Osteochondritis dessicans of the ankle is a condition typically encountered by the foot and ankle physician. Many treatments have been described within the literature together with cast immobilization, arthroscopic debridement, open debridement, and autogenous grafting. The NEXA OsteoCure™ bone graft plug permits for speedy lesion excision while avoiding the morbidity related to acquiring an autograft. The authors provide a short evaluation of talar dome lesions including staging and classification and their expertise and approach concerned for utilizing NEXA Orthopedics OsteoCure™ bone graft plugs. This is an Open Access article distributed under the terms of the Creative Commons Attribution License. It permits unrestricted use, distribution, and reproduction in any medium, supplied the original work is properly cited. Osteochondral defects of the talar dome, aka osteochondritis dissecans, are widespread pathological entities encountered by the podiatric physician. Although trauma is thought to play a main function in the genesis of those lesions, idiopathic osteonecrosis could even be a cause. Subjectively, these patients regularly current complaining of a deep, aching, non-descript pain within the ankle joint that worsens with activity.
Clinical examination may reveal joint line tenderness, effusion, in addition to pain upon ankle joint range of motion. Diagnosis is incessantly made with imaging after excessive clinical suspicion, and the lesions are usually seen anterolaterally or posteromedially. Figure 1 Diagnosis of osteochondral defects are sometimes made with CT scans. The lesions are typcially seen anterolaterally and posteromedially. Insight into the morphology and mechanism of motion of those lesions was illustrated in a retrospective research of thirty-one ankles in twenty-9 patients with osteochondral lesions by Canale, et al. It was found that lateral lesions were related to inversion or inversion-dorsiflexion trauma and that these lesions are morphologically shallow and anteriorly positioned on the talar dome. Lateral lesions were more more likely to turn out to be displaced in the joint and to have persistent signs. Medial lesions were each traumatic and atraumatic in origin, morphologically deep, positioned extra posteriorly on the talar dome, and less symptomatic. These usually occurred with a plantarflexion and inversion kind of injury.
With an acute harm, the osteochondral lesion is probably not seen on the preliminary radiographs. If there’s a high index of suspicion, repeat radiographs in two to 4 weeks must be obtained or one ought to consider more superior imaging. In a study by Anderson, et al., it was found that when plain radiographs of the ankle are relied on for the prognosis of an osteochondral fracture of the talus, many lesions stay undiagnosed. Stage-I osteochondral fractures show no diagnostic changes on plain radiographs, and Stage-II lesions are usually subtle and, therefore, are sometimes overlooked by each radiologists and clinicians. The most commonly used classification system for these accidents was created by Berndt and Harty. A kind I lesion represents a small area of compression. A kind II lesion is a partially detached osteochondral lesion. When the lesion becomes completely detached, however stays in its anatomical location, it is a kind III lesion. A detached lesion with any motion or migration is classified as sort IV.
A CT could provide extra correct staging of the lesion, although classification could not correlate with intraoperative findings. Figure 2 The CT may supply more correct staging of the lesion, though classification could not correlate with intraoperative findings. Pettine, et al., evaluated seventy-one osteochondral fractures of the talus for a mean of 7.5 years after the onset of signs to determine which components influenced the ultimate end result. It was discovered that the type of fracture was a very powerful issue and that delay in therapy also affected the results adversely. In the study by Canale, et al., utilizing the classification system of Berndt and Harty, it appeared that Stage-I and Stage-II lesions needs to be treated non-operatively, regardless of location. Stage-III medial lesions should be handled non-operatively initially but when signs persist, surgical excision and curettage are indicated. Stage-III lateral lesions and all Stage-IV lesions should be treated surgically and early. Long-time period results indicated that few lesions unite when treated non-operatively. Degenerative adjustments within the ankle joint, whether or not symptomatic or not, have been frequent regardless of the kind of therapy.
Non-operative remedy of those lesions includes casting and immobilization. There is no evidence, nevertheless, that these patients need to be immobilized if they’re saved non-weight bearing. There can be no proof that a non-weight bearing forged presents better results than a weight bearing solid. A retrospective study of 22 ankles in 22 patients with osteochondral talar dome lesions between 1975 and 1983 indicated that surgical therapy yields superior outcomes to conservative therapy. Many of these lesions are treated surgically with arthroscopic joint examination and debridement of the lesion. This course of may be aided by an exterior joint distracting device. Anterolateral lesions are sometimes extra amenable to arthroscopic debridement than posteromedial lesions due to their anatomical location. In a research by Kumai, et al., the authors discovered good clinical leads to arthroscopic debridement and okay-wire drilling of lesions in patients who had been youthful than sixty years previous.6 Posteromedial lesions sometimes necessitate an osteotomy of the medial malleolus for exposure, with open discount and inside fixation and subsequent prolonged non weight-bearing.