Osteochondral Lesions of the Talus: Change in MRI Findings Over Time in Talar Lesions Without Operative Intervention and Implications for Staging Systems

Elias, Ilan; Jung, Jennifer W.; Raikin, Steven M.; Schweitzer, Mark W.; Carrino, John A.; Morrison, William B.

doi:10.1177/107110070602700301

Cited by 90 publications

(56 citation statements)

References 22 publications

(62 reference statements)

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“…This rate of ankle osteoarthritis in patients with OLT is comparable with data from earlier studies. 4,7,12,18,21 Bauer et al 2 described the development of severe ankle osteoarthritis after an average follow-up of 21 years in only 1 of 30 patients having OLT. In our study population, only 1 patient demonstrated a stage progression from 0 to 1 on the van Dijk classification, 22 whereas all others remained unchanged.…”

Section: Discussionmentioning

confidence: 99%

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Natural History of Nonoperatively Treated Osteochondral Lesions of the Talus

et al. 2014

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BACKGROUND We hypothesized that patients undergoing nonoperative treatment for asymptomatic or minimally symptomatic osteochondral lesions of the talus (OLTs) would not deteriorate clinically or radiologically over time. METHODS Forty-eight patients (mean age = 48 years; range, 13-78 years) with an OLT confirmed by magnetic resonance imaging (MRI) who had not undergone ankle joint surgery were retrospectively reviewed. All patients were evaluated after a minimum follow-up of 2 years (mean = 52 months; range, 27-124 months). All patients filled out an individual questionnaire and underwent a physical and radiographic assessment (radiograph and hindfoot MRI). RESULTS At final follow-up, 43 ankles (86%) in 41 patients were pain-free (visual analogue scale [VAS] 0, n = 12) or less painful (VAS 1-3, n = 31). Radiographically, osteoarthritis was absent in 47%, and grade 1 and 2 osteoarthritis each were found in 27% (van Dijk classification). Magnetic resonance imaging revealed no substantial progression in staging or lesion size. Pain at time of follow-up correlated with the depth of the lesion at initial MRI (P < .05) and with subchondral cyst formation and presence or change of bone marrow edema at follow-up MRI (P < .05). CONCLUSION Minimally symptomatic OLTs did not appear to progress or worsen over time when treated nonoperatively.

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Section: Discussionmentioning

confidence: 99%

“…2,7,12,15,18 The natural history of OLTs is not well described. It is unclear whether these lesions tend to progress in terms of size and symptoms or lead to joint deterioration.…”

Section: Introductionmentioning

confidence: 99%

Natural History of Nonoperatively Treated Osteochondral Lesions of the Talus

et al. 2014

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“…Histological examination revealed two distinct patterns in the samples: (1) thick homogeneous hyaline cartilage alone with little Wbrous tissue surrounding areas of separation and (2) nearly normal, thin hyaline cartilage above a mixed layer of hyaline cartilage and subchondral trabeculae and Wbrous/Wbro-cartilaginous tissue at the areas of separation, indicating delayed or non-union. BML is present in 50% of cases [34], but the relation between emergence of BML and progression in this disease is still subject to debate [35].…”

Section: Osteochondritis Dissecansmentioning

confidence: 99%

Bone marrow lesions: a universal bone response to injury?

Eriksen

Ringe

2011

Rheumatol Int

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The ever increasing use of magnetic resonance imaging in clinical practice has led to the recognition of a new entity, bone marrow lesions (BMLs). These lesions are characterized by excessive water signals in the marrow space and have emerged as a central component of many different diseases affecting the musculoskeletal system. BMLs have in particular been associated with a wide variety of inflammatory and non-inflammatory rheumatologic conditions and are not only considered significant sources of pain, but also linked to the worsening of patient prognosis in many disease states. In this review, we summarize the current knowledge on BMLs with an emphasis on the clinical and histological features of this entity in inflammatory and non-inflammatory disease and provide a unifying hypothesis based on the appearance with various imaging technologies. We also try to pair this hypothesis with the apparent beneficial effects of various treatment regimens, mainly within the group of bone antiresorptive drugs (calcitonin, bisphosphonates) on symptoms associated with BMLs.

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“…Other signs of an unstable OCL are focal cartilage defects or defects in the subchondral bony end plate, the presence of subchondral cysts or an empty bony defect zone filled with fluid [25,29]. However, mechanical stability assessment alone, based on MRI findings, has also been critically discussed [41], and one study of the knee demonstrated no relationship between the size and localization of an OCL and its stability [42]. The aforementioned signs of instability of an OCL apply to adults and adolescents with closed epiphyseal plates [25,43].…”

Section: Classification Of Osteochondral Lesionsmentioning

confidence: 99%

Modern Cartilage Imaging of the Ankle

Weber

Wünnemann

Jungmann

et al. 2017

Fortschr Röntgenstr

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ABSTR AC TBackground Talar osteochondral lesions are an important risk factor for the development of talar osteoarthritis. Furthermore, osteochondral lesions might explain persistent ankle pain. Early diagnosis of accompanying chondral defects is important to establish the optimal therapy strategy and thereby delaying or preventing the onset of osteoarthritis. The purpose of this review is to explain modern cartilage imaging with emphasis of MR imaging as well as the discussion of more sophisticated imaging studies like CT-arthrography or functional MR imaging.Methods Pubmed literature search concerning: osteochondral lesions, cartilage damage, ankle joint, talus, 2 D MR imaging, 3 D MR imaging, cartilage MR imaging, CT-arthrography, cartilage repair, microfracture, OATS, MACT.Results and Conclusion Dedicated MR imaging protocols to delineate talar cartilage and the appearance of acute and chronic osteochondral lesions were discussed. Recent developments of MR imaging, such as isotropic 3 D imaging that has a higher signal-to noise ratio when compared to 2 D imaging, and specialized imaging methods such as CT-arthrography as well as functional MR imaging were introduced. Several classifications schemes and imaging findings of osteochondral lesions that influence the conservative or surgical therapy strategy were discussed. MRI enables after surgery the noninvasive assessment of the repair tissue and the success of implantation. Key points▪ Modern MRI allows for highly resolved visualization of the articular cartilage of the ankle joint and of subchondral pathologies. ▪ Recent advances in MRI include 3 D isotropic ankle joint imaging, which deliver higher signal-to-noise ratios of the cartilage and less partial volume artifacts when compared with standard 2 D sequences. ▪ In case of osteochondral lesions MRI is beneficial for assessing the stability of the osteochondral fragment and for this discontinuity of the cartilage layer is an important factor. ▪ CT-arthrography can be used in case of contraindications of MRI and in unclear MRI findings as further diagnostic approach. Citation Format

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Osteochondral Lesions of the Talus: Change in MRI Findings Over Time in Talar Lesions Without Operative Intervention and Implications for Staging Systems

Cited by 90 publications

References 22 publications

Natural History of Nonoperatively Treated Osteochondral Lesions of the Talus

Natural History of Nonoperatively Treated Osteochondral Lesions of the Talus

Bone marrow lesions: a universal bone response to injury?

Modern Cartilage Imaging of the Ankle

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