All patients complained of ankle pain. Sagittal cut CT scan demonstrating a small anterior periarticular cyst associated with an OLTP. The prevalence of osteochondritis dissecans in the tibial plafond detected on radiography is unknown. We thank Ellen Henson and Debbie Parker for their assistance with the photographs. Osteochondritis dissecans of the tibial plafond is rarely described. The average age was 39 years (age range, 33-49 years). On conventional radiographs, osteochondritis dissecans of the tibial plafond appears lucent and may contain a loose bony fragment. OCD can occur in any diarthrodial joint, including the following in decreasing order of frequency: Elbow (capitellum) Ankle (talar dome or tibial plafond) Tarsal navicular; Hip (femoral capital epiphysis) Shoulder (humeral head or glenoid) Wrist (scaphoid) System(s) affected: musculoskeletal Bone grafting is usually performed in an antegrade manner. Its radiologic findings are similar to those of osteochondritis dissecans located elsewhere in the body. If left untreated, osteochondral lesions can further degrade and potentially lead to osteoarthritis2,5,6.How-ever, the treatment guidelines and prognostic indicators that Under experimental conditions, Berndt and Harty [8] produced osteochondritis dissecans in the middle or anterior half of the talar dome with strong inversion of the dorsiflexed ankle. The imaging characteristics of an osteochondral injury in the tibial plafond are similar to those of osteochondritis dissecans found elsewhere in the body. Bachmann et al. The lesion can be subtle on conventional radiographs. Utilizing standard anteromedial and anterolateral portals, a diagnostic evaluation should be performed as described by Ferkel to evaluate for associated pathologies [, Arthroscopic view of OLTP in the central plafond, OLTP post debridement of unstable cartilage. Osteochondritis dissecans (OCD or OD) is a joint disorder primarily of the subchondral bone in which cracks form in the articular cartilage and the underlying subchondral bone. [7] reported that radiographic findings corresponded with arthroscopic staging in only 56% of the patients because fibrosis may provide stability in instances of osseous separation; this may explain the discrepancy between the arthroscopic findings and the imaging findings in one of our patients. If both the tibia and fibula are fractured, which is usually the case in the severe cases, it really doesn't matter where the fibula is fractured (mid-shaft, lower shaft, or distally/lateral malleolus), the fixation of the fibula at any level would be included in the code 27828.So the answer to your question is no. 0.0 (0) See More See Less. Apart from the location, osteochondral injury of the tibial plafond has radiographic findings similar to those of osteochondritis dissecans of the talar dome. However, the talar dome was irregular, with areas of ruffled tissue. In the ankle joint, OCD occurs more frequently in the talus (see the first 9 images below) than in the tibial plafond (see the last 4 images below) and is 4-14 times more common. In my experience these lesions have a good healing potential without developing a loose body. Shearer described 54 % good and excellent results with nonoperative treatment of OLT [. On lateral images, osteochondritis dissecans is less apparent. Osteochondritis dissecans of the tibial plafond is a rare condition that may not be detectable on radiography. 1C). We retrospectively reviewed the medical records of three patients with osteochondral injury in the tibial plafond. In later stages of the disorder there will be swelling of the affected joint which catches and locks during movement. The prevalence of osteochondritis dissecans in the tibial plafond detected on radiography is unknown. The cartilage in the anterolateral aspect of the distal tibia was stiffer and thicker than that in the anterolateral aspect of the talus. MRI of the Thumb: Anatomy and Spectrum of Findings in Asymptomatic Volunteers, Original Research. OCD: talus, tibial plafond, navicular Subtalar joint Calcaneonavicular coalition [anteater nose sign] Talocalcaneal coalition [complete C-sign] Anterior process of calcaneus Check base of fifth metatarsal for Jones fracture Medial aspect of 2nd metatarsal aligns with medial aspect of middle cuneiform Foot and ankle disorders 359 In the other patient, ankle arthroscopy revealed a depressed area in the posterolateral aspect of the tibial plafond filled with fibrocartilage. Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), on Approach to Osteochondral Lesions of the Tibial Plafond, Follow-up Imaging for Osteochondral Lesions of the Ankle, Diagnosis of Osteochondral Lesions by MRI, Diagnosis of Chondral Injury After Supination Trauma, Preoperative Planning for Osteochondral Defects, Rehabilitation After Bone Marrow Stimulation, Diagnosis of Osteochondral Defects of the Talus by Computerized Tomography (CT) and Single-Photon Emission Computed Tomography (SPECT-CT), Diagnosis of Osteochondral Defects by Arthroscopy. Five months after arthroscopy and débridement, the patient continued to have medial ankle pain, but the severity of the pain decreased. Its radiologic findings are similar to those of osteochondritis dissecans located elsewhere in … A literature search was conducted on the MEDLINE database using the PubMed search engine of the National Library of Medicine [3]. 1B). Consequently, radiologists must be aware of this entity and its imaging characteristics on different imaging techniques. Background: The aim of this study was to evaluate the incidence and morphologic characteristics of osteochondral lesions of the distal tibial plafond (OLTP) by location and morphologic characteristics on MRI. Osteochondritis dissecans in the ankle accounts for approximately 4% of all osteochondritis dissecans [1]. The tibial plafond cartilage was intact without any visible defect or flap. The debrided lesion is located arthroscopically with the ball tip of a microvector guide. OCD usually causes pain during and after sports. However, this study was small, consisting of only seven cadavers, and anatomic variation may be present. Its radiologic findings are … On conventional radiographs, the lesions appear lucent, seen best on anteroposterior images (Fig. It involves the articular surface of the ankle joint. cartilage injury with associated subchondral fracture but without detachment This is useful in screening for osteochondral lesions, as well as other potential musculoskeletal cases of ankle pain or instability. Imaging Characteristics and a Review of the Literature, Osteochondritis Dissecans of the Tibial Plafond, Review. Two patients (7%) had osteochondritis dissecans of the tibial plafond; the remaining had osteochondritis dissecans of the talar dome, giving a ratio of talar dome to tibial plafond of 28:2 or 14:1. Members receive the 'Picture of the week', new operative techniques and can submit their problem cases for an expert opinion. Osteochondritis dissecans (OCD) is a localized injury or condition affecting an articular surface that involves separation of a segment of cartilage and subchondral bone (Schenck, 1996). All patients underwent radiography, one patient underwent CT, and one patient underwent MR imaging. Osteochondral injuries to the talus (OCD lesions), whether acquired at the time of an ankle fracture-dislocation or of idiopathic origin, predispose patients to the development of ankle arthritis. Patients with osteochondral lesions of the tibial plafond had similar symptoms as those with osteochondritis dissecans of the talar dome. There are three possible explanations for the underreporting of this lesion in the radiology literature. Typical Revenue Codes (for form UB … The second most common localization of the osteochondral defect in the OCD with loose bodies group was the medial plafond of distal tibia [in 9 of 29 (31.1%) patients]. 1A). On axial scans, osteochondral lesions of the tibial plafond may be initially mistaken for osteochondritis dissecans of the talar dome (Fig. CONCLUSION. [OCOSH Code: D010008 203413004 M93.2 BD_OC_OCD_A] Search only this category the entire directory Advanced Search. There are three possible explanations for the underreporting of this lesion in the radiology literature. Diagnosis is usually made on a CT scan or magnetic resonance imaging (MRI) [ 2, 6 ]. As the dorsiflexed foot was inverted, the lateral border of the talar dome was compressed against the articular surface of the distal fibula. All lesions were centrally located, superior to the talus, without a predominant site. Such lesions are a tear or fracture in the cartilage covering one of the bones in a joint. If non-surgical approaches fail to relieve the symptoms of an OCD, surgery may be necessary. Inversion and rotation of a plantar flexed foot causes compression of the posterior half of the talar dome by the posterior malleolus, resulting in osteochondritis dissecans [8]. Zone 1 was the most anterior and medial, zone 3 was anterior and lateral, … No complication was reported at a 20-year follow-up examination [5]. Lateral talar lesions are more common than medial lesions. Also, in one of the patients who had ankle arthroscopy, the talar dome was irregular, suggesting traumatic contact between the talus and the tibial plafond. Osteochondral defect. [6] reported on a series of 30 patients who had osteochondritis dissecans of the ankle. In general, tibial cartilage was stiffer than talar cartilage. The search was limited to English literature and human subjects. Two of the patients were treated conservatively. • 29892 – Arthroscopically aided repair of large OCD lesions, talar dome fracture or tibial plafond fracture, with or without internal fixation • 29999 – Unlisted procedure, arthroscopy. Ankle Platform is for Orthopedic Surgeons with special interest in Ankle and Hindfoot. A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. The lesion may not be visible on conventional radiographs, as was the case in one of our patients. The cause of Tibial Plafond Fracture is axial or rotational forces occurring from motor vehicle accidents or falling from a height. Table 1 summarizes the findings in our three patients and the cases in the literature. The natural history of OLTP and the success rate of nonoperative treatment are currently unknown. The ankle joint has a rich arterial supply. Treatment options for large talar osteochondral lesions (greater than 1.5 cm) or those that fail to adequately respond to microfracture, have broadened over the last decade, with most procedures directly aimed at hyaline-like cartilage restoration. The sex and age were known in only two patients; both patients were women, 46 and 51 years old. The softest cartilage was found in the posterior half of the talus. Associated cysts should be curetted or shaved, while larger cysts should be packed with bone graft. Open ankle fracture with exposed tibial plafond. Most OLTP can be surgically managed arthroscopically. The cartilage can be torn, crushed or damaged and, in … Material and methods: We assigned 9 zones to the distal tibial plafond articular surface in an equal 3 x 3 grid configuration. 72 plays. An Osteochondral Lesion of the Distal Tibia and Fibula in Patients With an Osteochondral Lesion of the Talus on MRI: Prevalence, Location, and Concomitant Ligament and Tendon Injuries. Three of the patients described in the literature underwent surgery, curettage of subchondral cyst with bone graft [4] or débridement of the damaged articular surface followed by a period of non—weight-bearing on crutches for 6 weeks [5]. There are few cases describing this lesion in the literature, with little information on mechanism of injury, history/physical findings or recommendations for management. Short description: Osteochondritis dissecans, unsp ankle and joints of foot The 2021 edition of ICD-10-CM M93.279 became effective on October 1, 2020. Osteochondral injury of the tibial plafond is not as rare as previously reported in the radiologic literature. We noted a large amount of scar tissue infolding onto the lateral shoulder of the talus, which was débrided. steochondral lesions of the distal tibial plafond are rare—far less common than osteochondral lesions of the talus1-4. Overview. Clinical and experimental evidence has confirmed the traumatic nature of osteochondritis dissecans of the talus [8, 9]. Perhaps in some individuals, the tibial plafond is less stiff than the talar dome, placing them at risk for osteochondritis dissecans of the tibial plafond. Diagnosis is usually made on a CT scan or magnetic resonance imaging (MRI) [, Sagittal T2 and T2 MRI images demonstrating a posterior OLTP with active bone marrow edema. In a series of 15 patients undergoing operative arthroscopy of the ankle, Parisien and Vangsness [5] described two patients (13%) with osteochondral lesions of the tibial plafond and nine with osteochondritis dissecans of the talar dome, giving a ratio of the talar dome to the tibial plafond of 9:2. Two patients underwent arthroscopy. OCD Ankle and Talus Internet resources relating to Osteochondritis Dissecans affecting the Talus & Tibial Plafond. Conclusion: Osteochondritis dissecans of the tibial plafond is a rare condition that may not be detectable on radiography. When Tibial Plateau Fractures Are A Pain The tibial plateau is an important weight -bearing part of the body that connects the thighbone (femur) to the shinbone via ligaments. Although the biomechanic topography of human ankle cartilage explained the occurrence of osteochondritis dissecans in the talus, it did not explain the cause for an osteochondral lesion in the distal tibia. Osteochondral injury staging system for MRI attempts to grade the stability and severity of osteochondral injury and is used to plan management.. stage I. injury limited to articular cartilage; MRI findings: subchondral edema; x-ray findings: none; stage II. One patient was treated conservatively; currently, this patient is asymptomatic. Athanasiou et al. Introduction: Osteochondral lesions of the tibial plafond account for approximately 2.6% of osteochondral lesions in the ankle. Also, the posteromedial aspect of the tibial plafond was stiffer than that of the posteromedial aspect of the talus. Trauma ⎜ Tibial Plafond Fractures (ft. Dr. Brian Weatherford) Team Orthobullets (AF) Trauma - Tibial Plafond Fractures; Listen Now 26:30 min. All three patients were men. This includes initial rest, immobilization, and unloading protocol, in either a fracture boot or cast. In our series, the average size of the osteochondral lesions was 1.4 × 1.3 cm. Osteochondritis dissecans is suggested by a loss of the sharp cortical line (Fig. The necrotic fragment usually becomes revascularised and reattaches to the surrounding bone. Osteochondral lesions or osteochondritis dessicans can occur in any joint, but are most common in the knee and ankle. Osteochondritis dissecans of the talar articular surface of the ankle joint has been well described. 27826 Open treatment of fracture of weight bearing articular surface/portion of distal tibia (eg, pilon or tibial plafond), with internal fixation, when performed; of fibula only 27827 Open treatment of fracture of weight bearing articular surface/portion of distal tibia (eg, pilon or tibial plafond), Copyright © 2013-2020, American Roentgen Ray Society, ARRS, All Rights Reserved. “Osteo” means bone and “chondral” refers to cartilage. Ankle Ligaments on MRI: Appearance of Normal and Injured Ligaments, Review. The indications for arthroscopic exploration were disabling symptoms and a previous history of ankle injury [5]. Methods: A retrospective review was conducted for patients who underwent arthroscopic microfracture surgery for osteochondral lesions of the tibial plafond from January 2014 to June 2017. It is also known as Pilon fracture and explosion fracture. Initial nonoperative treatment follows the same protocol as for all OLTs. The dome of the talus lies in the mortise created by the tibial plafond, distal fibula, and malleoli, and serves as a weight-bearing surface for the entire body. Two patients underwent ankle arthroscopy. On MR imaging, osteochondral defect of the tibial plafond has low signal intensity on T1-weighted images and high signal intensity on T2-weighted images, with adjacent bone marrow edema (Figs. A 1995 study [9] of the biomechanic topography of human ankle cartilage supports the experimental study of Berndt and Harty [8]. Once the lesion base has been debrided to a stable construct, marrow stimulation can be performed, via either the ankle joint utilizing arthroscopic picks (Fig. Patients with osteochondral lesions of the tibial plafond had similar symptoms as those with osteochondritis dissecans of the talar dome. We report the imaging characteristics of osteochondritis dissecans of the tibial articular surface (tibial plafond). Cartilage Grafting Options for Large or Microfracture-resistant Osteochondritis Dessican (OCD) Lesions of the Talus. We noted no predominant location of the osteochondritis dissecans. The plafond is concave in the anteroposterior plane and convex in the lateral plane. A less likely explanation is that some patients may undergo surgery without radiologic examination or that the radiographs were obtained in the orthopedist's office and were not available to the radiologists for review. Treatment for this may be different then in the early stages of the OCD lesion. Talar dome lesions are usually caused by … In the ankle joint, helical CT has the advantage of multiplanar capability. The purpose of this study was to evaluate the clinical outcomes and the level of sports activity following arthroscopic microfracture for osteochondral lesions of the tibial plafond. Bauer et al. In our series, two of three osteochondral lesions of the tibial plafond were detected on radiography. Address correspondence to L. T. Bui-Mansfield. It contains free information. Two months after ankle arthroscopy, the patient was asymptomatic. Typical HCPCS Codes • C1762 – Billing code for allograft . Patients with OCD in the knee may have quadriceps weakness, not gluteus maximus weakness; however, this does not lead to a lack of patellar tracking. The MRI is not however very accurate in determining the true size and depth of the lesion, nor the presence of subtle associated subchondral cysts, which are all better evaluated on CT scans (Fig. However, a case of mirror image osteochondral defects of the talus and distal tibia suggests trauma as a potential cause of this lesion [4]. As such, it is vulnerable when the ankle is forcibly inverted, everted, or rotated. Recently, we encountered three patients with osteochondral injury of the tibial plafond. We report the imaging appearance of osteochondral injury of the tibial plafond on conventional radiography, CT, and MR imaging and review the literature describing osteochondritis dissecans of the tibial plafond. The cause of osteochondral injury in the tibial plafond is unknown. Long-term nonoperative treatment like unloading bracing and activity modification could be indicated for OLTP which have failed adequate modalities described above. High-Resolution 3-T MRI of the Fingers: Review of Anatomy and Common Tendon and Ligament Injuries, Original Research. CONCLUSIONS: Clinical and radiological evidence of anterolateral impingement syndrome often accompanies stage 4 OCDs. CT and MR imaging are able to show the exact location and extent of the lesion. Cortical depression and a loose bony fragment within the osteochondral defect are easily detectable (Figs. The opinions and assertions contained herein are those of the authors and should not be construed as official or as representing the opinions of the Department of the Army or the Department of Defense. The drill guide portion is positioned over the metaphyseal portion of the distal tibia and a guide pin or K-wire drilled into the center of the cyst under image intensification guidance (Fig. 10/18/2019. The medial central tibial plafond was most frequently involved site with 8 of the 38 (21%) lesions located there; the posterior medial tibial plafond was second most frequently involved with six of the 38 lesions (16%). The duration of nonoperative treatment is not well defined and should include input from the patient. In a patient with OCD of the knee, the affected leg may be externally rotated during gait in an attempt to avoid impingement of the tibial spine on the lateral aspect of the condyle. The patients were referred to our department of radiology, and their conditions were diagnosed with various imaging techniques within a 2-week period. Resources. One patient had osteochondritis dissecans in both the tibia and talus [4]. Very interesting case of a typical Osteochondritis Dissecans in the posterior tibial plafond. Osteochondral defects ( OCD) or lesions ( OCL) are focal areas of damage with articular cartilage damage and injury of the adjacent subchondral bone … Our literature search yielded three articles on osteochondritis dissecans of the ankle, which included cases of osteochondral lesions of the tibial plafond [4,5,6]. Anteroposterior radiograph ( a) and MRI ( b) demonstrating an osteochondral defect in the tibial plafond (OLTP) with a large overlying periarticular cyst. 3C). [9] measured the thickness and mechanical properties of the articular surface of the distal tibia and talus. In the radiology literature, we are aware of only one textbook describing this entity, without a specific reference [2]. Radiologists may not be aware of this entity and may not recognize the lesion on conventional radiographs. Most osteochondritis dissecans in the ankle is found in the talar dome. OBJECTIVE. Tibial Plafond Fracture is an uncommon fracture occurring in the distal region of the tibia. ... OCD is seen as a complication of approximately 6.5% of ankle sprains. 1D, 1E, and 2A,2B). One patient had a twisting injury, but the other two patients did not recall an incidence of trauma. It is wider in the anterior plane to provide stability, especially while weight-bearing. Vascular insult is an unlikely cause of osteochondral injury in the tibial plafond. Three patients had a history of trauma, and all patients were symptomatic, requiring orthopedic evaluation and surgery. Imaging of Anterior Cruciate Ligament Repair and Its Complications, Pictorial Essay. The ankle joint is the most commonly injured joint in athletes, and OCD lesions primarily are found in the ankle (Giovanni et al, 2007). We report the imaging characteristics of osteochondritis dissecans of the tibial articular surface (tibial plafond). Cortical depression is clearly seen (Fig. The distal portion of the tibia is known as the plafond, which, along with the medial and lateral malleoli, forms the mortise to articulate with the talar dome. In conclusion, we presented the imaging findings of osteochondritis dissecans of the tibial plafond, with three different imaging techniques and a review of the world literature. Six of 38 ankles had both a talar osteochondral lesion … Surgical treatment is indicated for patients with recalcitrant pain and functional limitations despite adequate nonoperative interventions described above. 3A and 3B). The appropriate treatment for osteochondral injury of the tibial plafond is unclear. It is also called an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). However, coronal and sagittal images clearly show that the lesion originates from the tibial plafond. Five patients were diagnosed with osteochondral injury of the tibial plafond. Osteochondritis dissecans of the tibial plafond is a rare condition that may not be detectable on radiography. In one patient, markedly hyperemic proliferative synovial tissue involved the entire ankle. M93.279 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes.
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