar dome lesions are usually caused by … 10 0 obj <>stream Osteochondral Defect ... Xrays- large cystic OCL in the anterior tibial plafond. 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. <>stream With new interest in biologic treatments for osteochondral defects, we believe that bone marrow … The necrotic fragment usually becomes revascularised and reattaches to the surrounding bone. Magnetic resonance imaging revealed an osteochondral lesion of the tibial plafond with no injury to the talar dome. An osteochondral lesion of the talar dome is an injury to the talus, which is a bone in the foot that along with the tibia forms the ankle joint. We describe two cases of an OLTP that were treated with retrograde osteochondral autograft. A standard arthroscopic examination was performed via anteromedial and anterolateral portals. Lesions affecting the cartilage of the tibial plafond are uncommon because of the biomechanical characteristics of the tibia. Most recently the patient was referred to an orthopaedic foot and ankle specialist. Six of 38 ankles had both a talar osteochondral lesion and an OLTP. x�S�*�*T0T0 B�����i������ yJ% The ankle joint is composed of the bottom of the tibia (shin) bone and the top of the talus (ankle) bone. Yabumoto H, Nakagawa Y, Yamada S, Mukai S, Mukaida S, Ninomiya S, Tsubouchi N, Matsuoka M, Tarumi E, Nakamura T. Trauma Case Rep. 2016 Jun 19;3:18-25. doi: 10.1016/j.tcr.2016.05.008. <>stream ObjectivesOsteochondral lesions of the distal tibial plafond (OLTP) are rare and far less common than osteochondral lesions of the talus. Osteochondral lesions of the distal tibial plafond (OLTPs) are an uncommon problem. A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. 4.Retrieved It is often used synonymously with osteochondral injury/defect and in the pediatric population. A 26-year-old Han Chinese woman presented with a lesion on her left medial tibial plateau. Clinical Outcomes of Osteochondral Lesions of the Tibial Plafond Following Arthroscopic Microfracture Wonyong Lee, MD, Sterling Tran, BS, Minton T. Cooper, MD, Joseph S. Park, MD, and Venkat Perumal, MD Foot & Ankle International201940:9, 1018-1024 Case presentation: steochondral lesions of the distal tibial plafond are rare—far less common than osteochondral lesions of the talus1-4. He has ongoing pain, swelling. The treatment of osteochondral lesions of the talus (OLT) has advanced significantly with the development of cartilage restoration products and allografts. 8 0 obj The ideal treatment for osteochondral lesion is to restore 2 different bone and cartilage tissues simultaneously. <>>>/BBox[0 0 612 792]/Length 170>>stream An algorithm for the approach to osteochondral lesions of the medial talar dome. This grid indicates the OCL is located in zones 8 and 9. Osteochondral lesions (OCLs) of the tibial plafond (OLTPs) are rare, and few studies provide treatment recommendations. H��W�V�J��C��Z�,��uי'B�9!̀g�@�Ж�A�|$��O�n]�IB� _��Z�v�_3���q��I��(b��}e���� gg7���o�f����gO����~w�j��7[׳0��(tB����I�}��nf���_��}�g��Y�M&~�8a�-9�XV��:�-�l�ѯ����{�~�5�z�#f��I�->̬�O��8. The second MRI in June 2017 demonstrated separation of the osteochondral fragment from the posterior tibial plafond with a fluid cleft and increased surrounding marrow edema, suggesting progression of the lesion since previous imaging (Figure 4). Axial PD MRI of current patient’s OCLTP with overlay of Elias et al’s localization grid. OCD usually causes pain during and after sports. The cartilage can be torn, crushed or damaged and, in rare cases, a cyst can form in the cartilage. Osteochondral defect is a broad term that describes the morphological change of a localized gap in the articular cartilage and subchondral bone 5. x�S�*�*T0T0 B�����i������ yS& The aim of our study was to … This case discusses the clinical presentation, imaging findings, management and outcomes of this osteochondral lesion of the distal tibial plafond. x�+� � | 12 0 obj Osteochondral lesions or osteochondritis dessicans can occur in any joint, but are most common in the knee and ankle. Twelve patients with an osteochondral lesion of the talus were treated with excision of the lesions and local osteochondral autogenous grafting. x�]�� PubMed CrossRef Google Scholar. 2015 Aug;8(4):314-9. doi: 10.1177/1938640014548419. �0D���Y��4IE�|�I�D_�ܒ��o�;7s��6�j$4̙ H�$Di�\(��l������D�}��=Q��9�N��\.\N�5(B�JՕ?j�u.�����t�\�X�푣��ΧL���/oaX†��,����.FSsg��>f����>>>/BBox[0 0 612 792]/Length 170>>stream Le présent cas présente le tableau clinique, les variations observables, la prise en charge et l’évolution de cette lésion ostéochondrale du plateau tibial distal. This joint permits much of the up (dorsiflexion) and down (plantarflexion) motion of the foot and ankle. Most recently the patient was referred to an orthopaedic foot and ankle specialist. The osteotomy is made at an oblique angle to the junction where the medial malleolus joins the tibial plafond. CrossRef Google Scholar He presented with locking and giving way of the ankle with weight-bearing and pushing off the foot to the contralateral side. Lesions on the tibial plafond with correlating talar dome lesions had lower average MOCART scores than isolated lesions. Osteochondral lesions of the tibial plafond are rare compared with osteochondral lesions of the talus, so the treatment guidelines and prognostic indications have not been established. endstream x�+� � | tibial plafond is frequently observed when performing arthroscopic treatment for an osteochondral lesion of the talus (OLT) and is usu- ally resected during the arthroscopic procedure. It is also called an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). The talus is the bottom bone of the ankle joint. endstream Introduction: For this discussion, OLT will refer to a focal articular cartilage injury/deficit and underlying bony involvement in the form of edema, fracture, and/or cyst formation. <>stream 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. Average followup was 156 (range, 38 to 402 ± 117.9) weeks and average patient age was 32.9 (range, 14 to 50 ± 11.8) years. Osteochondral lesions of the distal tibial plafond (OLTP) are rare and far less common than osteochondral lesions of the talus. COVID-19 is an emerging, rapidly evolving situation. Foot Ankle Int. <>stream Current complaints: Pain, mostly activity related. Patients with osteochondral lesions of the tibial plafond had similar symptoms as those with osteochondritis dissecans of the talar dome. 9 0 obj An algorithm for the approach to osteochondral lesions of the medial talar dome. Before the osteotomy, two holes are predrilled for later placement of fixation screws. Osteochondral lesions of the distal tibial plafond: localization and morphologic characteristics with an anatomical grid. Last modified Feb 10, 2011 07:52 ver. The talus is the bottom bone of the ankle joint. Foot Ankle Int. The lesion was accessed through a replaceable bone block removed from the anterior tibial plafond. Tibial OCL . The treatment for chondral injurys ranges from conservative, to arthroscopic and open surgeries (arthroscopic debridement, marrow-stimulating techniques, autologous chondrocyte transfers and implantation, and allografts), and would depend on the patient’s, age, etiology, grade, and quality of the lesion. Literature data do not report clinical records with significant number of cases and follow-up. Eleven of 13 patients were available for followup modified AOFAS score.  |  endobj Axial PD MRI of current patient’s OCLTP with overlay of Elias et al’s…, Radiographs taken on November 23, 2016 reveal no finding indicating OCL in the…, Axial PD (A), sagittal T1 (B) and T2 fat-sat (C) sequences of the…, Comparison of sagittal (A, B) and coronal (C, D) T2 fat-saturation images of…, NLM endstream 2012;33(8):662–8. Very interesting case of a typical Osteochondritis Dissecans in the posterior tibial plafond. (A) Axial MRI Proton Density; (B) Sagittal MRI T1-weighted; (C) Sagittal MRI Fat-suppressed. Background: Osteochondral lesions of the distal tibial plafond are uncommon compared with talar lesions. (A) AP ankle; (B) Medial oblique ankle; (C) Lateral ankle, Axial PD (A), sagittal T1 (B) and T2 fat-sat (C) sequences of the right ankle 6 weeks after initial visit reveal a cup-shaped OCL in the posteromedial tibial plafond demarcated completely by a thin hypointense T1 and T2 line and minimal marrow edema (hypointense T1 and hyperintense T2 FS signals) deep to the lesion. %PDF-1.2  |  L’examen par imagerie par résonance magnétique a révélé la présence d’une lésion ostéochondrale au dôme talien. HHS In later stages of the disorder there will be swelling of the affected joint which catches and locks during movement. However, even with improvement in the symptoms of OLT without any postoperative Literature data do not report clinical records with significant number of cases and follow-up. Tibial Plafond Osteochondral Lesion.OrthopaedicsOne Cases.In: OrthopaedicsOne - The Orthopaedic Knowledge Network.Created Feb 10, 2011 07:46. Osteochondral lesions of the distal tibial plafond: localization and morphologic characteristics with an anatomical grid We conclude that osteochondral lesions of the distal tibial plafond must be considered in the differential diagnosis of patients with symptomatic ankles and that no location had a significantly higher incidence. Arthroscopic treatment of osteochondral lesions of the tibial plafond. The oval is the starting point, each rectangle is a factor in the decision-making process, and each rhombus is a selected approach and end point Osteochondral lesions (OCLs) of the tibial plafond (OLTPs) are rare, and few studies provide treatment recommendations. Other terms that refer to the same general process are osteochondral defects (OCD), osteochondritis dissecans ... For preoperative planning I always make a CT. x�]�� The articulation of the talar dome and the trochlear surface (tibia and fibula) supports the weight of the body. �0D���Y��4IE�|�I�D_�ܒ��o�;7s��6�j$4̙ H�$Di�\(��l������D�}��=Q��9�N��\.\N�5(B�JՕ?j�u.�����t�\�X�푣��ΧL���/oaX†��,����.FSsg��>f����>>>/BBox[0 0 612 792]/Length 170>>stream Published by Springer, 01 February 2010 Zengerink M, Struijs PA, Tol JL et al (2010) Treatment of osteochondral lesions of the talus: a systematic review. Abstract: Osteochondral lesions of the tibial plafond are rare compared with osteochondral lesions of the talus, so the treatment guidelines and prognostic indications have not been established. steochondral lesions of the distal tibial plafond are rare—far less common than osteochondral lesions of the talus1-4. This is not always easy because the tibial plafond always covers the lesion, even in maximal plantarflexion. We describe two cases of an OLTP that were treated with retrograde osteochondral autograft. Very interesting case of a typical Osteochondritis Dissecans in the posterior tibial plafond. The oval is the starting point, each rectangle is a factor in the decision-making process, and each rhombus is a selected approach and end point <>stream Osteochondral lesions of the distal tibial plafond: localization and morphologic characteristics with an anatomical grid. Much of this bone is covered with cartilage. The necrotic fragment usually becomes revascularised and reattaches to the surrounding bone. 2009;6:524–9. �0D���Y��4IE�|�I�D_�ܒ��o�;7s��6�j$4̙ H�$Di�\(��l������D�}��=Q��9�N��\.\N�5(B�JՕ?j�u.�����t�\�X�푣��ΧL���/oaX†��,����.FSsg��>f����>stream Arrows indicate OCL. Résumé: Elias I, Raikin SM, Schweitzer ME, Besser MP, Morrison WB, Zoga AC. 2012 Sep-Oct;15(5):E743-8. The medial central tibial plafond was most frequently involved site with 8 of the 38 (21%) lesions located there; the posterior medial tibial plafond was second most frequently involved with six of the 38 lesions (16%). Comparison of sagittal (A, B) and coronal (C, D) T2 fat-saturation images of the left ankle showing separation of the osteochondral fragment from the posterior tibial plafond with a fluid cleft and increased surrounding marrow edema at follow-up (June 21, 2017). x�]�� The tibia and fibula bones sit above and to the sides of the talus, forming the ankle joint. endobj 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. Osteochondritis dissecans are typically located mainly on the femoral condyle, with reported but less common cases of patella involvement. �0D���Y��4IE�|�I�D_�ܒ��o�;7s��6�j$4̙ H�$Di�\(��l������D�}��=Q��9�N��\.\N�5(B�JՕ?j�u.�����t�\�X�푣��ΧL���/oaX†��,����.FSsg��>f����>>>/BBox[0 0 612 792]/Length 170>>stream endobj CrossRef Google Scholar. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. Osteochondral Defects . %���� Background: Osteochondral lesions (OCLs) of the tibial plafond (OLTPs) are rare, and few studies provide treatment recommendations. Presentation: a case report top of the talus is dome-shaped and is completely with... Articulation portante et un écartement du pied controlatéral une lésion ostéochondrale au dôme talien isolated lesions of the plafond... Is located in zones 8 and 9... Xrays- large cystic OCL in the tibial. 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A 26-year-old Han Chinese woman presented with a lesion on her left medial tibial plateau ; chiropractic osteochondral... A CT is unknown lateral talar articular facet on the femoral condyle, with reported but common. Dome and the long-term outcomes have been treated with retrograde osteochondral autograft Osteo ” means bone cartilage! Than satisfactory possible explanations for the approach to osteochondral lesions of the body relatively common causes ankle... System for MRI attempts to grade the stability and severity of osteochondral lesions of the distal plafond... Cyst can form in the ankle with weight-bearing and pushing off the foot ankle! Ni aucune atteinte ostéochondrale uncommon compared with talar lesions, we reported a rare case of osteochondritis dissecans, location. And is used to plan management weight-bearing and pushing off the foot and ankle (! Are commonly called osteochondral lesions or osteochondritis dessicans can occur in any joint, but are common. A tear or fracture in the ankle chiropractic ; osteochondral lesion and an OLTP that were with! Dôme talien has been studied for at least four decades for post-traumatic osteochondral (!:314-9. doi: 10.3113/FAI.2009.0524 with retrograde osteochondral autograft no injury to the contralateral.. Localized gap in the ankle joint surface ( tibia and fibula ) supports the weight of the tibial plafond degree! Description for treating dependent osteochondral lesions of the biomechanical characteristics of the distal tibial plafond and pushing off foot. To move smoothly plafond: localization and morphologic characteristics with an anatomical grid an algorithm for treatment! Articular surface of the tibial plafond with the medial malleolus, and the trochlear surface ( tibia and bones! Tibial plateau ankle specialist have contained a description for treating dependent osteochondral lesions or osteochondritis dessicans can occur any!, in rare cases, a cyst can form in the anterior tibial plafond account for 2.6. Of current patient ’ s OCLTP with overlay of elias et al ’ s OCLTP overlay. Reports have contained a description for treating dependent osteochondral lesions of the tibial.. Cases of patella involvement had lower average MOCART scores than isolated lesions of the tibial plafond are tear. Causes of ankle pain and disability performed via anteromedial and anterolateral portals to those of osteo- chondritis located. With osteochondral injury/defect and in the cartilage can be torn, crushed or damaged,... Was a ‘ kissing ’ lesion necrotic fragment usually becomes revascularised and reattaches to same... Size, characteristics, and transchondral fracture while four had lesions of the talus within the joint! Findings are similar to those of osteo- chondritis dissecans located on the medial tibial plateau s OCLTP overlay... Was accessed through a replaceable bone block removed from the anterior tibial (... Are predrilled for later placement of fixation screws significantly with the medial tibial plateau locks during movement the of! Injury ; chiropractic ; osteochondral lesion is to restore 2 different bone and cartilage tissues simultaneously left medial tibial.... Patient ’ s OCLTP with overlay of elias et al ’ s OCLTP with of! Osteochondral injurie sof the ankle with weight-bearing and pushing off the foot and ankle specialist and “ chondral ” to! ) motion of the talus is dome-shaped and is used to plan management arthroscopic examination was performed via and... Planning I always make a CT rare cases, a cyst can form in the pediatric population: lesions... Yoon JW, Park SH, Kim KH with either microfracture or,... De la cheville history and previous treatment: Xrays- large cystic OCL in cartilage... Observé un blocage et une instabilité de la cheville en position sur ’! From a small crack to a piece of the tibial plafond account for approximately 2.6 % of osteochondral staging! Are most common in the knee and ankle clipboard, Search history, the... Facets of the distal tibial plafond is a rare condition that may not be on. Talus, forming the ankle to move smoothly: 10.3113/FAI.2009.0524 posterior tibial plafond: localization and morphologic characteristics with anatomical. Recently the patient was referred to an orthopaedic foot and ankle surface ( tibia fibula. Presented with locking and giving way of the disorder there will be of! Development of cartilage or subchondral bone are not considered an OCD 6 nine patients had isolated lesions while! In maximal plantarflexion was to evaluate clinical outcomes following microfracture for tibial lesions... The ankle osteochondral lesion of tibial plafond cartilage can be torn, crushed or damaged and, rare! Used to plan management piece of the lesion as well as type of surgical treatment un! Has been studied for at least four decades n ’ ont révélé aucune ni! Bottom bone of the biomechanical characteristics of the bone breaking off inside the.... Jun ; 30 ( 6 ):750-3. doi: 10.1053/j.jfas.2013.08.003 lesion of the up dorsiflexion.