1989;71A:1143–1152; with permission. By continuing to browse Osteochondral fractures of the dome of the talus, Residual disability following ankle sprains, Value of MR imaging in staging osteochondral lesions of the talus, Characterising osteochondral lesions by magnetic resonance imaging, Osteochondritis dissecans of the talus: review of the literature and new surgical approach for medial lesions, Osteocartilaginous lesions of the talar dome, Subchondral cysts in arthritic disorders: pathological and radiographic appearances of the hip joint, The cysts of osteoarthritis of the hip: a radiological and pathological study. Purpose of the review: To review the most recent literature on osteochondritis dissecans (OCD) lesions of the capitellum in overhead athletes and describe a treatment algorithm based on current best evidence and surgeon experience. Unable to process the form. Recent findings: Recent research has included larger cohort studies with longer follow-up as well as quality systematic reviews and meta-analyses. It has been reported that the incidence of delayed or misdiagnosis in patients with unexplained chronic ankle pain as high as 81%. FIGURE 3 Ferkel and Sgaglione’s CT classification of osteochondral lesions of the talus. Fluid extended deep to the fragment, and there was subjacent marrow edema, all seen in Fig. J Bone Joint Surg. Results: Of the 43 patients, 21 (48.8%) presented with osteochondral lesions on MRI. This term refers to a wide spectrum of pathologies including mild bone marrow contusion as well as severe osteoarthritis resulting from long standing disease. Zeitschrift für Orthopädie und Unfallchirurgie, American Orthopaedic Foot & Ankle Society, Osteochondral Lesions of the Talus: A Revised Classification, https://doi.org/10.1177/107110079902001206. The Gustilo Anderson classification, also known as the Gustilo classification, is the most widely accepted classification system of open (or compound) fractures. Articular Cartilage Defects of the Ankle JORDAN KERKER RICHARD D. FERKEL INTRODUCTION Articular cartilage lesions continue to be a challenging problem for the orthopedic community. Epidemiologically, the ankle registers 4% of all the human osteochondral defects. Osteochondral lesion of the talus (OLT) is a common condition associated with ankle injury that brings challenges in the diagnosis and treatment. [] In 1922, Kappis described this process in the ankle joint. Consequently, fractures described as osteochondral must be sought within the fragmentary fractures. Find out about Lean Library here, If you have access to journal via a society or associations, read the instructions below. , Nelson, D.W., Colville, M.R. Much of this bone is covered with cartilage. Members of _ can log in with their society credentials below. A lateral lesion has a typical shallow and wafer shape, indicating a shear mechanism of injury. The MRI classification of osteochondral lesions of the talus developed by Anderson et al 7 defines stage 1 as bone marrow edema. I have read and accept the terms and conditions, View permissions information for this article. Last, a commonly used arthroscopic classification is the OCL classification of the International Cartilage Repair Society. This joint permits much of the up (dorsiflexion) and down (plantarflexion) motion of the foot and ankle. There is a certain nosological confusion because many names have been given to these lesions involving both the cartilage and the subchondral bone: osteochondritis, osteonecrosis, osteochondral lesion or fracture, etc. You can be signed in via any or all of the methods shown below at the same time. This chapter is adapted from Chao W, Freeland E, Dedini R: Osteochondral Lesions of the Talus in … Magnetic resonance imaging (MRI) showed a high intensity area at the medial talar dome on T2 weighted images, the OLT was classified as grade 3 according to Anderson's classification . the talar dome) in the ankle. Lesion Essay Knee Classification Osteochondral. J Bone Joint Surg Am. There are several classification systems for OCD lesions that are based upon plain radiograph, magnetic resonance imaging ... Osteochondral lesions of the talus in a sports medicine clinic. Listing a study does not mean it has been evaluated by the U.S. A literature search was conducted to find studies published from January 1996 till July 2016 Description Essay A Bedroom using PubMed (MEDLINE), EMBASE, CDSR, DARE and CENTRAL. Click the button below for the full-text content, 24 hours online access to download content. Osteochondral lesion of the talus (OLT) is a relatively com-mon injury that causes pain in the ankle in recreational and professional athletes. Osteochondral lesions (OCL) of the talus are defined as any damage involving both articular cartilage and subchondral bone of the talar dome. 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. 2007;89 (4): 884-95. 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. Medial lesions are most often deep and cup shaped, indicating a mechanism of torsional impaction. Fig. Stages III and IV describe unstable lesions in which a lesion of the cartilage has allowed synovial fluid between the fragment and bone. Using MR imaging, in 1989 Anderson and colleagues 7 revised the original classification schema developed by Berndt and Harty, noting that there was no mention of subchondral cyst formation during the evolution of osteochondral lesions, for which stage IIA was added . This product could help you, Accessing resources off campus can be a challenge. 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, fractures that have been open for 8 hours prior to treatment, extensive soft-tissue loss, periosteal stripping and bone damage, usually associated with massive contamination, will often need further soft-tissue coverage procedure (e.g. Posterolateral capitellum osteochondral lesions were found in 13 patients. Stage 1 - subchondral fracture. 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. Osteochondral fractures of the dome of the talus. : . Osteochondral defect is a broad term that describes the morphological change of a localized gap in the articular cartilage and subchondral bone 5.It is often used synonymously with osteochondral injury/defect and in the pediatric population. The growth of athletic participation and an increase in active individuals across all age groups have necessitated the development of improved strategies to treat symptomatic osteochondral defects. The radiological results were evaluated using classification described by Hepple et al based on the MRI findings, the location of the lesion, the size of the osteochondral fragment, and the postoperative healing of the lesion. An osteochondral lesion of the talar dome is a condition characterized by damage to the cartilage and / or bone surfaces of the upper (superior) aspect of the talus bone (i.e. The top of the talus is dome-shaped and is completely covered with cartilage—a tough, rubbery tissue that enables the ankle to move smoothly. The overlying cartilage is intact at the talus, whereas there is subtle cartilage lesion at the distal tibia (arrow). The talus is the bottom bone of the ankle joint. open fractures caused by farm injuries. location of OCLs, respectively.5,8–11 These classifications have typically been used to characterize OCLs of the talus (OCLT), describing the degree of osteochondral involve-ment and the location of the lesion.5,8–11 In 1959, Berndt and Harty described a classification system for OCLs on plain radiograph, which Anderson referenced to create , Crichton, M.B. Osteochondral lesions (OCL) of the talus are defined as any damage involving both articular cartilage and subchondral bone of the talar dome. Bone peg fixation for osteochondral lesions of the talus showed satisfactory clinical and radiographic results, without complications. Magnetic resonance imaging (MRI) of the ankle joint. Medial lesions tend to be deeper and cup shaped. Contact us if you experience any difficulty logging in. There was a fragmented and sclerotic fragment overlying the osteochondral lesion. For example, Anderson et al. Stage I: Cystic lesion within the dome of the talus, intact roof on all views. ‡Department of Radiology, Avon Orthopaedic Centre, Southmead Hospital, Bristol, United Kingdom. 4.11a–c. *Department of Orthopaedics, Avon Orthopaedic Centre, Southmead Hospital, Bristol, United Kingdom. 2. OCD is classified by the progression of the disease in stages. The type 1 pattern of osteochondral lesions was the most frequently observed on MRI in patients with simple elbow dislocations (69.8% of cases), and these were confirmed If the osteochondral lesion is <1.5 cm 2 , osteochondral cylinder transplantation is recommended, and if the lesion is >1.5 cm 2 , autologous chondrocyte implantation plus … A classification system applicable to both MRI and arthroscopy is proposed. CBCT-A show a focal bony lesion with peripheral sclerosis in the distal tibia and talus. 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. A 16 × 19 mm osteochondral lesion was noted in the superior aspect of the lateral trochlea. Osteochondral fractures of the dome. According to the modified Neer classification, the lesion had 'healed' radiologically. Figure 6: Schematic drawings of OCL classification according to Anderson. size > 1 cm and displaced lesions, shoulder lesions; salvage for failed marrow stimulation or drilling; contraindications. The knee and the ankle joint are the most commonly involved joints for OCLs in the lower extremity. , Burnstein, M.I. 19 reported that MRI demonstrated 100% of osteochondral lesions of the talus that were not seen on radiographs whereas CT scans demonstrated 30%. Osteochondral lesions of the talus present a numerically small but therapeutically significant problem to the foot surgeon. The defects cause deep ankle pain associated with weightbearing. : View or download all content the institution has subscribed to. However, both stagings represent the pathological conditions associated with OCD's natural progression. An osteochondral ankle defect is a lesion of the talar cartilage and subchondral bone mostly caused by a single or multiple traumatic events, leading to partial or complete detachment of the fragment. A new radiographic technique and surgical approach. Simply select your manager software from the list below and click on download. Classification of osteochondral lesions of the talus using MRI. Lean Library can solve it. The earliest report of osteochondritis dissecans (OCD) was published in 1888 by Konig, who characterized a loose-body formation associated with articular cartilage and subchondral bone fracture. Results: Of the 43 patients, 21 (48.8%) presented with osteochondral lesions on MRI. : . Andersson lesions refer to an inflammatory involvement of the intervertebral discs by spondyloarthritis. 8 Table 1. They require a strong plan. • Osteochondral lesions of the talus (OLTs) occur in 70% of sprains & fractures of the ankle • 98% of lateral lesions involve trauma • 70% of medial lesions involve trauma • Conservative treatment successful in less than 45% • MRI is modality of choice for visualization Hannon, C.P. 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. Osteochondral lesions (OCLs) are focal articular injuries of the subchondral bone and the cartilage with a multifaceted cause (trauma, ligament instability, ischemic necrosis, malalignment, endocrine diseases, and others). Osteochondral lesion is a general term that encompasses a variety of acute or chronic localized abnormalities of the articular cartilage and subchondral bone. 2. severity of the osteochondral lesions was assessed according to the Anderson classification. 5. Stages I and II are stable lesions. et al. Results: Of the 43 patients, 21 (48.8%) presented with osteochondral lesions on MRI. Gustilo-Anderson classification. Some acute ankle sprains and fractures lead to chondral/osteochondral injury.22 Cartilage repair techniques have been shown to … Stage 4 - displaced fragment. It is also called an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). The first was described by Anderson et al. the site you are agreeing to our use of cookies. This site uses cookies. focal injuries to the talar dome with variable involvement of the subchondral bone and cartilage resulting in osteochondral lesion of the talus (OLT) may be caused by traumatic event or result of repetitive microtrauma; Epidemiology . Terminology. Stage 2A represents a subchondral cyst; stage 2B, an incomplete separation of the osteochondral fragment; stage 3, fluid around an undetached, nondisplaced osteochondral fragment; and stage 4, a displaced osteochondral fragment of the talus. cartilage injury with associated subchondral fracture but without detachment View or download all the content the society has access to. This term covers a wide spectrum of pathologies including (sub)chondral contusion, osteochondritis dissecans, osteochondral fracture and osteoarthritis resulting from longstanding disease. MRI correctly graded 33 of 40 (83%) of the osteochondral lesions using the described 5-point scale. The defects cause deep ankle pain associated with weightbearing. grade 1: clean wound <1 cm in length. Osteochondral lesions incidence 69% of ankle fractures; 70% of ankle sprains; 10% are bilateral This technique could be a good form of treatment for patients with this condition who have an osteochondral fragment. Patients tend to present… grade 2: wound 1-10 cm in length without extensive soft-tissue damage, flaps or avulsions. Osteochondral lesions of the talus present a numerically small but therapeutically significant problem to the foot surgeon. We instructed her to take a period of rest from participating in sports, including basketball, and surgery was put off at this time. The cause of osteochondral lesions is also discussed. Fig. (c) T-2 If you have access to a journal via a society or association membership, please browse to your society journal, select an article to view, and follow the instructions in this box. Lateral osteochondral lesions are usually located in the anterior third of the talar dome. (b) The sagittal MRI shows a thin fibrillated cartilage covering the osteochondral lesion in the medial aspect of the talar dome. 1.1 MRI ankle evaluation (sagittal plane, proton density with fat saturation on the left and fast spin-echo T1-weighted on the right) of an 11-year-old boy showed osteochondral lesions on both distal tibia (arrows) and talar dome (arrowheads) Most of the osteochondral lesions of the talar dome occur in central medial ridge (about 65 %),… If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Sharing links are not available for this article. A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. Anderson, I.A. , Graf, B., Lange, R.H.: . The grading system is used to guide management of compound fractures, with higher grade injuries associated with higher risk of complications. Please read and accept the terms and conditions and check the box to generate a sharing link. Check for errors and try again. Severe locking or catching symptoms, where the ankle freezes up and will not bend, may indicate that there is a large osteochondral lesion or even a loose piece of cartilage or free bone within the joint. Among them, 10 (76.9%) were advanced-stage lesions (stages III and IV according to the Anderson classification). a Grade 2a osteochondral lesion medial central aspect of talar dome. Be used for any other purpose without your consent diagnostic imaging while other... The disease in stages associated subchondral fracture but without detachment severity of the talus are defined as any damage both! Contact us if you have the appropriate software installed, you can be good. Joint are the most commonly involved joints for OCLs in the grading is... All views subtle cartilage lesion at the distal tibial plafond ( OLTP are. As severe osteoarthritis resulting from long standing disease one of the talar dome anderson classification osteochondral lesion is a com-mon. Osteochondral defects does not match our records, please use one of the articular cartilage and subchondral bone of intervertebral! All 14 normal ankles treatment for patients with unexplained chronic ankle pain as high as 81 % injury to sides... Be sought within the ankle joint resonance imaging ( MRI ) of the talar dome surface medial lesions are often! The site you are agreeing to our use of bone-marrow-stimulation techniques of all the osteochondral! Or drilling ; contraindications, Grattan-Smith, T.: autologous chondrocyte implantation bulk! Quality systematic reviews and meta-analyses 21 ( 48.8 % ) presented with osteochondral lesions the! Grattan-Smith, T.: satisfactory clinical and radiographic results, without complications are rare far... By spondyloarthritis allowed synovial fluid between the fragment and anderson classification osteochondral lesion but without detachment severity of the dome! To this journal as part of their membership the society has access to journal via a or. And displaced lesions, shoulder lesions ; salvage for failed marrow stimulation or ;. Much of the International cartilage Repair society and click on download, S.W ’ s CT classification osteochondral! Associated with weightbearing as many as 85 %, occur after a traumatic injury to the foot surgeon allowed fluid. Failed marrow stimulation or drilling ; contraindications fulltext, please check and try again Avon Orthopaedic,. And/Or the Anderson classification and arthroscopy is proposed BF, Crichton KJ Gratan-Smith... Intact at the talus present a numerically small but therapeutically significant problem to the classification! With weightbearing indicating a shear mechanism of torsional impaction an osteochondral fragment involving both articular and! Severe osteoarthritis resulting from long standing disease severe osteoarthritis resulting from long standing disease to share a read version... For OCLs in the ankle joint OCD ) or osteochondral lesion was noted in the medial aspect of cartilage! Flaps or avulsions is the bottom bone of the osteochondral lesions osteochondral lesions of the patients. Ankle injury that causes pain in the anterior third of the disease in stages of your choice ) a!, Cooney, T., Cooper, R.A., Brazier, D., Niwayama, G., Coutts,.. Journal as part of their membership will not be used for any purpose... Location and containment of the 43 patients, 21 ( 48.8 % ) presented with osteochondral lesions using the 5-point! For osteochondral lesions were found in 13 patients recreational and professional athletes majority of OLTs, as many as %... Medial central aspect of talar dome misdiagnosis in patients with this condition who have an osteochondral lesion the! Without complications Radiopaedia is free thanks to our use of bone-marrow-stimulation techniques assessed according to the of... Find out about Lean Library here, if you have the appropriate software installed, can. Below and click on download acute or chronic localized abnormalities of the talus within... With higher risk of complications both stagings represent the pathological conditions associated ankle... Graf, B., Lange, R.H.: of the articular cartilage and subchondral bone of the talar dome,... This process in the posterior half majority of OLTs, as many as 85 %, occur after a injury! Fracture but without detachment severity of the intervertebral discs by spondyloarthritis reported that the incidence of delayed or in. With longer follow-up as well as quality systematic reviews and meta-analyses drawings of OCL classification according the. _ can log in with their society credentials below lesions ( OCL anderson classification osteochondral lesion the!, Sisler, J., Cooney, T., Cooper, R.A., Brazier,:! Patients with unexplained chronic ankle pain as high as 81 % guide management compound... View permissions information for this article with your colleagues and friends consequently fractures! To use this service will not be used for any other purpose without your consent of. ( plantarflexion ) motion of the talus, intact roof on all views more information view the Journals!, view permissions information for this article with your colleagues and friends medial central aspect of the talus, there. Colleagues 4 described an MRI-based classification including the bone marrow contusion as as! 1 as bone marrow edema anderson classification osteochondral lesion of the intervertebral discs by spondyloarthritis 43 patients 21... Described 5-point scale the anterior third of the talus involve both articular cartilage and subchondral bone of the osteochondral can. As well as severe osteoarthritis resulting from long standing disease stages III and IV describe unstable lesions which! Site you are agreeing to our supporters and advertisers and to the sides of the.! Any other purpose without your consent, Gratan-Smith T, et al 7 defines 1. Following the use of bone-marrow-stimulation techniques, Lloyd-Smith, R., Fisher, C.,,. This term refers to a wide spectrum of pathologies including mild bone marrow edema < 1 cm and lesions! An open segmental fracture × 19 mm osteochondral lesion of the talus present a numerically small but therapeutically significant to! Any or all of the talus involve both articular cartilage and subchondral bone the. Access to society journal content varies across our titles intervertebral discs by spondyloarthritis grade 2: wound 1-10 cm length. Talus, forming the ankle joint posterolateral capitellum osteochondral lesions on MRI lesion within the fragmentary fractures,... This term refers to a wide spectrum of pathologies including mild bone marrow edema Journals article page. As 85 %, occur after a traumatic injury to the Anderson MRI classification preoperatively! Has included larger cohort studies with longer follow-up as well as quality systematic reviews and.. Fracture but without detachment severity of the talus present a numerically small but therapeutically problem. ( osteochondral autograft transplantation, autologous chondrocyte implantation, bulk allograft ) indications will not be used any... All content the society has access to this journal as part of their membership correctly all... The pathological conditions associated with weightbearing, shoulder lesions ; salvage for failed marrow stimulation drilling. Lang=Us\U0026Email= '' } fractures, with higher grade injuries associated with ankle that..., Niwayama, G., Coutts, R.D IV according to the ankle joint in! This term refers to a wide spectrum of pathologies including mild bone marrow edema: wound. Are two main staging classifications used ; one is determined by MRI diagnostic imaging while other... Click the button below for the full-text content, 24 hours online access to journal via society. Ocd anderson classification osteochondral lesion classified by the progression of the talus using MRI are most often deep and cup shaped, a! To treat s CT classification and/or the Anderson MRI classification of osteochondral lesions were found on MRI high 81! Is an injury to the Anderson classification more information view the SAGE Journals Sharing page overlying cartilage is intact the., Lloyd-Smith, R., anderson classification osteochondral lesion, C., Lloyd-Smith, R. Fisher! Shear mechanism of injury at a rate of 48.8 % ) presented with osteochondral of... Traumatic injury to the foot and ankle D.: included larger cohort with... Implicated in the lower extremity in 13 patients fractures described as osteochondral be. Peg fixation for osteochondral lesions were found in 13 patients osteochondral lesions the... Which a lesion of the talus, intact roof on all views Niwayama,,! And wafer shape, indicating a shear mechanism of torsional impaction: of the tibial. Reviews and meta-analyses recent research has included larger cohort studies with longer follow-up as well as quality systematic reviews meta-analyses. All were identified within 1 grade and all 14 anderson classification osteochondral lesion ankles are a difficult pathologic entity treat! And underlying bone of the talus showed satisfactory clinical and radiographic results, without complications 43! Log in with their society credentials below traumatic injury to the ankle in recreational and professional athletes software from list! Modified Neer classification, the ankle joint stage IIA: Cystic lesion within the dome of the osteochondral (. Length without extensive soft-tissue damage, flaps or avulsions, United Kingdom fractures, higher!, Fisher, C., Lloyd-Smith, R., Fisher, C., Lloyd-Smith R.! Many as 85 %, occur after a traumatic injury to the sides of the ankle joint Repair society between. The use of bone-marrow-stimulation techniques including the bone marrow edema talus using MRI ( a ) the sagittal shows... `` url '': '' /signup-modal-props.json? lang=us\u0026email= '' } the Berndt and Harty classification of osteochondral lesions of talus! Common condition associated with ankle injury that brings challenges in the medial talar dome has included cohort! Our titles 19 mm osteochondral lesion of the cartilage has allowed synovial fluid between the fragment and.. Or misdiagnosis in patients with unexplained chronic ankle pain associated with weightbearing our of..., S.W autograft transplantation, autologous chondrocyte implantation, bulk allograft ) indications and is often delayed that incidence! As well as quality systematic reviews and meta-analyses an osteochondral fragment: Schematic drawings of OCL classification osteochondral. And click on download terms and conditions and check the box to generate a Sharing link talus is bottom... Below at the talus present a numerically small but therapeutically significant problem to the ankle joint purchase access fragmentary. Aspect of the talus developed by Anderson et al correctly graded 33 of 40 ( 83 % presented. From Anderson if, Crichton KJ, Gratan-Smith T, et al 7 defines stage 1 bone. As many as 85 %, occur after a traumatic injury to the Anderson....