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Cartilage Dec 2021This is a review on talus osteochondritis dissecans and talus osteochondral lesions. A majority of the osteochondral lesions are associated with trauma while the cause... (Review)
Review
This is a review on talus osteochondritis dissecans and talus osteochondral lesions. A majority of the osteochondral lesions are associated with trauma while the cause of pure osteochondritis dissecans is still much discussed with a possible cause being repetitive microtraumas associated with vascular disturbances causing subchondral bone necrosis and disability. Symptomatic nondisplaced osteochondral lesions can often be treated conservatively in children and adolescents while such treatment is less successful in adults. Surgical treatment is indicated when there is an unstable cartilage fragment. There are a large number of different operative technique options with no number one technique to be recommended. Most techniques have been presented in level II to IV studies with a low number of patients with short follow ups and few randomized comparisons exist. The actual situation in treating osteochondral lesions in the ankle is presented and discussed.
Topics: Adolescent; Adult; Ankle Joint; Arthroscopy; Child; Humans; Intra-Articular Fractures; Magnetic Resonance Imaging; Osteochondritis Dissecans; Osteonecrosis; Talus; Tomography, X-Ray Computed
PubMed: 33423507
DOI: 10.1177/1947603520985182 -
Journal of Orthopaedic Surgery (Hong... 2021This study aimed to use MRI to evaluate the fibula and talus position difference in functional and mechanical ankle stability patients.
PURPOSE
This study aimed to use MRI to evaluate the fibula and talus position difference in functional and mechanical ankle stability patients.
METHODS
61 and 68 patients with functional and mechanical instability, and 60 healthy volunteers were involved. Based on the axial MRI images, the rotation of the talus was identified through the Malleolar Talus Index (MTI). The position relative to the talus (Axial Malleolar Index, AMI) and medial malleolus (Intermalleolar Index, IMI) were used to evaluated the displacement of the fibula.
RESULTS
Post hoc analysis showed that the values of malleolar talus index was significantly larger among mechanical instability (89.18° ± 2.31°) than that in functional instability patients (86.55° ±61.65°, P < 0.001) and healthy volunteers (85.59° ± 2.42°, P < 0.001). The axial malleolar index of the mechanical instability patients (11.39° ± 1.41°) were significantly larger than healthy volunteers (7.91° ± 0.83°) (P < 0.0001). There were no statistically significant differences in the above three indexes between the functional instability patients and healthy volunteers.
CONCLUSION
The functional instability patients didn't have a posteriorly positioned fibula and an internally rotated talus. The malleolar talus index was significantly larger among mechanical instability patients than that in functional instability patients. Increased malleolar talus index may become a new indirect MRI sign for identifying functional and mechanical instability patients.
Topics: Adult; Anatomy, Cross-Sectional; Ankle Injuries; Ankle Joint; Bone Malalignment; Female; Fibula; Humans; Joint Instability; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; Rotation; Talus; Young Adult
PubMed: 33427040
DOI: 10.1177/2309499020984575 -
Joint Diseases and Related Surgery 2021This study aims to investigate the characterization and follow-up results of tumors and tumor-like lesions in the talus.
OBJECTIVES
This study aims to investigate the characterization and follow-up results of tumors and tumor-like lesions in the talus.
PATIENTS AND METHODS
Twenty-one patients (15 males, 6 females; mean age: 31.6±17 years; range, 4 to 67 years) with benign and malignant tumors or tumor-like lesions in the talus region treated and followed in our clinic between January 2007 and January 2019 were evaluated retrospectively. Radiological, pathological, surgical, and demographic features were scanned from the database.
RESULTS
Patients were followed for mean 80±45.1 (range, 25 to 156) months. The most common complaint was pain and antalgic gait. Benign bone tumors were found in 15 (71%) of 21 patients, while tumor-like lesions (two intraosseous ganglia, osteomyelitis, and bone infarction) were found in four patients. The remaining two were patients with lung and bladder cancer metastasis. Lesion size was mean 2.1±0.5 (range, 1.1 to 3.3) cm. Recurrence developed in 14.3% (n=3) of the patients during follow-up.
CONCLUSION
The talus is a rare location for tumors; however, benign and malignant tumors and tumor-like lesions may be localized in the talus.
Topics: Adult; Bone Diseases; Bone Neoplasms; Female; Humans; Male; Neoplasm Recurrence, Local; Neoplasms; Orthopedic Procedures; Radiography; Retrospective Studies; Talus; Turkey
PubMed: 33463440
DOI: 10.5606/ehc.2021.78769 -
BMJ Case Reports Oct 2014In this case study we report a fracture of the lateral process of the talus (LPF) in a snowboarder. The fracture is frequently overlooked initially, due to subtle... (Review)
Review
In this case study we report a fracture of the lateral process of the talus (LPF) in a snowboarder. The fracture is frequently overlooked initially, due to subtle clinical and radiological findings and a low incidence rate. However, LPF are associated with significant morbidity when missed. To address this, we report one case of a patient with a LPF and provide a review of the available literature.
Topics: Adult; Ankle; Ankle Joint; Female; Fracture Fixation, Internal; Fractures, Bone; Humans; Skiing; Talus
PubMed: 25355745
DOI: 10.1136/bcr-2014-204220 -
Archives of Orthopaedic and Trauma... Nov 2022Progressive collapsing foot deformity (PCFD) is a complex 3-dimensional (3-D) deformity with varying degrees of hindfoot valgus, forefoot abduction, and midfoot varus.... (Review)
Review
BACKGROUND
Progressive collapsing foot deformity (PCFD) is a complex 3-dimensional (3-D) deformity with varying degrees of hindfoot valgus, forefoot abduction, and midfoot varus. The first aim of this study was to perform a 3-D analysis of the talus morphology between symptomatic PCFD patients that underwent operative flatfoot correction and controls. The second aim was to investigate if there is an impact of individual talus morphology on the success of operative flatfoot correction.
METHODS
We reviewed all patients that underwent lateral calcaneal lengthening for correction of PCFD between 2008 and 2018 at our clinic. Radiographic flatfoot parameters on preoperative and postoperative radiographs were assessed. Additionally, 3-D surface models of the tali were generated using computed tomography (CT) data. The talus morphology of 44 flatfeet was compared to 3-D models of 50 controls without foot or ankle pain of any kind.
RESULTS
Groups were comparable regarding demographics. Talus morphology differed significantly between PCFD and controls in multiple aspects. There was a 2.6° increased plantar flexion (22.3° versus 26°; p = 0.02) and medial deviation (31.7° and 33.5°; p = 0.04) of the talar head in relation to the body in PCFD patients compared to controls. Moreover, PCFD were characterized by an increased valgus (difference of 4.6°; p = 0.01) alignment of the subtalar joint. Satisfactory correction was achieved in all cases, with an improvement of the talometatarsal-angle and the talonavicular uncoverage angle of 5.6° ± 9.7 (p = 0.02) and 9.9° ± 16.3 (p = 0.001), respectively. No statistically significant correlation was found between talus morphology and the correction achieved or loss of correction one year postoperatively.
CONCLUSION
The different morphological features mentioned above might be contributing or risk factors for progression to PCFD. However, despite the variety of talar morphology, which is different compared to controls, the surgical outcome of calcaneal lengthening osteotomy was not affected.
LEVEL OF EVIDENCE
III.
Topics: Calcaneus; Flatfoot; Foot; Humans; Osteotomy; Talus
PubMed: 33970321
DOI: 10.1007/s00402-021-03925-w -
Orthopaedics & Traumatology, Surgery &... Feb 2023Ankle pain and/or instability is a frequent, non-specific reason for consultation, and may reveal an osteochondral lesion of the talar dome (OLTD). There are 2 types of... (Review)
Review
Ankle pain and/or instability is a frequent, non-specific reason for consultation, and may reveal an osteochondral lesion of the talar dome (OLTD). There are 2 types of OLTD: (1) posteromedial, usually idiopathic, wide and deep, featuring isolated pain with severe functional impact; (2) anterolateral, often implicating trauma and associated in 30% of cases with lateral ligament involvement, in a clinical presentation associating pain and instability. The aim of the present study was to review the issue of OLTD, with 5 questions: HOW TO ESTABLISH THE DIAGNOSIS, WITH WHAT WORK-UP?: There are no specific clinical signs. A diagnosis of OLTD should be considered in all cases of painful and/or unstable ankle and especially in case of history of sprain. The clinical work-up screens systematically for laxity or associated hindfoot malalignment. CT-arthrography is the gold-standard, enabling morphologic analysis of OLTD. WHAT CLASSIFICATIONS SHOULD BE USED?: CT-arthrography determines length, depth and any cartilage dissection, classifying OLTD in 3 grades. Grade 1 is a lesion<10mm in length and<5mm in depth. Grade 2 is>10mm in length and/or>5mm in depth with intact cartilage around the lesion. Grade 3 is the same as grade 2 but with overlying cartilage dissection. WHAT ARE THE CURRENT TREATMENT INDICATIONS?: After failure of 6 months' well-conducted medical treatment (sports rest, analgesics, physiotherapy), surgical options in France today comprise microfracture in grade 1 OLTD, raising the fragment, freshening the floor of the lesion and fixing the fragment (known as "lift, drill, fill, fix" (LDFF)) in grade 2, and mosaicplasty in grade 3. WHAT ARE THE PROSPECTS FOR FUTURE TREATMENTS AND THEIR ROLES?: Treatments are progressing and improving. Ideal treatment should restore hyaline cartilage to prevent secondary osteoarthritis. Matrix and cell culture techniques need to be validated. WHAT RESULTS CAN BE EXPECTED AND WHAT SHOULD PATIENTS BE TOLD?: Management according to grade secures AOFAS scores≥80/100 in 80% of cases, whatever the grade. Return to sport is feasible in 80% of case, at a mean 6 months. Progression is satisfactory after treatment adapted to the lesion. LEVEL OF EVIDENCE: V, expert opinion.
Topics: Humans; Talus; Cartilage, Articular; Arthrography; Foot; Ankle Joint; Pain
PubMed: 36273506
DOI: 10.1016/j.otsr.2022.103452 -
Clinical Anatomy (New York, N.Y.) Sep 2021Flattening of the trochlear tali is clinically observed as structural and functional changes advance in patients with hemarthropathy of the ankle. However, the degree of... (Comparative Study)
Comparative Study
Flattening of the trochlear tali is clinically observed as structural and functional changes advance in patients with hemarthropathy of the ankle. However, the degree of this flattening has not yet been quantified, and distribution of the morphological changes across the talus not yet defined. Chronologically sequential MR images of both a hemophilic patient group (N = 5) and a single scan from a nondiseased, sex-matched, control group (N = 11) were used to take four measurements of the trochlear talus morphology at three locations (medial, central and lateral) along the sagittal plane. Three ratios of interest were defined from these to assess whether the talar dome flattens with disease. The control group MRI measurements were validated against literature data obtained from CT scans or planar X-Rays. The influence of disease on talar morphology was assessed by direct comparison of the hemophilic cases with the control group. The values for all three ratios, in all locations, differed between the control and the hemophilic group. Flattening was indicated in the hemophilic group in the medial and lateral talus, but differences in the central talus were not statistically significant. This work demonstrates that morphological assessment of the talus from MR images is similar to that from CT scans or planar X-Rays. Talar flattening does occur with hemarthropathy, especially at the medial and lateral edges of the joint surface. General flattening of the trochlear talus was confirmed in this small patient sample, however the degree and rate of change is unique to each ankle.
Topics: Adolescent; Adult; Ankle Joint; Child; Diagnostic Imaging; Hemophilia A; Humans; Talus; Young Adult
PubMed: 33998061
DOI: 10.1002/ca.23757 -
Acta Orthopaedica Et Traumatologica... Sep 2019The aim of this study was to assess the effectiveness of microfracture and cell free hyaluronic acid (HA) based scaffold combination in the treatment of talus...
OBJECTIVE
The aim of this study was to assess the effectiveness of microfracture and cell free hyaluronic acid (HA) based scaffold combination in the treatment of talus osteochondral defects (OCD).
METHODS
This study retrospectively evaluated the clinical results of the 20 patients (14 males and 6 females, mean age at the time of surgery: 32.9 years (range: 16-52 years)) who were treated with MFx and cell-free HA-based scaffold combination for talus OCD smaller than 1.5 cm and deeper than 7 mm. Results were evaluated with AOFAS and VAS scores. Also, patients' satisfaction was questioned.
RESULTS
Patients were evaluated after an average follow-up of 20.3 months. Intraoperative measurements showed that mean depth of the lesions were 10.4 ± 1.9 mm after debridement. The mean preoperative AOFAS score was 57.45 ± 9.37, which increased to 92.45 ± 8.4 postoperatively (p < 0.05). VAS score was improved from 7.05 ± 2.45 to 1.65 ± 2.20 postoperatively (p < 0.05).
CONCLUSION
MFx and cell-free HA-based scaffold combination appear to be a safe and efficient technique that provide good clinical outcomes for lesions deeper than 7 mm.
LEVEL OF EVIDENCE
Level IV, Therapeutic Study.
Topics: Adult; Arthroplasty, Subchondral; Female; Fractures, Stress; Humans; Hyaluronic Acid; Male; Osteochondritis Dissecans; Retrospective Studies; Talus; Tissue Scaffolds; Treatment Outcome; Viscosupplements
PubMed: 31126702
DOI: 10.1016/j.aott.2019.04.002 -
Acta Bio-medica : Atenei Parmensis Jan 2018The talus is the second largest bone of the foot. It is fundamental to ensure normal ankle-foot movements as it connects the leg and the foot. Talar fractures are... (Review)
Review
INTRODUCTION
The talus is the second largest bone of the foot. It is fundamental to ensure normal ankle-foot movements as it connects the leg and the foot. Talar fractures are usually due to high energy traumas (road accidents, high level falls). They are not common as they account for 3-5% of ankle and foot fractures and 0.85% of all body fractures. However, talar fractures not correctly diagnosed and treated can lead to avascular necrosis of the astragalus, pseudoarthrosis, early osteoarthrisis and ankle instability, declining the quality of life of patients.
METHODS
A PubMed search was performed using the terms "talus" "talus AND radiology", "talar fractures", and "talar fractures classification", selecting articles published in the last 98 years. We selected articles about pre-treatment and post-surgery talar fractures diagnostic imaging. We also selected articles about talar fractures complications and traumatic talar dislocations. Case reports have not been included.
AIM OF THE WORK
to describe radiological evaluations, classification systems, and biomechanical patterns involved in talar fractures. Also we will briefly describe talar fractures complications and treatment option and strategies.
CONCLUSIONS
This work suggests a radiological approach aimed to classify talar fractures and guide treatment strategies, improving patient outcomes.
Topics: Cartilage, Articular; Foot Joints; Fractures, Bone; Humans; Imaging, Three-Dimensional; Joint Dislocations; Radiography; Talus; Tomography, X-Ray Computed
PubMed: 29350644
DOI: 10.23750/abm.v89i1-S.7019 -
American Journal of Physical... Aug 2017Internal bone structure, both cortical and trabecular bone, remodels in response to loading and may provide important information regarding behavior. The foot is well...
OBJECTIVES
Internal bone structure, both cortical and trabecular bone, remodels in response to loading and may provide important information regarding behavior. The foot is well suited to analysis of internal bone structure because it experiences the initial substrate reaction forces, due to its proximity to the substrate. Moreover, as humans and apes differ in loading of the foot, this region is relevant to questions concerning arboreal locomotion and bipedality in the hominoid fossil record.
MATERIALS AND METHODS
We apply a whole-bone/epiphysis approach to analyze trabecular and cortical bone in the distal tibia and talus of Pan troglodytes and Homo sapiens. We quantify bone volume fraction (BV/TV), degree of anisotropy (DA), trabecular thickness (Tb.Th), bone surface to volume ratio (BS/BV), and cortical thickness and investigate the distribution of BV/TV and cortical thickness throughout the bone/epiphysis.
RESULTS
We find that Pan has a greater BV/TV, a lower BS/BV and thicker cortices than Homo in both the talus and distal tibia. The trabecular structure of the talus is more divergent than the tibia, having thicker, less uniformly aligned trabeculae in Pan compared to Homo. Differences in dorsiflexion at the talocrural joint and in degree of mobility at the talonavicular joint are reflected in the distribution of cortical and trabecular bone.
DISCUSSION
Overall, quantified trabecular parameters represent overall differences in bone strength between the two species, however, DA may be directly related to joint loading. Cortical and trabecular bone distributions correlate with habitual joint positions adopted by each species, and thus have potential for interpreting joint position in fossil hominoids.
Topics: Animals; Anthropology, Physical; Cancellous Bone; Cortical Bone; Humans; Pan troglodytes; Talus; Tibia; Walking
PubMed: 28542704
DOI: 10.1002/ajpa.23249