Talar Articular Cartilage Research Articles

Cartilage repair techniques of the talus: An update.

Symptomatic chondral or osteochondral defects of the talus reduce the quality of life of many patients. Although their pathomechanism is well understood, it is well known that different aetiologic factors play a role in their origin. Additionally, it is well recognised that the talar articular cartilage strongly differs from that in the knee. Despite this fact, many recommendations for the management of talar cartilage defects are based on approaches that were developed for the knee. Conservative treatment seems to work best in paediatric and adolescent patients with osteochondritis dissecans. However, depending on the size of the lesions, surgical approaches are necessary to treat many of these defects. Bone marrow stimulation techniques may achieve good results in small lesions. Large lesions may be treated by open procedures such as osteochondral autograft transfer or allograft transplantation. Autologous chondrocyte transplantation, as a restorative procedure, is well investigated in the knee and has been applied in the talus with increasing popularity and promising results but the evidence to date is poor. The goals of the current article are to summarise the different options for treating chondral and osteochondral defects of the talus and review the available literature.

Treatment principles for osteochondral lesions in foot and ankle

Osteochondral lesion of the talus (OLT) is a broad term used to describe an injury or abnormality of the talar articular cartilage and adjacent bone. A variety of terms have been used to refer to this clinical entity, including osteochondritis dissecans (OCD), osteochondral fracture and osteochondral defect. Whether OLT is a precursor to more generalised arthrosis of the ankle remains unclear, but the condition is often symptomatic enough to warrant treatment. In more than one third of cases, conservative treatment is unsuccessful, and surgery is indicated. There is a wide variety of treatment strategies for osteochondral defects of the ankle, with new techniques that have substantially increased over the last decade. The common treatment strategies of symptomatic osteochondral lesions include nonsurgical treatment, with rest, cast immobilisation and use of nonsteroidal anti-inflammatory drugs (NSAIDs). Surgical options are lesion excision, excision and curettage, excision combined with curettage and microfracturing, filling the defect with autogenous cancellous bone graft, antegrade (transmalleolar) drilling, retrograde drilling, fixation and techniques such as osteochondral transplantation [osteochondral autograft transfer system (OATS)] and autologous chondrocyte implantation (ACI). Furthermore, smaller lesions are symptomatic and when left untreated, OCDs can progress; current treatment strategies have not solved this problem. The target of these treatment strategies is to relieve symptoms and improve function. Publications on the efficacy of these treatment strategies vary. In most cases, several treatment options are viable, and the choice of treatment is based on defect type and size and preferences of the treating clinician.

Treatment of talar osteochondral lesions using local osteochondral talar autograft mid term results

BackgroundOsteochondral lesion of the talus (OLT) is a broad term used to describe an injury or abnormality of the talar articular cartilage and adjacent bone. A variety of treatment methods...

Current Concept Review: Osteochondral Lesions of the Talus

Osteochondral lesion of the talus (OLT) is a broad term used to describe an injury or abnormality of the talar articular cartilage and adjacent bone. Historically, a variety of terms have been used to refer to this clinical entity including osteochondritis dissecans, osteochondral fracture, and osteochondral defect. Currently, six characteristics are used to categorize a particular lesion (Table 2). An OLT can be described as chondral (cartilage only), chondral-subchondral (cartilage and bone), subchondral (intact overlying cartilage), or cystic. Lesions can then be subdivided as stable or unstable and non-displaced or displaced. The stability of a lesion can be assessed directly with arthroscopy or indirectly with MRI using DeSmet’s criteria.6 A lesion can also be categorized by its location on the articular surface of the talus as medial, lateral, or central with added subdivisions into anterior, central, or posterior as advocated by some authors.82 An additional description of identifying whether the lesion is contained or uncontained (shoulder) may also be included. Finally, although no accepted definition of lesion size exists, OLTs can generally be considered as either small or large based on their cross-sectional area or greatest diameter (area greater than or less than 1.5 cm2 or diameter greater than or less than 15 mm). Although these characteristics provide a scheme to classify OLTs and to select a therapeutic modality, they do not reliably predict the outcome of treatment. While the exact incidence of symptomatic OLTs is unknown, they are quite prevalent and are a significant

Cartilage Transplantation Techniques for Talar Cartilage Lesions

Talar articular cartilage is known to differ significantly from knee cartilage. Even so, recommendations for the treatment of talar cartilage lesions have been based on strategies for the knee. Arthroscopic management of osteochondral lesions of the talus is well documented. Results have been favorable with reparative techniques such as débridement with curettage and débridement with drilling, whether undertaken via early open techniques or more recent arthroscopic procedures. Salvage of failed reparative techniques is controversial. Early efforts to salvage failed débridement focused on osteochondral allografts and autografts that used the knee as a donor site. Results of these restorative techniques have been favorable, but concerns have been raised regarding knee donor site morbidity, the use of malleolar osteotomy, and incomplete restoration of the talar articular surface. More recent restorative techniques developed for the knee have been adapted for the ankle, such as autologous chondrocyte implantation and matrix-induced autologous chondrocyte implantation.

The functional anatomy of the human anterior talofibular ligament in relation to ankle sprains

The anterior talofibular ligament is the most commonly injured ligament in the ankle. Despite considerable interest in the clinical outcome of treatment protocols, we do not know whether the distinctive pattern of localization of the injuries relates to regional differences in the structure and molecular composition of the ligament. To address this issue, ligaments were examined by histology and immunohistochemistry. Differences in the structure of its two attachments (i.e. entheses) were evaluated with quantitative, morphometric techniques, and regional differences in the distribution of collagens, glycosaminoglycans and proteoglycans were determined qualitatively by immunolabelling. Morphometric analyses showed that bone density was less at the fibular attachment, but that enthesis fibrocartilage was more prominent. Immunohistochemistry revealed the presence of a fibrocartilage (containing type II collagen and aggrecan) at the site where the ligament wraps around the lateral talar articular cartilage in a plantarflexed and inverted foot: the fibrocartilage is regarded as an adaptation to resisting compression. We propose that avulsion fractures are less common at the talar end of the ligament because (1) bone density is greater here than at the fibular enthesis, and (2) stress is dissipated away from the talar enthesis by the 'wrap-around' fibrocartilaginous character of the ligament near the talar articular facet.