Osteochondral lesions

Magnetic resonance (MR) imaging for acute paediatric ankle injuries conveys no real advantage over radiography (Lohman et al. 2001). It is probably as useful as CT in the assessment of transitional fractures and is also helpful in the evaluation of the articular cartilage in traumatic osteochondral lesions of the talus. Where it is perhaps most useful is in the later stages, following physeal injury, to identify and characterise physeal arrest (Futami et al. 2000 Sailhan et al. 2004). 

Fig. 15.7. a Mortise view showing lateral talar dome osteochondral lesion. b,c Coronal and axial MRl indicating precise location and extent of the lesion... 

Diapaola JD, Nelson DW, Colville MR (1991) Characterising osteochondral lesions by magnetic resonance imaging. Arthroscopy 7 101-104... 

Hepple S, Winson IG, Glew D (1999) Osteochondral lesions of the talus a revised classification. Foot Ankle Int 20 789-793... 

Stone JW (1996) Osteochondral lesions of the talar dome. J Am Acad Orthop Surg 4 63-73... 

Hyalofast Anika therapeutics (Italy) Biodegradable hyaluronic acid—based scaffold used for the entrapment of mesenchymal stem cells Chondral and osteochondral lesions in the knee and ankle Marketed... 

Kon, E., Delcogbano, M., Filardo, G., Pressato, D., Busacca, M., Grigolo, B., Desando, G., and Marcacci, M. 2010a. A novel nano-composite multi-layered biomaterial for treatment of osteochondral lesions Technique note and an early stability pilot clinical trial. Injury. 41 778-786. 

Chuckpaiwong, B., Berkson, E.M., Theodore, G.H., 2008. Microfracture for osteochondral lesions of the ankle outcome analysis and outcome predictors of 105 cases. Arthroscopy-The Journal of Arthroscopic and Related Surgery 24, 106-112. 

Anderson et al. treated 37 patients with talar osteochondral defect (OCD) lesions via arthroscopic micioliacture repair and AM. Average OCD size was 1.9 cm on MRI and 1.3 cm intraoperatively. Liqnid form AM was used and applied directly to the lesion post debridement via needle technique and under direct visualization. Postoperative American College of Foot and Ankle Surgery (ACFAS) scores over a 2-year follow-up danonstrate significant improvement in ankle joint pain reduction and conclude that flowable AM shows promise in the adjunctive treatment of talar dome OCDs <2 cm in diameter. ... 

Kocher MS, Czarnecki JJ, Andersen JS, Micheli LJ (2007) Internal fixation of juvenile osteochondritis dissecans lesions of the knee. Am J Sports Med. 35 712-718 Lazerte GD (1958) Pathogenesis of Osgood-Schlatters disease. AM J Pathol 34 803-815... 

In the talus the terms osteochondral fracture, tran-schondral fracture and osteochondritis dissecans are used interchangeably. The condition is usually seen in adolescence. An associated history of trauma is identified in 64%-92% of patients (Berndt and Harty 1959 Ogilvie-Harris and Sarrosa 1999 Stone 1996) and tends to be an inversion type injury. Lateral lesions are said to be more commonly associated with trauma than medial lesions. The initial complaint is of ankle pain, swelling and a limp. Symptoms of instability and locking or clicking within the joint may also be described. 

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