[] This is a broad terminology that encompasses a variety of disorders including osteochondritis dissecans, osteochondral fractures, and osteochondral defects. He guided me thru the journey all the way up until surgery. Talar dome lesions are usually caused by … Microfracture and stem cell injection work well for simple lesions. During this period of immobilization, non-weightbearing range-of-motion exercises may be recommended. Instability, locking, or catching can be other symptoms. Patients may have an OLT that is present and doesn't cause pain or limitations or a lesion that becomes painful but improves. 6200 Sunset Drive Suite #402 Suite #101, Pembroke Pines, FL 33028, Aventura 21000 NE 28th Ave. These authors evaluate the effectiveness of procedures such as microfracture and arthroscopy, and recent innovations such … Surgery may be done arthroscopically depending on the size or location of the lesion. [] Although majority may be associated with trauma, some may develop insidiously. Alternatively, the primary objective may be to create an environment amenable to fibrocartilaginous proliferation or resurfacing with hyaline cartilage. The hope is to minimize symptoms and limit the risk of developing arthritis. It may not be possible to properly treat certain lesions arthroscopically due to the size or location of the lesion. Left and right arrows move across top level links and expand / close menus in sub levels. They can start as bone bruising that develops into an osteochondral lesion. The tibia and fibula bones sit above and to the sides of the talus, forming the ankle joint. I highly recommend him not only because he is very knowledgeable but also because he is considerate and caring of his patients. Much of this bone is covered with cartilage. Miami Beach Had surgery and I couldn’t be happier he did a great job and was always there if I needed him. Patients who have osteochodral lesions typically will have pain in the involved joint. Poor healing of the bones (due to the drilling). It is recommended that you avoid bearing weight until your ankle has healed. After carefully considering different options from various medical professionals, Dr. Lopez was my go to for this injury. The site navigation utilizes arrow, enter, escape, and space bar key commands. © 2019 BunionSurgeryMiami.com - Dr. Ray Lopez - All Rights Reserved. Usually, a broken piece of the damaged cartilage/bone will float inside the ankle. Main Office: This prevents the need from harvesting bone and cartilage from another part of the body (ex. Appropriate treatment of this disorder remains controversial. Bone marrow aspirate, PRP and amniotic cells are good additions to your treatment protocol. Osteochondral lesions if left untreated can cause significant pain and discomfort during weight bearing activities, swelling, dull aching pain, locking or clicking, instability and giving way of the knee joint. Persistent pain in spite of appropriate treatment after several months may raise concern for an OLT. I would highly recommend Dr. Lopez and his team. Complications, such as infection or wound healing problems, are uncommon after arthroscopic ankle surgery. Symptoms can be vague. Surgery may involve removal of the loose bone and cartilage fragments within the joint and establishing an environment for healing. Although wearing a brace or cast may ease the discomfort of an osteochondral lesion, they are usually not enough to remedy the problem permanently, except in children, who can respond well to non-surgical treatment. The knee and the ankle joint are the most commonly involved joints for OCLs in the lower extremity. Hemorrhage or formation of blood clots (risk for thrombosis or pulmonary embolism) 6. A history of trauma to the joint or prior joint surgery may be clues leading to an osteochondral lesion diagnosis. The results of non-surgical treatment of OLTs have been disappointing. Non-surgical: Osteochondral lesions of the ankle can be treated with injections of Platelet-rich plasma and hyaluronic acid, which results in a decrease in pain scores and an increase in function for at least 6 months. 4308 Alton rd. Imaging is necessary to confirm the diagnosis. Osteochondral lesions are injuries to the talus (the bottom bone of the ankle joint) that involve both the bone and the overlying cartilage. Up and Down arrows will open main level menus and toggle through sub tier links. Some patients, however, have no history of an injury to their ankle. knee). The content is not intended to substitute Sometimes, your surgeon will inject the joint with an anesthetic to measure if the pain goes away for a while, indicating that the pain is coming from inside the joint. The majority of OLTs, as many as 85%, occur after a traumatic injury to the ankle joint. You may feel pain primarily at the lateral (outside) or medial (inside) point of the ankle joint. The diagnosis of cartilage damage (osteochondral lesion, also known as talar dome) is often done with x-rays and/or an MRI. Your surgeon may have a suspicion that you have this type of injury from the history you provide and their physical examination. Miami Beach, FL 33140, South Miami An osteochondral cyst can also be present following surgery. The “classical” defect involves a disruption of both the bone (osteo) and cartilage (chondral) .They usually occur on the Talus if effecting the ankle joint and are a region where the cartilage and underlying bone have been disrupted. The articulation of the talar dome and the trochlear surface (tibia and fibula) supports the weight of the body. 601 N. Flamingo Road If the lesion is stable (without loose pieces of cartilage or bone), one or more of the following nonsurgical treatment options may be considered: If nonsurgical treatment fails to relieve the symptoms of talar dome lesions, surgery may be necessary. Osteochondral lesions of the talus (OLTs) are a difficult pathologic entity to treat. Patient- and lesion-specific factors must be identified when evaluating a patient with an articular cartilage defect. The approach and objectives of surgery are variable and are determined by the type of lesion. Most treatments require a period of immobilization and restricted weightbearing that can range from several weeks to several months. In addition to standard surgical risks, additional complications may include the failure of any transplanted tissue (bone or cartilage). Surgery may be needed in stable osteochondral lesion’s that have a failed to improve despite a prolonged period of non-operative management. Osteochondral Allograft Transfer (i.e., Cadaver): A bone and cartilage plug may also be obtained from a cadaver and transplanted into the OLT. This may be followed with gradual progression of weightbearing and physical therapy. Much of this bone is covered with cartilage. With an MRI, the ligament structures, tendons and cartilage of the ankle can be examined and analyzed. Goals may range from removal of a loose fragment to securing a larger fragment anatomically. A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. Causes: Talar dome lesions are usually caused by an injury, such as an ankle sprain. I had an unfortunate incident, breaking my leg, dislocating my ankle and rupturing all of my tendons in my left foot. This is referred to as an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). With this type of injury, a section of the talus surface may impact another part of the ankle joint (tibia or fibula) and injure the talus. Surgical options are lesion excision, excision and curettage, excision combined with curettage and microfracturing, filling the defect with autogenous cancellous bone graft, antegrade (transmalleolar) drilling, retrograde drilling, fixation and techniques such as osteochondral transplantation [osteochondral autograft transfer system (OATS)] and autologous chondrocyte implantation (ACI). 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