There is slight irregular delineation of the cartilage (white arrow). The presence of intraarticular contrast and high spatial resolution improves visualization of the cartilage surfaces compared to routine MRI on 1.5 Tesla. Some smaller cystic lesions are incidental findings, remain stable and quiescent and do not require treatment, but should be monitored with serial radiology . Presentation. They may also be called osteochondritis dessicans or osteochondral fractures. The talus is the bottom bone of the ankle joint. CBCT, which was first introduced for preoperative evaluation of dental implants, is currently also used for musculoskeletal applications. On a corresponding sagittal reformatted CBCT-A (c), there is almost complete detachment of the cartilage at the superolateral aspect of the talar dome (black arrow). Clinical management of these lesions is based on whether or not the fragments are attached. For staging of OCL of the talus several grading systems have been proposed. This term covers a wide spectrum of pathologies including (sub)chondral contusion, osteochondritis dissecans, osteochondral fracture and osteoarthritis resulting from longstanding disease. The most common sites are the posteromedial (53%) ( Fig. (2020) Skeletal Radiology. MRI is the modality of choice, with high sensitivity and specificity for the detection of separation of the osteochondral fragment (see: osteochondral injury staging and osteochondritis dissecans surgical staging). The purpose of this study was to directly compare the MRI with the arthroscopic findings. Direct comparison of conventional radiography and cone-beam CT in small bone and joint trauma. MRI is the most sensitive method to depict this stage without any correlating signs on CR or CBCT with injection of intraarticular contrast. Weigelt L(1), Hartmann R(1), Pfirrmann C(2), Espinosa N(3), Wirth SH(1). 2006;187 (5): 1332-7. Journal of the Academy of Chiropractic Orthopedists. On plain films, the subchondral bone is seen as a thin layer of compact bone with a smooth surface and a uniform adjacent trabecular bone (Figure 2b). Osteochondral autograft transfer involves harvesting single or multiple cylindrical cartilage and subchondral bone grafts from the non-weight-bearing part of the ipsilateral knee and transplanting them into the talar defect after preparation. Moreover, despite several modifications of the staging systems on MRI, not all combination of the degree of involvement of the cartilage and subchondral bone are included and therefore these classification systems remain uncomprehensive, complicated and less valuable for use in daily routine. Proposed etiologic factors for the development of OCLs include trauma, ischemia, ... W.B. Lomax, A, Miller, RJ, Fogg, QA, Jane Madeley, N and Senthil Kumar, C. Quantitative assessment of the subchondral vascularity of the talar dome: A cadaveric study. Dr. Ebraheim’s educational animated video describes Osteochondral Lesions of the Talus. 1, pp. Because the plasticity of the cartilage in children and adolescents is higher than in adults, OCL lesions in young patients are often characterized by isolated subchondral bony changes without overlying cartilage disruption (Figure 5). Past history of trauma. Osteochondral lesions (osteochondritis dissecans) of the talus are common articular lesions that are usually traumatic in origin. It is often associated with a traumatic injury such as a severe ankle sprain. 1. Diagnostic value of CT arthrography for evaluation of osteochondral lesions at the ankle. Additional CBCT-Arthrography is, however, very useful for more accurate cartilage staging and should be considered in those clinical scenarios where arthroscopic treatment of the lesion is considered. following anterior cruciate ligament repair), femoral condyle (most common in the lateral aspect of the medial femoral condyle), the signal is variable with intermediate to low signal adjacent to fragment and variable fragment signal, low signal loose bodies, outlined by high signal fluid, donor defect filled with high signal fluid. Osteochondral defects of the talus (OCD) are a well-established pathology within the ankle. Maya Patel1 & Michael L. Francavilla2,3 & J. Todd R. Lawrence3,4 & Christian A. Barrera2 & Michael K. Nguyen2 & Cruz Longoria5 & Jie C. Nguyen2,3 Received: 12 January 2020 /Revised: 23 March 2020/Accepted: 30 March 2020 Radiology. Author information: (1)Department of Orthopedic Surgery, Konkuk University School of Medicine, 4-12 Hwayang-dong, Gwangjin-gu, Seoul, 143-729, Republic of Korea. Alternative diagnosis on CBCT compared to MRI. DOI: https://doi.org/10.1016/j.fas.2013.10.005, Pritsch, M, Horoshovski, H and Farine, I. Arthroscopic treatment of osteochondral lesions of the talus. Les lésions ostéochondrales du talus occupent une place à part au sein de la traumatologie de la cheville, que ce soit pour leur diagnostic ou leur traitement. Background: Magnetic resonance imaging (MRI) is widely used for diagnosing osteochondral lesions in the talus. As such, the term encompasses a variety of pathologies, including: osteochondritis dissecans, osteochondral defects, and osteochondral fractures. Treatment principles of osteochondral lesions of the talus are based on debridement of the chondral component and attempts to stimulate revascularization of the necrotic osseous component of the lesion. It contains free information. Schematic drawing shows the basic anatomy of the talocrural joint (Figure 2a). 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. When the latter is present, then joint replacement is often the only feasible treatment. Home MRI Musculoskeletal MRI Musculoskeletal radiology Osteochondral Defect. Coronal computed tomographic (CT) scan (a) and sagittal T1-weighted magnetic resonance (MR) image (b) demonstrate the normal skeletal anatomy of the foot and ankle. CBCT-Arthrography (CBCT-A) of the talocrural joint, coronal reformatted image (d) showing smooth cartilage lining covering the normal subchondral bone of the talus (arrow) and tibia (arrowhead). Page 6 of 19 talar dome in the ankle joint. in 2003. A modified grading system has been proposed by Hepple in 1999 [5] and by Dipaola et al. Based on the combination of MRI and CBCT findings the diagnosis of a subchondral insufficiency fracture (SIF) was made. Vira S(1), Ramme AJ(1), Chapman C(2), Xia D(3), Regatte RR(4), Chang G(5). Commonly, this is achieved by drilling the subchondral bone (6 – 12). “Osteo” means bone and “chondral” refers to cartilage. Treatment depends on the location and size of the defect as well as the presence of secondary degenerative changes. Coronal (b) and sagittal (c) reformatted CBCT-A show subtle subchondral sclerosis (black arrow) at the superolateral aspect of the talar dome, but the overlying cartilage is intact. S2, 2017, p. 1. Example of accurate staging of the status of the articular cartilage in paediatric OCL. Cartilage thickness in cadaveric ankles: Measurement with double-contrast multi-detector row CT arthrography versus MR imaging. Dr. Ebraheim’s educational animated video describes Osteochondral Lesions of the Talus. Materials and method: This retrospective IRB-approved and HIPPA-compliant study included children with OLT, who underwent an ankle MRI examination between March … Cone Beam Computed Tomography (CBCT) arthrography is better suited for precise staging of cartilage lesions. This condition is also known as osteochondritis dissecans (OCD) of the talus or a talar osteochondral lesion (OCL). Osteochondral Lesions of the Talus with Midfoot Arthritis (C2537) Gilberto Consoli Foot & Ankle - Osteochondral Lesions of the Talus E 3/20/2016 604 . Berndt and Harty radiographic classification of osteochondral lesions of the talus is as follows: Stage I - … Osteochondral lesions of the talus (OLTs) are a difficult pathologic entity to treat. Example of improved visualization of communication of subchondral cysts with the joint through deep articular cartilage lesions on CBCT arthrography. 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