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|Osteochondral lesion of the talar dome|
When two bones move relative to each other, their surface consists of a softer substance that we call cartilage. In most joints of the foot and ankle, this layer of cartilage is one to a few millimeters thick. To make these surfaces slide more easily, there is also fluid in the joint that is created by the capsule of the joint.
An osteochondral defect can be described as an interruption of the normal lining of a joint surface in which both the cartilage and the directly underlying bone are affected. A cyst can be seen as a cavity filled with synovial fluid.
A simple tear may go unnoticed and heal spontaneously without you ever knowing it. Because of the pressure in the joint, however, it may also happen that the synovial fluid is pushed into this crack and quietly creates an accumulation of fluid in the bone (osteochondral cyst), just below the cartilage. At that time, patients can have three different kinds of complaints, whether or not in combination:
Depending on the location, the size of the injury, your age and previous treatments, several kinds of surgery may be proposed:
This in itself has, according to the literature, a success rate of 60%. However, if in addition, several holes are made in the underlying bone, enhancing a better bleeding, improvement can be hoped for in 85% of the patients. After surgery, a pressure bandage is applied for three days, you are prompted to move the ankle as much as possible, but also “demanded” not to bear weight for 6 weeks on the operated leg. The reason for this latter is our hope that the hematoma will turn partly into bone and partly into a kind of cartilage that will attach to the existing bone and cartilage.
While leaning, the synovial fluid is under pressure and can more easily push its way through the hematoma and the remaining bone and cartilage, creating a new type of cartilage injury, with relapse as a result.
In case of a non-displaced fracture, you are asked not to lean for 6 weeks. Since ligament lesions are often present as well, a cast should be applied for a few weeks, with or without mobilization exercises by a physiotherapist.
If the cartilage injury has torn off part of the underlying bone and has moved into the joint, the treatment will depend on the size of the fragment. If it is too small to be secured in its place with a screw, it can simply be removed, after which a debridement and microfracture should be done where the fragment came from. In the case of fixation, we find ourselves in a similar situation as of a non-displaced fracture.
Another entity is an osteochondritis dissecans, in which an osteochondral injury has occurred during the development of the body. After a trauma, or spontaneously, this fragment can become mobile, causing inflammation around the lesion. Treatment may include:
In the case of complete diffuse or local disappearance of cartilage in a joint, we can speak of osteoarthritis (cf. section “osteoarthritis”).