(2018) Radiographics : a review publication of the Radiological Society of North America, Inc. 38 (5): 1478-1495. Purpose: The purpose of our study was to investigate the performance of MRI findings to predict instability of osteochondral lesion of the talus (OLT) in children and the association between skeletal maturity and lesion stability. Unstable lesions – if left untreated – predispose for early osteoarthritis. “Staging of Osteochondral Lesions of the Talus: MRI and Cone Beam CT”. There is slight irregular delineation of the cartilage (white arrow). This joint permits much of the up (dorsiflexion) and down (plantarflexion) motion of the foot and ankle. 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). Subchondral bone involvement can be manifested by bone marrow edema (BME), fracture, sclerosis and/or cyst formation. DOI: https://doi.org/10.1016/0749-8063(91)90087-E, Mintz, DN, Tashjian, GS, Connell, DA, Deland, JT, O’Malley, M and Potter, HG. Osteochondral lesions (OCL) of the talus are defined as any damage involving both articular cartilage and subchondral bone of the talar dome. In addition, the trabecular architecture of subchondral bone is far better visualized on CBCT than on CR. Large uncontained lesions are usually painful as the structure of the talus is threatened. MRI of osteochondral defects of the lateral femoral condyle: incidence and pattern of injury after transient lateral dislocation of the patella. 1991;7:101– 104. 1959; 41–A: 988–1020. DOI: http://doi.org/10.5334/jbr-btr.1377, Posadzy, Magdalena, Julie Desimpel, and Filip M. Vanhoenacker. Most classification systems are based on lesion descriptions by Berndt and Harty ( 2 ): Open mosaicplasty in osteochondral lesions of the talus: a prospective study. Radiology. The aim of this study was to summarize all eligible studies to compare the effectiveness of treatment strategies for osteochondral defects (OCD) of the talus. S2 (2017): 1. Arthroscopic evaluation of the cartilage is regarded as the gold standard [2], but due to its invasiveness and the need for anesthesia, it should be reserved for preoperatively well-documented cases and combined with surgical treatment procedures. Morrison, et al.Osteochondral lesions of the talus: localization and morphologic data from 424 patients using a novel anatomical grid scheme. Despite the combination of these MR parameters, accurate cartilage evaluation remains often illusive. Journal of the Belgian Society of Radiology 101, no. Based on the combination of MRI and CBCT findings the diagnosis of a subchondral insufficiency fracture (SIF) was made. The purpose of our study was to investigate the performance of MRI findings to predict instability of osteochondral lesion of the talus (OLT) in children and the association between skeletal maturity and lesion stability. In adult patients, the depth of the cartilage lesions is often understaged (Figures 3 and 4). The diagnosis and investigation of such lesions have been greatly enhanced by modern high resolution magnetic resonance imaging capabilities, which have provided far greater detail of the pathological anatomy. This chapter is adapted from Chao W, Freeland E, Dedini R: Osteochondral Lesions of the Talus in Chou LB, ed: Orthopaedic… 16 . The overlying cartilage is difficult to assess on MRI but seems to be slightly inhomogeneous (white arrow). Sagittal (a) and coronal (b) fat suppressed T2-WI showing multilocular subchondral cysts (black arrowheads) at the medial aspect of the talar dome. Commonly, this is achieved by drilling the subchondral bone (6 – 12). Coronal fat suppressed T2-WI (intermediate weighting) showing BME (white asterisk) at the lateral corner of the talar dome (a). 5. It is often associated with a traumatic injury such as a severe ankle sprain. Autologous Matrix-Induced Chondrogenesis for Osteochondral Lesions of the Talus: A Clinical and Radiological 2- to 8-Year Follow-up Study. Sagittal (a) fat suppressed T2-WI show a subchondral band-like area of low signal at the subchondral cortex (white arrow) with surrounding BME (white asterisk). DOI: https://doi.org/10.1177/0363546508316773, Dipaola, JD, Nelson, DW and Colville, MR. Characterizing osteochondral lesions by magnetic resonance imaging. Sagittal fat suppressed T2-WI (intermediate weighting) showing BME (white asterisk) at the lateral corner of the talar dome (b). Schmid MR et col. Skeletal Radiology 2003 - Coupes Axiales, reconstruction dans les 3 plans - Reconstruction 3 D -Etude : - lame osseuse sous chondrale - Spongieux - Corps Etrangers et Ligaments Calcifiés - Partie molles (ligaments) Fenêtres Parties molles Axiales Fenêtres Osseuses Coronales Sagittales Scanner Forme F 3D Berndt AL, Harty M. J Bone Joint Surg 1959 … Diagnostic value of CT arthrography for evaluation of osteochondral lesions at the ankle. Disqus. Although Magnetic Resonance Imaging (MRI) at 1.5 Tesla is the leading cross-sectional modality for detection and staging of OCL, lack of spatial resolution hampers accurate assessment of thin articular cartilage. Coronal reformatted CBCT-A (c) barely shows subtle subchondral sclerosis at the superolateral aspect of the talar dome and intact overlying cartilage. Characterizing osteochondral lesions by magnetic resonance imaging. The articular surface of the talus is large and its blood supply is critical in the watershed areas [1] explaining an impaired healing process and predisposition to posttraumatic necrosis in those vulnerable areas. DOI: http://doi.org/10.5334/jbr-btr.1377. Pioneer in Rad Blogging. Example of improved visualization of communication of subchondral cysts with the joint through deep articular cartilage lesions on CBCT arthrography. On CBCT arthrographic images, the contrast separating the OCL fragment from the talar dome can be evaluated with more confidence (Figure 8). Members receive the 'Picture of the week', new operative techniques and can submit their problem cases for an expert opinion. Planning of the pathway and adjustment of the targeting device were performed outside the operating room. Accurate staging of cartilage lesions is of utmost importance, as this will have a major impact on the treatment strategy and ultimate prognosis. It is often used synonymously with osteochondral injury/defect and in the pediatric population. 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. Electronic databases from January 1966 to December 2006 were systematically screened. Prognosis of these lesions depends on stability, location, and size of the lesion.Imaging has an essential role in the diagnosis, staging, and management of osteochondral lesions. Due to the widespread use of fluid-sensitive sequences on MRI, even subtle foci of BME may be seen adjacent to a cartilage defect, particularly in acute or subacute OCL lesions. With the advent of MRI, this grading system was further revised including evaluation of structures invisible on conventional radiology, such as the integrity of the cartilage and presence of BME. C = cuneiform bone, Cal = calcaneus, Cu = cuboid bone, F = fibula, M = metatarsal bones, N = navicular bone, Ph = phalanges, STJ = posterior facet of the subtalar joint, Tb = talar body, TD = talar dome, Th = talar head, Ti = tibia, Tn = talar neck. Autologous Matrix-Induced Chondrogenesis for Osteochondral Lesions of the Talus: A Clinical and Radiological 2- to 8-Year Follow-up Study. This term covers a wide spectrum of pathologies including (sub)chondral contusion, osteochondritis dissecans, osteochondral fracture and osteoarthritis resulting from longstanding disease. Contributed by Dr. Hemilianna Hadassa Silva Matozinho M.D. CBCT following intra-articular injection of Iodine contrast (CBCT-Arthrography) may render exquisite detail of the articular cartilage using very thin slices and multiplanar reformation. On the other hand, although MRI a very useful and sensitive technique for evaluation of the subchondral compartment (showing either BME or cyst formation), the precise depth and extent of the overlying cartilage lesion is often not accurately staged. Osteochondral lesion of the talus in children: Are there MRI findings of instability? The overlying cartilage is intact at the talus, whereas there is subtle cartilage lesion at the distal tibia (arrow). 2017. Radiology. Osteochondral lesions (OCL) of the talus involve both articular cartilage and subchondral bone of the talar dome. 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