Talar dome

OBJECTIVE: Osteochondral lesions of the talus (OLT) with a fragment on the talar dome that fail conservative treatment and need surgical treatment can benefit from in situ fixation of the OLT. Advantages of fixation include the preservation of native cartilage, a high quality subchondral bone repair, and the restoration of the joint congruency by immediate fragment stabilization. To improve the chance of successful stabilization, adequate lesion exposure is critical, especially in difficult to reach lesions located on the posteromedial talar dome...

UNLABELLED: Osteochondral lesions of the talar dome (OLTD) are most often found in patients for whom the return to sports activities is the main issue. Two types of surgery have been distinguished at present, bone marrow stimulation techniques and mosaicplasty techniques. The size of the lesion indicating the need for bone marrow stimulation as the required surgical procedure has recently been decreased (< 1cm). The main objective of this study was therefore to evaluate the return to sport after OLTD surgery...

Pure dislocation of the ankle is an extremely rare injury accounting for only 0.065% of all ankle injuries and 0.46% of all ankle dislocations. The mechanism of the injury generally consists of high-energy trauma which is associated with a combination of plantar flexion and inversion or eversion of the foot. We present a case of a 22-year-old male patient who sustained a closed pure ankle dislocation after a fall from a small height. He was treated conservatively with closed reduction and circumferential cast immobilization for six weeks, followed by a functional rehabilitation program...

BACKGROUND: To present prospective short-term results of a limited patient series treated with two innovative partial ankle arthroplasties: talar dome resurfacing for mild-to-moderate ankle osteoarthritis (OA) and talar shoulder hemiarthroplasty for chronic medial osteochondral lesions of the talus (OLT). METHODS: Eleven subjects underwent talus resurfacing, and six subjects were enrolled for talar hemiarthroplasty. The outcome was followed by patient-reported measures and by pursuing serious adverse events or implant failures over a 2-year period...

To evaluate the outcome of Achilles tenotomy at first cast in neonates with stiff clubfoot undergoing Ponseti's method of treatment. One hundred forty stiff clubfeet (Dimeglio grades III and IV) scheduled for Ponseti's method were prospectively randomized into two groups of 70 each: (1) early, tenotomy at first cast; (2) late, tenotomy at fourth to sixth casts (conventional). The procedure was performed under local lidocaine spray in an office setting using a needle. The results were assessed at an average follow-up of 12...

BACKGROUND: Press-fit Talar OsteoPeriostic grafting from the Iliac Crest (TOPIC) is a novel technique for the treatment of large osteochondral lesions of the talus. The purpose of the present study was to prospectively evaluate the 2-year clinical outcomes for patients with medial osteochondral lesions of the talus that were treated with the TOPIC procedure. METHODS: Forty-three patients were prospectively assessed before and 24 months after the TOPIC procedure...

BACKGROUND: In vivo evaluation of ankle joint biomechanics is key to investigating the effect of injuries on the mechanics of the joint and evaluating the effectiveness of treatments. The objectives of this study were to 1) investigate the kinematics and contact strains of the ankle joint and 2) to investigate the correlation between the tibiotalar joint contact strains and the prevalence of osteochondral lesions of the talus distribution. METHODS: Eight healthy human ankle joints were subjected to compressive load and 3 T MRIs were obtained before and after applying load...

Subchondroplasty is a novel and minimally invasive technique used to treat large subchondral talar cysts. It avoids soft tissue scarring, the need for osteotomies, bone grafting and its associated complications as seen with conventional approaches. Subchondroplasty involves arthroscopically approaching the cyst and injecting it with calcium phosphate paste injection, which undergoes an endothermic process and crystallizes in a manner that resembles cancellous bone to fill the defect. This case series presents two patients who underwent subchondroplasty: a 44-year-old female nurse with atraumatic right ankle pain of 2 years with a CT scan revealing a large subchondral cyst over the medial talar dome and a 55-year-old male chemical plant worker with left ankle pain following a biking accident 6 years ago whose CT scan too showed a large subchondral cyst in the medial talus...

OBJECTIVES: We present a 3-D approach to joint space width (JSW) measurement across the ankle from weight-bearing CT (WBCT) to demonstrate inter-operator reproducibility, test-retest repeatability, and how differences in angulation affect ankle JSW distribution. METHODS: One side from repeat WBCT imaging of both feet and ankles was analysed from 23 individuals as part of their routine clinical care pathway. Joint space mapping was performed at four facets across the talus: talonavicular, talar dome and medial gutter (dome-medial), lateral gutter, and posterior subtalar...

PURPOSE: Arthrodesis of the ankle joint is an accepted treatment option in patients with end-stage ankle arthritis. The goal is to achieve fusion between the tibia and the talus, thereby stabilizing the joint and alleviating pain. There might be associated limb length discrepancy, especially in post-traumatic and post-infectious cases. These patients require limb lengthening and arthrodesis. The purpose of this study is to report our experience with simultaneous ankle arthrodesis and lengthening using external fixation in adolescent and young adult patients...

BACKGROUND: We investigated the relationship between ankle radiographic bone morphology and observed fracture type. METHODS: We retrospectively reviewed patients who had visited the emergency department with ankle injuries between June 1, 2012, and July 31, 2018. Patients were treated with open reduction and internal fixation. Patients were grouped by fracture pattern. Group 1 consisted of isolated lateral malleolar fractures, and group 2 comprised bimalleolar fractures...

INTRODUCTION: Bosworth ankle injuries (BAIs) are rare talocrural dislocations with bi or trimalleolar fractures. Attempted closed reduction fails due to incarcerated fibular fracture behind the distal tibia. The diagnostic delay and failed attempts to restore anatomical reduction result in significant ankle swelling, compromised skin, and imminent compartment syndrome. In neglected cases with unreduced dislocation over months, capsular and tendo-Achilles contracture, additional disuse osteoporosis, adds to the complexity of surgical management...

Osteochondral lesions of the dome of the talus are becoming an increasingly frequent problem in sports traumatology, and questioning is a major element in the diagnostic orientation, as these are usually young, athletic patients. The main part of the diagnosis is based on complementary imaging examinations. We report the clinical observation of an adult patient, an athlete, referred to a rheumatology consultation for chronic pain of the right ankle with a mechanical appearance and difficulty in walking. Clinical and paraclinical examinations (standard X-ray, CT scan and magnetic resonance imaging) finally led to the conclusion of an osteochondritis of the talus...

BACKGROUND: Osteochondral defects of the talus can be effectively treated using microfracture, which is technically safe, accessible, and affordable. However, fibrous tissue and fibrocartilage comprise the majority of tissue repairs resulting from these procedures. These tissue types lack the mechanical characteristics of native hyaline cartilage and might significantly contribute to the decline in long-term outcomes. Recombinant human-bone morphogenetic protein-2 (rhBMP-2) has been shown to promote matrix synthesis and increase cartilage formation, thus enhancing chondrogenesis in vitro...

The early effects of progressive collapsing foot deformity (PCFD) on the ankle and syndesmotic joints have not been three-dimensionally quantified. This case-control study focused on using weight bearing CT (WBCT) distance (DM) and coverage maps (CM) and volumetric measurements as 3D radiological markers to objectively characterize early effects of PCFD on the ankle and syndesmotic joints. Seventeen consecutive patients with symptomatic stage I flexible PCFD and 20 matched controls that underwent foot/ankle WBCT were included...

BACKGROUND: Though flatness of the talar dome (TD) is a potential consequence of operative and nonoperative clubfoot management, the functional impact of this deformity is not well understood. This study analyzes the relationship between TD morphology and ankle function at skeletal maturity in patients treated for idiopathic clubfoot during infancy. METHODS: 33 skeletally mature patients (average age 17.9 years) with 48 idiopathic clubfeet were identified. Weightbearing radiographs, gait analysis, and patient-reported outcomes using the Pediatric Orthopaedic Data Collection Instrument (PODCI) were obtained...

INTRODUCTION: Dysplasia epiphysealis hemimelica, also known as Trevor disease, is a rare skeletal development disorder of childhood, characterized by asymmetric growth of the epiphyseal cartilage in childhood. The disease can be locally aggressive at the ankle, and can result in deformity or instability. We present a case of Trevor disease involving the lateral aspect of distal tibia and talus in a 9-year-old patient, and of highlight its clinical and radiological presentation, treatment, and outcomes...

We suggest a similar approach to evaluating osteochondral lesions of the talar dome both pre- and postoperatively. This review addresses the etiology, natural history, and treatment of talar dome osteochondral lesions with an emphasis on imaging appearances. High-resolution magnetic resonance imaging, ideally combining a small field-of-view surface coil with ankle traction, optimizes visibility of most of the clinically relevant features both pre- and postoperatively.

Large talar bone cyst can cause pathologic fracture and damage to the articular cartilage, resulting in persistent swelling and pain of the subtalar joint and ankle joint. For a symptomatic cyst not responding to conservative treatment, surgery can be considered. Open debridement and bone grafting frequently require extensive soft-tissue dissection or even different types of malleolar osteotomy for proper access to the lesion. Arthroscopic treatment of talar bone cyst is a feasible alternative minimally invasive approach to reduce surgical trauma and eliminate the need for osteotomy...

OBJECTIVE: To provide a natural scaffold, good quality cells, and growth factors to facilitate replacement of the complete osteochondral unit with matching talar curvature for large osteochondral lesions of the lateral talar dome. INDICATIONS: Symptomatic primary and non-primary lateral osteochondral lesions of the talus not responding to conservative treatment. The anterior-posterior or medial-lateral diameter should exceed 10 mm on computed tomography (CT) for primary lesions; for secondary lesions, there are no size limitations...