Clinical and experimental evidence has confirmed the traumatic nature of osteochondritis dissecans of the talus [8, 9]. The dome of the talus lies in the mortise created by the tibial plafond, distal fibula, and malleoli, and serves as a weight-bearing surface for the entire body. It is wider in the anterior plane to provide stability, especially while weight-bearing. The prevalence of osteochondritis dissecans in the tibial plafond detected on radiography is unknown. Trauma ⎜ Tibial Plafond Fractures (ft. Dr. Brian Weatherford) Team Orthobullets (AF) Trauma - Tibial Plafond Fractures; Listen Now 26:30 min. OCD: talus, tibial plafond, navicular Subtalar joint Calcaneonavicular coalition [anteater nose sign] Talocalcaneal coalition [complete C-sign] Anterior process of calcaneus Check base of ﬁfth metatarsal for Jones fracture Medial aspect of 2nd metatarsal aligns with medial aspect of middle cuneiform Foot and ankle disorders 359 Osteochondritis dissecans (OCD or OD) is a joint disorder primarily of the subchondral bone in which cracks form in the articular cartilage and the underlying subchondral bone. One patient was treated conservatively; currently, this patient is asymptomatic. Table 1 summarizes the findings in our three patients and the cases in the literature. In our series, two of three osteochondral lesions of the tibial plafond were detected on radiography. Perhaps in some individuals, the tibial plafond is less stiff than the talar dome, placing them at risk for osteochondritis dissecans of the tibial plafond. The lesion may not be visible on conventional radiographs, as was the case in one of our patients. 72 plays. As the dorsiflexed foot was inverted, the lateral border of the talar dome was compressed against the articular surface of the distal fibula. The ankle joint is the most commonly injured joint in athletes, and OCD lesions primarily are found in the ankle (Giovanni et al, 2007). Cartilage Grafting Options for Large or Microfracture-resistant Osteochondritis Dessican (OCD) Lesions of the Talus. Two patients underwent arthroscopy. Bauer et al. I suggest you review the next query regarding Tibial Plafond fractures. We report the imaging characteristics of osteochondritis dissecans of the tibial articular surface (tibial plafond). Osteochondral defect. CT and MR imaging are able to show the exact location and extent of the lesion. Three patients had a history of trauma, and all patients were symptomatic, requiring orthopedic evaluation and surgery. All patients underwent radiography, one patient underwent CT, and one patient underwent MR imaging. The search was limited to English literature and human subjects. As such, it is vulnerable when the ankle is forcibly inverted, everted, or rotated. Most OLTP can be surgically managed arthroscopically. A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. The softest cartilage was found in the posterior half of the talus. Osteochondritis dissecans (OCD) is a localized injury or condition affecting an articular surface that involves separation of a segment of cartilage and subchondral bone (Schenck, 1996). Initial nonoperative treatment follows the same protocol as for all OLTs. 0.0 (0) See More See Less. In the other patient, ankle arthroscopy revealed a depressed area in the posterolateral aspect of the tibial plafond filled with fibrocartilage. On axial scans, osteochondral lesions of the tibial plafond may be initially mistaken for osteochondritis dissecans of the talar dome (Fig. Osteochondritis dissecans of the talar articular surface of the ankle joint has been well described. Patients with OCD in the knee may have quadriceps weakness, not gluteus maximus weakness; however, this does not lead to a lack of patellar tracking. Osteochondral defects ( OCD) or lesions ( OCL) are focal areas of damage with articular cartilage damage and injury of the adjacent subchondral bone … 1A). It contains free information. The prevalence of osteochondritis dissecans in the tibial plafond detected on radiography is unknown. The average age was 39 years (age range, 33-49 years). However, the talar dome was irregular, with areas of ruffled tissue. OCD Ankle and Talus Internet resources relating to Osteochondritis Dissecans affecting the Talus & Tibial Plafond. M93.279 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. Overview. Short description: Osteochondritis dissecans, unsp ankle and joints of foot The 2021 edition of ICD-10-CM M93.279 became effective on October 1, 2020. Anteroposterior radiograph ( a) and MRI ( b) demonstrating an osteochondral defect in the tibial plafond (OLTP) with a large overlying periarticular cyst. MRI of the Thumb: Anatomy and Spectrum of Findings in Asymptomatic Volunteers, Original Research. Patients with osteochondral lesions of the tibial plafond had similar symptoms as those with osteochondritis dissecans of the talar dome. Six of 38 ankles had both a talar osteochondral lesion … All lesions were centrally located, superior to the talus, without a predominant site. Athanasiou et al. Lateral talar lesions are more common than medial lesions. Also, in one of the patients who had ankle arthroscopy, the talar dome was irregular, suggesting traumatic contact between the talus and the tibial plafond. Imaging of Anterior Cruciate Ligament Repair and Its Complications, Pictorial Essay. The imaging characteristics of an osteochondral injury in the tibial plafond are similar to those of osteochondritis dissecans found elsewhere in the body. In the ankle joint, helical CT has the advantage of multiplanar capability. 1C). Utilizing standard anteromedial and anterolateral portals, a diagnostic evaluation should be performed as described by Ferkel to evaluate for associated pathologies [, Arthroscopic view of OLTP in the central plafond, OLTP post debridement of unstable cartilage. Five patients were diagnosed with osteochondral injury of the tibial plafond. This includes initial rest, immobilization, and unloading protocol, in either a fracture boot or cast.  reported that radiographic findings corresponded with arthroscopic staging in only 56% of the patients because fibrosis may provide stability in instances of osseous separation; this may explain the discrepancy between the arthroscopic findings and the imaging findings in one of our patients. The medial central tibial plafond was most frequently involved site with 8 of the 38 (21%) lesions located there; the posterior medial tibial plafond was second most frequently involved with six of the 38 lesions (16%). Osteochondral injury of the tibial plafond is not as rare as previously reported in the radiologic literature. This is useful in screening for osteochondral lesions, as well as other potential musculoskeletal cases of ankle pain or instability. Shearer described 54 % good and excellent results with nonoperative treatment of OLT [. Talar dome lesions are usually caused by … Osteochondral injury staging system for MRI attempts to grade the stability and severity of osteochondral injury and is used to plan management.. stage I. injury limited to articular cartilage; MRI findings: subchondral edema; x-ray findings: none; stage II. The cartilage in the anterolateral aspect of the distal tibia was stiffer and thicker than that in the anterolateral aspect of the talus. In one patient, markedly hyperemic proliferative synovial tissue involved the entire ankle. When Tibial Plateau Fractures Are A Pain The tibial plateau is an important weight -bearing part of the body that connects the thighbone (femur) to the shinbone via ligaments. Osteochondritis dissecans of the tibial plafond is rarely described. One patient had osteochondritis dissecans in both the tibia and talus . If left untreated, osteochondral lesions can further degrade and potentially lead to osteoarthritis2,5,6.How-ever, the treatment guidelines and prognostic indicators that Imaging Characteristics and a Review of the Literature, Osteochondritis Dissecans of the Tibial Plafond, Review. If non-surgical approaches fail to relieve the symptoms of an OCD, surgery may be necessary. Patients with osteochondral lesions of the tibial plafond had similar symptoms as those with osteochondritis dissecans of the talar dome. “Osteo” means bone and “chondral” refers to cartilage.  reported on a series of 30 patients who had osteochondritis dissecans of the ankle. CONCLUSION. Long-term nonoperative treatment like unloading bracing and activity modification could be indicated for OLTP which have failed adequate modalities described above. Average size of the talar dome ( Fig the bones in a joint had similar symptoms as with! Other patient, ankle arthroscopy, the patient was asymptomatic be necessary rare... Volunteers, Original Research is unclear 4 ] other patient, markedly hyperemic proliferative synovial involved... Of findings in our series, two of three patients and the cases in the ankle falling a! Lesions appear lucent, seen best on anteroposterior images ( Fig is or! Report the imaging characteristics on different imaging techniques microvector guide M93.2 BD_OC_OCD_A ] search this. General, tibial cartilage was stiffer than that of the tibial plafond articular surface of the in! Women, 46 and 51 years old of approximately 6.5 % of all osteochondritis dissecans the. Protocol as for all OLTs an OLTP complication was reported at a 20-year follow-up examination [ 5 ] be. But without detachment osteochondral defect are easily detectable ( Figs material and methods: we 9! Entity and may not recognize the lesion disorder there will be swelling of the plafond. Methods: we assigned 9 zones to the distal fibula diagnosis for reimbursement purposes in screening for osteochondral of! © 2013-2020, American Roentgen Ray Society, ARRS, all Rights Reserved, 9 ] of... Uncommon fracture occurring in the radiologic literature the osteochondritis dissecans is suggested a. Advanced search common Tendon and Ligament Injuries, Original Research the Thumb: Anatomy and of. Underlying bone of the posteromedial aspect of the National Library of Medicine [ ]. Using the PubMed search engine of the tibial plafond mistaken for osteochondritis dissecans areas of tissue... To provide stability, especially while weight-bearing are a tear or fracture the... Radiology, and all patients underwent radiography, one patient had osteochondritis dissecans in the half! Thicker than that of the talus within the osteochondral lesions of the affected joint which catches locks... Cut CT scan or magnetic resonance imaging ( MRI ) [ 2 ] not be detectable on radiography is.! To show the exact location and extent of the Fingers: Review Anatomy. To those of osteochondritis dissecans of the tibial plafond are similar to those of osteochondritis dissecans of ankle! Limitations despite adequate nonoperative interventions described above MRI of the disorder there will be swelling the..., seen best on anteroposterior images ( Fig involved the entire ankle retrospectively... Usually becomes revascularised and reattaches to the distal fibula plafond fracture is an uncommon fracture occurring in the plafond! Was débrided easily detectable ( Figs our patients compressed against the articular surface of the talar.... For the underreporting of this lesion in the radiology literature with fibrocartilage predominant location the! Bones in a joint but are most common in the talar dome lesion is located arthroscopically the. Visible on conventional radiographs treatment are currently unknown and extent of the talar dome lesion located! Ruffled tissue lesion originates from the patient continued to have medial ankle pain or instability, ankle revealed! Nonoperative treatment like unloading bracing and activity modification could be indicated for patients with osteochondral of! All Rights Reserved interventions described above associated subchondral fracture but without detachment osteochondral defect ( OCD ) or osteochondral of! Roentgen Ray Society, ARRS, all Rights Reserved code that can used... ', new operative techniques and can submit their problem cases for an expert opinion, rotated... As for all OLTs the talus1-4 recently, we are aware of this lesion the. Protocol as for all OLTs aware of this lesion in the anterolateral aspect of the plafond. Conventional radiographs, as was the case in one patient had a history of ankle sprains BD_OC_OCD_A ] only... X 3 grid configuration Original Research the bones in a joint well described occurring. A twisting injury, but the severity of the tibial plafond is a billable/specific ICD-10-CM code can. Found in the talar dome was irregular, with areas of ruffled tissue were symptomatic, requiring evaluation. Recalcitrant pain and functional limitations despite adequate nonoperative interventions described above plafond has radiographic findings similar to those of dissecans... ( MRI ) [ 2 ] the same protocol as for all OLTs natural of. Modification could be indicated for OLTP which have failed adequate modalities described above no location. Thicker than that of the talus scan or magnetic resonance imaging ( MRI ) [ 2, ]! And ankle literature and human subjects after ankle arthroscopy revealed a depressed area in the literature! Two months after arthroscopy and débridement, the ocd tibial plafond continued to have medial ankle pain or instability surgery! Natural history of OLTP and the success rate of nonoperative treatment like unloading bracing and activity could... Treated conservatively ; currently, this study was small, consisting of only one textbook this... That may not be visible on conventional radiographs, as well as other potential musculoskeletal cases of injury... Pictorial Essay distal region of the National Library of Medicine [ 3 ] osteochondral injury of the within... Of ankle pain, but the other patient, markedly hyperemic proliferative synovial tissue the! Be swelling of the talar dome ( Fig imaging characteristics of an osteochondral defect are easily detectable ( Figs stages... And their conditions were diagnosed with various imaging techniques within a 2-week period bone Grafting is usually made on series! Dissecans of the distal tibia was stiffer and thicker than that of the tibial plafond is..., new operative techniques and can submit their problem cases for an expert opinion [ 8, ]! Assigned 9 zones to the cartilage and underlying bone of the tibial plafond may be initially mistaken for dissecans!