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At least 109 records · Page 6Linked to original sources
PubMed2005

Bone-cartilage transplantation from the ipsilateral knee for chondral lesions of the talus.

PURPOSE: We present a prospective analysis to review talus dome chondral and osteochondral lesions treated with autogenous bone-cartilage transplantation harvested from the ipsilateral knee since 1998. The clinical outcome of osteochondral defects is investigated by using a method for resurfacing that supplies hyaline cartilage. The outcome analysis also considers defect size and the number of transplanted osteochondral cylinders. TYPE OF STUDY: Prospective analysis of a case series. METHODS: Included in the study were 43 patients with ankle joint pain resulting from osteochondritis dissecans stage III-IV (n = 22), post-traumatic cartilage defects (n = 16), and focal osteoarthritis (n = 5). The mean age of this group was 31.2 years; there were 30 male and 13 female patients. To carry out the osteochondral resurfacing procedure, anteromedial or anterolateral arthrotomy (23 cases) or medial malleolar osteotomy (20 cases) of the distal tibia was performed. The osteochondral autograft transfer system (OATS; Arthrex, Naples, FL) was used for transplantation. The follow-up examinations were performed after 3 months (clinical, radiological), after 6 months (clinical, radiological), after 9 months (clinical, radiological, hardware removal, and second-look arthroscopy), after 12 months, and every following year (clinical, radiological, magnetic resonance imaging). The follow-up of 11 patients was greater than 2 years (maximum, 4.5 years), for 8 patients 1 to 2 years, for 12 patients 6 to 12 months, and for another 12 patients 0 to 6 months. The results have been validated by the scores of Evanski and Waugh score and Mazur et al. RESULTS: The mean pain intensity measured by visual analogue scale (0 to 10, with 10 representing the worst imaginable pain) reduced from 4.4 to 2.3 after 6 months (n = 34), to 1.6 after 1 year (n = 23), and after 2 years to 1.1 (n = 14). Patients reported a significantly improved range of motion of the ankle compared with their preoperative status. The smaller the diameter of the transplants and the smaller the number of transplants used, the better were the results in pain reduction and postoperative range of motion. The Evanski and Waugh score improved from 52 to 88 points and the score described by Mazur et al. from 53 to 90 of 100 possible points. All medial osteotomies were healed clinically and radiographically. All grafts showed bony integration in the talus as seen in the radiographs and by magnetic resonance imaging. Second-look arthroscopy found integration of the osteocartilaginous graft with surrounding cartilage within the first year. A series of needle biopsies showed hyaline structure. CONCLUSIONS: Autogenous osteochondral transplantation of the talus using ipsilateral knee osteochondral grafts is a very promising surgical procedure to treat local cartilage lesions of the ankle joint. LEVEL OF EVIDENCE: Level IV.

Adult↗
PubMed2005

Assessment of talus deformity by three-dimensional MRI in congenital clubfoot.

PURPOSE: To evaluate the morphological deformity of talus in congenital clubfoot by three-dimensional MRI. MATERIAL AND METHOD: Subjects were five patients (two male, three female, mean age 5 months) with unilateral congenital clubfoot. Magnetic resonance imaging was performed of both feet using 1.5 T magnet. Based on the resulting magnetic resonance imaging volume data, a three-dimensional surface bone model was reconstructed by the Marching Cubes method. The long axis of the reconstructed model was determined, and in relation to the standard planes including this axis, the degree of talar head and neck deviation, and the relative positioning of the talus and navicular in the talonavicular joint were compared between normal foot and clubfoot. RESULT: The talar head and neck angle in relation to the talus exhibited significant medial deviation in the clubfoot, but the degree of plantar deviation of the talar head and neck did not show significance. The navicular was located more medially in clubfoot than in normal foot. The volume of the total talar and of the ossific nucleus for the clubfoot was smaller than that for the normal foot. CONCLUSION: The assessment technique presented herein was shown to be useful in ascertaining the various pathological characteristics associated with clubfoot.

Ankle Joint↗
PubMed2006

A complex fracture of the talus following a rugby union line-out.

Fractures of the talus are frequently difficult to treat. The vulnerable blood supply and abundant articular surfaces may lead to long-term problems with avascular necrosis and osteoarthritis. A case of a complex injury to the talus occurring in a rugby union player during a line-out is presented. The laws relating to line-out play disallow "lifting" and "levering" in the line out, but in reality allow "supporting" of the jumper on his shorts, once he has jumped. A further law insists on "lowering" of the supported jumper to the ground as soon as the ball has been won. This unusual injury to the talus clearly demonstrates the potential dangers of the line-out and the necessity that the laws of the game must be strictly adhered to, in order to ensure the safety of the line-out jumper.

Adult↗
PubMed2004

[Talus bipartitus].

Talus bipartitus is an exceptional congenital malformation consisting in the presence of two non-fused bony talar fragments. We report the case of an adolescent girl who complained of mechanical pain in the left ankle which became increasingly invalidating. Plain radiographs, CT-scan and MRI led to the diagnosis of this congenital anomaly: talus bipartitus. Surgical correction by subtalar arthrodesis provided improvement at the cost of reduced ankle mobility. Surgical treatment should be proposed for talus bipartitus in patients with invalidating pain or stiffness when rehabilitation fails to provide sufficient improvement.

Adolescent↗
PubMed1997

Isolated talus fractures: description of a new clinical sign.

Isolated talus fractures are very uncommon and are usually associated with severe trauma. Five cases of isolated talus fracture associated with relatively minor trauma are reported. These five patients had one clinical sign in common, pain out of proportion to the severity of their injury. The treatment of talus fractures is reviewed.

Adult↗
PubMedDate not supplied

Tibialis anterior transfer "into talus" for control of the severe planus pediatric foot: a preliminary report.

Transfer of tibialis anterior into the talus has been utilized for correction of the vertical talus, as well as for paralytic valgus foot deformities with the suggestion for its use in severe flatfoot deformities. The authors present transfer of tibialis anterior through the talus for controlling the severe planus pediatric foot. The procedure is presented, and six feet having undergone this procedure are analyzed. This procedure, in combination with others, has proven successful in reconstructing this pediatric deformity clinically and radiographically.

Achilles Tendon↗
PubMedDate not supplied

Ankle and subtalar fusion utilizing a tricortical bone graft, bone stimulator, and external fixator after avascular necrosis of the talus.

A unique ankle and subtalar fusion was performed on a patient with avascular necrosis of the talus. The body of the talus was removed and replaced with an autogenous tricortical bone graft. Healing was aided by the use of a bone stimulator and external fixator. The authors believe this fusion to be a more stable fusion than others used to treat avascular necrosis of the talus.

Adult↗
PubMed2003

Osteochondral lesions of the talus.

Osteochondral lesions of the talus (OLT) are rare joint disorders. The talus is the third most common location of this disorder, following the knee and elbow joints. OLT represents 4% of all osteochondral lesions in the body. This article discusses the surgical treatment and postoperative rehabilitation of osteochondral lesions of the talus.

Bone Transplantation↗
PubMed2000

Massive intraosseous ganglion of the talus: reconstruction of the articular surface of the ankle joint.

We report on the outcome after autologous chondrocyte and spongiosal bone transplantation in a case of a massive intraosseous ganglion of the talus in a young patient. A 24-year-old man suffered from decreased ankle joint motion, recurrent swelling, and pain. Diagnostic evaluation by plain radiographs, computed tomography, and magnetic resonance imaging revealed cystic lesions in the head and the body of the talus with additional involvement of the cartilage surface. Operative treatment consisted primarily of an initial diagnostic arthroscopy, which established grade VI articular damage according to the arthroscopic classification of Bauer and Jackson. Pathological examination of intralesional biopsy tissue revealed the existence of an intraosseous ganglion. Additionally, healthy cartilage biopsy specimens were obtained and sent for chondrocyte extraction and cultivation with 60 mL of autologous serum. To retain the function of the ankle joint and to minimize the number of necessary operative interventions, 3 weeks after the initial arthroscopic operation, we performed a simultaneous curettage of the cystic lesion followed by autologous spongiosal bone and cultivated chondrocytes transplantation of the talus. Continuous passive motion was applied postoperatively and full weight bearing was allowed after 8 weeks. There were no complications. The clinical result after 18 months was excellent, with a fully functional, pain-free, and weight-bearing ankle joint. The postoperative evaluation score of Finsen (modified Weber score) of 2/6 = 0.3 showed an improvement comparison with the preoperative value of of 21/6 = 3.5 (0 = normal, 4 = pathologic). We encountered no complications postoperatively. Clinical success was achieved by this method of treatment on a patient too young to be treated through arthrodesis.

Adult↗
PubMedDate not supplied

[The role of MRI in therapy and follow-up after surgical treatment of osteochondrosis dissecans of the talus].

AIM: Our study was designed to evaluate the use of magnetic resonance imaging (MRI) in the follow-up of surgically treated osteochondrosis dissecans (OCD) of the talus. METHOD: We investigated 16 patients (18 joints) with OCD of the talus, surgically treated in our department between 1990 and 1997. All of them had preoperative MRI scans of the affected ankle. The mean follow-up was 40 months (8-82). All patients were evaluated by clinical examination, plain radiography and MRI using a standard protocol. RESULTS: The clinical Bray score improved significantly from 58 preoperative to 82 postoperative. Using a visual analogue scale we saw a significant reduction of the patients pain level post-op. In 72% of the patients the preoperative MRI was able to predict the accurate stage of the cartilage. Postoperative MRI showed no more lesion in 3, intact articular cartilage in 11, and disrupted cartilage in 4 joints. There was no correlation between clinical, plain radiographical, and MRI findings postoperative. CONCLUSION: Arthroscopy remains the golden standard in evaluating articular cartilage. Using our data, MRI is not the method of choice in the follow-up of surgically treated OCD lesions of the talus. Postoperative use of intravenous contrast media gave no additional information. Postoperative MRI should be reserved only for symptomatic patients to gather additional information about the actual state of the OCD. Afterwards a prompt arthroscopy of the symptomatic ankle should be performed.

Adolescent↗
PubMedDate not supplied

[Osteochondral lesions of the talus -- indications for MRI with a contrast agent].

AIM: This study aims to establish the indication for a pre- and postoperative MRI examination with an intravenous contrast agent in patients with an osteochondral lesion of the talus. METHODS: 20 patients with an osteochondral lesion of the talus in the different stages according to DiPaola were prospectively examined preoperatively and 6 months postoperatively by an MRI investigation with an i. v. contrast agent. The Weber ankle score was determined pre- and postoperatively. A correlation was calculated between MRI and arthroscopic findings of an osteochondral lesion (Spearman-rho). RESULTS: There was a significant correlation among the radiological, the MRI and the arthroscopically determined locations. With regard to staging only 12 out of 20 lesions were staged correctly by MRI using arthroscopy as a gold standard. Due to metal artifacts and morphological changes the postoperative MRI could not be used for staging. CONCLUSION: A preoperative MRI investigation is indicated in patients with ankle pain of unknown origin, a normal radiograph and a suspected osteochondral lesion of the talus. MRI is not indicated to determine the localization and the stage of an osteochondral lesion. A postoperative MRI is only necessary for the exclusion of a secondary pathology.

Adolescent↗
PubMedDate not supplied

[Idiopathic talus necrosis in an infant].

A case of a spontaneous osteonecrosis of the talus in a 22 months old girl is reported. Under treatment in a non-weight-bearing leg brace the talus recovered without remaining deformities. Osteomyelitis, tumors, neurogenic arthropathy and traumatic origin were taken into diagnostic consideration, but could be excluded by clinical, radiological and laboratory examinations. According to our knowledge an idiopathic osteonecrosis of the talus occurring in an infant of 22 months has never been reported before.

Casts, Surgical↗
PubMedDate not supplied

Osteochondritis dissecans of the talus in children.

Osteochondritis dissecans (OCD) of the talus is rare in children. The lesion is encountered on either the medial or lateral surface of the talar dome. The etiology is unknown, although trauma has been implicated, particularly in lateral lesions. Since 1983, 24 children have been treated for OCD of the talus at a major Canadian pediatric referral center. Two children had bilateral involvement, for a total of 26 lesions. There were 10 boys and 14 girls. The average age at initial presentation was 13 years 4 months (range 6 years 7 months to 17 years 1 month). The lesion involved the medial aspect of the talus in 19, the lateral in 5, and the central talar dome in 3. Magnetic resonance imaging was very useful in preoperative assessment in six cases. Surgical intervention was required in 15 (58%) ankles. The results at the most recent follow-up revealed resolution or decreased symptoms in 25 (96%) and no change in 1 (4%).

Child↗
PubMed1997

Open total talus dislocation: case report and review of the literature.

An open pure total lateral dislocation of the right talus with extrusion of the whole talar body is reported. Immediately surgical debridement, reduction, and primary closure were accomplished under antibiotic coverage. The ankle was immobilized for 6 weeks, and weight-bearing was restricted for 6 more weeks. Neither avascular necrosis (AVN) of the talus nor infection developed. Both ankle and foot regained full pain-free range of motion at 16 weeks, except for a mild restriction of the last 5 degrees of supination. Four years postinjury, the patient continues in the same preinjury occupation. A thorough review of the literature suggested that (a) immediate closed or open reduction is preferable; (b) if AVN develops, it can be treated in most cases by weight-bearing restrictions; and (c) talectomy, alone or associated with a tibiocalcaneal arthrodesis, should be reserved for an eventual reconstructive procedure, particularly in the event of talus infection.

Accidents, Traffic↗
PubMed2002

Single stage surgical correction of congenital vertical talus by complete subtalar release and peritalar reduction by using the Cincinnati incision.

Seventeen feet of 12 patients with congenital vertical talus, which were treated with a single-stage surgical correction of complete subtalar release and peritalar reduction by using the Cincinnati incision, were reviewed. Five of the feet were associated with neuromuscular disorders, four with neural tube defects, and eight were idiopathic. All patients were operated on by the same surgeon and all were available for clinical and radiographic follow-up averaging 42.9 months (range 19-81) from the time of surgery. There were no wound complications or avascular necrosis of the talus. None required subsequent reoperation. At final follow-up, results were based on clinical and radiographic outcomes and included five excellent, eight good, two fair, and two poor. All families were satisfied with the results and appearance of the feet. Radiographically, there was a significant improvement in the anteroposterior and lateral talocalcaneal and talo-first metatarsal angles, and at follow-up, the group averages for each of these angles were within the normal ranges. In the treatment of congenital vertical talus, good clinical and radiographic outcomes can be obtained, with a low incidence of complications, using this single-stage surgical correction procedure.

Child, Preschool↗
PubMedDate not supplied

Snowboarder's talus fracture. Mechanism of injury.

Fracture of the lateral process of the talus is an injury unique to snowboarders and is of particular clinical relevance because it masquerades as an anterolateral ankle sprain and is difficult to detect on standard radiographic views. Misdiagnosis can lead to long-term morbidity in a young and active population, with ensuing severe degeneration of the subtalar joint. To date, the precise mechanism of injury has not been established, making it difficult to identify potential preventive strategies in equipment design or snowboarding technique. Fracture of the lateral process of the talus in snowboarders has been thought to result from pure dorsiflexion and inversion combined with axial loading. We hypothesized, however, that external rotation is a key component of the mechanism of injury. Ten cadaveric ankles were mounted on a materials testing machine in a position of fixed dorsiflexion and inversion. All ankles were loaded to failure axially, with or without combined external rotation. No fractures occurred after axial loading in dorsiflexion and inversion, but six of eight specimens sustained fractures of the lateral process of the talus when similarly loaded with external rotation added, supporting our hypothesis. Further study is needed to evaluate the relationship between various types of snowboarding equipment and fracture mechanism.

Aged↗
PubMed2001

Osteochondral defects of the talus treated with fresh osteochondral allograft transplantation.

Between 1980 and 1996, 9 patients with osteocartilagenous lesions of the talus were treated surgically using fresh osteochondral allograft transplantation. In 8 cases the reason for surgery was osteochondritis dissecans (4 of these cases had a previous traumatic injury). In 1 case a fresh osteochondral allograft of the talus was required following a traumatic open fracture of the talus sustained in a motor vehicle accident. Of these 9 grafts, 6 grafts remain in situ with a mean survival of 11 years (range 4 to 19). In the three cases requiring fusion the reason for surgery was not related to arthritic deterioration but due to resorption and fragmentation of the graft.

Adult↗
PubMed2004

The avascular talus: revascularization in an animal model.

Avascular necrosis of bone such as the talus can lead to collapse and loss of function. To avoid this, early revascularization has been proposed as an important event. Revascularization can occur either by vessel growth directly through the bony surface, or by vessel growth into the periosteum or ligaments with secondary reconnection to the bone. The ability to attract new vessels (angiogenesis) of the bony surface and the connective tissue was compared in an animal model. A talus isograft (all cortical surface, periosteum, and ligaments remaining; n = 11) or a sector of a femoral head isograft (cancellous surface, no connective tissue; n = 12) of adult mice was implanted into dorsal skinfold chambers of mice of the same strain. The implants were observed by intravital microscopy every 12 hours. First indicators of angiogenesis were hemorrhages around the implants (tali: 11 of 11, 72 +/- 12 hours; femoral heads: 6 of 12, 84 +/- 24 hours). Next, a sudden redness of the transplant indicated marrow hemorrhage (tali: 9 of 11 after 84 +/- 36 hours; femoral heads: 10 of 12 after 96 +/- 36 hours). Histology showed clear growth of capillaries into the cancellous surface of the femoral heads and possible growth of capillaries into the ligament stumps (tali). However, there was widespread necrosis of the marrow cells indicating failure of recirculation. A cancellous bony surface as well as the soft tissues attached to the bone provided a stimulus to rapid revascularization of the grafts. This model was able to evaluate differing rates of early partial revascularization for various bone surfaces, which may have implications for studying treatment options for certain fracture dislocations (e.g., in the talus).

Animals↗