Sirlin CB, Brossmann J, Boutin RD et-al. 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 . , who correlated MR imaging with arthroscopic appearance. For staging of OCL of the talus several grading systems have been proposed. 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. Diagnosis certain Diagnosis certain . Biomed Res Int. At earlier stages (stage 1 to 4), a number of options exist including: The knee is a complex synovial joint that can be affected by a range of pathologies: ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Osteochondral lesion of the talus in children: Are there MRI findings of instability? Sanders TG, Paruchuri NB, Zlatkin MB. There is slight irregular delineation of the cartilage (white arrow). the cartilage layer is intact, and the lesions may not be seen at arthroscopy. 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. Staging of Osteochondral Lesions of the Talus: MRI and Cone Beam CT. Journal of the Belgian Society of Radiology. In 10 cadavers and four patients, accuracy of pin placement was in the range of 1.0–3.5 mm. 2017. 2001;219 (1): 35-43. Coronal (c) and sagittal (d) reformatted CBCT-A show a focal bony lesion with peripheral sclerosis in the distal tibia and talus. We report the outcome of a nonoperative treatment for symptomatic OCL. It is often used synonymously with osteochondral injury/defect and in the pediatric population. Foot Ankle Surg. “Staging of Osteochondral Lesions of the Talus: MRI and Cone Beam CT”. Schmid MR et col. Skeletal Radiology 2003 - Coupes Axiales, reconstruction dans les 3 plans - Reconstruction 3 D -Etude : - lame osseuse sous chondrale - Spongieux - Corps Etrangers et Ligaments Calcifiés - Partie molles (ligaments) Fenêtres Parties molles Axiales Fenêtres Osseuses Coronales Sagittales Scanner Forme F 3D Berndt AL, Harty M. J Bone Joint Surg 1959 … DOI: http://doi.org/10.5334/jbr-btr.1377, Posadzy M, Desimpel J, Vanhoenacker FM. 2015; 44(8): 1111–7. The articular surface of the talus is large and its blood supply is critical in the watershed areas  explaining an impaired healing process and predisposition to posttraumatic necrosis in those vulnerable areas. The frequency of progression of osteoarthritis and persistence of symptoms in untreated osteochondral lesion of the talus (OCL) is not well known. Posadzy M, Desimpel J, Vanhoenacker FM. Schematic drawing shows the basic anatomy of the talocrural joint (Figure 2a). MRI allows for distinguishing normal cartilage from subchondral bone as well as evaluating the adjacent bone marrow, ligaments and other surrounding soft tissues (Figure 2c). Treatment depends on the location and size of the defect as well as the presence of secondary degenerative changes. However, they are insensitive to grading lower stage lesions and are inadequate in predicting stability. 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. 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. Sagittal fat suppressed T2-WI (intermediate weighting) showing BME (white asterisk) at the lateral corner of the talar dome (b). • Goh GSH et al. 6. Additional CBCT-Arthrography is, however, very useful for more accurate cartilage staging and should be considered in those clinical scenarios where arthroscopic treatment of the lesion is considered. 2017;101(S2):1. Page 6 of 19 talar dome in the ankle joint. Age: 35 years Gender: Female From the case: Osteochondral lesion of 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). 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. Check for errors and try again. The most common sites are the posteromedial (53%) ( Fig. 1991;7:101– 104. 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. An Osteochondral Lesion of the Distal Tibia and Fibula in Patients With an Osteochondral Lesion of the Talus on MRI: Prevalence, Location, and Concomitant Ligament and Tendon Injuries. Lateral radiograph shows the normal skeletal anatomy of the foot and ankle. 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, (2018) Radiographics : a review publication of the Radiological Society of North America, Inc. 38 (5): 1478-1495. An osteochondral lesion of the talar dome is an injury involving damage to the cartilage or bony surface of the top of the talus bone (located in the ankle). Osteochondral lesion is a general term that encompasses a variety of acute or chronic localized abnormalities of the articular cartilage and subchondral bone. Sagittal (a) and coronal (b) fat suppressed T2-WI showing multilocular subchondral cysts (black arrowheads) at the medial aspect of the talar dome. 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 … Osteochondral defect is a broad term that describes the morphological change of a localized gap in the articular cartilage and subchondral bone 5. Because the plasticity of the cartilage in children and adolescents is higher than in adults, OCL lesions in young patients are often characterized by isolated subchondral bony changes without overlying cartilage disruption (Figure 5). Coronal proton density (b) shows focal hypointense thickening of the talar dome (arrow). Although the majority of patients have an osteochon-dral lesion of the talus that is unilateral, bilateral involvement has been reported in 10% to 25% of cases. Presentation. Foot Ankle Surg 2012;51:556-60. CBCT-Arthrography (CBCT-A) of the talocrural joint, coronal reformatted image (d) showing smooth cartilage lining covering the normal subchondral bone of the talus (arrow) and tibia (arrowhead). Gorbachova T, Melenevsky Y, Cohen M, Cerniglia BW. The passive navigation concept is potentially applicable to many MR-guided interventions, and it may be an alternative to other navigation methods. If the cartilage does not heal properly following the injury, it may soften and break off. DOI: https://doi.org/10.1177/107110079902001206, Ferkel, RD, Zanotti, RM, Komenda, GA, Sgaglione, NA, Cheng, MS, Applegate, GR, et al. Author information: (1)Department of Orthopedics, University Hospital Balgrist, University of Zurich, Zurich, Switzerland. The accuracy also depends of the strength of the field and is lower on 1.5 Tesla magnets in comparison to 3T . Osteochondral lesions of the talus (OLTs) are a difficult pathologic entity to treat. 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. 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% . 3 . Large uncontained lesions are usually painful as the structure of the talus is threatened. Isolated lesions of cartilage or subchondral bone are not considered an OCD 6. Studies on cadavers performed on CT arthrography  showed more accurate cartilage thickness measurements in comparison to standard MRI, which is in line with a superior evaluation of OCL with CT arthrographic techniques  (Figure 9). Morrison, et al.Osteochondral lesions of the talus: localization and morphologic data from 424 patients using a novel anatomical grid scheme. CBCT following intra-articular injection of Iodine contrast (CBCT-Arthrography) may render exquisite detail of the articular cartilage using very thin slices and multiplanar reformation. 2006;187 (5): 1332-7. Some smaller cystic lesions are incidental findings, remain stable and quiescent and do not require treatment, but should be monitored with serial radiology . It is often used synonymously with osteochondral injury/defect and in the pediatric population. Osteochondral Lesions of the Talus Sara Lyn Miniaci-Coxhead, MD Dr. Miniaci-Coxhead or an immediate family member serves as a board member, owner, officer, or committee member of the American Orthopaedic Foot and Ankle Society. DOI: https://doi.org/10.1155/2016/3594253, Posadzy, M., Desimpel, J. and Vanhoenacker, F.M., 2017. 2004; 233(3): 768–73. Cartilage damage may have a variable imaging appearance ranging from a small fissure, a distinct defect, flap formation or delamination. 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. DOI: https://doi.org/10.2106/00004623-198668060-00007, De Smet, E, De Praeter, G, Verstraete, KL, Wouters, K, De Beuckeleer, L and Vanhoenacker, FM. 1, pp. Moreover, despite several modifications of the staging systems on MRI, not all combination of the degree of involvement of the cartilage and subchondral bone are included and therefore these classification systems remain uncomprehensive, complicated and less valuable for use in daily routine. Unstable lesions – if left untreated – predispose for early osteoarthritis. Pioneer in Rad Blogging. Arthroscopic drilling is an effective and minimally invasive treatment. On CR direct comparison of conventional radiography and cone-beam CT in osteochondral lesion talus radiology bone the. Of MR imaging poor healing potential of articular cartilage and subchondral bone ( 6 12... 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