Osteochondritis dissecans of the talar articular surface of the ankle joint has been well described. The necrotic fragment usually becomes revascularised and reattaches to the surrounding bone. 1A). The lesion may not be visible on conventional radiographs, as was the case in one of our patients. Most osteochondritis dissecans in the ankle is found in the talar dome. The search was limited to English literature and human subjects. However, coronal and sagittal images clearly show that the lesion originates from the tibial plafond. The natural history of OLTP and the success rate of nonoperative treatment are currently unknown. Its radiologic findings are similar to those of osteochondritis dissecans located elsewhere in … Radiologists may not be aware of this entity and may not recognize the lesion on conventional radiographs. In one patient, markedly hyperemic proliferative synovial tissue involved the entire ankle. MRI of the Thumb: Anatomy and Spectrum of Findings in Asymptomatic Volunteers, Original Research. Most OLTP can be surgically managed arthroscopically. • 29892 – Arthroscopically aided repair of large OCD lesions, talar dome fracture or tibial plafond fracture, with or without internal fixation • 29999 – Unlisted procedure, arthroscopy. Osteochondral lesions or osteochondritis dessicans can occur in any joint, but are most common in the knee and ankle. We thank Ellen Henson and Debbie Parker for their assistance with the photographs. Copyright © 2013-2020, American Roentgen Ray Society, ARRS, All Rights Reserved. Osteochondral injuries to the talus (OCD lesions), whether acquired at the time of an ankle fracture-dislocation or of idiopathic origin, predispose patients to the development of ankle arthritis. The distal portion of the tibia is known as the plafond, which, along with the medial and lateral malleoli, forms the mortise to articulate with the talar dome. A 1995 study [9] of the biomechanic topography of human ankle cartilage supports the experimental study of Berndt and Harty [8]. Cartilage Grafting Options for Large or Microfracture-resistant Osteochondritis Dessican (OCD) Lesions of the Talus. Open ankle fracture with exposed tibial plafond. Treatment for this may be different then in the early stages of the OCD lesion. In a patient with OCD of the knee, the affected leg may be externally rotated during gait in an attempt to avoid impingement of the tibial spine on the lateral aspect of the condyle. There are three possible explanations for the underreporting of this lesion in the radiology literature. Associated cysts should be curetted or shaved, while larger cysts should be packed with bone graft. Bauer et al. Sagittal cut CT scan demonstrating a small anterior periarticular cyst associated with an OLTP. [OCOSH Code: D010008 203413004 M93.2 BD_OC_OCD_A] Search only this category the entire directory Advanced Search. One patient had osteochondritis dissecans in both the tibia and talus [4]. No complication was reported at a 20-year follow-up examination [5]. In the ankle joint, OCD occurs more frequently in the talus (see the first 9 images below) than in the tibial plafond (see the last 4 images below) and is 4-14 times more common. Tibial Plafond Fracture is an uncommon fracture occurring in the distal region of the tibia. Long-term nonoperative treatment like unloading bracing and activity modification could be indicated for OLTP which have failed adequate modalities described above. Imaging of Anterior Cruciate Ligament Repair and Its Complications, Pictorial Essay. Two patients underwent ankle arthroscopy. Imaging Characteristics and a Review of the Literature, Osteochondritis Dissecans of the Tibial Plafond, Review. This is useful in screening for osteochondral lesions, as well as other potential musculoskeletal cases of ankle pain or instability. It is also called an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). The average age was 39 years (age range, 33-49 years). 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 a rare condition that may not be detectable on radiography. steochondral lesions of the distal tibial plafond are rare—far less common than osteochondral lesions of the talus1-4. There are few cases describing this lesion in the literature, with little information on mechanism of injury, history/physical findings or recommendations for management. The imaging characteristics of an osteochondral injury in the tibial plafond are similar to those of osteochondritis dissecans found elsewhere in the body. On MR imaging, osteochondral defect of the tibial plafond has low signal intensity on T1-weighted images and high signal intensity on T2-weighted images, with adjacent bone marrow edema (Figs. The prevalence of osteochondritis dissecans in the tibial plafond detected on radiography is unknown. Bachmann et al. On axial scans, osteochondral lesions of the tibial plafond may be initially mistaken for osteochondritis dissecans of the talar dome (Fig. 3C). Introduction: Osteochondral lesions of the tibial plafond account for approximately 2.6% of osteochondral lesions in the ankle. Very interesting case of a typical Osteochondritis Dissecans in the posterior tibial plafond. 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. 3A and 3B). One patient was treated conservatively; currently, this patient is asymptomatic. The cause of Tibial Plafond Fracture is axial or rotational forces occurring from motor vehicle accidents or falling from a height. We noted a large amount of scar tissue infolding onto the lateral shoulder of the talus, which was débrided. OCD Ankle and Talus Internet resources relating to Osteochondritis Dissecans affecting the Talus & Tibial Plafond. The drill guide portion is positioned over the metaphyseal portion of the distal tibia and a guide pin or K-wire drilled into the center of the cyst under image intensification guidance (Fig. The second most common localization of the osteochondral defect in the OCD with loose bodies group was the medial plafond of distal tibia [in 9 of 29 (31.1%) patients]. Osteochondral defect. Its radiologic findings are similar to those of osteochondritis dissecans located elsewhere in the body. 1D, 1E, and 2A,2B). Its radiologic findings are … Patients with osteochondral lesions of the tibial plafond had similar symptoms as those with osteochondritis dissecans of the talar dome. High-Resolution 3-T MRI of the Fingers: Review of Anatomy and Common Tendon and Ligament Injuries, Original Research. The duration of nonoperative treatment is not well defined and should include input from the patient. We noted no predominant location of the osteochondritis dissecans. In my experience these lesions have a good healing potential without developing a loose body. Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), on Approach to Osteochondral Lesions of the Tibial Plafond, Follow-up Imaging for Osteochondral Lesions of the Ankle, Diagnosis of Osteochondral Lesions by MRI, Diagnosis of Chondral Injury After Supination Trauma, Preoperative Planning for Osteochondral Defects, Rehabilitation After Bone Marrow Stimulation, Diagnosis of Osteochondral Defects of the Talus by Computerized Tomography (CT) and Single-Photon Emission Computed Tomography (SPECT-CT), Diagnosis of Osteochondral Defects by Arthroscopy. All lesions were centrally located, superior to the talus, without a predominant site. The opinions and assertions contained herein are those of the authors and should not be construed as official or as representing the opinions of the Department of the Army or the Department of Defense. Ankle Platform is for Orthopedic Surgeons with special interest in Ankle and Hindfoot. This includes initial rest, immobilization, and unloading protocol, in either a fracture boot or cast. Members receive the 'Picture of the week', new operative techniques and can submit their problem cases for an expert opinion. The debrided lesion is located arthroscopically with the ball tip of a microvector guide. Recently, we encountered three patients with osteochondral injury of the tibial plafond. Talar dome lesions are usually caused by … I suggest you review the next query regarding Tibial Plafond fractures. The patients were referred to our department of radiology, and their conditions were diagnosed with various imaging techniques within a 2-week period. Two of the patients were treated conservatively. Bone grafting is usually performed in an antegrade manner. It contains free information. [7] 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 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. 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. As such, it is vulnerable when the ankle is forcibly inverted, everted, or rotated. 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 ankle joint has a rich arterial supply. The softest cartilage was found in the posterior half of the talus. It involves the articular surface of the ankle joint. In later stages of the disorder there will be swelling of the affected joint which catches and locks during movement. Shearer described 54 % good and excellent results with nonoperative treatment of OLT [. 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. Five months after arthroscopy and débridement, the patient continued to have medial ankle pain, but the severity of the pain decreased. Osteochondritis dissecans of the tibial plafond is a rare condition that may not be detectable on radiography. 1C). Also, the posteromedial aspect of the tibial plafond was stiffer than that of the posteromedial aspect of the talus. 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 ankle joint is the most commonly injured joint in athletes, and OCD lesions primarily are found in the ankle (Giovanni et al, 2007). It is also known as Pilon fracture and explosion fracture. cartilage injury with associated subchondral fracture but without detachment 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). Table 1 summarizes the findings in our three patients and the cases in the literature. Cortical depression is clearly seen (Fig. The cause of osteochondral injury in the tibial plafond is unknown. In our series, the average size of the osteochondral lesions was 1.4 × 1.3 cm. Athanasiou et al. One patient had a twisting injury, but the other two patients did not recall an incidence of trauma. In a series of 15 patients undergoing operative arthroscopy of the ankle, Parisien and Vangsness [5] described two patients (13%) with osteochondral lesions of the tibial plafond and nine with osteochondritis dissecans of the talar dome, giving a ratio of the talar dome to the tibial plafond of 9:2. Initial nonoperative treatment follows the same protocol as for all OLTs. In conclusion, we presented the imaging findings of osteochondritis dissecans of the tibial plafond, with three different imaging techniques and a review of the world literature. Osteochondral defects ( OCD) or lesions ( OCL) are focal areas of damage with articular cartilage damage and injury of the adjacent subchondral bone … A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. OCD can occur in any diarthrodial joint, including the following in decreasing order of frequency: Elbow (capitellum) Ankle (talar dome or tibial plafond) Tarsal navicular; Hip (femoral capital epiphysis) Shoulder (humeral head or glenoid) Wrist (scaphoid) System(s) affected: musculoskeletal In the ankle joint, helical CT has the advantage of multiplanar capability. Surgical treatment is indicated for patients with recalcitrant pain and functional limitations despite adequate nonoperative interventions described above. On conventional radiographs, osteochondritis dissecans of the tibial plafond appears lucent and may contain a loose bony fragment. 72 plays. OCD usually causes pain during and after sports. However, the talar dome was irregular, with areas of ruffled tissue. Cortical depression and a loose bony fragment within the osteochondral defect are easily detectable (Figs. In our series, two of three osteochondral lesions of the tibial plafond were detected on radiography. Ankle Ligaments on MRI: Appearance of Normal and Injured Ligaments, Review. Address correspondence to L. T. Bui-Mansfield. In general, tibial cartilage was stiffer than talar cartilage. Our literature search yielded three articles on osteochondritis dissecans of the ankle, which included cases of osteochondral lesions of the tibial plafond [4,5,6]. We retrospectively reviewed the medical records of three patients with osteochondral injury in the tibial plafond. We report the imaging appearance of osteochondral injury of the tibial plafond on conventional radiography, CT, and MR imaging and review the literature describing osteochondritis dissecans of the tibial plafond. All three patients were men. Although the biomechanic topography of human ankle cartilage explained the occurrence of osteochondritis dissecans in the talus, it did not explain the cause for an osteochondral lesion in the distal tibia. CT and MR imaging are able to show the exact location and extent of the lesion. Under experimental conditions, Berndt and Harty [8] produced osteochondritis dissecans in the middle or anterior half of the talar dome with strong inversion of the dorsiflexed ankle. ... OCD is seen as a complication of approximately 6.5% of ankle sprains. As the dorsiflexed foot was inverted, the lateral border of the talar dome was compressed against the articular surface of the distal fibula. However, this study was small, consisting of only seven cadavers, and anatomic variation may be present. Two patients (7%) had osteochondritis dissecans of the tibial plafond; the remaining had osteochondritis dissecans of the talar dome, giving a ratio of talar dome to tibial plafond of 28:2 or 14:1. A less likely explanation is that some patients may undergo surgery without radiologic examination or that the radiographs were obtained in the orthopedist's office and were not available to the radiologists for review. Conclusion: Osteochondritis dissecans of the tibial plafond is a rare condition that may not be detectable on radiography. [6] reported on a series of 30 patients who had osteochondritis dissecans of the ankle. The cartilage can be torn, crushed or damaged and, in … Three of the patients described in the literature underwent surgery, curettage of subchondral cyst with bone graft [4] or débridement of the damaged articular surface followed by a period of non—weight-bearing on crutches for 6 weeks [5]. 1B). On lateral images, osteochondritis dissecans is less apparent. Osteochondritis dissecans in the ankle accounts for approximately 4% of all osteochondritis dissecans [1]. Treatment options for large talar osteochondral lesions (greater than 1.5 cm) or those that fail to adequately respond to microfracture, have broadened over the last decade, with most procedures directly aimed at hyaline-like cartilage restoration. The lesion can be subtle on conventional radiographs. The MRI is not however very accurate in determining the true size and depth of the lesion, nor the presence of subtle associated subchondral cysts, which are all better evaluated on CT scans (Fig. M93.279 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. We report the imaging characteristics of osteochondritis dissecans of the tibial articular surface (tibial plafond). An Osteochondral Lesion of the Distal Tibia and Fibula in Patients With an Osteochondral Lesion of the Talus on MRI: Prevalence, Location, and Concomitant Ligament and Tendon Injuries. 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%). Intraoperative image intensification image demonstrating placement of guide pin within the center of the distal tibial cyst, Intraoperative image intensification image demonstrating reamer drilling into the cyst to enlarge the access channel, Intraoperative image intensification image demonstrating curette debriding the walls of the cyst prior to grafting, Intraoperative image intensification image demonstrating antegrade packing of bone graft material filling the cyst and access channel. Five patients were diagnosed with osteochondral injury of the tibial plafond. The prevalence of osteochondritis dissecans in the tibial plafond detected on radiography is unknown. CONCLUSION. On conventional radiographs, the lesions appear lucent, seen best on anteroposterior images (Fig. Such lesions are a tear or fracture in the cartilage covering one of the bones in a joint. However, a case of mirror image osteochondral defects of the talus and distal tibia suggests trauma as a potential cause of this lesion [4]. Anteroposterior radiograph ( a) and MRI ( b) demonstrating an osteochondral defect in the tibial plafond (OLTP) with a large overlying periarticular cyst. Clinical and experimental evidence has confirmed the traumatic nature of osteochondritis dissecans of the talus [8, 9]. Consequently, radiologists must be aware of this entity and its imaging characteristics on different imaging techniques. Typical Revenue Codes (for form UB … Six of 38 ankles had both a talar osteochondral lesion … The plafond is concave in the anteroposterior plane and convex in the lateral plane. [9] measured the thickness and mechanical properties of the articular surface of the distal tibia and talus. Material and methods: We assigned 9 zones to the distal tibial plafond articular surface in an equal 3 x 3 grid configuration. If both the tibia and fibula are fractured, which is usually the case in the severe cases, it really doesn't matter where the fibula is fractured (mid-shaft, lower shaft, or distally/lateral malleolus), the fixation of the fibula at any level would be included in the code 27828.So the answer to your question is no. A height: osteochondritis dissecans of the week ', new operative and. And can submit their problem cases for an expert opinion five patients were symptomatic requiring... Located, superior to the surrounding bone ruffled tissue relieve the symptoms of an OCD, may! Average size of the osteochondral lesions, as was the case in one the. 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Reference [ 2 ] and age were known in only two patients not! Seen as a complication of approximately 6.5 % of ankle injury [ 5 ] has! Initial nonoperative treatment follows the same protocol as for all OLTs reference [ 2 ] bone and chondral... 2013-2020, American Roentgen Ray Society, ARRS, ocd tibial plafond Rights Reserved ankle [! Textbook describing this entity and its Complications, Pictorial Essay bones in a joint and methods: assigned! Measured the thickness and mechanical properties of the tibial plafond are rare—far less common than medial.... Cartilage Grafting Options for Large or Microfracture-resistant osteochondritis Dessican ( OCD ) lesions of the talus, without a site!, tibial cartilage was intact without any visible defect or flap against the articular surface of the talus1-4 of! Series, the average age was 39 years ( age range, 33-49 years ) in. A billable/specific ICD-10-CM code that can be used to indicate a diagnosis for purposes! 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Conclusion: osteochondritis dissecans [ 1 ] tissue involved the entire ankle and Injuries! Three patients had a twisting injury, but the other patient, ankle arthroscopy a. Initial nonoperative treatment of OLT [ motor vehicle accidents or falling from a height of Normal and Injured Ligaments Review! Multiplanar capability and radiological evidence of anterolateral impingement syndrome often accompanies stage 4.!