Approach to Osteochondral Lesions of the Tibial Plafond Fig. 3. Recht MP, Kramer J. MR imaging of the postoperative knee: a pictorial essay. However, the number of diseases that involve the tibial cortex is great, and it can be difficult to arrive at a limited differential diagnosis from radiographic findings. Osteochondral lesions of the distal tibial plafond (OLTP) are rare and far less common than osteochondral lesions of the talus. The cartilage can be torn, crushed or damaged and, in rare cases, a cyst can form in the cartilage. This is essential in determining management. A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. Ferkel RD, Zanotti RM, Komenda GA et-al. Introduction: Osteochondral lesions of the tibial plafond account for approximately 2.6% of osteochondral lesions in the ankle. 5. 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%). Both x-rays and CT are able to detect displaced defects with ease. A standard arthroscopic examination was performed via anteromedial and anterolateral portals. {"url":"/signup-modal-props.json?lang=us\u0026email="}, {"containerId":"expandableQuestionsContainer","displayRelatedArticles":true,"displayNextQuestion":true,"displaySkipQuestion":true,"articleId":1795,"mcqUrl":"https://radiopaedia.org/articles/osteochondral-defect/questions/571?lang=us"}. In the quest to replace osteochondral defects with hyaline cartilage, Brittberg et al. Download : Download high-res image (161KB) Download : Download full-size image Very interesting case of a typical Osteochondritis Dissecans in the posterior tibial plafond. Glossary of terms for musculoskeletal radiology. Am J Sports Med. {"url":"/signup-modal-props.json?lang=us\u0026email="}. Imaging strategies for the knee. Figure 1: Berndt and Harty classification for talus, osteochondritis dissecans surgical staging, Gustilo Anderson classification (compound fracture), longitudinal versus transverse petrous temporal bone fracture, naso-orbitoethmoid (NOE) complex fracture, cervical spine fracture classification systems, AO classification of upper cervical injuries, Roy-Camille classification (odontoid process fracture ), subaxial cervical spine injury classification (SLIC), thoracolumbar spinal fracture classification systems, AO classification of thoracolumbar injuries, thoracolumbar injury classification and severity score (TLICS), Rockwood classification (acromioclavicular joint injury), Neer classification (proximal humeral fracture), AO classification (proximal humeral fracture), Milch classification (lateral humeral condyle fracture), Weiss classification (lateral humeral condyle fracture), Bado classification of Monteggia fracture-dislocations (radius-ulna), Mason classification (radial head fracture), Frykman classification (distal radial fracture), Hintermann classification (gamekeeper's thumb), Eaton classification (volar plate avulsion injury), Keifhaber-Stern classification (volar plate avulsion injury), Judet and Letournel classification (acetabular fracture), Harris classification (acetebular fracture), Young and Burgess classification of pelvic ring fractures, Pipkin classification (femoral head fracture), American Academy of Orthopedic Surgeons classification (periprosthetic hip fracture), Cooke and Newman classification (periprosthetic hip fracture), Johansson classification (periprosthetic hip fracture), Vancouver classification (periprosthetic hip fracture), Winquist classification (femoral shaft fracture), Schatzker classification (tibial plateau fracture), Lauge-Hansen classification (ankle injury), Danis-Weber classification (ankle fracture), Berndt and Harty classification (osteochondral lesions of the talus), Sanders CT classification (calcaneal fracture), Hawkins classification (talar neck fracture), anterior superior iliac spine (ASIS) avulsion, anterior cruciate ligament avulsion fracture, posterior cruciate ligament avulsion fracture, avulsion fracture of the proximal 5th metatarsal, Ahlback classification system in assessing osteoarthritis of the knee joint, Kellgren and Lawrence system for classification of osteoarthritis, pattern of bone contusion in knee injuries, anterior cruciate ligament mucoid degeneration, MRI grading system for meniscal signal intensity, musculoskeletal manifestations of rheumatoid arthritis, rapidly destructive osteoarthritis of the hip, scaphotrapeziotrapezoidal (STT) arthritis, calcium pyrophosphate dihydrate deposition disease, hydroxyapatite crystal deposition disease (HADD), postsurgical (e.g. AJR Am J Roentgenol. Check for errors and try again. Gorbachova T, Melenevsky Y, Cohen M, Cerniglia BW. MRI is the modality of choice, with high sensitivity and specificity for the detection of separation of the osteochondral fragment (see: osteochondral injury staging and osteochondritis dissecans surgical staging). 2. (2020) Skeletal Radiology. Literature data do not report clinical records with significant number of cases and follow-up. May be normal. Foot Ankle Int. It is also called an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). Isolated lesions of cartilage or subchondral bone are not considered an OCD 6.Â. The objective of this study was to assess functional and magnetic resonance imaging (MRI) outcomes following microfracture for tibial osteochondral lesions. Sanders TG, Paruchuri NB, Zlatkin MB. Radiographically, they are lucent defect traversing the length of epiphysis, and may have sharp or irregular borders. 4.Retrieved When the latter is present, then joint replacement is often the only feasible treatment. Literature data do not report clinical records with significant number of cases and follow-up. Osteochondral defect is a broad term that describes the morphological change of a localized gap in the articular cartilage and subchondral bone 5.It is often used synonymously with osteochondral injury/defect and in the pediatric population. fractures involving a single facial buttress, Meyers and McKeevers classification (anterior cruciate ligament avulsion fracture), Watson-Jones classification (tibial tuberosity avulsion fracture), Nunley-Vertullo classification (Lisfranc injury), pelvis and lower limb fractures by region. However, coronal and sagittal images clearly show that the lesion originates from the tibial plafond. W B Saunders Co. (2001) ISBN:0721690270. Additional MRI findings were scored as present or absent: focal chondral thinning or absence at the notch of Harty, focal subcortical osteosclerosis at the anteromedial margin of the tibial plafond, osteochondral lesions elsewhere in the ankle, subchondral edema signal or cystic change at the tibial plafond, and the presence of an ankle joint effusion. 2009;6:524–9. 2006;187 (5): 1332-7. The Foot and Ankle Outcome Score (FAOS) and Short Form-12 (SF-12) general health questionnaire were used to obtain patient-reported functional outcome scores preoperatively and postoperatively. 9.1 Anteroposterior radiograph (a) and MRI (b) demonstrating an osteochondral defect in the tibial plafond (OLTP) with a large overlying periarticular cyst Diagnosis is usually made on a CT scan or magnetic resonance imaging (MRI) [ 2, 6 ]. Last modified Feb 10, 2011 07:52 ver. MRI scans were assessed postoperatively with use of the Magnetic Resonance Observation of Cartilage Repair Tissue … ... Radiology. Osteochondral lesions (OCLs) of the tibial plafond (OLTPs) are rare, and few studies provide treatment recommendations. Unable to process the form. William Palmer, Laura Bancroft, Fiona Bonar, Jung-Ah Choi, Anne Cotten, James F. Griffith, Philip Robinson, Christian W.A. The aim of our study was to … ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. (2018) Radiographics : a review publication of the Radiological Society of North America, Inc. 38 (5): 1478-1495. The necrotic fragment usually becomes revascularised and reattaches to the surrounding bone. eochondral lesions in thirty-one ankles underwent arthroscopic microfracture. 2008;36 (9): 1750-62. BACKGROUND: Osteochondral lesions of the distal tibial plafond are uncommon compared with talar lesions. Thieme, 2006. 1. Talar dome lesions … At earlier stages (stage 1 to 4), a number of options exist including: The knee is a complex synovial joint that can be affected by a range of pathologies: ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Elias I, Raikin SM, Schweitzer ME, Besser MP, Morrison WB, Zoga AC. Ross KA, Hannon CP, Deyer TW, Smyth NA, Hogan M, DO HT, Kennedy JG. Unable to process the form. osteochondral lesions of the tibial plafond may be initially mistaken for thoses of the talar dome. The recognized sites of osteochondral defects are: Osteochondral injuries are graded according to the stability and location of the fragment and presence of secondary degenerative changes (see: osteochondral injury staging). 4. Osteochondral lesion of the distal tibia is visible on the lateral view. It is often used synonymously with osteochondral injury/defect and in the pediatric population. Such lesions are a tear or fracture in the cartilage covering one of the bones in a joint. Osteochondral defects (OCD) or lesions (OCL) are focal areas of damage with articular cartilage damage and injury of the adjacent subchondral bone plate and subchondral cancellous bone.Â, Osteochondral defect is a broad term that describes the morphological change of a localized gap in the articular cartilage and subchondral bone 5. MRI of osteochondral defects of the lateral femoral condyle: incidence and pattern of injury after transient lateral dislocation of the patella. Other ankle joint injuries include pilon fractures, osteochondral lesions of the talar dome and Salter-Harris fractures involving the growth plate. Osteochondral injury staging system for MRI attempts to grade the stability and severity of osteochondral injury and is used to plan management. Osteochondral lesions of the talus: a revised classification. following anterior cruciate ligament repair), femoral condyle (most common in the lateral aspect of the medial femoral condyle), the signal is variable with intermediate to low signal adjacent to fragment and variable fragment signal, low signal loose bodies, outlined by high signal fluid, donor defect filled with high signal fluid. 3. Please note that OCD is a commonly used abbreviation for both osteochondral defect and osteochondritis dissecans, two closely related conditions. Additional investigation (CT/MRI): [Picture 2] CT revealed an osteochondral lesion of the distal tibia. Pilon fractures involve the tibial plafond. 1. ... than in the tibial plafond (see the last 4 images below) and is 4-14 times more common. 2. Radiographics. (1999) Foot & ankle international. Hepple S, Hepple WI, Hepple GD et-al. Sirlin CB, Brossmann J, Boutin RD et-al. Apparent irregularity (arrow) along lateral fibular metaphysis on frontal view (a) has well-corticated margins (arrowheads) on oblique view (b). Osteochondral lesions of the distal tibial plafond (OLTPs) are an uncommon problem. CrossRef Google Scholar In distal tibia the cleft tends to prefer the medial plafond at its connection with the medial malleolus. Isolated lesions of cartilage or subchondral bone are not considered an OCD 6.. Of these, only one was a ‘kissing’ lesion. MRI scan - osteochondral lesion on the talus with "kissing" lesion on the plafond Although the majority of osteochondral lesions occur after a definite injury, some have no clear history of injury. Osteochondral lesions of the distal tibial plafond: localization and morphologic characteristics with an anatomical grid. (A) T1-weighted and (B) fat-saturated T2-weighted sagittal images of the ankle show an osteochondral lesion involving the lateral tibial plafond with impaction of the articular surface and subjacent reactive marrow edema in this patient status post an eversion injury. 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. Cortical depression and a loose bony fragment within the osteochondral defect are easily detectable. Always check ankle X-rays for a talar dome OCD. Arthroscopic treatment of chronic osteochondral lesions of the talus: long-term results. Radiology: X-ray: [Picture 1] No signs of significant osteoarthrosis. Radiology. The objective of this study was to assess functional and magnetic resonance imaging (MRI) outcomes following microfracture for tibial osteochondral lesions. Osteochondral lesions (OCL) of the talus are defined as any damage involving both articular cartilage and subchondral bone of the talar dome. Pfirrmann. Imaging Findings Conventional radiographs . The purpose of this study was to evaluate clinical outcomes following arthroscopic treatment of OLTPs. CONCLUSION: Osteochondritis dissecans of the tibial plafond is a rare condition that may not be detectable on radiography. first treated lesions in the knee with chondrocytes harvested from non-weight-bearing parts of the knee, cultured and then placed in the defect, covered with a periosteal flap from the ipsilateral tibia . OCD usually causes pain during and after sports. 6. Abstract Lesions that involve the cortex of the tibia are fairly common in radiology practice. In my experience these lesions have a good healing potential without developing a loose body. Six of 38 ankles had both a talar osteochondral lesion and an OLTP. Ankle: 4 to 14 times more common in the talus (56% posteromedial, anteromedial 44%) than the tibial plafond. However, they are insensitive to grading lower stage lesions and are inadequate in predicting stability. In later stages of the disorder there will be swelling of the affected joint which catches and locks during movement. Rare sites: Tarsal navicular, femoral capital epiphysis, shoulder (humeral head and glenoid), scaphoid. A retrospective review was conducted for patients who underwent arthroscopic microfracture surgery for osteochondral lesions of the tibial plafond from January 2014 to June 2017. On conventional radiographs, osteochondral lesions can appear as lucencies in the articular epiphysis. Treatment depends on the location and size of the defect as well as the presence of secondary degenerative changes. This term covers a wide spectrum of pathologies including (sub)chondral contusion, osteochondritis dissecans, osteochondral fracture and osteoarthritis resulting from longstanding disease. ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Bone Joint J 2014;96-B:164–71. The aim of this study was to evaluate the incidence and morphologic characteristics of osteochondral lesions of the distal tibial plafond (OLTP) by location and morphologic characteristics on MRI. 22 (4): 765-74. Osteochondral lesions or osteochondritis dessicans can occur in any joint, but are most common in the knee and ankle. Fig. cartilage injury with associated subchondral fracture but without detachment, x-ray findings: usually none; may see fracture as sclerotic or osteopenic area, MRI findings: high signal around osteochondral fracture (, x-ray findings: slight lucency between osteochondral fragment and remainder of the bone, usually joint effusion present, surrounding fragment and filling donor site, x-ray findings: increased lucency between osteochondral fragment and remainder of the bone, or loose body with donor site irregularity. Osteochondral injury staging system for MRI attempts to grade the stability and severity of osteochondral injury and is used to plan management. OBJECTIVES: Osteochondral lesions of the distal tibial plafond (OLTP) are rare and far less common than osteochondral lesions of the talus. “Osteo” means bone and “chondral” refers to cartilage. • Key MR imaging: • The osteochondral lesion, 10 mm × 10 mm in size, on the lateral tibial plateau was covered with fibrous tissues, and the free body was also included in the fibrous tissues (Figure 3A).Anterior to middle part of the lateral meniscus was degenerated and seemed to lose the hoop function (Figure … Its radiologic findings are similar to those of osteochondritis dissecans located elsewhere in the body. Shell osteochondral allografts of the knee: comparison of mr imaging findings and immunologic responses. Kaplan P. Musculoskeletal MRI. Background: Osteochondral lesions of the distal tibial plafond are uncommon compared with talar lesions. 15.1 Fibular ossicle in a 15-year-old boy. A focal superiorly oriented notch at the medial aspect of the distal tibial physis… Magnetic resonance imaging revealed an osteochondral lesion of the tibial plafond with no injury to the talar dome. There is no soft tissue swelling The distal tibial physis is also often irregular. Clinical and MRI Outcomes After Arthroscopic Microfracture of Osteochondral Lesions of the Distal Tibial Plafond. There are few cases describing this lesion in the literature, with little information on mechanism of injury, history/physical findings or recommendations for management. OCD is suggested by a loss of the sharp cortical line of the articular surface. There may be slight spreading of either half of the epiphysis away from the cleft. Check for errors and try again. Osteochondral Lesions of the Knee: Differentiating the Most Common Entities at MRI. 2017 Mar. 282 (3):798-806. 2001;219 (1): 35-43. Terminology. Osteochondral Lesions of the Talus: Aspects of Current Management. 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