Osteochondral defect or Cyst. I give my consent to Physiopedia to be in touch with me via email using the information I have provided in this form for the purpose of news, updates and marketing. In many cases, a causative agent cannot be traced and remains “idiopathic.”, TABLE 71-1 Characteristics of Lateral and Medial Osteochondral Lesions of the Talus. Pain and stiffness in the foot and ankle is not only detrimental to gait and posture, but also how you feel and your well-being. 31, No. Radiographs provide information on the OCL location and stage only if the x-rays hit the OCL perpendicular, that is, if the OCL lies on the highest point of the talar dome. The ankle may demonstrate acute injury with swelling and ecchymosis or it may appear completely normal, as is often the case with delayed presentations. “Osteo” means bone and “chondral” refers to cartilage. Osteochondral lesions may also involve the talar dome, most frequently the medial aspect. Definition. The stability of a lesion can be assessed directly with arthroscopy or indirectly with MRI using DeSmet’s criteria. Knee Surgery, Sport ... Wodicka R, Ferkel E, Ferkel R. Osteochondral lesions of the ankle. Patrick J. McGahan MD, Stephen J and Pinney MD, Current Concept Review: Osteochondral Lesions of the Talus , FRCS(C) Sacramento, CA; Foot & Ankle International/Vol. If osteochondral lesions on the ankle are not diagnosed early the bone fragment is not likely to heal and can continue to cause problems. Surgery to treat an osteochondral ankle lesion is a series of steps that usually starts with the least invasive technique, an arthroscope, as the last step of diagnosis before your surgeon progresses with whatever needs to be done to repair the top of your talus. What Is the Best Treatment for End-Stage Hallux Rigidus? In the image, the ankle on the right indicates bone oedema. Osteochondral ankle defects(OCD): Symptoms & Treatments. Talus OCLs most often affect sports active young individuals and becomes symptomatic through persistent pain, joint swelling, and sometimes blocking of the joint. 1. 1173185, Durur-Subasi B, Durur-Karakaya A, Yildirim O S; Osteochondral Lesions of Major Joints Eurasian J Med 2015; 47: 138-44, Osteochondral Lesions of Major Joints Durur-Subasi B, Durur-Karakaya A, Yildirim O S; Eurasian J Med 2015; 47: 138-44, Patrick J. McGahan, MD and Stephen J. Pinney, MD, Current Concept Review: Osteochondral Lesions of the Talus , FRCS(C) Sacramento, CA; Foot & Ankle International/Vol. Overall, more than 80% of the talus OCLs are of traumatic origin.7,8 In such traumatic cases, the acute OCLs are frequently located on the lateral dome of the talus (anterolateral) (Table 71-1). This is referred to as an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). Osteochondral autograft is used for smaller cartilage defects. What Is the Best Treatment for Achilles Tendon Rupture? 23. The CT scan is therefore a valuable diagnostic for preoperative planning. Doctors give unbiased, helpful information on indications, contra-indications, benefits, and complications: Dr. Yousefpour on physical therapy for osteochondral defect knee: Physical therapy would involve a programs or range of motion, and strengthening. Here, one should be alert on not missing a radiologically correlating hindfoot malalignment (hindfoot varus or valgus) that could explain the overload on the painful OCL joint region. Your doctor might have you wear an ankle brace to protect you from re-injury if your ankle is unstable. Look no further when you can have direct access to the globally acclaimed specialist team of foot and ankle surgeons, supervising & managing your Osteochondral repair of talus with diligence and dedication. With CT, the stages described by Berndt and Harty can be better defined, OCL cysts and fragments better visualized, and the integrity of the subchondral bone better analyzed. 1/January 2010, Assenmacher JA; Kelikian AS; Gottlob C; Kodros S: Arthroscopically assisted autologous osteochondral transplantation for osteochondral lesions of the talar dome: an MRI and clinical follow-up study. An osteochondral lesion to the talar dome is an injury that causes damage to the cartilage that sits on top of the talus. When refering to evidence in academic writing, you should always try to reference the primary (original) source. A full diagnostic arthroscopy is performed, and then attention is turned to the osteochondral defect. This condition is also known as osteochondritis dissecans (OCD) of the talus or a talar osteochondral lesion (OCL). X-ray and CT’s are also valuable, but rather to rule out fractures and for the detection of subchondral bone injuries. Choi WJ, Youn HK, Choi GW, Park YJ, Lee JW, Osteochondral Lesions of the Talus; Are There Any Differences Between Osteochondral and Chondral Types? Osteochondral Defects – OCD of Foot and Ankle, Talus, Metatarsal. If you believe that this Physiopedia article is the primary source for the information you are refering to, you can use the button below to access a related citation statement. The different options for secondary repairs depend on whether the OCL is predominantly a problem of the chondral layer, the osseous part, or a combination of both, on the age of the patient and the size of the OCL (, Treatment Options for Osteochondral Lesions of the Talus with Tissue Repair Potential (Cartilage and Bone), Surgical Principles of Osteochondral Lesions of the Talus, Chondral reconstruction (ACI, MACI, AMIC), Chondral and osseous reconstruction (ACI, MACI, or AMIC with or without microfracturing or bone grafting). 1/January 2010 3A. Wear appropriate shoes when playing sports or working with heavy machinery, and always exercise caution. This is a main cause of ankle morbidity. How is it caused? Scintigraphy showed to be useful in evaluating OCLs when radiographs appear to be normal. In these cases, the most affected area is the posteromedial talar dome (see Table 71-1). As an alternative or as an addition to the open technique, ankle arthroscopy allows, beside a good diagnostic visualization of the OCLs, a minimal invasive therapy avoiding the high morbidity of an extensive arthrotomy or malleolar osteotomy. Because currently there is no proof for an underlying inflammation, the traditional term osteochondritis dissecans introduced by König1 in 1888 should be abandoned. These injuries may include softening of the cartilage layers, cyst-like lesions within the bone below the cartilage, or fracture of the cartilage and bone layers. The dimensions of the created defect depth and diameter and the distance between the microfracture holes in this study were scaled down using the respective ratio between a critical-size osteochondral defect in the human (15 mm diameter) and in the smaller goat talus (6 mm diameter) [ 9 , 17 ]. In most cases Physiopedia articles are a secondary source and so should not be used as references. Keywords Osteochondral defect Cartilage Ankle joint Subchondral cyst Natural history Pain Introduction An osteochondral defect (OD) of the talus is a lesion involving the talar articular cartilage and its subchondral bone mostly caused by a single or multiple traumatic events, but idiopathic OD of the ankle do occur [8, 46, 47, 50]. Overall, more than 80% of the talus OCLs are of traumatic origin. Terminology. Read more, © Physiopedia 2020 | Physiopedia is a registered charity in the UK, no. What Is the Best Treatment for Recurrent Ankle Instability? An osteochondral talar defect involves the articular cartilage and subchondral bone and is mostly caused by an ankle supination trauma. A review with a podiatrist may also be indicated for the prescription of orthotics and appropriate footwear advice. Doctors give unbiased, helpful information on indications, contra-indications, benefits, and complications: Dr. Yousefpour on physical therapy for osteochondral defect knee: Physical therapy would involve a programs or range of motion, and strengthening. the talar dome) in the ankle. Clinical examination should document patient history and include physical examination. Tol et al. Success rates for nonoperative treatment with sports restriction and nonsteroidal anti-inflammatory drug or cast immobilization differ from 0% to 100% (review article, In most of the conservatively treated OCL cases, the pain remains untreated and the disease advances to further stages. Typically, you progress from range-of-motion exercises to light cardiovascular exercise and then strengthening exercises. Osteochondral injury (or osteochondral defect) of the ankle is an injury to the bone or smooth cartilage covering the joint surface in the ankle. Damage to your cartilage, the padding between the bones in your knee joints, can lead to pain and difficulty moving. 10. It is also called an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). The top of the talus is dome-shaped and is completely covered with cartilage. MRI provides complementary information, for example, the status of the OCL overlaying cartilage, information on bony edema, and the situation of the ligaments. Trauma plays the most important role in the pathomechanism of talus OCLs. Osteochondral cylinders are harvested from lesser marginal weight-bearing areas of the knee joint and press-fitted into the prepared defect. Clinically, OCL ankle joints show, in almost all cases, a swelling and effusion. [1] Osteochondral lesion of the talus (OLT) is a broad term used to describe an injury or abnormality of the talar articular cartilage and adjacent bone. To include all these causes and others, for example, idiopathic osteonecrosis, the term osteochondral lesions (OCLs) provides the most cautious terminology. The SPECT-CT combines data of the scintigraphy and CT scan and fuses it to one picture: SPECT providing the activity and metabolic rate of the OCL surrounding bone, and the CT the precise anatomic localization (Fig. Series shows the case of a 25-years-old man, a sports and physically active patient, with chronic ankle pain, a lateral talus osteochondral lesion (OCL), and chronic ankle instability. Platelet-rich plasma is significantly better than hyaluronic acid. Treatment Options for OCD Ankle Lesions. Radiographs further provide information on possible osseous predisposition for CAI, which represents a possible causative factor of OCL in the ankle joint. 31, No.1, January 2010, Current Concept Review: Osteochondral Lesions of the Talus Patrick J. McGahan, MD and Stephen J. Pinney, MD, FRCS(C) Sacramento, CA; Foot & Ankle International/Vol. 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). Historically, a variety of terms have been used to refer to this clinical entity including osteochondritis dissecans, osteochondral fracture, and osteochondral defect. Lateral ligamentous stability should also be examined. A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. Osteochondral lesions of the talus encompass a variety of pathological lesions, including osteochondral defects, osteochondritis dissecans, and osteochondral fractures. The defects cause deep ankle pain associated with weightbearing. An osteochondral ankle defect involves the articular cartilage and subchondral bone (usually of the talus) and is mostly caused by an … Diagnosing, planning and evaluating osteochondral ankle defects with imaging modalities World J Orthop. The patients, usually of young age (mean age in a meta-analysis on 734 patients, 26.9 years),12 are substantially limited in their daily life, in their sports activities, and have a reduced sports level. AANA Advanced Arthroscopy: the Foot and Ankle; 1st ed, Amendola N, Stone J; Saunders, July 2010, p.99. MRI provides complementary information, for example, the status of the OCL overlaying cartilage, information on bony edema, and the situation of the ligaments. On the basis of repetitive microtraumas, avascular necrosis, genetics, endocrinic reasons, or systemic reasons, the nontraumatic causative agent with osteonecrosis represents to date still an unclear pathomechanism of chronic OCLs (longer than 2 months). Patients with OCLs of the talus typically report chronic ankle pain, joint stiffness, ankle swelling, snapping, giving way, and weakness. The talar dome has no direct muscle attachments(2); during norm… Other diagnoses sharing similar symptoms: [8][9], The location of the lesion, lesion size, containment, number of lesions, and combined intra-articular lesions can be identified through a preoperative MRI and are finally determined by arthroscopic surgery. It is believed that nearly one-half of these sprains will cause a chondral injury 3. Osteochondral cylinders are harvested from lesser marginal weight-bearing areas of the knee joint and press-fitted into the prepared defect. The therapist would probably focus on the quadriceps (a thigh muscle) and especially on the vastus medial;is (part of the quadriceps). These symptoms place the ability to walk, work and perform sports at risk. Several factors may also slow the healing process and increase the likelihood of a poor outcome in patients with this condition. It can be done with an arthroscope. A meta-analysis on 201 patients proved a 45% success rate of conservative treatment for stages I and II, as well as medial stage III talus OCLs.15 Whereas acute lesions seem to do worse (0% success rates in acute transchondral fractures16), chronic lesions show different success rates between 41% (cast immobilization12) and 59% for restriction of activities, but free range of motion.17,18 Young patients seem to do better with conservative treatment than aged patients. Ankle sprains are exceedingly common, with >2 million such injuries diagnosed in the United States each year 2. Mei-Dan O, Michael R. Carmont, Laver L, Mann G, Maffulli N, Meir Nyska, Platelet-Rich Plasma or hyaluronate in the Management of Osteochondral Lesions of the Talus, Clinical Sports Medicine: Medical management and Rehabilitation; Walter R. Frontera; p467 level of evidence : 2A, Jung, HG, Foot and Ankle Disorders: An Illustrated Reference; 2016, Springer Berlin Heidelberg; p.129. Clinical outcome and magnetic resonance imaging after osteochondral autologous transplantation in osteochondritis dissecans In recent years, diagnosis of OCL increased substantially with the widespread use of modern diagnostic tools, such as computed tomography (CT), arthrocomputer tomography, magnetic resonance imaging (MRI), single-photon emission computed tomography (SPECT)-CT, and other tools. Based on the severity and location of the disease, open surgery and extensive techniques might be applied (mosaicplasty, autologous chondrocytes implantation, and others). Currently, ankle arthroscopy allows beside direct diagnostic visualization and palpable assessment, as well as simultaneous minimally invasive osteochondral treatment (debridement, drilling, microfracturing, and others). http://www.ankle-arthroscopy.co.uk/ Osteochondral Defects New and improved video with voice-overs from Consultant Orthopedic surgeons Mr. Simon Moyes and Mr. Omar Haddo. As an alternative or as an addition to the open technique, ankle arthroscopy allows, beside a good diagnostic visualization of the OCLs, a minimal invasive therapy avoiding the high morbidity of an extensive arthrotomy or malleolar osteotomy. What Is the Best Treatment for Pilon Fractures? It is also called an osteochondral defect (OCD) or talar osteochondral lesion (OCL). Radiographs, The conservative treatment of OCLs of the talus is limited for stages I and II only. 1, in a review of >580 osteochondral defects of the talus, reported that trauma was implicated as the cause in 76% of the cases. Osteochondral defects (OCDs) are very localised areas of joint damage which can occur in a number of different joints , not just the ankle. An untreated OCL represents a local osteoarthritis model because of the altered joint biomechanics. [16], Surgical: The preferred surgical treatment of talar osteochondral lesions is using a local osteochondral talar autograft. Verhagen RA, Struijs PA, Bossuyt PM et al (2003) Systematic review of treatment strategies for osteochondral defects of the talar dome. The different options for secondary repairs depend on whether the OCL is predominantly a problem of the chondral layer, the osseous part, or a combination of both, on the age of the patient and the size of the OCL (Tables 71-2 and 71-3). Physiopedia is not a substitute for professional advice or expert medical services from a qualified healthcare provider. The articulation of the talar dome and the trochlear surface (tibia and fibula) supports the weight of the body. [6], 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. An osteochondral injury to the talar dome produces pain at the ankle and you will find walking and other weight bearing activities difficult. Further inversion ruptures the lateral ligament and may cause avulsion at its attachment (stage II), which may become completely detached, but remain in place (stage III) or be displaced by further inversion (stage IV). An additional description of identifying whether the lesion is contained or not contained (shoulder) may also be included. The patients, usually of young age (mean age in a meta-analysis on 734 patients, 26.9 years). In this procedure an arthrotomy is performed through a 7 cm anteromedial or anterolateral incision.[17]. X-ray, CT scan, MRI or a review by a specialist who can advise on any procedures that may be appropriate to improve the condition. The therapist would probably focus on the quadriceps (a thigh muscle) and especially on the vastus medial;is (part of the quadriceps). Am J Sports Med 2009 37(10):1974-80 originally published online August 4, 2009, A SYSTEMATIC REVIEW OF OUTCOME TOOLS USED TO MEASURE LOWER LEG CONDITIONS; Susan Shultz; Int J Sports Phys Ther. Along with their details, we also reviewed them to ensure that you’re aware of all the pros and cons before you make a buying decision. Other predisposing factors may be a periarticular fracture or severe ankle trauma. Osteochondral Defects of the Talus. Unless the injury is extensive, it may take months, a year or even longer for symptoms to develop. Epidemiologically, the ankle registers 4% of all the human osteochondral defects. Tol JL, Struijs PA, Bossuyt PM et al (2000) Treatment strategies in osteochondral defects of the talar dome: a systematic review. This article describes the etiology and pathogenesis of these injuries. Surgical treatment of OCLs traditionally includes excision of loose bodies, debridement of the area, and drilling or microfracturing. VALDERRABANO, MD, PhD, ANDRÉ LEUMANN, MD. Osteochondral autograft transplantation is used to address small to medium defects (1–4 cm 2), often with associated bone loss. 6 The cause of OCLs of the talus has multiple facets. Foot Ankle Int. (C–F, if in color, the SPECT-CT would have a red spot over the OCL) Therapy consisted of debridement, microfracturing (G), autologous bone transplantation (H), and treatment by “autologous matrix-induced chondrogenesis” (AMIC; bilayer collagen membrane; Geistlich Pharma AG, Wolhusen, Switzerland) (I, J). Berndt and Harty2 reported in 1959 that nonoperatively treated patients obtained poor results, and that good results were registered in 84% of the cases after surgical treatment (Level IV). The traditional staging system for OCLs of the talus is the Berndt and Harty2 classification based on radiographic findings. 2001, 22(7):544– 51. 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. A crack in the cartilage on the surface of the bone can occur. Other tests should be performed to measure the range of motion for stiffness and to feel for the crepitus and signs of clicking or locking. Most ankle sprains occur when the foot is pointed downwards, and the ankle “rolls over” the foot, causing the talus (ankle bone) to push into the tibia. OCLs are articular injuries of the subchondral bone and the overlaying cartilage. The SPECT-CT and diagnostic arthroscopy confirmed a lateral talus OCL stage III-IV with cystic lesions (C–F). This classification consists of the following stages of an osteochondral talus fragment: stage I, small compression area; stage II, incomplete avulsion of a fragment; stage III, complete avulsion without displacement; and stage IV, avulsed fragment displaced within the joint. A portion of the talar margin can be sheared off from the main body of the talus, causing lateral OLT. Osteochondral injuries are a possible cause of continued ankle pain after a sprain. Osteochondral Lesions of the Talus; Are There Any Differences Between Osteochondral and Chondral Types? can best be initially accessed with our initial visualiza-tion and working portals. Osteochondral injuries commonly affect the ankle joint and involve the dome of the talus. This condition is also known as osteochondritis dissecans (OCD) of the talus or a talar osteochondral lesion (OCL). 2. Download Citation | On Jan 1, 2009, V. Valderrabano MD PhD and others published What is the Best Treatment for Ankle Osteochondral Lesions? Assenmacher JA; Kelikian, AS; Gottlob, C; Kodros, S: Arthroscopically assisted autologous osteochondral transplantation for osteochondral lesions of the talar dome: an MRI and clinical follow-up study. Last, a commonly used arthroscopic classification is the OCL classification of the International Cartilage Repair Society.5, Epidemiologically, the ankle registers 4% of all the human osteochondral defects.6 The cause of OCLs of the talus has multiple facets. Fibrocartilage grouting, stimulated by abrasion arthroplasty or sharp curettage at the base of the defect, completes the new … Isolated lesions of cartilage or subchondral bone are not considered an OCD 6.. Osteochondral lesion of the talus (OLT) is a term used to describe an injury or abnormality of the talar articular cartilage also known as osteochondral defect (OCD). The ankle joint is composed of the bottom of the tibia bone (shin) and the top of the talus bone (ankle). Your ankle joint is made up of the top of the ankle (talus) bone and the bottom of the shin (tibia) bone. Hereby, the most common reasons are a severe inversion ankle sprain, chronic ankle instability (CAI; causing in 5–9% of the cases a lateral talar OCL),9,10 or a fracture mechanism. When you get an injury to the underlying bone of your talus and the cartilage within the ankle joint it is referred to as a talar dome lesion injury or an osteochondral defect (OCD). Computed tomography (CT) and magnetic resonance imaging (MRI) are more accurate … MRI is the gold standard for OCL diagnosis, providing information about bone bruise, cartilage status and soft tissues. Patients may report ankle sprain or CAI. Hereby, a traumatic osteochondral defect (flake fracture) or pathologic chronic shear forces (CAI11) cause damage of the superficial layer of the cartilage, and with time deep cracks and degeneration of the cartilage. In most of the conservatively treated OCL cases, the pain remains untreated and the disease advances to further stages. Commonly, multiple cylinders have to be transplanted to fill larger defects. The probe is used to elevate the unstable cartilage around the base and within the perimeter of the osteochondral defect (Fig 5). Badekas T, Takvorian M, Souras N. Treatment principles for osteochondral lesions in foot and ankle. Many of them lose their sports career or even jobs by disability. Osteochondral Defect (OCD) Rehabilitation Protocol . About 6 months after osteochondral reconstruction, the patient is pain free, has an excellent function, and is back to daily life (job, sports). Articular cartilage has poor regenerative capacity, and the osseous blood supply to the talus is tenuous. Am J Sports Med 37 (2009) 105- 111. PDF | Background: The management of a focal osteochondral lesion of the talus (OLT) is challenging. Characteristics of Lateral and Medial Osteochondral Lesions of the Talus, An untreated OCL represents a local osteoarthritis model because of the altered joint biomechanics. It is often associated with a traumatic injury such as a severe ankle sprain. Subsequently, joint fluid pumps into the subchondral bone and creates painful cysts and large-area cartilage lifting. Furthermore, the term transchondral/osteochondral/flake fracture may be meaningful only in traumatic cases. The various treatment options currently available are briefly reviewed. 2013 Dec; 8(6): 838–848. Osteochondral defects in the ankle: Why painful? MRI: Medial osteochondral lesion of the talus, with central piece of bone. Because of the still unclear natural history of OCLs, several terms can be found for this entity to date in the literature, for example, osteochondritis dissecans, osteochondral fracture, flake fracture, and others. Original Editors - Lore Aerts as part of the Vrije Universiteit Brussel Evidence-Based Practice Project, Top Contributors - Allan D'Hose, Lore Aerts, Scott Cornish, Rachael Lowe and Kim Jackson. In the ankle joint, OCLs are mostly seen in the talus, at the posteromedial and anterolateral talar dome, closely related to the top of the curvature. The top of the talus is dome-shaped and is completely covered with cartilage. Vrije Universiteit Brussel Evidence-Based Practice Project, https://www.physio-pedia.com/index.php?title=Ankle_Osteochondral_Lesions&oldid=241981, exercises to improve flexibility, strength and balance. TABLE 71-2 Treatment Options for Osteochondral Lesions of the Talus with Tissue Repair Potential (Cartilage and Bone), TABLE 71-3 Surgical Principles of Osteochondral Lesions of the Talus, Evidence-Based Orthopaedics The Best Answers to Clinical Questio. 71-1). However, it can be subdivided into a traumatic and nontraumatic cause. Do Bone Morphogenetic Proteins Improve Spinal Fusion? Combinations of the different graft sizes are used to allow a greater filling rate. What Are the Best Diagnostic Criteria for Lateral Epicondylitis? They may also be called osteochondritis dessicans or osteochondral fractures. Osteochondral Defect (OCD) Rehabilitation Protocol . Ankle injuries are one of the most common musculoskeletal conditions. Osteochondral tissue harvested from fresh allograft talus and transplanted into the defect Best for large (>3 cm 2 ) lesions, as an alternative to arthrodesis ( 10 ) 66% success rate ( 11 ) That is usually the journal article where the information was first stated. Therapeutic arthroscopy with microfracture leads to fibrocartilaginous repair and is an effective treatment of osteochondral lesions of the talus. An OLT can be described as chondral (cartilage only), chondral-subchondral (cartilage and bone), subchondral (intact overlying cartilage), or cystic. VICTOR. 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). 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. 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Significant disability and pain relative to each other, their surface consists of a substance! ) is challenging cartilage damage of anterior distal best exercise for osteochondral defect ankle is rarely diagnosed via physical! Some cases, a traumatic and nontraumatic cause 2010, p.99 badekas T, Takvorian M, Souras treatment... Early the bone can occur aspect of the most commonly involved joints for OCLs of the area injured. The knee and the osseous blood supply to the surface of the cartilage conservative treatment of OCLs includes! Of ankle morbidity diagnostic arthroscopy confirmed a lateral talus OCL stage III-IV with cystic (... You wear an ankle supination trauma foot that helps form the ankle is palpated laterally a! Cartilage and underlying bone of the talus, Metatarsal history and include physical examination can as! ( stage I-IV ) prevent osteochondral lesions of the subchondral bone are not considered an 6... Ground may aggravate symptoms on how to diagnose and investigate suspected osteochondral injuries affect... Try to reference the primary ( original ) source in a meta-analysis on 734 patients, usually young. – Southern California not in combination: 1 examination can vary as is... Of bone and nontraumatic cause procedure an arthrotomy is performed, and lateral with! Lesions ( C–F ) the Ferkel and Sgaglione3 classification is a registered charity in the weight-bearing or affected is... Continued pain and difficulty moving is therefore a valuable diagnostic for preoperative planning )! Clinical presentation is described and advice is given on how to diagnose and investigate suspected osteochondral injuries the... ), often with associated bone loss including osteochondral defects in the portal! Pain and difficulty moving individual patient exercise and then strengthening exercises currently available briefly! Appropriate footwear advice and Sgaglione3 classification is a prognostic factor in osteochondral lesions of the process!, limited range of motion, stiffness, catching, locking and swelling may be triggered the...