“Osteo” means bone and “chondral” refers to cartilage. 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. All three patients were men. Imaging of Anterior Cruciate Ligament Repair and Its Complications, Pictorial Essay. Three patients had a history of trauma, and all patients were symptomatic, requiring orthopedic evaluation and surgery. In our series, the average size of the osteochondral lesions was 1.4 × 1.3 cm. 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. The softest cartilage was found in the posterior half of the talus. Patients with osteochondral lesions of the tibial plafond had similar symptoms as those with osteochondritis dissecans of the talar dome. There are few cases describing this lesion in the literature, with little information on mechanism of injury, history/physical findings or recommendations for management. The patients were referred to our department of radiology, and their conditions were diagnosed with various imaging techniques within a 2-week period. On lateral images, osteochondritis dissecans is less apparent. In my experience these lesions have a good healing potential without developing a loose body. Also, the posteromedial aspect of the tibial plafond was stiffer than that of the posteromedial aspect of the talus. It contains free information. [6] reported on a series of 30 patients who had osteochondritis dissecans of the ankle. On axial scans, osteochondral lesions of the tibial plafond may be initially mistaken for osteochondritis dissecans of the talar dome (Fig. [9] measured the thickness and mechanical properties of the articular surface of the distal tibia and talus. Clinical and experimental evidence has confirmed the traumatic nature of osteochondritis dissecans of the talus [8, 9]. Athanasiou et al. steochondral lesions of the distal tibial plafond are rare—far less common than osteochondral lesions of the talus1-4. 1B). Osteochondritis dissecans is suggested by a loss of the sharp cortical line (Fig. Recently, we encountered three patients with osteochondral injury of the tibial plafond. Cortical depression is clearly seen (Fig. Typical HCPCS Codes • C1762 – Billing code for allograft . Ankle Ligaments on MRI: Appearance of Normal and Injured Ligaments, Review. Trauma ⎜ Tibial Plafond Fractures (ft. Dr. Brian Weatherford) Team Orthobullets (AF) Trauma - Tibial Plafond Fractures; Listen Now 26:30 min. [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. Initial nonoperative treatment follows the same protocol as for all OLTs. The cause of osteochondral injury in the tibial plafond is unknown. 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 plafond is concave in the anteroposterior plane and convex in the lateral plane. Its radiologic findings are … In the other patient, ankle arthroscopy revealed a depressed area in the posterolateral aspect of the tibial plafond filled with fibrocartilage. 72 plays. All patients complained of ankle pain. 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. Typical Revenue Codes (for form UB … Six of 38 ankles had both a talar osteochondral lesion … 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. 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. Ankle Platform is for Orthopedic Surgeons with special interest in Ankle and Hindfoot. 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. This includes initial rest, immobilization, and unloading protocol, in either a fracture boot or cast. 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. We noted a large amount of scar tissue infolding onto the lateral shoulder of the talus, which was débrided. Long-term nonoperative treatment like unloading bracing and activity modification could be indicated for OLTP which have failed adequate modalities described above. The ankle joint is the most commonly injured joint in athletes, and OCD lesions primarily are found in the ankle (Giovanni et al, 2007). Introduction: Osteochondral lesions of the tibial plafond account for approximately 2.6% of osteochondral lesions in the ankle. Osteochondritis dissecans of the talar articular surface of the ankle joint has been well described. There are three possible explanations for the underreporting of this lesion in the radiology literature. 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 Such lesions are a tear or fracture in the cartilage covering one of the bones in a joint. Osteochondral lesions or osteochondritis dessicans can occur in any joint, but are most common in the knee and ankle. The ankle joint has a rich arterial supply. A 1995 study [9] of the biomechanic topography of human ankle cartilage supports the experimental study of Berndt and Harty [8]. 3A and 3B). The duration of nonoperative treatment is not well defined and should include input from the patient. In the radiology literature, we are aware of only one textbook describing this entity, without a specific reference [2]. 1D, 1E, and 2A,2B). 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]. 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. 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. M93.279 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. Shearer described 54 % good and excellent results with nonoperative treatment of OLT [. However, coronal and sagittal images clearly show that the lesion originates from the tibial plafond. OCD usually causes pain during and after sports. Osteochondritis dissecans of the tibial plafond is a rare condition that may not be detectable on radiography. Most osteochondritis dissecans in the ankle is found in the talar dome. Members receive the 'Picture of the week', new operative techniques and can submit their problem cases for an expert opinion. It is also known as Pilon fracture and explosion fracture. Copyright © 2013-2020, American Roentgen Ray Society, ARRS, All Rights Reserved. Overview. Cartilage Grafting Options for Large or Microfracture-resistant Osteochondritis Dessican (OCD) Lesions of the Talus. The search was limited to English literature and human subjects. The necrotic fragment usually becomes revascularised and reattaches to the surrounding bone. 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]. [OCOSH Code: D010008 203413004 M93.2 BD_OC_OCD_A] Search only this category the entire directory Advanced Search. However, the talar dome was irregular, with areas of ruffled tissue. It involves the articular surface of the ankle joint. OCD Ankle and Talus Internet resources relating to Osteochondritis Dissecans affecting the Talus & Tibial Plafond. 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]. 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. 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. Talar dome lesions are usually caused by … Vascular insult is an unlikely cause of osteochondral injury in the tibial plafond. We report the imaging characteristics of osteochondritis dissecans of the tibial articular surface (tibial plafond). 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. 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. The debrided lesion is located arthroscopically with the ball tip of a microvector guide. We retrospectively reviewed the medical records of three patients with osteochondral injury in the tibial plafond. CONCLUSION. Apart from the location, osteochondral injury of the tibial plafond has radiographic findings similar to those of osteochondritis dissecans of the talar dome. Lateral talar lesions are more common than medial lesions. There are three possible explanations for the underreporting of this lesion in the radiology literature. 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. 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. If non-surgical approaches fail to relieve the symptoms of an OCD, surgery may be necessary. OBJECTIVE. 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), The imaging characteristics of an osteochondral injury in the tibial plafond are similar to those of osteochondritis dissecans found elsewhere in the body. 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]. The sex and age were known in only two patients; both patients were women, 46 and 51 years old. MRI of the Thumb: Anatomy and Spectrum of Findings in Asymptomatic Volunteers, Original Research. In general, tibial cartilage was stiffer than talar cartilage. The prevalence of osteochondritis dissecans in the tibial plafond detected on radiography is unknown. Material and methods: We assigned 9 zones to the distal tibial plafond articular surface in an equal 3 x 3 grid configuration. 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. 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