Cortical depression is clearly seen (Fig. We retrospectively reviewed the medical records of three patients with osteochondral injury in the tibial plafond. 3A and 3B). 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]. In the other patient, ankle arthroscopy revealed a depressed area in the posterolateral aspect of the tibial plafond filled with fibrocartilage. cartilage injury with associated subchondral fracture but without detachment This includes initial rest, immobilization, and unloading protocol, in either a fracture boot or cast. All patients complained of ankle pain. Ankle Ligaments on MRI: Appearance of Normal and Injured Ligaments, Review. Recently, we encountered three patients with osteochondral injury of the tibial plafond. The softest cartilage was found in the posterior half of the talus. 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. Tibial Plafond Fracture is an uncommon fracture occurring in the distal region of the tibia. The search was limited to English literature and human subjects. 72 plays. Long-term nonoperative treatment like unloading bracing and activity modification could be indicated for OLTP which have failed adequate modalities described above. Diagnosis is usually made on a CT scan or magnetic resonance imaging (MRI) [ 2, 6 ]. However, coronal and sagittal images clearly show that the lesion originates from the tibial plafond. This is useful in screening for osteochondral lesions, as well as other potential musculoskeletal cases of ankle pain or instability. Osteochondritis dissecans in the ankle accounts for approximately 4% of all osteochondritis dissecans [1]. Copyright © 2013-2020, American Roentgen Ray Society, ARRS, All Rights Reserved. “Osteo” means bone and “chondral” refers to cartilage. Most osteochondritis dissecans in the ankle is found in the talar dome. 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. Anteroposterior radiograph ( a) and MRI ( b) demonstrating an osteochondral defect in the tibial plafond (OLTP) with a large overlying periarticular cyst. The lesion may not be visible on conventional radiographs, as was the case in one of our patients. Osteochondral defect. 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. In one patient, markedly hyperemic proliferative synovial tissue involved the entire ankle. Conclusion: Osteochondritis dissecans of the tibial plafond is a rare condition that may not be detectable on radiography. As such, it is vulnerable when the ankle is forcibly inverted, everted, or rotated. The average age was 39 years (age range, 33-49 years). Such lesions are a tear or fracture in the cartilage covering one of the bones in a joint. On conventional radiographs, osteochondritis dissecans of the tibial plafond appears lucent and may contain a loose bony fragment. 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. OBJECTIVE. The purpose of this study was to evaluate the clinical outcomes and the level of sports activity following arthroscopic microfracture for osteochondral lesions of the tibial plafond. [OCOSH Code: D010008 203413004 M93.2 BD_OC_OCD_A] Search only this category the entire directory Advanced Search. OCD usually causes pain during and after sports. 27826 Open treatment of fracture of weight bearing articular surface/portion of distal tibia (eg, pilon or tibial plafond), with internal fixation, when performed; of fibula only 27827 Open treatment of fracture of weight bearing articular surface/portion of distal tibia (eg, pilon or tibial plafond), ... OCD is seen as a complication of approximately 6.5% of ankle sprains. 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 Overview. Bone grafting is usually performed in an antegrade manner. 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. We noted no predominant location of the osteochondritis dissecans. Background: 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. No complication was reported at a 20-year follow-up examination [5]. Vascular insult is an unlikely cause of osteochondral injury in the tibial plafond. A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. 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. The prevalence of osteochondritis dissecans in the tibial plafond detected on radiography is unknown. On lateral images, osteochondritis dissecans is less apparent. Lateral talar lesions are more common than medial lesions. Talar dome lesions are usually caused by … 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). The necrotic fragment usually becomes revascularised and reattaches to the surrounding bone. 1A). Osteochondral lesions or osteochondritis dessicans can occur in any joint, but are most common in the knee and ankle. The debrided lesion is located arthroscopically with the ball tip of a microvector guide. The cause of Tibial Plafond Fracture is axial or rotational forces occurring from motor vehicle accidents or falling from a height. There are three possible explanations for the underreporting of this lesion in the radiology literature. In my experience these lesions have a good healing potential without developing a loose body. 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. [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. 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. 1B). 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). Osteochondral injury of the tibial plafond is not as rare as previously reported in the radiologic literature. In the ankle joint, helical CT has the advantage of multiplanar capability. Members receive the 'Picture of the week', new operative techniques and can submit their problem cases for an expert opinion. Two patients underwent ankle arthroscopy. However, this study was small, consisting of only seven cadavers, and anatomic variation may be present. Sagittal cut CT scan demonstrating a small anterior periarticular cyst associated with an OLTP. On axial scans, osteochondral lesions of the tibial plafond may be initially mistaken for osteochondritis dissecans of the talar dome (Fig. 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 Two of the patients were treated conservatively. The tibial plafond cartilage was intact without any visible defect or flap. Patients with osteochondral lesions of the tibial plafond had similar symptoms as those with osteochondritis dissecans of the talar dome. M93.279 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. Trauma ⎜ Tibial Plafond Fractures (ft. Dr. Brian Weatherford) Team Orthobullets (AF) Trauma - Tibial Plafond Fractures; Listen Now 26:30 min. Apart from the location, osteochondral injury of the tibial plafond has radiographic findings similar to those of osteochondritis dissecans of the talar dome. Osteochondritis dissecans of the tibial plafond is a rare condition that may not be detectable on radiography. All patients underwent radiography, one patient underwent CT, and one patient underwent MR imaging. Radiologists may not be aware of this entity and may not recognize the lesion on conventional radiographs. In later stages of the disorder there will be swelling of the affected joint which catches and locks during movement. The prevalence of osteochondritis dissecans in the tibial plafond detected on radiography is unknown. 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. The duration of nonoperative treatment is not well defined and should include input from the patient. 0.0 (0) See More See Less. Osteochondritis dissecans is suggested by a loss of the sharp cortical line (Fig. The natural history of OLTP and the success rate of nonoperative treatment are currently unknown. Six of 38 ankles had both a talar osteochondral lesion … There are few cases describing this lesion in the literature, with little information on mechanism of injury, history/physical findings or recommendations for management. Bachmann et al. Zone 1 was the most anterior and medial, zone 3 was anterior and lateral, … Once the lesion base has been debrided to a stable construct, marrow stimulation can be performed, via either the ankle joint utilizing arthroscopic picks (Fig. The cartilage in the anterolateral aspect of the distal tibia was stiffer and thicker than that in the anterolateral aspect of the talus. 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. Five patients were diagnosed with osteochondral injury of the tibial plafond. In general, tibial cartilage was stiffer than talar cartilage. A literature search was conducted on the MEDLINE database using the PubMed search engine of the National Library of Medicine [3]. All three patients were men. 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. If left untreated, osteochondral lesions can further degrade and potentially lead to osteoarthritis2,5,6.How-ever, the treatment guidelines and prognostic indicators that On conventional radiographs, the lesions appear lucent, seen best on anteroposterior images (Fig. Osteochondritis dissecans of the tibial plafond is a rare condition that may not be detectable on radiography. [9] measured the thickness and mechanical properties of the articular surface of the distal tibia and talus. Three patients had a history of trauma, and all patients were symptomatic, requiring orthopedic evaluation and surgery. In our series, the average size of the osteochondral lesions was 1.4 × 1.3 cm. 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. Ankle Platform is for Orthopedic Surgeons with special interest in Ankle and Hindfoot. Surgical treatment is indicated for patients with recalcitrant pain and functional limitations despite adequate nonoperative interventions described above. 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 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. The patients were referred to our department of radiology, and their conditions were diagnosed with various imaging techniques within a 2-week period. A 1995 study [9] of the biomechanic topography of human ankle cartilage supports the experimental study of Berndt and Harty [8]. The ankle joint has a rich arterial supply. 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]. Typical Revenue Codes (for form UB … Consequently, radiologists must be aware of this entity and its imaging characteristics on different imaging techniques. Cartilage Grafting Options for Large or Microfracture-resistant Osteochondritis Dessican (OCD) Lesions of the Talus. 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. It is wider in the anterior plane to provide stability, especially while weight-bearing. [6] reported on a series of 30 patients who had osteochondritis dissecans of the ankle. It is also called an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). 1C). As the dorsiflexed foot was inverted, the lateral border of the talar dome was compressed against the articular surface of the distal fibula. The indications for arthroscopic exploration were disabling symptoms and a previous history of ankle injury [5]. 10/18/2019. In the radiology literature, we are aware of only one textbook describing this entity, without a specific reference [2]. 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. It involves the articular surface of the ankle joint. High-Resolution 3-T MRI of the Fingers: Review of Anatomy and Common Tendon and Ligament Injuries, Original Research. Treatment for this may be different then in the early stages of the OCD lesion. Inversion and rotation of a plantar flexed foot causes compression of the posterior half of the talar dome by the posterior malleolus, resulting in osteochondritis dissecans [8]. Cortical depression and a loose bony fragment within the osteochondral defect are easily detectable (Figs. Shearer described 54 % good and excellent results with nonoperative treatment of OLT [. 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. Introduction: Osteochondral lesions of the tibial plafond account for approximately 2.6% of osteochondral lesions in the ankle. 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. 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. 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 Characteristics and a Review of the Literature, Osteochondritis Dissecans of the Tibial Plafond, Review. Most OLTP can be surgically managed arthroscopically. Also, the posteromedial aspect of the tibial plafond was stiffer than that of the posteromedial aspect of the talus. The cartilage can be torn, crushed or damaged and, in … Initial nonoperative treatment follows the same protocol as for all OLTs. It contains free information. CONCLUSIONS: Clinical and radiological evidence of anterolateral impingement syndrome often accompanies stage 4 OCDs. 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. We thank Ellen Henson and Debbie Parker for their assistance with the photographs. Open ankle fracture with exposed tibial plafond. OCD Ankle and Talus Internet resources relating to Osteochondritis Dissecans affecting the Talus & 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).