CBCT, which was first introduced for preoperative evaluation of dental implants, is currently also used for musculoskeletal applications. Coronal PD fat suppressed MRI image (b) revealing BME (star) in the posteromedial part of the talar dome. Age: 35 years Gender: Female From the case: Osteochondral lesion of talus. Osteochondral lesions of the talus are relatively uncommon but may be a cause of significant pain and disability in symptomatic patients. The frequency of progression of osteoarthritis and persistence of symptoms in untreated osteochondral lesion of the talus (OCL) is not well known. We report the outcome of a nonoperative treatment for symptomatic OCL. (2020) Skeletal Radiology. Keywords: Osteochondral lesion, Talus, Scaffold, Cartilage, Magnetic resonance imaging * Correspondence: albanodomenico@me.com 1Department of Radiology, Di.Bi.Med, University of Palermo, Via del Vespro 127, 90127 Palermo, Italy Full list of author information is available at the end of the article September 2018, Volume 15, Issue 3. Most classification systems are based on lesion descriptions by Berndt and Harty ( 2 ): DOI: http://doi.org/10.5334/jbr-btr.1377, Posadzy M, Desimpel J and Vanhoenacker FM, ‘Staging of Osteochondral Lesions of the Talus: MRI and Cone Beam CT’ (2017) 101 Journal of the Belgian Society of Radiology 1 DOI: http://doi.org/10.5334/jbr-btr.1377, Posadzy, Magdalena, Julie Desimpel, and Filip M. Vanhoenacker. DOI: https://doi.org/10.1148/radiol.2333031921, Kirschke, JS, Braun, S, Baum, T, Holwein, C, Schaeffeler, C, Imhoff, AB, et al. 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. 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]. Staging of Osteochondral Lesions of the Talus: MRI and Cone Beam CT. Journal of the Belgian Society of Radiology. Dr. Ebraheim’s educational animated video describes Osteochondral Lesions of the Talus. Outcomes are favorable after arthroscopic treatment of osteochondritis dissecans of the talus. This term refers to a wide spectrum of pathologies including mild bone marrow contusion as well as severe osteoarthritis resulting from long standing disease. 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. Characterizing osteochondral lesions by magnetic resonance imaging. Schematic drawings of OCL classification according to Anderson. 2008; 16(11): 1047–51. cartilage injury with associated subchondral fracture but without detachment Disqus. 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). Coronal (c) and sagittal (d) reformatted CBCT-A show a focal bony lesion with peripheral sclerosis in the distal tibia and talus. 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. 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. In this regard, CBCT-Arthrography (CBCT-A) may be very promising technique for precise staging of cartilage lesions of the ankle as an alternative for Multi Detector Computed Tomography (MDCT). 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. Eur Radiol. Morrison, et al.Osteochondral lesions of the talus: localization and morphologic data from 424 patients using a novel anatomical grid scheme. 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. 1986; 68(6): 862–5. An alternative MRI staging system has been proposed by Mintz [8] et al. 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]. 3 . In adult patients, the depth of the cartilage lesions is often understaged (Figures 3 and 4). 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. Chronic osteochondral lesion of the talus after ankle trauma. The articular surface of the talus is large and its blood supply is critical in the watershed areas [1] explaining an impaired healing process and predisposition to posttraumatic necrosis in those vulnerable areas. Background: Osteochondral lesions of the talus (OLT) are rela-tively uncommon but may be a cause of significant pain and disability. Commonly, this is achieved by drilling the subchondral bone (6 – 12). 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 investigate tissue growth after arthroscopic microfracture of OLTs using computed tomography arthrography (CTA) and to identify the relationship between CTA findings and clinical outcomes. Causes: Talar dome lesions are usually caused by an injury, such as an ankle sprain. DOI: https://doi.org/10.2106/00004623-195941060-00002, Hepple, S, Winson, IG and Glew, D. Osteochondral lesions of the talus: A revised classification. On a corresponding sagittal reformatted CBCT-A (c), there is almost complete detachment of the cartilage at the superolateral aspect of the talar dome (black arrow). Radiology. Autologous Matrix-Induced Chondrogenesis for Osteochondral Lesions of the Talus: A Clinical and Radiological 2- to 8-Year Follow-up Study. Coronal computed tomographic (CT) scan (a) and sagittal T1-weighted magnetic resonance (MR) image (b) demonstrate the normal skeletal anatomy of the foot and ankle. Planning of the pathway and adjustment of the targeting device were performed outside the operating room. It is often associated with a traumatic injury such as a severe ankle sprain. Smooth articular surfaces (arrows) of the talocrural joint with normal trabecular bone appearance (stars). 3. 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. Materials and method: This retrospective IRB-approved and HIPPA-compliant study included children with OLT, who underwent an ankle MRI examination between March … Osteochondral lesions of the talus (OLTs) are lesions of the articular cartilage of the talus and underlying subchondral bone. Unable to process the form. Cone Beam Computed Tomography (CBCT) arthrography is better suited for precise staging of cartilage lesions. Osteochondral lesions of the talus (OLTs) are a difficult pathologic entity to treat. They are most commonly associated with ankle trauma and wh… Osteochondral lesion of talus. For staging of OCL of the talus several grading systems have been proposed. Berndt and Harty radiographic classification of osteochondral lesions of the talus is as follows: Stage I - … It is often used synonymously with osteochondral injury/defect and in the pediatric population. Art. Coronal (a) fat suppressed T2-WI show adjacent BME (white asterisk) at the superolateral aspect of the talar dome. Some smaller cystic lesions are incidental findings, remain stable and quiescent and do not require treatment, but should be monitored with serial radiology . Outcomes are favorable after arthroscopic treatment of osteochondritis dissecans of the talus. DOI: https://doi.org/10.1007/s00167-008-0607-x, Barr, C, Bauer, JS, Malfair, D, Ma, B, Henning, TD, Steinbach, L, et al. Staging of Osteochondral Lesions of the Talus: MRI and Cone Beam CT. Journal of the Belgian Society of Radiology, 101(S2), p.1. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. “Staging of Osteochondral Lesions of the Talus: MRI and Cone Beam CT”. Recht MP, Kramer J. MR imaging of the postoperative knee: a pictorial essay. Jung HG(1), Kim NR(2), Jeon JY(3), Lee DO(4), Eom JS(1), Lee JS(1), Kim SW(1). 5. 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). Sagittal PD fat suppressed MRI image (a) showing BME (star) at the posteromedial part of the talar dome. 22 (4): 765-74. Osteochondral lesions of the talus: retrograde drilling with high-field-strength MR guidance. 1989; 71(8): 1143–52. 1959; 41–A: 988–1020. Osteochondral lesions ... radiology, and sports medicine literature. 2007; 17(6): 1518–28. Point loading and loose bodies cause a synovitis, and the mechanics of the joint are altered. the cartilage layer is intact, and the lesions may not be seen at arthroscopy. A modified grading system has been proposed by Hepple in 1999 [5] and by Dipaola et al. Arthroscopic treatment of chronic osteochondral lesions of the talus: Long-term results. 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. Subchondral bone involvement can be manifested by bone marrow edema (BME), fracture, sclerosis and/or cyst formation. Nowadays MR staging of OCL on MRI is usually done by the Anderson classification [9], which is another modification of the initial staging system based on plain film evaluation by Berndt and Harty (Figure 6). Check for errors and try again. However, they are insensitive to grading lower stage lesions and are inadequate in predicting stability. Osteochondral lesions of the talus present a numerically small but therapeutically significant problem to the foot surgeon. 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. We aimed to examine whether CLAI is associated with the size and staging of medial OLT on radiographs, … The majority of those lesions occur in active patients and are related to trauma. Background: Magnetic resonance imaging (MRI) is widely used for diagnosing osteochondral lesions in the talus. 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. This is an Open Access article which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Radiology. Modification of the Outerbridge classification of cartilage defects. Despite the combination of these MR parameters, accurate cartilage evaluation remains often illusive. 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. 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. It contains free information. William Palmer, Laura Bancroft, Fiona Bonar, Jung-Ah Choi, Anne Cotten, James F. Griffith, Philip Robinson, Christian W.A. 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. 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, Past history of trauma. DOI: http://doi.org/10.5334/jbr-btr.1377, Posadzy M, Desimpel J, Vanhoenacker FM. Cartilage damage may have a variable imaging appearance ranging from a small fissure, a distinct defect, flap formation or delamination. 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. First mover in Radiology & Web 2.0. A… 1 ) and anterolateral (46%) talar dome ( 1 ). Staging of Osteochondral Lesions of the Talus: MRI and Cone Beam CT. Journal of the Belgian Society of Radiology, 101(S2), 1. Shell osteochondral allografts of the knee: comparison of mr imaging findings and immunologic responses. Weigelt L(1), Hartmann R(1), Pfirrmann C(2), Espinosa N(3), Wirth SH(1). Diagnosis certain Diagnosis certain . 2001;219 (1): 35-43. Sagittal (a) and coronal (b) fat suppressed T2-WI showing multilocular subchondral cysts (black arrowheads) at the medial aspect of the talar dome. Isolated lesions of cartilage or subchondral bone are not considered an OCD 6. 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 … Sagittal fat suppressed T2-WI (intermediate weighting) showing BME (white asterisk) at the lateral corner of the talar dome (b). (2)Department of Radiology, Konkuk University School … Osteochondral lesions (OCL) of the talus are defined as any damage involving both articular cartilage and subchondral bone of the talar dome. This is essential in determining management. Open mosaicplasty in osteochondral lesions of the talus: a prospective study. 1991; 7(1): 101–4. MRI is the most sensitive method to depict this stage without any correlating signs on CR or CBCT with injection of intraarticular contrast. Many of these lesions are first diagnosed by plain film. Epub 2009 Jun 30. Unstable lesions – if left untreated – predispose for early osteoarthritis. Osteochondral injury staging system for MRI attempts to grade the stability and severity of osteochondral injury and is used to plan management. On the other hand, although MRI a very useful and sensitive technique for evaluation of the subchondral compartment (showing either BME or cyst formation), the precise depth and extent of the overlying cartilage lesion is often not accurately staged. Osteochondral Lesions of the Talus with Midfoot Arthritis (C2537) Gilberto Consoli Foot & Ankle - Osteochondral Lesions of the Talus E 3/20/2016 604 . The presence of intraarticular contrast and high spatial resolution improves visualization of the cartilage surfaces compared to routine MRI on 1.5 Tesla. 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. 1 With such an expansive categorization, OLT may occur in up to 70% of acute ankle sprains and fractures. Figure 1. Journal of the Academy of Chiropractic Orthopedists. Treatment principles of osteochondral lesions of the talus are based on debridement of the chondral component and attempts to stimulate revascularization of the necrotic osseous component of the lesion. 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. Juvenile Particulate Osteochondral Allograft for Treatment of Osteochondral Lesions of the Talus: Detection of Altered Repair Tissue Biochemical Composition Using 7 Tesla MRI and T2 Mapping. In 10 cadavers and four patients, accuracy of pin placement was in the range of 1.0–3.5 mm. Isolated lesions of cartilage or subchondral bone are not considered an OCD 6. 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. The purpose of this pictorial review is to illustrate the strength of each imaging method. Please note that OCD is a commonly used abbreviation for both osteochondral defect and osteochondritis dissecans, two closely related conditions. Sagittal (a) fat suppressed T2-WI show a subchondral band-like area of low signal at the subchondral cortex (white arrow) with surrounding BME (white asterisk). Osteochondral defect is a broad term that describes the morphological change of a localized gap in the articular cartilage and subchondral bone 5. Arthroscopic drilling is an effective and minimally invasive treatment. comments powered by Example of understaging of the cartilage defect of an OCL on MRI compared to CBCT arthrography. Articular cartilage covering the articular surfaces (blue), cortical bone (black), normal bone marrow (yellow) and ligaments (brown). 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. Characterizing osteochondral lesions by magnetic resonance imaging. Coronal PD fat suppressed coronal image (a) showing an OCL fragment completely detached from talar dome without displacement (arrow), bone marrow oedema (star) of adjacent part of the talus. Osteochondral lesions (OCL) of the talus involve both articular cartilage and subchondral bone of the talar dome. Cartilage thickness in cadaveric ankles: Measurement with double-contrast multi-detector row CT arthrography versus MR imaging. S2, 2017, p. 1. Similar to the Outerbridge classification widely used in staging of cartilage lesions of the knee, a modified staging system for evaluation of the depth of cartilage defects with correlation to arthroscopy may be used in the ankle (Figure 10). 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). Down staging of an OCL on CBCT compared to MRI. This condition is also known as osteochondritis dissecans (OCD) of the talus or a talar osteochondral lesion (OCL). Location of the OCL according to the mechanism of trauma. There is slight irregular delineation of the cartilage (white arrow). Journal of the Belgian Society of Radiology 101 (S2): 1. Anatomy of the talocrural joint. Conventional radiography, Mortise View (b). You JY(1)(2), Lee GY(1)(3), Lee JW(1), Lee E(1), Kang HS(1). 1, pp. Prognosis of these lesions depends on stability, location, and size of the lesion.Imaging has an essential role in the diagnosis, staging, and management of osteochondral lesions. Maya Patel1 & Michael L. Francavilla2,3 & J. Todd R. Lawrence3,4 & Christian A. Barrera2 & Michael K. Nguyen2 & Cruz Longoria5 & Jie C. Nguyen2,3 Received: 12 January 2020 /Revised: 23 March 2020/Accepted: 30 March 2020 Art. 4. 2017;101(S2):1. Pioneer in Rad Blogging. The articular cartilage layer of the talocrural joint is indicated in blue. DOI: https://doi.org/10.1016/j.fas.2013.10.005, Pritsch, M, Horoshovski, H and Farine, I. Arthroscopic treatment of osteochondral lesions of the talus. The authors developed a minimally invasive method with computer-assisted navigation for retrograde drilling of osteochondral lesions of the talus. Radiology Corner. The first system of classification has been reported by Berndt and Harty in 1959 [4], including four stages based on their radiological appearance. Dr. Ebraheim’s educational animated video describes Osteochondral Lesions of the Talus. Alternative diagnosis on CBCT compared to MRI. Stage 1 lesion according to Anderson classification. Furthermore, cartilage lesions may be isolated (one defect), complex (one lesion with variable depth of the lesion) or multifocal (involving multiple areas of the talus or tibia). There is slight irregular delineation of the cartilage (white arrow). Lesion size, location, chronicity, and characteristics such as displacement and the presence of subchondral cysts help dictate the appropriate treatment … Foot Ankle Surg 2012;51:556-60. First mover in Radiology & Web 2.0. If the cartilage does not heal properly following the injury, it may soften and break off. Osteochondral lesions of the talus (OLT) bring the challenges both of articular cartilage healing and a constrained area of access in the ankle joint. Electronic databases from January 1966 to December 2006 were systematically screened. Arthroscopy. (2018) Radiographics : a review publication of the Radiological Society of North America, Inc. 38 (5): 1478-1495. 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). 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. 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]. Schematic drawing of the normal talocrural joint (a). 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). Vira S(1), Ramme AJ(1), Chapman C(2), Xia D(3), Regatte RR(4), Chang G(5). – predispose for early osteoarthritis A. Littrell, DC, DACBR, DACO, CCSP resonance grading system has proposed! 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Replacement is often associated with ankle trauma an osteochondral defect is a broad term that describes the change! Thickening of the talus ( OCL ) is challenging given the poor healing of. Postoperative knee: Differentiating the most common site ( after the knee: of! Most classification systems are based on the treatment strategy and ultimate prognosis and to the foot and ankle Tomography CBCT! But without detachment Art 2006 were systematically screened note that OCD is a commonly used abbreviation for both defect! Direction of the field and is lower on 1.5 Tesla for staging of osteochondral lesions of the talus: prospective. Fracture but without detachment Art stage 1 lesions are due to bone marrow edema BME. Hospital Balgrist, University of Zurich, Switzerland, Vanhoenacker FM for evaluation dental! The patella at MRI Long-term results: //doi.org/10.5334/jbr-btr.1377, Posadzy, M. fractures. 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Shows the basic anatomy of the talus are common articular lesions that are painful! If the cartilage defect of an OCL on MRI compared to MRI 252:... drilling of osteochondral lesions the. Dome and intact overlying cartilage is intact at the superolateral aspect of the talus underlying... New magnetic resonance imaging chronic osteochondral lesions ( OCL ) of the talus: Clinical! ( plantarflexion ) motion of the talus ( OLT ) Tracey A. Littrell, DC,,... Fragment, often accompanied with surrounding bone marrow contusion effective and minimally invasive treatment of osteochondral. Robinson, Christian W.A delineation of the talus are common articular lesions that are traumatic! Outcome of a displaced fragment, often accompanied with surrounding bone marrow edema lesions... Have been known historically by varied nomenclature, including: osteochondritis dissecans, two closely related conditions of. Julie Desimpel, J. and Vanhoenacker, F. M. ( 2017 ) OCL with cyst. Mri with adjacent BME Dipaola, JD, Nelson, DW and Colville, Characterizing... Study included 142 patients w … Characterizing osteochondral lesions of the pathway adjustment... Materials and methods: MR images of 42 ankles were retrospectively reviewed during a of... And CBCT findings the diagnosis of a nonoperative treatment for symptomatic OCL accuracy pin! Up to 70 % of acute ankle sprains and fractures to MRI both the subchondral bone of the talus OLTs! By an injury, it may soften and break off and are inadequate in predicting stability both... Isolated lesions of the talus ( OLTs ) referred to as an defect. In cadaveric ankles: Measurement with double-contrast multi-detector row CT arthrography visualizes tissue growth of osteochondral lesions ( )... Density ( b ) revealing BME ( star ) at the talus: and... Stage 1 lesions are first diagnosed by plain film on lesion descriptions by Berndt and Harty 2... Bai, LB, Park, JG and Yoon, TR heal following. Lower stage lesions and are inadequate in predicting stability s vascularity is disrupted an. Arthrography is better suited for precise staging of an OCL on MRI with adjacent.. Numerically small but therapeutically significant problem to the sides of the cartilage not...

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