Management of Osteochondral Lesions of the Talar Dome

Rungprai, Chamnanni; Tennant, Joshua N.; Gentry, Ryan D.; Phisitkul, Phinit

doi:10.2174/1874325001711010743

Cited by 35 publications

(29 citation statements)

References 130 publications

(226 reference statements)

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“…The choice depends on the patient’s age, symptom severity, and type of lesion [ 13 ]. Conservative therapy typically is used for Hepple modified magnetic resonance imaging (MRI) type I and milder type II injuries, which involve a smaller lesion area, stable exfoliated bone mass, and non-displaced talus cartilage [ 14 ], whereas surgery is require for Hepple type III to V injuries with severe symptoms, when conservative treatment for 3 to 6 months for talus cartilage injury with acute separation and displacement is ineffective, or the area of injury is large [ 15 , 16 ]. Reports in the literature underscore the fact that the area of the talus cartilage defect is an important influencing factor [ 17 – 19 ], and that a lesion range of 15 mm, lack of fracture displacement, and locaton of injury in the anterolateral talus [ 20 , 21 ] often suggest a better prognosis.…”

Section: Discussionmentioning

confidence: 99%

Finite Element Analysis of the Effect of Talar Osteochondral Defects of Different Depths on Ankle Joint Stability

Wei

2020

Med Sci Monit

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Background Talus cartilage injury leads to changes in biomechanics of the ankle joint and ultimately affects ankle joint function, but which talus cartilage defects require surgery is still uncertain. This research used a finite element method to simulate the effect of different depth of talus cartilage defects on the stress and stability of the ankle joint in a certain area. Material/Methods A three-dimensional finite element model with different depths of osteochondral defects was created to simulate and calculate joint stress and displacement of the articular surface of the distal tibia and the proximal talus while the ankle joint was in the push-off, midstance, and heel-strike phases. Results The equivalent stress of the proximal talus did not change significantly at a defect depth of 1 mm, whereas the equivalent stress of the upper talus increased significantly at a defect depth of ≥3 mm or more, reaching a maximum value at a defect depth of 10 mm. The equivalent stress of the tibial cartilage and the equivalent stress and displacement in the corresponding forces in the midstance phase and heel-strike phase were significantly different from those in the normal group, but the difference in stress in each defect group was not obvious. Conclusions The effect of cartilage defects of the talus on biomechanics of the ankle is clear, especially in the midstance and push-off phases. When the defect reaches the subchondral bone (at a depth of 3 mm), the most obvious change in ankle joint stability occurs, and it does not increase linearly with the increase in depth of the defect.

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Section: Discussionmentioning

confidence: 99%

Finite Element Analysis of the Effect of Talar Osteochondral Defects of Different Depths on Ankle Joint Stability

Wei

2020

Med Sci Monit

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“…Pain, swelling and stiffness are the most common complaints of presenting patients with OLTs, occurring particularly with high levels of activity such as sport, but rarely present at rest. 29 Occasionally, there may also be mechanical symptoms present such as locking and catching. 3 Patients will often relate the pain experienced to a history of either a single trauma or recurrent sprains.…”

Section: Diagnosis and Evaluationmentioning

confidence: 99%

The management of talar osteochondral lesions - Current concepts

Lan

McCarthy

Hulme

et al. 2021

Journal of Arthroscopy and Joint Surgery

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Osteochondral lesions of the talus (OLTs) are a common complication following trauma, involving both the articular cartilage and the underlying subchondral bone, with variable aetiologies and often presenting with non-specific symptoms. Diagnosis of OLTs requires a combination of clinical assessment and imaging and despite many different treatment options, there is no generalised consensus regarding which option is the most effective. Left untreated, OLTs risk progressing to osteoarthritis. Acute non-displaced OLTs can be treated non-operatively. However, OLTs refractory to non-surgical care for three to six months may be suitable for surgical care. In these cases, conservative treatments are often unsuccessful, particularly for larger and more severe defects and so the majority require surgical intervention. Although bone marrow stimulation techniques remain the “gold standard” for lesions <150 mm 2 , there still requires a need for better long term clinical data and cost-benefit analyses compared with other treatment options. Biological attempts at either regenerating or replacing the articular cartilage are however demonstrating some promising results, but each with their own advantages and disadvantages. In this review, we summarise the clinical management of OLTs and present the current concepts of different treatment regimes.

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“…Kubah ini berbentuk trapezoid dan permukaan sisi anterior nya lebih lebar sekitar 2,5 mm dibandingkan sisi posteriornya. 6 Pada sisi medial talus, terdapat facet yang akan berartikulasi dengan medial malleolus dari tibia. Sedangkan pada sisi lateral nya terdapat facet yang berartikulasi dengan malleolus lateral dari fibula.…”

Section: Anatomi Tulang Talusunclassified

Patofisiologi dan Tatalaksana Osteochondral Lesion of the Talus

Roychan

Desnantyo

2019

Medica Arteriana (Med-Art)

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ABSTRAKLatar Belakang: Penyakit Osteochondral Lesion of the Talus (OLT) adalah kelainan pada tulang talus di lapisan subchondral yang berupa lesi osteochondral pada talar dome dengan konsekuensi abnormalitas pada tulang rawan sendi talar. Review artikel bertujuan menjabarkan patofisiologi dan tatalaksana OLT. Metode: Review artikel menggunakan literatur terkini yang relevan dengan topik OLT. Hasil: Pasien biasanya datang berobat ke tenaga kesehatan dengan keluhan yang tidak spesifik dan dengan gejala seperti nyeri pada pergelangan kaki, bengkak serta berkurangnya berkurangnya ruang gerak (range of movement). Penegakan diagnosis bisa dilakukan dengan anamnesis, pemeriksaan fisik dan pemeriksaan penunjang sederhana seperti foto X-ray maupun pemeriksaan penunjang canggih seperti CT-Scan dan MRI. Tatalaksana pada OLT tergantung dari tahapan lesi, kronisitasnya, dan keluhan simtomatis yang menyertainya. Pasien dengan keluhan simtomatis yang akut dan non-displaced sering diberikan terapi konservatif dengan imobilisasi. Lesi yang tidak berhasil atau tidak menunjukkan perbaikan keluhan setelah 3 sampai 6 bulan, serta lesi dengan displacement dapat direncanakan untuk terapi operatif. Ada beberapa macam tehnik operatif yang dapat dilakukan untuk menyembuhkan OLT. Teknik operatif ini dapat dikategorikan menjadi cartilage repair, cartilage regeneration dan cartilage replacement techniques. Kesimpulan: OLT adalah lesiosteocondral pada talar dome yang dapat diterapi dengan terapi konservatif dan operatif cartilage repair, cartilage regeneration dan cartilage replacement techniques.Kata kunci: osteochondral lesion of the talus, patofisiologi, tatalaksana. ABSTRACT Background: Osteochondral Lesion of the Talus (OLT) is an abnormality in the talus bone in the subchondral layer in the form of osteochondral lesions in the talar dome with consequent abnormalities in the talar joint cartilage.This review wasa aimed to explain the pathophisiology and OLT management. Method: The litheratur review used recent literature suitable with OLT topics.Results: Patients usually come to a health care provider with nonspecific complaints and with symptoms such as pain in the ankles, swelling and reduced range of movement. The diagnosis can be made with a history taking, physical examination and simple investigations such as X-rays and sophisticated investigations such as CT-Scan and MRI. The management of OLT depends on the stage of the lesion, its chronicity, and the accompanying symptomatic complaints. Patients with acute and non-displaced symptomatic complaints are often given conservative therapy with immobilization. Lesions that are unsuccessful or show no improvement in symptomatic complaints after 3 to 6 months and lesions with displacement can be planned for operative therapy. There are several types of operative techniques that can be done to cure OLT. These operative techniques can be categorized into cartilage repair, cartilage regeneration, and cartilage replacement techniques. Conclusion: OLT is osteocondral lesion at talar dome can ...

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Management of Osteochondral Lesions of the Talar Dome

Cited by 35 publications

References 130 publications

Finite Element Analysis of the Effect of Talar Osteochondral Defects of Different Depths on Ankle Joint Stability

Finite Element Analysis of the Effect of Talar Osteochondral Defects of Different Depths on Ankle Joint Stability

The management of talar osteochondral lesions - Current concepts

Patofisiologi dan Tatalaksana Osteochondral Lesion of the Talus

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