Past history of trauma. Pain in right ankle joint. Sagittal (a) and coronal (b) fat suppressed T2-WI showing multilocular subchondral cysts (black arrowheads) at the medial aspect of the talar dome. 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. First mover in Radiology & Web 2.0. 1959; 41–A: 988–1020. 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. Open mosaicplasty in osteochondral lesions of the talus: a prospective study. Clinical management of these lesions is based on whether or not the fragments are attached. 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. AJR Am J Roentgenol. CBCT, which was first introduced for preoperative evaluation of dental implants, is currently also used for musculoskeletal applications. The talus is the 3rd most common site (after the knee and elbow) of osteochondral lesions. Pioneer in Rad Blogging. Large uncontained lesions are usually painful as the structure of the talus is threatened. Osteonecrosis can develop when the lesion’s vascularity is disrupted. 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. 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). Foot Ankle Surg 2012;51:556-60. Vira S(1), Ramme AJ(1), Chapman C(2), Xia D(3), Regatte RR(4), Chang G(5). Many of these lesions are first diagnosed by plain film. 2. As such, the term encompasses a variety of pathologies, including: osteochondritis dissecans, osteochondral defects, and osteochondral fractures. Coronal PD fat suppressed MRI image (b) revealing BME (star) in the posteromedial part of the talar dome. 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. The first system of classification has been reported by Berndt and Harty in 1959 [4], including four stages based on their radiological appearance. The red arrow indicates the direction of the applied force. 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. Biomed Res Int. They usually involve both the subchondral bone and the overlying articular cartilage. Presentation. 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. Isolated lesions of cartilage or subchondral bone are not considered an OCD 6. • Goh GSH et al. W B Saunders Co. (2001) ISBN:0721690270. The overlying cartilage is difficult to assess on MRI. 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 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. 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. 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). 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. DOI: https://doi.org/10.1007/s00330-006-0446-4, El-Khoury, GY, Alliman, KJ, Lundberg, HJ, Rudert, MJ, Brown, TD and Saltzman, CL. Example of accurate staging of the status of the articular cartilage in paediatric OCL. Commonly, this is achieved by drilling the subchondral bone (6 – 12). 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. Schematic drawings of OCL classification according to Anderson. DOI: https://doi.org/10.1177/107110079902001206, Ferkel, RD, Zanotti, RM, Komenda, GA, Sgaglione, NA, Cheng, MS, Applegate, GR, et al. The authors developed a minimally invasive method with computer-assisted navigation for retrograde drilling of osteochondral lesions of the talus. 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. Osteochondral Lesions of the Talus with Midfoot Arthritis (C2537) Gilberto Consoli Foot & Ankle - Osteochondral Lesions of the Talus E 3/20/2016 604 . (2018) Radiographics : a review publication of the Radiological Society of North America, Inc. 38 (5): 1478-1495. Page 6 of 19 talar dome in the ankle joint. 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. 2001;219 (1): 35-43. Radiology Corner. Smooth articular surfaces (arrows) of the talocrural joint with normal trabecular bone appearance (stars). The articular cartilage layer of the talocrural joint is indicated in blue. 5. 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. 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]. Coronal (a) and sagittal (b) fat suppressed T2-WI show adjacent kissing areas of bone marrow edema (white arrowheads) at the distal tibia and talar dome. Materials and methods: MR images of 42 ankles were retrospectively reviewed during a period of 67 months. It is often associated with a traumatic injury such as a severe ankle sprain. 4. If the cartilage does not heal properly following the injury, it may soften and break off. Author information: (1)Department of Orthopedics, University Hospital Balgrist, University of Zurich, Zurich, Switzerland. DOI: https://doi.org/10.1007/s00256-015-2127-3, Berndt, AL and Harty, M. Transchondral fractures (osteochondritis dissecans) of the talus. “Staging of Osteochondral Lesions of the Talus: MRI and Cone Beam CT”. Although it is adopted for osteochondral abnormalities of the talus (1), the term lacks specificity and should be only part of a description of a more specific diagnostic entity. 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