The MR-assisted retrograde drilling of osteochondral lesions may lead to precise and secure treatment without radiation exposure. Commonly, this is achieved by drilling the subchondral bone (6 – 12). In c, the artificial osteochondral lesion (*) was hit, but the remaining cartilage remained intact. The tubule marker, which indicates the artificial osteochondral lesion, and the cylinder-shaped marker, which indicates the lateral process, are in line. To avoid damage to healthy cartilage and malleolar bone by antegrade drilling techniques, some physicians prefer to use a retrograde transtalar technique (8,11). Author contributions: Guarantors of integrity of entire study, C.J.S., R.S., U.K.M.T. ; clinical studies, C.J.S., T.J.; experimental studies, C.J.S., H.J.B., F.W., T.J., I.S.P., J.C.R., R.S., A.W., S.S.C., U.K.M.T. Arthroscopic findings in acute fractures of the ankle, The response of articular cartilage to mechanical injury, Trends of concurrent ankle arthroscopy at the time of operative treatment of ankle fracture: a national database review, Osteochondritis dissecans of the talus (transchondral fractures of the talus): review of the literature and new surgical approach for medial dome lesions, Current concepts in the diagnosis and treatment of osteochondral lesions of the ankle, Epidemiology of sprains in the lateral ankle and foot, Associated injuries found in chronic lateral ankle instability, Chronic lateral instability: arthroscopic findings and long-term results, Chronic ankle instability: biomechanics and pathomechanics of ligaments injury and associated lesions, Review: interventions for cartilage disease: current state-of-the-art and emerging technologies, Osteochondral transplantation of the talus: long-term clinical and magnetic resonance imaging evaluation, Osteoarticular grafts in the treatment of OCD of the talus: mosaicplasty versus autologous chondrocyte transplantation, Autologous osteochondral transplantation for osteochondral lesions of the talus, Factors associated with the clinical outcomes of the osteochondral autograft transfer system in osteochondral lesions of the talus: second-look arthroscopic evaluation, Matrix-induced autologous chondrocyte implantation grafting in osteochondral lesions of the talus: evaluation of cartilage repair using T2 mapping, Arthroscopic treatment of osteochondral lesions of the ankle with matrix-associated chondrocyte implantation: early clinical and magnetic resonance imaging results, Intermediate outcomes of fresh talar osteochondral allografts for treatment of large osteochondral lesions of the talus, Fresh osteochondral allografts for large-volume cystic osteochondral defects of the talus, Outcomes and predictors of postoperative pain improvement following particulated juvenile cartilage allograft transplant for osteochondral lesions of the talus, Arthroscopic treatment of chronic osteochondral lesions of the talus: long-term results, Arthroscopic treatment for osteochondral defects of the talus. 22, No. a prospective study. incidence 69% of ankle fractures; 70% of ankle sprains; 10% are bilateral ; and manuscript editing, all authors. Much of this bone is covered with cartilage. DiGiovanni, BF, Fraga, CJ, Cohen, BE, Shereff, MJ. The high incidence of good outcome in our series indicates that the one-step BMDCT could be a valid option for the treatment of this rare type of lesions. Commonly, this is achieved by drilling the subchondral bone (6–12). The second step was to perform drilling with fluoroscopic guidance (10). In lesions that appear nondisplaced on plain radiography (low grade; stable), MR imaging is recommended so the clinician can evaluate the integrity of the overlying cartilage and assess the true stability of the lesion. [ … Diagnosis of Knee Osteochondral Lesions With Ultrasound Imaging Arthrosc Tech. Our results indicate that use of the piezoelectric drill in the high-field-strength MR environment is safe (21). Access to society journal content varies across our titles. Materials and methods: Eight patients (seven male patients, one female patient; age range, 15-42 years; mean age, 27 years) with an OCD in the glenoid fossa were identified. No MOCART score was associated with postoperative patient-reported outcomes (n.s.). We developed a passive navigation device for use in retrograde drilling of osteochondral lesions of the talus with MR guidance. However, this does not nullify our results since in vivo osteochondral lesions are often larger than 4.5 mm in diameter (22). The blood supply to the talus is not as rich as many other bones in the body, and as a result injuries to the talus sometimes are more difficult to heal than similar injuries in other bones. In two of the three repeated ex-aminations, the area of bone marrow edema had decreased in size in the interval. OLT size showed significant correlation with postoperative MRI scores (MOCART 1: P = 0.006; MOCART 2.0: P = 0.004). Prognosis of these lesions depends on stability, location, and size of the lesion.Imaging has an essential role in the diagnosis, staging, and management of osteochondral lesions. Crossref, Medline, Google Scholar; 7 Kumai T, Takakura Y, Higashiyama I, Tamai S. Arthroscopic drilling for the treatment of osteochondral lesions of the talus. CLINICAL MRI OF OSTEOARTHRITIS AND OSTEOCHONDRAL INJURY As discussed in Chapter 2, the structural integrity and function of cartilage and underlying bone are intimately coupled. It is a general term used to characterize the pathology encountered at the joint surface with no consideration of etiology. Osteochondral lesions (OCL) of the talus are defined as any damage involving both articular cartilage and subchondral bone of the talar dome. direct visual control of the aiming device alignment and drilling procedure. The artificial osteochondral lesion (aiming point) and the access point of drilling (lateral process of the talus) were visible (Fig 2). stage I. injury limited to articular cartilage; MRI findings: subchondral edema; x-ray findings: none; stage II. *Contributed equally to senior authorship. Fluid extended deep to the fragment, and there was subjacent marrow edema, all seen in Fig. In the talus, 96% of lateral lesions and 62% of … (c, d) Photographs show the talus after drilling. After the drilling capsule and marker tubules are placed and adjusted, they can be moved back and forth to accommodate the anatomic region and dimensions before being locked in place with the synthetic screws. Bone grafting was significantly associated with a MOCART 1 subscale (signal intensity of repair tissue; P = 0.038). 11, No. As the drill can be fully seen in one imaging plane during the drilling procedure, a second plane is not usually required. For more information view the SAGE Journals Sharing page. Despite the described use for drilling of osteochondral lesions, other applications, such as MR-guided anterior cruciate ligament reconstruction or navigation of various punctures, are conceivable. The main C-shaped component measures 21 cm in length and 12 cm in width. The line on the MR image shows the planned drilling direction. 2, 19 January 2012 | Knee Surgery, Sports Traumatology, Arthroscopy, Vol. This term covers a wide spectrum of pathologies including (sub)chondral contusion, osteochondritis dissecans, osteochondral fracture and osteoarthritis resulting from longstanding disease. What can be done? 2013 Jun 5. A 16 × 19 mm osteochondral lesion was noted in the superior aspect of the lateral trochlea. Although confusion remains between the terms osteochondral injury and osteochondritis dissecans, it is really the etiology of the process that is in question. Top: Interactive drilling of the phantom perpendicular to the main magnetic field. Sufficient accuracy and a reduction in surgery time, invasiveness, and radiation exposure can be achieved; this MR-assisted method of retrograde talus drilling represents a further evolution and simplification of existing techniques. Retrograde spongiosaplasty was performed easily. There was a fragmented and sclerotic fragment overlying the osteochondral lesion. Top: Interactive drilling of the phantom perpendicular to the main magnetic field. Diagnosis of Knee Osteochondral Lesions With Ultrasound Imaging Arthrosc Tech. The piezoelectric MR drill we used led to only a few intermittent artifacts during image acquisition. Stone JW. Much of this bone is covered with cartilage. You can be signed in via any or all of the methods shown below at the same time. Enter your email address below and we will send you the reset instructions. For this reason, some now recommend the addition of SPECT-CT for the evaluation of OLT [25]. In addition, a substantial disadvantage of all antegrade drilling techniques is that the hyaline cartilage must be drilled, and therefore damaged. We performed drilling with a 3.4-mm titanium alloy spiral drill bit (Invivo) in an agar-agar phantom (WiroGel; Bego, Bremen, Germany). The talus is the bottom bone of the ankle joint. Furthermore, many lesions are located in the posterior part of the talar dome. A postoperative diagnostic MR examination (T1-, T2, and intermediate-weighted fast SE sequences) was performed to verify positioning. This joint permits much of the up (dorsiflexion) and down (plantarflexion) motion of the foot and ankle. We drilled 16 holes in four ankle joints toward the talar dome. They typically are associated with a history of trauma; however, nontraumatic etiologies have been described. In the talus, 96% of lateral lesions and 62% of … It is often used synonymously with osteochondral injury/defect and in the pediatric population. Thus, multiple drillings are often required, which may lead to iatrogenic bone damage. Differentiability of anatomic structures is best in d. Figure 5d: MR images acquired with (a) T1-weighted gradient-recalled echo (T1w GRE),(b) T1-weighted fast SE (T1w FSE),(c) T2-weighted fast SE (T2w FSE), and (d) intermediate-weighted fast SE (Iw FSE) sequences. Simply select your manager software from the list below and click on download. After we drilled the talus (as described previously), the cancellous bone cylinder was brought into the drilling canal with MR guidance. Figure 8f: (a) Coronal and (b) paratransverse T2-weighted fast SE (T2w FSE) MR images obtained after interactive drilling. The intermediate-weighted fast SE sequence was shown to be superior to the other pulse sequences assessed (T1-weighted gradient-recalled echo and T1- and T2-weighted fast SE sequences). Bale et al (12) described a computer-assisted drilling technique. (The main part of the device is made of acrylic glass, while the locking bolts, marker tubules, and drilling capsule are made of polyethylene.) Many of these lesions are first diagnosed by plain film. The ankle joints were fixed in a retaining jig and positioned so that the lateral ankle was at the top, simulating a lateral patient position. MRI of the ankle is a useful study in evaluating the tendons of the ankle. Wiewiorski, M, Leumann, A, Buettner, O, Pagenstert, G, Horisberger, M, Valderrabano, V. Wiewiorski, M, Werner, L, Paul, J, Anderson, AE, Barg, A, Valderrabano, V. Kubosch, EJ, Erdle, B, Izadpanah, K, Kubosch, D, Uhl, M, Sudkamp, NP. All drilling was performed in an open 1.0-T MR imager with a 21-cm-diameter surface ring coil (Multipurpose L; Philips Healthcare). 6, © 2020 Radiological Society of North America, Impact of high field (3.0 T) magnetic resonance imaging on diagnosis of osteochondral defects in the ankle joint, Osteochondritis dissecans: history, pathophysiology and current treatment concepts, Characterizing osteochondral lesions by magnetic resonance imaging, Arthroscopic therapy of steochondrosis dissecans of the talus: follow-up with a new “ankle score” [in German]. Top: Interactive drilling of the phantom perpendicular to the main magnetic field. Osteochondral lesions of the talus are common and difficult problems to treat. The tali were extracted and cut with a saw along each drilling canal. (c, d) Photographs show the talus after drilling. The articular cartilage imaging group of the International Cartilage Repair Society has issued detailed recommendations with r… Subsequent MR imaging shows that there is a 15 mm osteochondral lesion at the lateral capitellum with separation of a bony fragment that is approximately 13 x 11 x 6 mm in depth. Thus, the drilling direction was oblique from the lateral ankle to the medial ankle. With 100 drill revolutions per minute and a torque of 40 N/cm, drilling of the talus could be performed fairly easily (20). Study design: Case series; Level of evidence, 4. The markers could be found and identified with interactive imaging. The safety criterion was to drill as close as possible to the cartilage without violating it. Viewer, Combined Therapy with Shock Wave and Retrograde Bone Marrow-Derived Cell Transplantation for Osteochondral Lesions of the Talus, Interventional articular and para-articular knee procedures, Retrograde Drilling for the Treatment of Osteochondral Lesions in the Ankle, Osteochondritis Dissecans Involving the Trochlear Groove Treated With Retrograde Drilling, Percutaneous antegrade scaphoid screw placement: a feasibility and accuracy analysis of a novel electromagnetic navigation technique versus a standard fluoroscopic method, MRI-guided percutaneous retrograde drilling of osteochondritis dissecans of the talus: a feasibility study, Simultaneous surgery for chronic lateral ankle instability accompanied by only subchondral bone lesion of talus, Retro-articular drilling and bone grafting of juvenile knee osteochondritis dissecans: a technical description, Real-Time MR-Guided Lumbosacral Periradicular Injection Therapy Using an Open 1.0-T MRI System, Arthroscopically assisted retrograde drilling for osteochondritis dissecans (OCD) lesions of the knee, Retrograde Drilling of Talar Osteochondritis Dissecans Lesions: A Feasibility and Accuracy Analysis of a Novel Electromagnetic Navigation Method Versus a Standard Fluoroscopic Method, Accuracy Analysis of a Novel Electromagnetic Navigation Procedure Versus a Standard Fluoroscopic Method for Retrograde Drilling of Osteochondritis Dissecans Lesions of the Knee, MRI-guided percutaneous retrograde drilling of osteochondritis dissecans of the knee, Diagnostic Performance of Dual-Energy CT for the Detection of Traumatic Bone Marrow Lesions in the Ankle: Comparison with MR Imaging, Ankle: Isotropic MR Imaging with 3D-FSE-Cube—Initial Experience in Healthy Volunteers, MR Imaging of Cartilage Repair in the Knee and Ankle, Talar Fractures and Dislocations: A Radiologist’s Guide to Timely Diagnosis and Classification, Avascular Necrosis of the Talus: A Pictorial Essay, Ankle Trip: A Guided Tour of Common and Uncommon Trauma Findings on Radiographs, Ankle Trauma: What Radiology Residents Need to Know, Ultrasound and MRI Pitfalls in Evaluating Hemophilic Arthropathy. With the transmalleolar antegrade drilling technique, the malleolar joint cartilage is also damaged (13). The experiments on drilling accuracy were performed in 16 fresh human ankle joint specimens from donated cadavers. This joint permits much of the up (dorsiflexion) and down (plantarflexion) motion of the foot and ankle. In this case, the ankle joints were positioned and fixed so that the lateral ankle was at the top, simulating a lateral patient position. The blood supply to the talus is not as rich as many other bones in the body, and as a result injuries to the talus sometimes are more difficult to heal than similar injuries in other bones. 10, 1 February 2012 | The American Journal of Sports Medicine, Vol. The coil was placed around the ankle joint in a ringlike fashion. The third step was to adjust the direction of the drilling guide so that the cylinder-shaped marker, access point of drilling, osteochondral lesion, and tubule marker were aligned (Fig 3). 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