osteochondritis dissecans of the ankle
TRANSCRIPT
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Osteochondritis Dissecans of the
Ankle
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Introduction
• Incidence and Presentation• Etiology and Mechanism of Injury• Pathoanatomy• Classification• Imaging• Treatment and Results
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Incidence and Presentation
• Osteochondral fracture of the Talar Dome
• Males avg 25 years• Presents with ankle sprain• Initially missed (75%)• 2-6% of all ankle sprains
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Incidence and Presentation
• “ankle sprain not improving”• Stiffness, pain, effusion• Localized tenderness• Locking if loose fragment
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Etiology and Mechanism of Injury
• Inversion injury• Lateral lesion, dorsiflexion, impacts and
shears against fibula• Medial lesion, plantar flexed, posterior
tibial plafond
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Pathoanatomy
• Once thought to be non-traumatic/AVN• Most agree now is traumatic• Osteochondral fragment is disrupted• If stable, new capillaries my cross
fracture and revascularize fragment• If not stable or displaced, AVN and
fragmentation
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Imaging
• 70% seen on plain films• Bone scan, CT are all used but MRI
superior• Assess cartilegde, stability
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Treatment
• Stage 1 - rest, cast, non-operative• Stage 2 – same for 6 weeks, 90% good
results• Stage 3 - lateral, definitely surgical –
medial, more conservative• Stage 4 - surgical
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Surgical Treatment
• Acute 3 or 4 should have an attempt at repair– Peg, countersunk screws
• Necrotic, fragmented, or small fragments– Excision, drill base
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Surgical Treatment
• Non-responding 1 and 2– Drill but attempt to preserve articular
surface
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Surgical Treatment
• Most can be done arthroscopically– +/- traction
• Medial malleolar osteotomy may be necessary
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OCD Long term
• 88% good – excellent early• Best if < 1 year between injury and
treatment• Lower grades do best
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OCD Long term
• Do poorly over time– Jensen et al.
• After 9 years– 60% of patients had pain and stiffess– 90% mild arthrosis on radiographs
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Conclusions
• Ankle sprain that does not get better• MRI best• Non-surgical then surgical• Arthroscopically• Great early then poor long term
prognosis