kissing contusion knee radiology. Deep Bone Bruise is an injury and bleed in the medullary part of the bone and hence it is classified as intraosseous bleed. The location is closer to cortex of the bone. When they are slightly deformed or one is too wide, they will rub together causing irritation and the kissing corn will form. A bone bruise may take few months to heal back to normal. Bone is usually made of a hard, outer surface with a softer, spongy inner surface. Imaging of osteochondroma : variants and complications with radiologic-pathologic correlation. Treatment is done with antibiotics, aspiration, steroids or surgery. The injury to the bone leads to swelling around the affected joint which is called as oedema of the bone marrow. The risk for injury is higher in sports with jumping, such as basketball, or sports with quick direction change, such as soccer or football. It is seen after ankle sprain when the person lands after an injury on the ankle with the foot twisted inwards. 2018;13(1):33-37. doi: 10.1007/s11678-018-0441-9. She had a mild swelling over the anterolateral and posterolateral aspects of the ankle. Ice. This is the American ICD-10-CM version of S80.02XA - other international versions of ICD-10 S80.02XA may differ. revealed linear columns of maturing chondrocytes within a cartilaginous cap and islands of cartilage within the bone of the stalk confirming the diagnosis of talocalcaneal osteochondromas on both sides of the joint (Figures 6 and 7). Epub 2002 Sep 21. If your foot bone is bruised, and not broken, you will likely be given a RIE treatment plan: rest, ice and elevation. Wrist and joints of the hand are involved before the patient tests positive for rheumatoid factor. The mass extended from the talus to the calcaneus. Talar lesions usually occur in two distinct regions: medially 70% of talar lesions ; 50-70% have a history of injury ; tend to be deep and cup-shaped, and may be cystic ; laterally 30% of talar lesions The ankle joint is an extremely stable joint. Although osteochondromas represent one of the most common bone lesions, they rarely present in the foot and ankle. Inversion Ankle Sprain This probably is the most common ankle injury that occurs to the average person. Spring ligament complex appears intact. Schematic drawing of talocrural joint injury in pronation (a) results in sprain of the medial collateral ligaments (brown) and lateral-sided OCL of the talar dome and/or kissing tibial lesion (orange zones), whereas injury in supination (b) causes sprain of the lateral ligaments and medial-sided OCL of the talar Severe locking or catching symptoms, where the ankle freezes up and will not bend, may indicate that there is a large osteochondral lesion or even a loose piece of cartilage or free bone within the joint. These characteristic lesions that occur both on the femoral and tibial condyle are of great importance, not only in that they are frequently a sign of more serious associated injury . The condition resolves after the baby is born. The sites of bone bruises are the upper tibia, the lateral epicondyle of femur. The known complications that are associated with intraosseous bleed are joint stiffness, post trauma osteoarthritis. The sports like football, basketball, hockey etc have maximum joint movements with speed and so the impact of the injury is greater. Magnetic resonance imaging demonstrated bony excrescences at the posterior subtalar joint with disruption of the posterior facet articular surfaces. They comprise 30 to 50% of benign bone lesion diagnoses and 15% of all bone tumors. Diagnosis can be made with plain ankle radiographs. The most common treatment method for knee contusions is the RICE protocol. Secondary chondrosarcoma in osteochondroma: report of 107 patients. The fractures healed uneventfully and all the patients recovered satisfactorily except two had moderate restriction in ankle movement. eCollection 2021 Apr. 1. Post operatively the patient was treated with standard protocol for subtalar joint arthrodesis. Unauthorized use of these marks is strictly prohibited. Unable to load your collection due to an error, Unable to load your delegates due to an error. A 21-year-old male reports right ankle pain after sustaining an inversion ankle injury 2 years ago. (d)Support the affected leg with the help of a splint or walking stick/crutches. The presence of underlying joint damage and degeneration can make the healing time longer. Osteochondromas of the foot and ankle are uncommon except in rare cases of Multiple Hereditary Exostoses. Created for people with ongoing healthcare needs but benefits everyone. Also, displaced intra-articular loose This is a primarily metaphyseal lesion of long bones (distal femur, proximal tibia, proximal humerus) and the pelvis [1,2]. Two exostoses were noted to be extending posteriorly from the talus and calcaneus, respectively. Accessibility To our knowledge, there are no prior reports of osteochondromas in such proximity of the talus and calcaneus [4]. After failure of conservative management, this patient underwent surgical excision followed with a planned arthrodesis for symptomatic peroneal impingement and subtalar arthrosis, both likely complications of the osteochondromata. (iii)Impaction: In a joint cavity, if both the bones rub against each other, the articular surface tends to get damaged resulting in a bone bruise on both the surfaces. The adjacent osteochondromas were then identified deep to the flexor hallucis longus, which was retracted medially to gain access to the lesions. By logical extension, the instability of torn knee cartilage could be the source of this type of pain. Flu-like symptoms ( fatigue, fever, sore throat, headache, cough, aches and pains) Heavy menstrual flow. Conclusion: In 16 (11%) of the 146 ankles, the lesions were present in the opposing bones of the joint ("kissing" lesions). The exostoses were removed at their base to the level of native contours of bone at both the talus and calcaneus (Figure 4). There have also been reports of DEH kissing lesions which grow adjacent to an affected joint and lead to pain and presentation in childhood [6]. The bone bruise tends to heal within 60 days whereas the ligament will take much longer to heal. Patella which is a small bone present in front of the knee joint. An inversion sprain occurs when your ankle twists into an inverted state, or in other words, when it rolls inward. Diagnosis by an X-ray is often difficult and higher investigations like MRI may be required. You may be told to keep your foot wrapped with a tight elastic bandage. An ankle fusion can often last a lifetime compared to an ankle replacement, which tends to have a higher failure rate. This is usually due to an injury to soft tissues. Avoidance of dancing with CAM walker boot for 2 weeks, Type in at least one full word to see suggestions list, Orthopaedic Summit Evolving Techniques 2021, Evolving Technique Update: Role Of An Osteotomy In The Treatment Of An Osteochondral Lesion Of The Talus - Phinit Phisitkul, MD, Orthopaedic Summit Evolving Techniques 2020, Evolving Technique Update: MSCs For Cartilage Repair: Let Me Show You How - Italy Guides The Way - Alberto Gobbi, MD, 2019 Orthopaedic Summit Evolving Techniques, Debridement And Abrasion: It's Simple And Yields Great Results: Watch Me! hamstring, stress fracture, ankle, herniated disc, bruise, more. (c)Types of Bone Bruises Based on MRI Findings. This leads to a severe blow on the knee joint, femur (thigh bone) and the tibia (shin bone). A contusion may involve nerve, subcutaneous tissue, tendon, etc. was consistent with a presumptive diagnosis of osteochondroma. eCollection 2021 Nov. Allahabadi S, Allahabadi S, Allala R, Garg K, Pandya NK, Lau BC. A condition where the blood collects inbetween the cortical bone and the periosteum is called as subperiosteal haematoma. Cartilage Tumors: Evaluation and Treatment. The authors declare that there is no conflict of interest regarding the publication of this manuscript, Ahmed AR, Tan TS, Unni KK, Collins MS, Wenger DE, Sim FH. Most bruises are not very deep under the skin so that the bleeding causes a visible discoloration. Figure C shows the corresponding MRI. associated with age . Pain, deformities, and the grinding or movement of broken bones of the knee, shin, ankle, and foot. The evolution towards tibiotalar degenerative arthritis or talar avascular necrosis has not been extensively studied in the literature. Hip: The commonest cause of oedema in the hip bone is avascular necrosis of the neck of femur. Severe locking or catching symptoms, where the ankle freezes up and will not bend, may indicate that there is a large osteochondral lesion or even a loose piece of cartilage or free bone within the joint. (ii)Geographic: This type of bone bruise is comparatively bigger in size and more dense as compared to reticular bruise. Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. For instance, if the anterior cruciate ligament were to rupture, the tibia can slide forward (subluxate) and impact the femoral condyle (a so-called kissing contusion). Reviewed By: Kristin Abruscato DPT, Published: Jan 22nd, 2022 LeBron James suffers high ankle sprain vs. Hawks, out indefinitely [UPDATE] Lakers All-Star was injured in second quarter against Atlanta. Trouble using your joint if the bruise occurs there How to Treat a Bone Bruise The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Osteochondromas of the subtalar joint: A case study, Management of an open crush fracture to the foot from a lawnmower injury: A case report, The clinical and patient centered outcomes following surgical correction of tailors bunion in an acute hospital based podiatric surgery service, Fluoroquinolone-induced Achilles tendinopathy A case report and management recommendations, Reconstruction of an Achilles rupture with 12 cm defect utilizing Achilles tendon allograft and calcaneal bone block: A case report, Congenital amniotic band constriction of the proximal tibia: A Yucatan project case report, Distal lower extremity manifestations in spina bifida patients of the Yucatan Peninsula: A 24-year retrospective case series, Management of a dislocated talar dome fracture with ankle arthrodiastasis and open reduction internal fixation: A case report, A case of recurrent hyperostotic macrodactyly. On this Wikipedia the language links are at the top of the page across from the article title. subchondral bone contusions, fractures, and kissing lesions of the talotibial joint after a sprain of the ankle shown on MR imaging. At six month and one year follow up visits the patient had returned to full activities without difficulty or pain at her left hindfoot. Dorsal talonavicular ligament is intact. Early surgical intervention has been advocated for metaphyseal or juxta-articular lesions to avoid complications with associated growth and deformity. kissing contusion ankle Best Selling Author and International Speaker. In three (table 2, cases 8, 10, and 11) the kissing contusion appeared in the lateral compart-ment, with a type II lesion on the femoral condyle and a type I lesion on the tibial condyle. Ankle Injury DL25. Swelling. There was also underlying severe bone on bone degenerative change of the posterior facet with associated reactive edema within the talus and calcaneus (Figure 2). A 43-year-old male sustained a left ankle injury 3 years ago. 2021 Apr 15;9(4):2325967121997120. doi: 10.1177/2325967121997120. Prognosis: After a knee joint bone bruise, the recovery time for atheletes is usually 6 months especially if the anterior cruciate ligament is torn. Contusions of both surfaces of the joint are known as kissing contusions. Figures A and B are radiographs of the left ankle. One of the peculiarities that can develop in the adult with juxta-articular "kissing" lesions, especially in the lower extremity, is the proclivity towards arthrosis of the involved joint owing to abnormal contact stresses. (OBQ12.74) marrow edema bordering a dark signaling fracture line. Keywords: osteochondroma, chondroma, talocalcaneal, kissing lesion, ISSN 1941-6806 Evaluation will include bone x-rays to rule . An injury to the bone is a broken or fractured ankle. Ankle sprains are a common cause of OLTs. Swelling, bleeding, and tissue damage. J Bone Joint Surg Am. 1996 Jan;25(1):49-54. doi: 10.1007/s002560050031. ; A bone bruise is characterised by three different kinds of bone injuries including: sub-periosteal hematoma, inter-osseous bruising and a sub-chondral lesion, or a combination . Subchondral lesions in the talus and tibia are relatively common after ankle trauma, occurring in 18% of patients in our series. Knee Surg Sports Traumatol Arthrosc. Bone bruise is defined as the localized blood collection inside a bone which may be associated with an internal fracture in the spongy part of the bone.The cortical layer on the outside remains normal and intact. ankle sprain series: ankle: ankle sprain intro: Ankle Anatomy: ankle injury: geoff jenkins ankle injury: alabama ankle injury: sprained ankle: Katy Perry kissing in teenage dreams; Katy Perry; Katy Perry Hot; Katy Perry without makeup; freida Pinto hot; freida Pinto cool pics; freida Pinto on maxim; GET THE RIGHT SIZE FOR THE BEST FIT - Refer to our size chart to get the best fit. The diagnosis can be done by an X-ray or MRI. Disclaimer. Fractures of the capitellum humeri and their associated injuries. June 25, 2022; 1 min read; california mustard plant; kikker 5150 with harley engine; kissing contusion knee radiology . There are several case reports demonstrating osteochondroma of adjacent metaphyseal regions developing concurrently, eventually leading to kissing lesions as the osteochondroma grow [1, 2, 4, 9]. Most osteochondral injuries, including ankle sprains, occur by accident. The MRI is supposed to reveal the grade of the lateral left ankle sprain. Objective: Bifurcate ligament is intact. One thing that will certainly be a talking point if LeBrons injury is serious is Solomon Hills role. National Library of Medicine Heres the bottom line: bone bruises require more care than simple black and blue marks on the surface of your skin. Seo SS, Park JY, Kim HJ, Yoon JW, Park SH, Kim KH. The site is secure. When identified in a child, conservative management of these uniquely paired osteochondromas or periosteal chondroma is usually advocated, as surgical intervention for asymptomatic, intra-articular lesions may result in secondary arthrosis. An osteochondroma is a benign chondrogenic lesion derived from aberrant cartilage. The reciprocal bone bruising of the navicular and medial cuneiform on MRI, also known as the kissing sign, is unique and signifies acute instability of the first ray. Many people try to tough out ankle injuries and don't seek medical attention. Ankle Injury : Contusion. Progressively worsening pain and stiffness over the prior 4-5 months were noted. T. he exostoses were removed at their base to the level of native contours of bone at both the talus and calcaneus (Figure 4). van Gils , Jan Willem K. Louwerens2, Eduard E. de Lange3 From the Departments of Radiology 1 and Orthopaedic Surgery 2 University Hospital Utrecht and Central Military Hospital, Utrecht. This may be heightened when walking on uneven ground or when wearing high heels. Reticular bruises tend to heal the fastest. Symptoms of a strain are pain, swelling, and having a problem moving or using the injured area. Takao M, Ochi M, Naito K, Uchio Y, Kono T, Oae K. Arthroscopy. A blunt injury to the bone results in collection of blood in the bone and gives rise to a blackish bruise that is called as bone bruise. Clarke, just before the end of the first quarter of their game against the Denver Nuggets at Ball Arena, missed a free throw and took a step back with his left leg. Epub 2018 Feb 5. Lateral and Mortise views of the left ankle demonstrate severe subtalar joint space narrowing with a well circumscribed pedunculated osseous lesion projecting posteriorly from the subtalar joint. The contrecoup mechanism describes the motion in the knee as the knee shifts back to compensate for the first pivot-shift during the initial injury. What would be the next most appropriate step for treatment? Ankle Injury : Contusion. The bones in your toes should resemble an hourglass shape. In this case the patient had symptomatic peroneal compression and subtalar arthrosis. The injury occurs when one or more of the ligaments in the ankle are stretched or torn, causing pain, swelling, and difficulty walking. Sports persons are very prone to these bruises. Sagittal T2-weighted image 1 year after injury reveals a subchondral cyst (arrow), an articular defect in the lateral tibial plateau, and a large knee effusion (arrowhead). Only six of the 12 talar fractures and none of the tibial fractures involving the 26 ankles were seen on conventional radiography. Traumatic injury to the ankle/foot (ankle sprain) or overuse is the main cause of this syndrome. Shown on Apple platforms as the sole of a foot. A strain is an injury to a muscle or to a tendon (tissue that connects muscle to bone). Bruising. Figure 2 Sagittal imaging demonstrating a bony protuberance just posterior to the calcaneus with reactive edema about the osteochondroma as well as within the talus and calcaneus consistent with osteoarthritic changes. A narrow osteotome was used to increase the exposed cancellous surface area. Physical examination elicits pain with ankle dorsiflexion and plantarflexion, although subtalar motion is normal. The classification is based on the type of injury and location of the bleeding. Clin Orthop 2003 ; 411 : 193-206. Results: Arthritis can occur at any joint in the foot and ankle region, although the ankle joint itself is most commonly affected. MATERIALS AND METHODS. In one case (table 2, case 9), a baker's dozen, english muffin, kissing cousin, ragamuffin, second cousin 5 minor, more People also search for: injury, contusion, sprain, charley horse hamstring, stress fracture, ankle, herniated disc, bruise, more Use concussion in a sentence. (, Herrera-Perez M, De Mendoza M, De Bergua-Domingo J, Pais-Brito J. Osteochondromas around the ankle: Report of a case and literature review; International Journal of Surgery Case Reports 4 (2013) 1025 1027. Subsequent inspection of the posterior facet of the subtalar joint demonstrated denuded cartilage with exposed subchondral bone. When compared to medial talar OCDs, which of the following statements is true regarding lateral talar OCDs? A contusion usually can be distinguished from a muscle rupture, because residual function remains after a contusion. Take an over the counter anti-inflammatory medication as well. Its also wise to see your podiatrist since he or she will perform an X-ray to confirm whether the bone is simply bruised, or if a fracture has occurred. The bruise will encroach into the joint space on MRI. These changes are seen in MRI and are diagnosed as reactive oedema of the bone marrow. Please enable it to take advantage of the complete set of features! by Christopher Gaunder MD, Brandon McKinney DO*, Joseph Alderete MD, Thomas Dowd MD, The Foot and Ankle Online Journal 10 (3): 2. Rough first quarter for the Celtics who shot 9-for-23 from the field, committed five turnovers and lost Jaylen Brown for the game with a right ankle injury. The vision trouble increases with each passing day. Osteochondral Fracture: If the hairline bone fracture affects the cartilage and forms a connection between the joint and the bone bruise then it is diagnosed as an osteochondral fracture. Its function and structure make it vulnerable to injury, especially during activities like jumping and running. Contusions of the femur can occur from extreme blunt trauma to the thigh or from the femur jamming the tibia at the knee joint, which might happen if you landed awkwardly from a jump. Posttraumatic subchondral bone contusions and fractures of the talotibial joint: occurrence of kissing lesions. Measure your arch circumference to determine your size. 1. Also, displaced intra-articular loose 6 m. Rathke Cleft Cyst. PENNYSUE. Consider these drawings of the lateral view of the ankle, showing, left to right, normal alignment; a tibio-talar subluxation and then a tibio-talar dislocation: And now think about the structural damage: with a dislocation, there could be a bone contusion where there is abnormal contact (shown below as the green "kissing contusion"); and the . S80.02XA is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. X-ray is used to diagnose a fracture in the bone. What is the next appropriate step in the management of this patient? Initial treatment consists of rest, ice, compression and elevation. 4.3k views Answered >2 years ago. Materials and methods: If lesions grow in adulthood they usually represent malignant transformation of the cartilage into chondrosarcoma [1, 6, 7]. The results will vary depending on the type of the MRI. In 16 (11%) of the 146 ankles, the lesions were present in the opposing bones of the joint ("kissing" lesions). Disabling symptoms are often prolonged. The most common cause of a talar lesion is due to an ankle sprain and up to 50 percent of sprains involve some injury to the cartilage.1-3Two common lesions are notable on the talus. It is a rare (6.3% in this series) but significant injury, often associated with ligamentous or menisceal tears. It is seen after ankle sprain when the person lands after an injury on the ankle with the foot twisted inwards. Physical therapy and NSAID's have not alleviated the symptoms. Foot was approved as part of Unicode 11.0 in 2018 and added to Emoji 11.0 in 2018.. re-rupture. No funding was acquired for this manuscript. In situ compression and fixation was achieved with two 6.5mm partially threaded screws across the subtalar joint (Figure 5). Sagittal imaging demonstrating a bony protuberance just posterior to the calcaneus with reactive edema about the osteochondroma as well as within the talus and calcaneus consistent with osteoarthritic changes. and transmitted securely. Memphis Grizzlies forward Brandon Clarke had to be helped off the court on Friday night after he sustained what appeared to be a non-contact left leg injury after shooting a free throw. (OBQ06.213) Causes: Bone bruises in and around the knee joint are very common in atheletes. kissing contusion anklevet tech jackets. In our patients case, she presented with peroneal impingement and subtalar arthrosis. Little Women (2019) Jo March reflects back and forth on her life, telling the beloved story of the March sisters - four young women, each determined to live life on her own terms. Federal government websites often end in .gov or .mil. Should the damage affect the talus in addition to another part of the joint like the tibia or fibula, this can compress or scuff the talus, leading to injury. A femoral bone contusion is a deep bruise, or hematoma, of the thighbone. Ankle impingement is a common condition occurring secondary to sprain or repeated microtrauma. Pain Physician. Radiographs are unremarkable. Our case report is important as it is the first description of these MRI findings which will help enable clinicians to recognise this rare injury and allow for appropriate management. This time is usually shorter than healing time. This happens when the ankle rolls so that the sole of the foot is facing inward. Last Reviewed: Jan 19th, 2023, Extracoporeal Pulse Activation Therapy (EPAT), Laser/PinPointe Laser Treatment for Fungal Nails. This can be done by wrapping ice packs in a towel got get greater joint coverage. It leads to chronic pain and the only treatment is surgery. Type I lesions are most common on the lateral femoral condyle and type III on the lateral tibial condyle. Weight bearing is not allowed on the injured leg. Hi woud appreciate any opinons on this. This takes only a few months. Bone contusions in both surfaces of the knee (kissing contusion) are rather rare complex injuries of the knee and their importance has not been well established. Causes of Numbness and Tingling (Paresthesia) in, Acute trauma affecting the person and involving the joint, Excessive impact or friction between the two bones present in a joint. Before HHS Vulnerability Disclosure, Help Orthop J Sports Med. Bookshelf The causes of this type of bone marrow oedema are: Bone Fracture is a condition where the outer cortical layer and the inner medullary layer are affected. A T2 weighted scan or a fat suppressed type of MRI will show increased intensity. 2012 Sep-Oct;15(5):E743-8. 604 Trauma to the skin, subcutaneous tissue and breast with mcc; 605 Trauma to the skin, subcutaneous tissue and breast without mcc; 963 Other multiple significant trauma with mcc; An ankle X-ray can detect broken bones, assist a physician in setting the broken bone, and can monitor the treatment process to determine whether the bone is properly aligned and the break is healing properly. Depending on the severity of the injury, the bone may be broken and the broken parts may be separated with a gap in the middle. Foot Ankle Int 2009;30(9):836841.4. The majority of OLTs, as many as 85%, occur after a traumatic injury to the ankle joint. A drill bit (2mm diameter) was used to create several channels between the surface and underlying cancellous bone. An ankle sprain is one of the most common musculoskeletal injuries in people of all ages, athletes and couch potatoes alike. A: Ha ha ha! Figure 6 Histopathology revealed cartilaginous island with an active chondrocyte surrounded by osteoid matrix of the attached bony stalk. Severe sprains and fractures have similar symptoms (pain, swelling, bruising, tenderness) and are both caused by twisting or rotating your ankle, tripping or falling, or trauma to your ankle. At six month and one year follow up visits the patient had returned to full activities without difficulty or pain at her left hindfoot. The common sites where these bruises are seen are: Bone bruises are common in the ankle region especially in the lower ends of the tibia or the talus bone. Muscle ruptures are usually straightforward; sudden intense pain . Bone contusions cause deep, achy pain and often . Its important to note that, with a blunt injury, you may have bruised some bones and fractured others, so X-rays are a good way to determine the full extent of your injury. We observed joint effusion of the subtalar joint with high signal intensity of the adjacent talar and calcaneal bone identified on T2 and STIR sequencing as well as arthrosis on cartilage sequencing anterior to these lesions, presumably secondary to decreased mobility of the subtalar joint and a shift in the normal mechanical stresses anteriorly. Clipboard, Search History, and several other advanced features are temporarily unavailable. Playing on Chromecast. Sort by Popularity - Most Popular Movies and TV Shows tagged with keyword "sprained-ankle". Physical exam reveals some joint swelling but no ligamentous instability. When this happen, it can cause a, We use cookies to enhance your experience while using our website. 4,10,24 The absolute risk of ankle sprains had been estimated to be 1 per 1000 sports hours 23 and makes up a significant amount of lost playing time. Ice packs are useful in reducing the swelling. Use an ice pack, or put crushed ice in a plastic bag. If the geographic type of bruise is in connection with the joint then it is diagnosed as osteochondral fracture. If the bruise has occurred around a joint, like that at your toe, you may need to immobilize the injury to ensure the joint heals properly. A cartilage cap to suggest osteochondroma was not appreciated. During your one-on-one consultation in Dr. Loebs office, hell take the time to get to know you and understand your aesthetic concerns. Radiographs at the time were negative and his pain improved over the next two months. Injury to the muscles and tendons of the joints, Joint pain which lasts even when the bruise has healed, Calcaneum bone in the heel. One theory is that bone bruising occurs as a result of a mechanism referred to as contrecoup. It is sometimes called a "pulled muscle.". Radiographics 2000 ; 20 : 1407-1434. The objective of this study was to determine the presence and location of subchondral bone contusions, fractures, and "kissing" lesions of the talotibial joint after a sprain of the ankle shown on MR imaging. ankle inversion and dorsiflexion during axial load creates shearing of lateral talar dome and lateral OLT, ankle inversion, external rotation, and plantarflexion during axial load creates shearing of medial talar dome and medial OLT, possible repeitive microtrauma creates ischemic environment and loss of integrity of subchondral bone, leads to softening and disruption of overlying cartilage, among the thickest in the body (implications for osteochondral autografting), maintains tensile strength longer than femoral head with aging process, deltoid artery supplies majority of talar body and dome, ankle is a highly congruent mortise joint, oriented 15 degrees externally from midsagittal line of ankle, talus articulates with the medial malleolus medially, tibial plafond superiorly, posterior malleolus posteriorly, and fibula laterally, Berndt and Harty Radiographic Classification, Complete fragment detachment but not displaced, Cystic lesion within dome of talus with an intact roof on all view, Cystic lesion communication to talar dome surface, Open articular surface lesion with the overlying nondisplaced fragment, Cartilage injury with underlying fracture and surrounding bony edema, mechanical symptoms such as catching or locking, often limited secondary to pain or effusion, evaluate for ligamentous laxity or insufficiency, suspicion for OLT in setting of equivocal radiographs, helpful in evaluating subchondral bone and cysts, less reliable in purely cartilaginous lesions of nondisplaced OLTs, provides fine detail of lesions for pre-operative planning, persistent pain following injury, ankle sprains that do not heal with time, variable edema patterns, may overestimate degree of injury, unstable lesions show fluid deep to subchondral bone, predicts stability of lesion with 92% sensitivity, nondisplaced fragment with incomplete fracture, osteochondral grafting (osteochondral autograft transplantation, autologous chondrocyte implantation, bulk allograft), size > 1 cm and displaced lesions, shoulder lesions, salvage for failed marrow stimulation or drilling, period of immobilization in cast or boot for 6 weeks, followed by progressive weight bearing with physical therapy emphasizing peroneal strengthening, range of motion, and proprioceptive training, debridement of unstable cartilage flaps to create stable and contained defect using curettes or shaver, loose bodies and cartilage removed using shaver or grasper, microfracture awl placed perpendicular to surface and tapped into subchondral bone 2-4 mm deep, inflow stopped to allow fat or blood to emanate from holes, indicating adequate penetration, Kirschner wire can be passed using anterior portals, or transmalleolar for central or posterior lesions, talus dorsiflexed and plantar flex to necessitate only 1 transosseous passing of wire, articular cartilage delamination and graft failure, 65-90% improvement in patient reported outcomes, fibrocartilage formation at site of lesion in 60% of patients on second-look arthroscopy, no correlation noted with patient outcomes, evaluate cartilaginous surface for softening, dimpling with probe seen, Kirschner wire drilled from sinus tarsi into defect, fluoroscopy often helpful to confirm location, if bone grafting indicated, cannulated drill placed over K wire, dictated by location of OLT and concomitant procedures required (i.e.
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