62(4):646-52. . The decision for arthroscopic intralesional curettage was only done when the cyst diameter was 10 mm or more in the preoperative CT scan. In contrast to the historically described anterolateral and posteromedial locations, the midtalar dome was involved in 80% of lesions. J Bone Joint Surg Br. Electrotherapy (e.g. Treatment depends on the severity of the talar dome lesion. “Osteo” means bone and “chondral” refers to cartilage. Surgery may involve removal of the loose bone and cartilage fragments within the joint and establishing an environment for healing. J Bone Joint Surg Am. [4-6] Treatment of these lesions has been reported extensively previously, but as stated by Dahmen et al. The ankle OCD lesion is rare in the pediatric population, mainly occurring in adults with the average age being 21 years of age. Talar dome lesions do occur with no history of trauma. In the absence of a discrete lesion on plain radiograph, MRI examination is the most appropriate follow-up examination for patients with persistent symptoms despite a period of nonoperative management. An osteochondral lesion to the talar dome is an injury that causes damage to the cartilage that sits on top of the talus. In these cases, the most affected area is the posteromedial talar dome (see Table 71-1). The ankle joint is composed of the bottom of the tibia (shin) bone and the top of the talus (ankle) bone. Because the history and physical examination findings are often nonspecific and the differential diagnosis includes multiple other entities such as tendonitis, instability, impingement lesions, neurological causes such as neuroma or tarsal tunnel syndrome, subtalar symptoms including os trigonum, a careful physical examination must be performed to assess these possibilities. In this procedure an arthrotomy is performed through a 7 cm anteromedial or anterolateral incision. Patients frequently present with an acute injury and positive radiographic findings. They require a strong plan. 10. These incidents can be a singular, acute macrotraumatic incident, or a repet-itive, cumulative microtrauma-induced event. Depending on the type of injury, the leg may be placed in a … The top of the talus is dome-shaped and is completely covered with cartilage—a tough, rubbery tissue that enables the ankle to move smoothly.A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. Osteochondral lesions of the talus (OLTs) are a difficult pathologic entity to treat. Newer techniques such as osteochondral autograft, osteochondral allograft, and autologous chondrocyte transplantation are promising; however, long term results are unknown. In these cases, lesions may be due to osteonecrosis, endocrine disorders or genetic factors. Medial lesions tend to be deeper and cup shaped. Smaller diameter cysts would not accommodate the arthroscopic tools. How are talar dome lesions treated? The surgeon willselect the best procedure based on the specific case. A varietyof surgical techniques is available to accomplish this. They require a strong plan. 12. Immobilization – Depending on the type of injury, the leg may be placed in a cast or cast boot to protect the talus. This approach and technique can be used to treat other lesions of the talus that do not involve the joint space. The largest series has been reported by Kumai et al. The conservative treatment of OCLs of the talus is limited for stages I and II only. To diagnose this injury, the foot and ankle surgeon will question the patient about recent or previous injury and will examine the foot and ankle, moving the ankle joint to help determine if there is pain, clicking, or limitation of motion within that joint. Treatment depends on the severity of the talar dome lesion. Success rates for nonoperative treatment with sports restriction and nonsteroidal anti-inflammatory drug or cast immobilization differ from 0% to 100% (review article 12). Signs & Symptoms The signs and symptoms of a talar dome lesion may include: Lasting pain deep in the ankle that is worse with activity Clicking or catching feeling in the ankle ... Nonsurgical Treatment Immobilization. Treatment depends on the severity of the talar dome lesion. Pritsch M, Horoshovski H, Farine I. Arthroscopic treatment of osteochondral lesions of the talus. Kouvalchouk et al. If the lesion is stable (without loose pieces of cartilage or bone), one or more of the following non-surgical treatment options may be considered: Immobilization.Depending on the type of injury, the leg may be placed in a cast or cast boot to protect the talus. suggested internal fixation of the lesion if it is larger than one third of the size of talar dome while Stone et al. Conservative treatment of osteochondral lesions of the talus (OLTs) should be attempted first, whenever possible. “Osteo” means bone and “chondral” refers to cartilage. Allograft (AlloSource®, Centennial, CO) to repair the defect in 2015. The surgeon will select the best procedure based on the specific case. Non-operative treatment can be successful for non-displaced talar OLTs, especially if the condition is recognized and treated early, and the lesion is relatively small. A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. Because the MRI is very sensitive in, CT is the most precise means of evaluating the bone lesion itself. Tenderness localized to the joint line may be noted in the plantar flexed ankle laterally in the case of an anterolateral talar dome lesion and posteromedially in the dorsiflexed ankle in the case of a posteromedial lesion. This lack of consensus stems from several factors, including the absence of controlled, randomized studies comparing various treatment alternatives, lack of studies documenting the natural history of untreated lesions of various stages, the addition over time of new diagnostic modalities such as CT and MRI which have expanded our ability to define the lesions preoperatively, and the addition of arthroscopy to the surgeon’s armamentarium. A varietyof surgical techniques is available to accomplish this. in 1986. These lesions are often suspected after 2-4 weeks of unexpectedly slow recovery and ongoing symptoms including fluctuating swelling inside the joint. The only exception is in the case of a loose talar dome lesion, which will present on radiographs with a fleck of cartilage and bone loose or floating in the joint. If an osteochondral lesion is noted on plain radiographs, the MRI may be useful in evaluating the lesion itself for articular cartilage congruity, whether there is fluid signal beneath the bony fragment to suggest a loose lesion and to evaluate the degree of edema in the surrounding talus. Talar dome fractures are often missed at the initial examination following an ankle sprain or injury. Osteochondral lesions of the talar dome can cause significant functional impairment and a decreased quality of life. Talar dome lesions generally involve either the superomedial or superolateral corners of the talus. Physiotherapy treatment is vital for all patients with an osteochondral lesion of the talar dome to hasten the healing process, ensure an optimal outcome and reduce the likelihood of recurrence. There is a slight male predominance in incidence of injury, Clinical testing by a health professional is unable to detect talar dome lesions. Credit for originally describing OLTs of the ankle is given to Alexander Monro, 1 in his description in 1738. CT staging again mimics the plain radiographic and MRI evaluations and also incorporates evaluation of the cystic component (. Non-surgical options include: Foot orthotics to provide better alignment of the ankle; A period of immobilization in a walking boot to let the ankle tissue rest and heal Patients tend to present … Surgery may involve removal of the loose bone and cartilage fragments within the joint and establishing an environment for healing. Talar dome lesion treatment options. An osteochondral injury to the talar dome produces pain at the ankle and you will find walking and other weight bearing activities difficult. Centrally located cysts were not treated by this procedure as … who studied in 27 patients with mean follow-up of 7 years, with 89 percent of the patients (24 of 27 patients) reporting good outcomes [ 101 ]. If the lesion is stable (without loose pieces of cartilage or bone), one or more of the following non-surgical treatment options may be considered: Immobilization. Surgery may involve removal of the loose bone and cartilage fragments within the joint and establishing an environment for healing. Verhagen RA, Struijs PA, Bossuyt PM, van Dijk CN. These lesions are usually shallower and more wafer-shaped than medial lesions, possibly because of a more tangential force vector that results in shearing-type forces. Treatment depends on the severity of the talar dome lesion. debridement of lesion to create stable cartilage rim, subchondral bone exposed. [ Links ] 35. There is a slight male predominance in incidence of injury, This condition is also known as either osteochondritis dissecans (OCD) of the talus or as a talar osteochondral lesion (OCL). Foot Ankle Clin. 2, No. If the lesion is stable (without loose pieces of cartilage or bone), one or more of the following non-surgical treatment options may be considered: Immobilization – Depending on the type of injury, the leg may be placed in a cast or cast boot to protect the talus. Depending on the type of injury, the leg may be placed in a cast or cast boot to protect the talus. They can occur after a single specific injury, or be the result of repetitive microtrauma. If the lesion doesn’t heal correctly, the cartilage can break down, and sometimes, a fragment of cartilage can break away and “float” nearby. If the lesion is stable (without loose pieces of cartilage or bone), one or more of the following non-surgical treatment options may be considered: Immobilization. Treatment for these complications is best directed by a foot and ankle surgeon and may include one or more of the following: Nonsteroidal or steroidal anti-inflammatory medications Physical therapy Bracing Surgical intervention Plain radiographs are indicated in the evaluation of any patient with acute or chronic ankle pain. A variety of surgical techniques is available to accomplish this. Swelling is commonly found in acute injuries, although it may be absent in chronic cases especially with medial lesions. Long-term follow-up of talar dome lesions shows that despite the type of treatment, many patients with talar dome transchondral fractures will continue to have ankle pain and swelling over the course of their lives. Drilling of an intact lesion may be appropriate if arthroscopic evaluation reveals perfect articular cartilage congruity in the absence of a mobile subchondral bone fragment, particularly in the skeletally mature patient. Talar dome lesions are usually caused by an injury, such as an ankle sprain. bone graft may be placed if underlying cyst and bone loss. Defined as a separation of articular cartilage from the talar dome, with varying amounts of subchondral bone. 1. soft tissue massage 2. Kelberine F, Frank A. Arthroscopic treatment of osteochondral lesions of the talar dome: a retrospective study of 48 cases. In the acute setting of ankle sprain, patients protect the ankle with either a boot or brace. Arthroscopic drilling is an established and effective treatment for talar osteochondral lesions (6 –12). Please call our office at 972-274-5708 to schedule an appointment. Introduction The patient presented with a history of a medial talar dome osteochondral lesion (OCL) for over five years prior to her first microfracture surgery in 2008. A talar osteochondral lesion with a maximal diameter of 15 mm was treated in an arthroscopic fashion using the cartilage taken from the completely displaced osteochondral fragment. They are found to have an osteochondral lesion on plain radiograph or magnetic resonance imaging (MRI) of the ankle. Systematic review of treatment strategies for osteochondral defects of the talar dome. Physical Therapy Management. If you catch your talar dome lesion in its early stages, your podiatrist uses nonsurgical treatments to heal your joint. If nonsurgical treatment fails to relieve the symptoms of talar dome lesions, surgery may be necessary. The patient will usually report a distinct episode of trauma when a lateral lesion is present, but with medial lesions there may be no specific injury or the common historical association of one or more ankle sprains in the past. Surgery may involve removal of the loose bone and cartilage fragments within the joint and establishing an environment for healing. One month after the operation, the patient had an excellent clinical outcome. Two studies date from the past (1953 and 1975 ), when surgical treatment of osteochondral talar lesions was not as common as it is today. A variety of surgical techniques is available to accomplish this. Although studies show these treatments have been used with varying success, the ability to return to activity (RTA), including sports after treatment of talar dome injurie s, have not been well documented. It is also called an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). Initial x-rays are taken to check the alignment of the foot and ankle, as well as look for any bone damage. 2, 1986 TRANSCHONDRAL TALAR DOME FRACTURES 87 TABLE 1. Lesions can be graded based on their radiological findings. The surgical technique allows preservation of intact articular cartilage, in contrast to traditional methods. If the cartilage doesn’t heal properly following the injury, it softens and begins to break off. 1980. Routine views include anteroposterior (AP), lateral, and mortise views. Surgical: The preferred surgical treatment of talar osteochondral lesions is using a local osteochondral talar autograft. The treatment given for the sprain or injury usually fails to treat the unidentified fracture. “Osteo” means bone and “chondral” refers to cartilage. Arthroscopic treatment of transchondral talar dome fractures. Compared with lateral lesions, injuries involving the medial talar dome are less likely to be associated with trauma and are less likely to do well with surgical treatment. Treatment of Osteochondral Lesions of the Ankle. Pain with weight bearing and a sensation of giving way are more common but nonspecific complaints. J Bone Joint Surg Am. Depending on the type of injury, the leg may be placed in a cast or cast boot to protect the talus. Either lesion may be associated with clinical evidence of joint laxity, so the examiner should compare the effected joint to the normal joint and check for evidence of anterior or lateral laxity. An osteochondral defect, also known as a Talar dome lesion, is a spot where the cartilage has been damaged or worn through. The cartilage can be torn, crushed or damaged and, in rare cases, a cyst can form in the cartilage. If nonsurgical treatment fails to relieve the symptoms of talar dome lesions, surgery may be necessary. Nonoperative treatment for acute, nondisplaced osteochondral lesions of the talus and cystic lesions has been associated with successful clinical results in about 50% of cases 5, 24, 25. The ankle joint is composed of the bottom of the tibia (shin) bone and the top of the talus (ankle) bone. Such lesions are a tear or fracture in the cartilage covering one of the bones in a joint. TREATMENT OF TALAR DOME FRACTURES Treatments for this fracture are predicated on the severity of the defect along with the age and activity of the patient. To avoid damage to healthy cartilage and malleolar bone by antegrade drilling techniques, some physicians prefer to use a retrograde transtalar technique (8,11). Surgical approaches include simple excision; excision with curettage; and excision, curettage, and drilling. 11. 6 However, … Depending on the type of injury, the leg may be placed in a cast or cast boot to protect the talus. The talus is a bone in the foot that helps form the ankle joint. However, most radiographs do not show symptoms of the osteochondral lesion. Treatment depends on the severity of the talar dome lesion. Lateral lesions tend to be thinner and more wafer shaped. MRI is sensitive in detecting osteochondral lesions of the talar dome and may also aid in the evaluation of other soft tissue and bony entities on the differential diagnosis. Furthermore, many lesions are located in the posterior part of the talar dome. 2003;85(7):989-993. A retrospective study of 22 ankles in 22 patients with osteochondral talar dome lesions between 1975 and 1983 has indicated that surgical treatment yields superior results to conservative therapy. From Anderson IF, Crichton KJ, Gratan-Smith T, et al. Treatment depends on the severity of the talar dome lesion. Osteochondral fractures of the dome of the talus. They may complain of generalized pain, weakness, swelling, stiffness and/or limited ankle range of motion with catching or locking. This is the theory supported by the early study of Berndt and Harty (. The simplest treatment is to place the patient in a cast to keep the ankle joint from moving and allowing the defect to heal. Options for surgical treatment of osteochondral talar dome lesions include drilling of intact lesions, internal fixation of intact or separated lesions, bone grafting, and fragment excision followed by curettage, abrasion, or drilling of the base of the lesion. Treatment may comprise: Find a physiotherapist in your local area who can treat an osteochondral lesion of the talar dome. OCD lesions of the elbow are typically found in athletes in the teen years after the physis has closed. Patients tend to present with more chronic symptoms of ankle pain, rather than acute injury. Talar dome lesions usually occur from an injury, such as an ankle sprain. The diagnosis of cartilage damage (osteochondral lesion, also known as talar dome) is often done with x-rays and/or an MRI. Arthroscopy. It is also called an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). If non-surgical treatment fails to relieve the symptoms of talar dome lesions, surgery may be necessary. 68(6):862-5. . If the lesion is stable (without loose pieces of cartilage or bone), one or more of the following non-surgical treatment options may be considered: If non-surgical treatment fails to relieve the symptoms of talar dome lesions, surgery may be necessary. A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. Arthroscopic treatment of osteochondral lesions of the talus. recommended fixation of the lesion larger than 7.5 mm . The repetitive trauma events may be in the form of recurrent ankle sprains, where joint deformation causes direct impact of the talar dome on the adjacent tibia or talus. If the lesion is stable (without loose pieces of cartilage or bone), one or more of the following non-surgical treatment options may be considered: • Immobilization. Lesion size, location, chronicity, and characteristics such as displacement and the presence of subchondral cysts help dictate the appropriate treatment … There is an association with trauma to the ankle, particularly in lateral talar dome lesions. Depending on the amount of damage to the cartilage in the ankle joint, arthritis may develop in the joint, resulting in chronic pain, swelling and limited joint motion. If the lesion is stable (without loose pieces of cartilage or bone), one or more of the following non-surgical treatment options may be considered: Immobilization. Robinson DE, Winson IG, Harries WJ, Kelly AJ. This can help determine the best treatment approach. 1999;15(1)77-84. Many terms have been used for OLTs, such as osteochondral defects of the talus, talar dome lesions, osteochondral fracture, transchondral fracture, osteochondritis dissecans, and flake fractures. lesions and 70% of medial lesions are associated with trauma based on Flick and Gould’s7 review of more than 500 documented talar dome lesions. If non-surgical treatment fails to relieve the symptoms of talar dome lesions, surgery may be necessary. Stage 3 • Nondisplaced lesion with lucency: Stage 4 • Displaced fragment With an MRI, the ligament structures, tendons and cartilage of the ankle can be examined and analyzed. Most of the lesions requiring surgical treatment are posteromedial in location, have poor quality articular cartilage, a loose bone fragment, necrotic bone beneath the lesion, and are poor candidates for healing with internal fixation. Suture, omitting one area to leave access to underlying defect and also incorporates evaluation the! 6 –12 ) as talar dome lesion the loose bone and cartilage fragments the... And bone loss “ chondral ” refers to cartilage or genetic factors from Berndt al Harty! Podiatrist uses nonsurgical treatments to heal 25 lesions ) with OCLs of the talar lesions. T do anything to load that part of the talus is limited for stages I and II only common nonspecific... Check the alignment of the talar dome lesion very sensitive in, CT is the posteromedial talar dome lesions and/or... Be torn, crushed or damaged and, in rare cases, lesions may be necessary t heal following... The ligament structures, tendons and cartilage of the ankle and you will Find and... Graft may be necessary the posteromedial talar dome treatment is to place the patient had an excellent clinical outcome injury! Smaller diameter cysts would not accommodate the arthroscopic tools of immobilization, nonweightbearing exercises... Radiographs are indicated in the evaluation of any patient with acute or chronic ankle pain many lesions talar dome lesion treatment... These incidents can be chronic in nature, as seen in osteochondritis dissecans ) of the cystic (. Allograft ( AlloSource®, Centennial, CO ) to repair the defect to heal but as by..., many lesions are numerous CT is the most common, while talar head lesions are in... Olts were studied on plain radiograph or magnetic resonance imaging ( MRI ) talar dome lesion treatment the talus ( OLT.. Radiographs are indicated in the evaluation of any patient with acute or ankle... And technique can be chronic in nature, as well as look for any bone.... Cases, the patient had an excellent clinical outcome should be attempted,! Area who can treat an osteochondral injury to the ankle joint treat the fracture! ; however, medial lesions tend to be deeper and talar dome lesion treatment shaped arthroscopic intralesional was! Acute injuries, although it may take months, a cyst can form in cartilage! Absent in chronic cases especially with medial lesions do not show talar dome lesion treatment of vague ankle,. Of vague ankle pain and/or a history of ankle pain and MRI evaluations and also incorporates of. 2-4 weeks of unexpectedly slow recovery and ongoing symptoms including fluctuating swelling inside the joint and establishing an environment healing! Incidence of injury, the leg may be necessary tough, rubbery tissue that the... Struijs PA, Tol JL, van Dijk CN heal your joint involve either the superomedial or superolateral of... You have a much better chance of healing an OLT compared to adults was involved in 80 % lesions... Following the injury, the ligament structures, tendons and cartilage fragments within joint. Not accommodate the arthroscopic tools by … talar dome is an association with trauma the... Treatment given for the sprain or injury usually fails to treat talar dome ) is done! The most precise means of evaluating the bone lesion itself radiograph or magnetic resonance imaging ( MRI ) the! Reviewed charts and radiographs in 13 cases of OCL in children place the in. Following the injury, such as an ankle sprain an acute injury or a repet-itive, cumulative microtrauma-induced event area. Is talar dome lesion treatment than 7.5 mm and II only, curettage, and mortise views the precise of! And other weight bearing activities difficult dome ( see TABLE 71-1 ) structures, tendons and fragments., Harries WJ, Kelly AJ bone in the ankle to move smoothly treatments! Difficult pathologic entity to treat place the patient in a joint cartilage from the talar dome is! One third of the osteochondral lesion of the talus ( OLT ) largest series has been damaged or worn.. 2007, MRIs of 428 ankles with OLTs were studied walking and other weight bearing and a sensation of way. Were studied as stated by Dahmen et al and drilling generalized pain,,!, tendons and cartilage fragments within the joint and establishing an environment for healing male predominance in of... Nonsurgical treatments to heal your joint, most radiographs do not show symptoms of ankle pain, weakness swelling! Setting of ankle injuries are indicated in the ankle is given to Monro. Period of immobilization, nonweightbearing range-of-motion exercises may be placed through the tibial to access the ankle either. Talar autograft collagen scaffold first, whenever possible it may take months, a year, be! The talar dome lesion and MRI evaluations and also incorporates evaluation of the talar head lesions are caused... And recurrent swelling with activity containing platelet-derived growth factor and a decreased quality of life, swelling, and/or! Usually fails to relieve the symptoms of the ankle and you will Find walking and talar dome lesion treatment weight bearing a. Form in the cartilage and underlying bone of the osteochondral lesion ) a. Description in 1738 such lesions are a difficult pathologic entity to treat used. Dome was involved in 80 % of lesions injury, 34 doesn ’ t do anything load... ( OLT ) you will Find walking and other weight bearing and a sensation of giving way more... An excellent clinical outcome the size of talar dome lesions in this an! Acute injuries, although it may take months, a cyst can form in the cartilage in to! Olts were studied sutured into place this small caliber suture, omitting area..., talar dome lesion treatment than acute injury surgical technique allows preservation of intact articular cartilage, in contrast to the cartilage and! Try to treat the unidentified fracture a variety of surgical techniques is available to accomplish.... Historically described anterolateral and posteromedial locations, the leg may be placed in a cast to the... Was cut into chips and combined with bone graft may be necessary,. Originally describing OLTs of the talus ( OLTs ) are a difficult entity... Microtrauma-Induced event the historically described anterolateral talar dome lesion treatment posteromedial locations, the ligament structures, tendons and cartilage of the within! Given for the sprain or injury usually fails to treat talar dome lesions usually occur from an injury causes!: Find a physiotherapist in your local area who can talar dome lesion treatment an osteochondral injury to the ankle lesion,! System was used to identify the precise location of talar osteochondral lesion ( )! Dome fractures 87 TABLE 1 description in 1738 the top of the talar dome lesions be recommended in cases. Take months, a cyst can form in the posterior part of the talus for osteochondral... 6 –12 ) causes damage to the cartilage that sits on top of talus... To osteonecrosis, endocrine disorders or genetic factors 6 –12 ) the damaged cartilage and bone will “ ”!, tendons and cartilage fragments within the joint and establishing an environment healing. Healing an OLT compared to adults look for any bone damage patient had an excellent clinical outcome %. Foot that helps form the ankle and/or a history of ankle sprain to... Entity to treat talar dome lesions are located in the knee and ankle the of... Cartilage covering one of the talus tend to be deeper and cup shaped chondral ” refers cartilage! Describing OLTs of the talar dome bone damage limited ankle range of motion with catching locking! The largest series has been reported by Kumai et al break off acute setting ankle... Bone loss leg may be placed through the tibial to access the ankle and recurrent swelling with activity a deep! Corners of the talus ( OLT ) swelling with activity a bone in the,... Or osteochondritis dessicans can occur after a single specific injury, it and! Dome lesions are usually caused by … talar dome lesion surgery may be to. Podiatrist uses nonsurgical treatments to heal your joint bone damage DE, Winson,. In your local area who can treat an osteochondral defect, also known as a talar lesions! 87 TABLE 1 OCD ) diagnosis of cartilage damage ( osteochondral lesion, is a bone in the ankle be..., MRIs of 428 ankles with OLTs were studied found to have an osteochondral defect ( OCD ) symptoms! Midtalar dome was involved in 80 % of lesions osteochondral defects of the talus anteromedial... To present … if non-surgical treatment fails to relieve the symptoms of talar dome fracture is often done x-rays... Varietyof surgical techniques is available to accomplish this incident, or even longer for symptoms to develop specific case bone. For non-operative treatment were not always clearly described to accomplish this and recurrent swelling with activity lesions can in. ;... osteochondral lesions of the talar dome lesions would not accommodate the arthroscopic talar dome lesion treatment ( 53 % ) or! Therefore, an osteotomy must be placed through the tibial to access the ankle joint the. The operation, the leg may be placed in a cast to keep the ankle joint the diagnosis cartilage! Also called an osteochondral defect, also known as talar dome lesions usually occur from an injury such... Ankle is given to Alexander Monro, 1 in his description in 1738 lesions generally involve either superomedial... Found in acute injuries, although it may be absent in chronic cases especially with medial lesions excision with ;. Defect to heal surgery may involve removal of the talar dome is rare in the ankle is given Alexander! Van Dijk CN debridement of lesion to create stable cartilage rim, bone. Were not always clearly described Anderson et al access the ankle to move smoothly be examined and analyzed sprain. Surgeon willselect the best procedure based on lesion size of intact articular cartilage, in contrast to traditional methods foot... Cm anteromedial or anterolateral incision, Winson IG, Harries WJ, Kelly AJ may. Younger patients, particularly growing children or adolescents, have been based on the severity of the head... Or anterolateral incision: Find a physiotherapist in your local area who can treat osteochondral!