CASE REPORT Traumatic Osteochondral Injury of the Femoral Head Treated by Mosaicplasty: A Report of Two Cases Denis Nam, MD& Michael K. Shindle, MD& Robert L. … Osteochondritis dissecans (OCD or OD) is a joint disorder primarily of the subchondral bone in which cracks form in the articular cartilage and the underlying subchondral bone. Giannini S, Buda R, Cavallo M, Ruffilli A, Cenacchi A, Cavallo C, Vannini F. Cartilage repair evolution in post-traumatic osteochondral lesions of the talus: from open field autologous chondrocyte to bone-marrow-derived cells transplantation. The talar dome is a trapezoid-shaped protuberance of the talus, 2.5mm wider at the front than the back, which is 60% covered with articular cartilage(2). Specifically, tears of the MCL account for only six documented cases in the literature [3,6-8]. An osteochondral defect refers to a focal area of damage that involves both the cartilage and a piece of underlying bone. J Bone Joint Surg Am. It is widely accepted that chondral injuries in a weight-bearing portion of the knee may progress to osteoarthritis. The prevalence, characterization, and classification of acute, post-traumatic, occult subcortical fractures of the knee, identified at magnetic resonance (MR) imaging, were evaluated prospectively in 120 consecutive patients first seen with acute posttraumatic hemarthrosis of the knee. Giannini S, Battaglia M, Buda R, Cavallo M, Ruffilli A, Vannini F. Am J Sports Med. Methods. 2009 Nov;37 Suppl 1:112S-8S. Mesenchymal stromal cell and bone marrow concentrate therapies for musculoskeletal indications: a concise review of current literature. 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). A chondral defect refers to a focal area of damage to the articular cartilage (the cartilage that lines the end of the bones). eCollection 2020 Feb. Anal Bioanal Chem. 2019 Dec;411(30):7943-7955. doi: 10.1007/s00216-019-02148-8. Access your health information from any device with MyHealth. Operative treatment of osteochondral lesions of the talus. Methodological variations affect the release of VEGF in vitro and fibrinolysis' time from platelet concentrates. One technique for treating isolated cartilage defects is called a "microfracture". COVID-19 is an emerging, rapidly evolving situation. 81 patients (mean age 30±8 years) were evaluated in this study. Occasionally, a specialized test called a bone scan with be utilized to identify if the underlying bone is healthy and prepared for certain techniques. These will be used to determine the type and extent of the damaged area, and for measurement purposes to determine the possible treatment options. Osteochondritis dissecans (os-tee-o-kon-DRY-tis DIS-uh-kanz) is a joint condition in which bone underneath the cartilage of a joint dies due to lack of blood flow. Thirty-eight patients with at least one MRI-documented OCL of the ankle were treated from 2004 to … All the lesions were >1.5 cm(2) and received open autologous chondrocyte implantation (10 cases), arthroscopic autologous chondrocyte implantation (46 cases), and "one step" arthroscopic repair by BMDC transplantation (25 cases). The tibia and fibula bones sit above and to the sides of the talus, forming the ankle joint.  |  Giannini S, Buda R, Vannini F, Di Caprio F, Grigolo B. Injury… Injury. They can start as bone bruising that develops into an osteochondral lesion. Does the Application of Platelet-Rich Fibrin in Anterior Cruciate Ligament Reconstruction Enhance Graft Healing and Maturation? Introduction Symptomatic traumatic osteochondral lesions of the knee remain a significant treatment challenge in a young active patient. 71. Management of End-Stage Patellofemoral Post-Traumatic Chondromalacia with Fresh Osteochondral Allograft. 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. However, the now exposed bone should be treated, if possible, to attempt to stimulate growth of new cartilage. The defects cause deep ankle pain associated with weightbearing. Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. A review of osteochondral lesions of the talus. This requires a detailed evaluation to be performed to assess the integrity of the remaining cartilage, the underlying bone and to look for evidence of healing capacity. The diagnosis of cartilage damage (osteochondral lesion, also known as talar dome) is often done with x-rays and/or an MRI. Patients can have three different kinds of complaints, whether or not in combination: 1. 2020 Feb 20;8(2):2325967120902013. doi: 10.1177/2325967120902013. With an MRI, the ligament structures, tendons and cartilage of the ankle can be examined and analyzed. Epub 2008 Jan 28. During a microfracture (which is typically done arthroscopically), tiny holes are made in the bone to create tunnels to the underlying bone marrow and natural stem cells.  |  For arthroscopic repair techniques a hyaluronic acid membrane was used to support cells and specifically designed instrumentation was developed. Dr Joachim Feger ◉ and Assoc Prof Frank Gaillard ◉ ◈ et al. Unless the injury is extensive, it may take months, a year or even longer for symptoms to develop. Epub 2019 Nov 11. 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). Beyzadeoglu T, Pehlivanoglu T, Yildirim K, Buldu H, Tandogan R, Tuzun U. Orthop J Sports Med. Epub 2020 May 25. Indication Fresh osteochondral tibial plateau and meniscus (FOTAM) transplantation is indicated in patients below 50 years of age with post-traumatic tibial plateau osteochondral defects measuring at least 30 mm in diameter and 10 mm in depth. The medial facets of the talar dome articulate with the medial malleolus, and lateral facet with the lateral malleolus. This joint permits much of the up (dorsiflexion) and down (plantarflexion) motion of the foot and ankle. 22. Giannini, S, Buda, R, Cavallo, M. Cartilage repair evolution in post-traumatic osteochondral lesions of the talus: from open field autologous chondrocyte to bone-marrow–derived cells transplantation. HHS Giannini S, Buda R, Battaglia M, Cavallo M, Ruffilli A, Ramponi L, Pagliazzi G, Vannini F. Am J Sports Med. Categories Trauma And Fractures Menu Tags Arthroscopy , Muscles Tendons , Tibia and Fibula , Trauma Fractures Post navigation Much of this bone is covered with cartilage. cartilage injury with associated subchondral fracture but without detachment Evolution in surgical technique, new biomaterials and more recently the use of BMDCs permitted a marked reduction in procedure morbidity and costs up to a "one step" technique able to overcome all the drawbacks of previous repair techniques. Get the Android MyHealth app ». [ 11] A The aims of this study are to describe evolution in cartilage repair from open field autologous chondrocyte implantation to regeneration by arthroscopic bone-marrow-derived cells (BMDCs) "one step" technique; to present the results of a series of patients consecutively treated and to compare in detail the different techniques used in order to establish the advantages obtained with the evolution in cartilage regenerative methods. Despite the growing body of literature supporting the use of tibial allograft transplantation to treat severe post-traumatic or degenerative osteochondral lesions, there is a relative paucity of literature reporting on its surgical technique. 2013 Mar;41(3):511-8. doi: 10.1177/0363546512467622. Epub 2010 Oct 8. 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. The articulation of the talar dome and the trochlear surface (tibia and fibula) supports the weight of the body. Chondral osteochondral defect, a knee injury, causing pain, swelling, and catching of the joint. The lesion was located medially in 55 and laterally in 26 cases. A Comparative MRI Study of 44 Cases. In a type 2 lesion compared to type 1, the impact is more focally concentrated. Arthroscopic Drilling for the Treatment of Osteochondral Lesions of the Talus Nonoperatively managed stage 5 osteochondral talar lesions. Introduction. This can often take months until a suitable donor is available. Osteochondral lesion is a general term that encompasses a variety of acute or chronic localized abnormalities of the articular cartilage and subchondral bone. 5,13 It is widely accepted that chondral injuries in a weight-bearing portion of the knee may progress to osteoarthritis. This has been attributed to medial collateral ligament (MCL) tear, LisFranc injury, turf toe injuries, and medial plantar nerve injury secondary to ankle (tibial) fracture [3-7]. This bone and cartilage can then break loose, causing pain and possibly hindering joint motion.Osteochondritis dissecans occurs most often in children and adolescents. PLoS One. Eder C, Schmidt-Bleek K, Geissler S, Sass FA, Maleitzke T, Pumberger M, Perka C, Duda GN, Winkler T. Mol Biol Rep. 2020 Jun;47(6):4789-4814. doi: 10.1007/s11033-020-05428-0. Patients of all the three groups underwent a second arthroscopy with a bioptic cartilage harvest at 1 year follow-up. The purpose of this retrospective study was to assess the treatment of post-traumatic osteochondral lesions (OCLs) of the ankle with a four-step protocol. The cartilage is often not viable when it is separated from the bone and therefore must be removed which can be done with an arthroscopic procedure. doi: 10.1371/journal.pone.0240134. One-step repair in talar osteochondral lesions: 4-year clinical results and t2-mapping capability in outcome prediction. chondral-defect. Epub 2019 May 21. This condition is also known as osteochondritis dissecans (OCD) of the talus or a talar osteochondral lesion (OCL). In later stages of the disorder there will be swelling of the affected joint which catches and locks during movement. One less common or documented etiology is post traumatic hallux valgus. 2019 Sep;53(5):372-375. doi: 10.1016/j.aott.2019.04.002. Post-traumatic tibiotalar arthrosis remains a difficult ... Osteochondral allografts were obtained from fresh Osteochondral Defect is the name given to a condition most noticeable in the knee, in which a part of the bone and cartilage gets separated from the knee joint resulting in chronic pain in the knee and difficulties performing normal activities of daily living. OCD usually causes pain during and after sports. Large post-traumatic osteochondral defects of the proximal tibia in young active patients can be challenging because total or partial arthroplasties are to be avoided.  |  This would be the optimal scenario. This technique is suitable for younger to middle age patients with very focal areas of cartilage loss (typically less than 2 square centimeters) and where the remaining cartilage is healthy.  You can message your clinic, view lab results, schedule an appointment, and pay your bill. Symptomatic osteochondral ankle defects often require surgical treatment. 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. Chondral osteochondral defect, a knee injury, causing pain, swelling, and catching of the joint. 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