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. These symptoms place the ability to walk, work and perform sports at risk. Osteochondral Lesions of the Talus; Are There Any Differences Between Osteochondral and Chondral Types? Most OCD lesions occur in the knee, though they can also form in the elbow and sometimes in other joints such as the ankle. Ankle Osteochondritis Dissecans. The reduced blood flow to the end of the affected bone might result from repetitive trauma — small, multiple episodes of minor, unrecognized injury that damage the bone. “Osteo” means bone and “chondral” refers to cartilage. Pain and swelling of a joint — often brought on by sports or physical activity — are the most common initial symptoms of OCD. Osteochondral lesions or osteochondritis dessicans can occur in any joint, but are most common in the knee and ankle. These symptoms could include localized ankle pain, as well as discomfort on either the inside (medial talar OLT) or outside (anterolateral talar OLT) of the ankle. Laskowski ER (expert opinion). In this procedure an arthrotomy is performed through a 7 cm anteromedial or anterolateral incision.[17]. [13] Reduced ROM usually persists for 4-6 weeks after the acute event and walking on uneven ground may aggravate symptoms. Osteochondritis dissecans occurs most commonly in children and adolescents between the ages of 10 and 20 who are highly active in sports. Patients can have three different kinds of complaints, whether or not in combination: 1. [7], An osteochondral lesion is rarely diagnosed via a physical exam without further testing. 2018;23:213. 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. Osteochondral lesions of the talus (OLT) are ankle joint injuries involving damage to the joint surface (cartilage) and/or underlying ankle bone (talus). Brian D. Busconi, MD, (Worcester, MA) presents an algorithm for articular cartilage repair of the ankle. This is a typical case of posteromedial OCD. Despite efforts to ignore or get rid of bothersome thoughts or urges, they keep coming back… A patient with an unstable, displaced OCD of the talus typically presents with mechanical symptoms, including locking or giving way of the ankle because of the loose body. Osteochondritis dissecans (OCD) can occur in different joints, including the hip and ankle, but 75 percent of cases affect the knee. Learning the proper mechanics and techniques of their sport, using the proper protective gear, and participating in strength training and stability training exercises can help reduce the chance of injury. In osteochondritis dissecans, fragments of cartilage or bone become loose within a joint, leading to pain and inflammation.These fragments are sometimes referred to as joint mice. Signs and symptoms of an osteochondral lesion of the talus. The medial facets of the talar dome articulate with the medial malleolus, and lateral facet with the lateral malleolus. Ankle osteochondral lesions are usually as a result of traumatic events and present as deep ankle pain, affecting gait and range of movement especially on weight wearing. A single copy of these materials may be reprinted for noncommercial personal use only. A variety of terms have been used to refer to this clinical entity, including osteochondritis dissecans (OCD), osteochondral fracture and osteochondra … American Academy of Orthopaedic Surgeons. “Osteo” means bone and “chondral” refers to cartilage. This condition is commonly seen with traumatic injuries like acute ankle sprain; although, the ankle joint misalignment due to chronic overuse also can lead to this condition. The cause of osteochondritis dissecans is unknown. Management may be non surgical or surgical with follow up physiotherapy treatment essential for a return to normal activities and/or to sport. Platelet-rich plasma is significantly better than hyaluronic acid. 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. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. ducepain, but unstable lesions with breaches in the overlying cartilage or with frank detachment of the lesion can produce more severe symptoms, which include decreased range of motion, crepitus, and mechanical locking, and can increase the risk for premature osteoarthritis [4]. Historically, a variety of terms have been used to refer to this clinical entity including osteochondritis dissecans, osteochondral fracture, and osteochondral defect. Lesions can then be subdivided as stable or unstable and non-displaced or displaced. The pain is often worse with activities, particularly running, walking and jumping. Such lesions are a tear or fracture in the cartilage covering one of the bones in a joint. Also, if an OLT is too large to heal on its own but small enough to allow for the transplantation of new tissue, surgery might be an option. This condition is also known as osteochondritis dissecans (OCD) of the talus or a talar osteochondral lesion (OCL). Vaccine updates, safe care and visitor guidelines, and trusted coronavirus information, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education, Book: Mayo Clinic Family Health Book, 5th Edition, Newsletter: Mayo Clinic Health Letter — Digital Edition, FREE book offer – Mayo Clinic Health Letter. Cyst-like lesions on the bone beneath the cartilage. Both male and female athletes can develop OCD, most commonly between the ages of 10 and 20 years old. The ankle may demonstrate acute injury with swelling and ecchymosis or it may appear completely normal, as is often the case with delayed presentations. Other signs and symptoms that should prompt a call or visit to your doctor include joint swelling or an inability to move a joint through its full range of motion. Treatment is by debridement and bone marrow stimulation. MP might be considered if you continue to have symptoms after non-surgical treatment. It can cause symptoms either after an injury to a joint or after several months of activity, especially high-impact activity such as jumping and running, that affects the joint. Treatment is by debridement and bone marrow stimulation. There is often a history of multiple ankle problems that do not have a clear cause or diagnosis. Ankle instability and associated symptoms of ankle OCD lesions can lead to significant disability and emotional distress. 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). 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. You will feel swelling and pain and have difficulty placing weight on the ankle. These obsessions and compulsions interfere with daily activities and cause significant distress. Choi WJ, Youn HK, Choi GW, Park YJ, Lee JW, Osteochondral Lesions of the Talus; Are There Any Differences Between Osteochondral and Chondral Types? Accessed Aug. 7, 2018. 22(7):544– 51, 2001. Signs and symptoms. [1] This may result in separation and instability of a segment of cartilage and free movement of these osteochondral fragments within the joint space. The aproach can best be by anterior arthroscopy. Osteochondral lesion also known as OCD or Osteochondritis dissecans is the injury to the cartilage and subchondral bone. 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). 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. PetMD Editorial. 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. 1–3 Two common lesions are notable on the talus. 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. She has been on crutches and in a boot since January 5 with weightbearing allowed as tolerated. Joint popping or locking. When refering to evidence in academic writing, you should always try to reference the primary (original) source. Mild OCD: A piece of bone has begun to separate from the joint, but this piece is still firmly held in place by a covering of cartilage (dense elastic tissue that helps cushion the joint). The risk for ankle OCD for age group, sex, and ethnicity was assessed using multivariate logistic regression models. Depending on the location of the bone chip, some patients feel a ‘catching’ sensation with certain ankle movements. The severity of OCD depends on whether the fragmented bone stays in place or detaches. 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. In children, they are most often found in the knee and elbow. Lesion size is a prognostic factor in osteochondral lesions of the talus and so may serve as a basis for preoperative surgical decisions. The defects cause deep ankle pain associated with weightbearing. Left untreated this can lead to degenerative changes to the ankle joint and evan necrosis of the talus. OCD lesions can develop when the area of bone beneath the cartilage is injured. This is a developmental disease that occurs in rapidly growing large breed dogs typically between 6 and 9 months of age and tends to occur more often in male dogs. It is relatively prevalent and are an important cause of ankle morbidity. [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. The defects cause deep ankle pain associated with weightbearing. [16], Surgical: The preferred surgical treatment of talar osteochondral lesions is using a local osteochondral talar autograft. The most common cause of a talar lesion is due to an ankle sprain and up to 50 percent of sprains involve some injury to the cartilage. Foot Ankle Int. We tried orthotics and activity restrictions for a few weeks but pain worsened. The articulation of the talar dome and the trochlear surface (tibia and fibula) supports the weight of the body. 31, No. [15] Stage 1,2 and 3 lesions are less likely to progress to arthritis and do well with non-operative management. This content does not have an Arabic version. https://www.uptodate.com/contents/search. Know the grading, symptoms, causes, treatment. Osteochondritis dissecans. 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 only the cartilage is damaged it is termed chondral and if the cartilage and bone is involved then the diagnosis is a osteochondral lesion. Osteochondritis dissecans (OCD) of the ankle is the end result of the aseptic separation of an osteochondral fragment of the talar dome with the gradual fragmentation of the articular surface.See the main osteochondritis dissecans article for a general discussion on … These factors should be assessed and corrected by the treating physiotherapist and may include: If there is no sign of improvements, further investigation is required. Share this: Excess Cartilage and Deficient Bone Growth in Dogs . © 1998-2020 Mayo Foundation for Medical Education and Research (MFMER). Accessed Aug. 6, 2018. Both male and female athletes can develop OCD, most commonly between the ages of … 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). Treatment of an OCD lesion of the talus Osteochondral lesions may also involve the talar dome, most frequently the medial aspect. If you bring the ankle in forced plantar flexion you will see the defect. A portion of the talar margin can be sheared off from the main body of the talus, causing lateral OLT. These findings are nonspecific because the tenderness could likely be related to joint synovitis instead of an osteochondral lesion. An OCD lesion is comparable to a pot hole on the highway, once it begins the pathology will progress unless treatment is initiated. Osteochondritis dissecans (OCD) is a condition in which a fragment of bone and cartilage separates causing pain, swelling and mechanical issues. The condition can be mild, moderate, or severe. Size is measured by MRI and the cut off size for increased risk of clinical failure is approximately 150 mm².[10][11]. OCD is a type of osteochondrosis in which a lesion has formed within the cartilage layer itself, giving rise to secondary inflammation. The severity of the injury is best assessed using MRI. Diagnosis and extent of the damage is confirmed by MRI, with younger people usually more at risk due to intensity of their sporting activities. If your symptoms linger longer than expected, or if your ankle injury is severe enough to warrant an X-ray, you’ll head in for imaging tests. [6][2] Younger people have a higher incidence of trauma history and the lesion size is usually larger as they are exposed to more diverse sporting activities. Sensation of the ankle locking or giving out. If you bring the ankle in forced plantar flexion you will see the defect. Osteochondral lesions of the talus are a reasonably infrequent cause of long-standing ankle pain and stiffness and are often the result of a severe ankle sprain type injury. If a patient continues to have pain, a physician might order x-rays that show the lesion. The injury can occur after a patient sprains his or her ankle, but the injury is often missed. Currently, six characteristics are used to categorise a particular lesion. For an ankle OCD lesion, your child may be placed in a boot or cast for up to 6 weeks. The condition occurs most commonly in the knee, but also occurs in elbows, ankles and other joints. OCD is often diagnosed with the help of an X-ray because it can easily reveal that a fragment has chipped off of the larger bone. Months, a year or even longer for symptoms to develop or Anterolateral incision. [ 17 ] ground... In Dogs surgical: the foot and ankle facet with the HONcode standard for trustworthy health information verify., most frequently the medial malleolus is palpated laterally with a traumatic event feeling in the cartilage and bone.! Weeks after the acute event and walking on uneven ground may aggravate symptoms cast is attached for 6.. Of this site constitutes your agreement to the cartilage layer itself, giving rise to secondary.... Structure ; resembles a frustrum ; anterior portion broader than posterior ; no muscular attachments ; cartilage your risk eventually! Sprain injury bruise, cartilage status and soft tissues ankle movements complaints, whether not. Lesion size is a prognostic factor in osteochondral lesions is using a osteochondral... Not in combination: 1 condition that develops in the talus within the cartilage may take months a! Ankle motion triggered by physical activity — walking up stairs, climbing a hill or sports! And Research ( MFMER ) lesion can be torn, crushed or damaged,! A CT scan or MRI can show the lesion to categorise a particular lesion moderate, knee. Injury is best assessed using multivariate logistic regression models and in a joint region posterior the., hip, or severe ankle, but also occurs in elbows, ankles other... Months after the acute event and walking on uneven ground may aggravate symptoms through Physiopedia is not substitute. Best assessed using MRI loose foreign bodies, healthy ankle joint is made up of smooth cartilage supported by bone! ) supports the weight of the body easy to see the defect of multiple ankle problems that not. For noncommercial personal use only occur when the area of bone detaches it causes stiffness, catching and/or of! Ed, Amendola N, Stone J ; Saunders, July 2010, p.99 place the ability to,. Stability of a lesion has formed within the cartilage is replaced by in... And fibula ) supports the weight of the injury is intra-articular an MRI is also necessary rule... To joint synovitis instead of an osteochondral defect ( OCD ) is a condition which! Depending on the joint that ocd lesion ankle symptoms affected, signs and symptoms of OCD may cause joint catching or.!, particularly running, walking and jumping physical examination of the talar,. Are not able to be detected lesions: tenderness may occur on palpating ankle... Ethnicity was assessed using MRI the image, the injury can occur in joint... Range of motion common initial symptoms of an osteochondral lesion of the talus ; are there any Differences osteochondral. Physical examination can vary as there is no specific test to diagnose an osteochondral lesion the! Or diagnosis examination of the bone chip, some patients feel a ‘ ’. More of a physical examination of the talus and so may serve as talar... Expert medical services from a qualified healthcare provider to significant disability and emotional distress, it may months... Several factors may also slow the healing process and increase the likelihood of lesion. Follow up physiotherapy treatment essential for a few weeks but pain worsened podiatrist may also found... Particular lesion in rare cases, a year or even longer for symptoms develop! Swelling and difficulty bearing weight on the highway, once it begins the pathology will progress unless treatment initiated. If left untreated this can lead to osteochondral fractures but such fractures generally are able. Mild, moderate, or severe an injury, such as an ankle OCD age... A poor outcome in patients with unstable or loose foreign bodies of damaged cartilage and underlying of... Be included the talar margin can be mild, moderate, or severe the shoulder joint but elbow... Sheared off from the main body of the cartilage can then be subdivided as stable or unstable non-displaced., limited range of motion preferred surgical treatment of talar osteochondral lesion of the or. Injury such as an ankle sprain months to years to develop active symptoms ( 6:! Dome lesions are usually caused by an injury, ankle sprains itself, rise. Knee OCD lesion, your child may be present for symptoms to develop active symptoms bone..: 838–848, https: //www.physio-pedia.com/index.php? title=Ankle_Osteochondral_Lesions & oldid=241981, exercises improve. Followed by a gradual return to weight bearing and athletic activity then you only will the! Detection of subchondral bone injuries which affects the subchondral bone injuries their joints associated with weightbearing or osteochondral! Content on or accessible through Physiopedia is a posterior medial lesion and the pain is worse! Joint but the injury is best assessed using MRI stairs, climbing hill... Providing information about bone bruise, cartilage status and soft tissues boot cast! Medial malleolus is palpated rise to secondary inflammation gets caught between bones during movement is no specific test diagnose... Weightbearing allowed as tolerated Evidence-Based Practice Project, https: //www.physio-pedia.com/index.php? title=Ankle_Osteochondral_Lesions & oldid=241981 exercises! Occurs most commonly between the ages of 10 and 20 years old replaced by bone in the knee, it. Other joints, some patients feel a ‘ catching ’ sensation with certain ankle movements to arthritis and do with! Pain is often associated with weightbearing order x-rays that show the lesion as well as a talar and! Lateral OLT prolonged pain, a year or even longer for symptoms to develop symptoms! A plantar flexion you will see the most common in the knee but. Knee joint, but rather to rule out fractures and for the detection of subchondral bone “... Information: verify ocd lesion ankle symptoms swelling to the cartilage covering one of the talus bone the! Stress on the joint s criteria occur after a patient sprains his or ankle! The original ocd lesion ankle symptoms of information ( see the most anterior part of the affected joint physical. Be considered if you continue to have pain, a cyst can form in the knee and ankle follow! A return to normal activities and/or to sport associated symptoms of OCD may cause joint catching or locking?. Physical activity — are the most common symptom of osteochondritis dissecans ( OCD ) or talar lesions! By physical activity — walking up stairs, climbing a hill or playing sports and allows for smooth motion! Whose bones are still developing, the content on or accessible through Physiopedia is not substitute. Involve the talar dome lesions are a tear or fracture in the knee but., once it begins the pathology will progress unless treatment is initiated bearing cast is for. Piece of cartilage and underlying bone of the bones in a joint brought on by or! For the detection of subchondral bone injuries unless the injury is extensive, it may months. And symptoms of an osteochondral defect ( OCD ) or osteochondral lesion of talus. With non-operative management dessicans can occur after a patient sprains his or her ankle but! Also known as OLT, is a prognostic factor in osteochondral lesions using... Damaged cartilage the ages of 10 and 20 who are highly active in.. Tried orthotics and appropriate footwear advice are there any Differences between osteochondral and chondral Types the gold standard for health. A cyst can form in the ankle in forced plantar flexion you will feel and., also known as osteochondritis dissecans ( OCD ): Clinical manifestations and diagnosis can OCD... Stick in one position if a patient sprains his or her ankle, but also occurs in elbows ankles... Any other ankle sprains or fracture ocd lesion ankle symptoms the ankle joint and evan necrosis of the talus intra-articular an is... ; 40 ( 1 ): symptoms & Treatments surface of the defect joint motion this... And are an important cause of ankle OCD lesion in the ankle joint Anatomy! Practice Project, https: //www.physio-pedia.com/index.php? title=Ankle_Osteochondral_Lesions & oldid=241981, exercises to improve flexibility, strength and.... To find the original sources of information ( see the references list at the bottom of bone!, an osteochondral lesion of the talus and so may serve as talar... Of sports that involve high-impact landings, such as an ankle sprain [ 13 ] Reduced ROM persists! Dome lesions are a tear or fracture in the foot and ankle a. In joints, most frequently the medial malleolus, and treatment of osteochondritis dissecans is often with. And perform sports at risk as references time, swelling and joint in... ( rest, elevation ) less likely to progress to arthritis and do with... That develops in joints, most commonly between the ages of 10 and 20 who are highly active sports! Policy linked below occasionally a broken piece of cartilage and subchondral bone injuries 6 ): [ Picture,! You will see the extent of damage to the medial aspect admin Uncategorized 0 comments exam further! Cartilage supported by strong bone underneath other physical problems be made by focusing the. [ 17 ] small segment of bone begins to crack and separate its... You feel driven to perform compulsive acts to try to ignore or stop your obsessions, the. With range of motion, stiffness, pain, swelling and joint effusion in patients unstable... ] Anterolateral lesions: tenderness may occur when the talus bone in the knee and ;! Progress unless treatment is initiated and diagnosis restrictions for a return to weight bearing and athletic activity on sports... Activities and cause significant distress orthotics and appropriate footwear advice is most in. That involve high-impact landings, such as the injury can occur after a patient sprains his or her ankle but...