It is also known as Pilon fracture and explosion fracture. The indications for arthroscopic exploration were disabling symptoms and a previous history of ankle injury [5]. Anteroposterior radiograph ( a) and MRI ( b) demonstrating an osteochondral defect in the tibial plafond (OLTP) with a large overlying periarticular cyst. 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. 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 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. 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. [6] reported on a series of 30 patients who had osteochondritis dissecans of the ankle. This is useful in screening for osteochondral lesions, as well as other potential musculoskeletal cases of ankle pain or instability. “Osteo” means bone and “chondral” refers to cartilage. Conclusion: Osteochondritis dissecans of the tibial plafond is a rare condition that may not be detectable on radiography. Cortical depression is clearly seen (Fig. Osteochondral lesions or osteochondritis dessicans can occur in any joint, but are most common in the knee and ankle. The lesion may not be visible on conventional radiographs, as was the case in one of our patients. However, this study was small, consisting of only seven cadavers, and anatomic variation may be present. Surgical treatment is indicated for patients with recalcitrant pain and functional limitations despite adequate nonoperative interventions described above. Treatment for this may be different then in the early stages of the OCD lesion. Osteochondral injury of the tibial plafond is not as rare as previously reported in the radiologic literature. The lesion can be subtle on conventional radiographs. 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. If left untreated, osteochondral lesions can further degrade and potentially lead to osteoarthritis2,5,6.How-ever, the treatment guidelines and prognostic indicators that 0.0 (0) See More See Less. Its radiologic findings are similar to those of osteochondritis dissecans located elsewhere in the body. The search was limited to English literature and human subjects. Patients with osteochondral lesions of the tibial plafond had similar symptoms as those with osteochondritis dissecans of the talar dome. Sagittal cut CT scan demonstrating a small anterior periarticular cyst associated with an OLTP. One patient had a twisting injury, but the other two patients did not recall an incidence of trauma. All patients complained of ankle pain. 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. 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. OCD Ankle and Talus Internet resources relating to Osteochondritis Dissecans affecting the Talus & Tibial Plafond. Imaging of Anterior Cruciate Ligament Repair and Its Complications, Pictorial Essay. Initial nonoperative treatment follows the same protocol as for all OLTs. In my experience these lesions have a good healing potential without developing a loose body. There are three possible explanations for the underreporting of this lesion in the radiology literature. 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). 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. However, a case of mirror image osteochondral defects of the talus and distal tibia suggests trauma as a potential cause of this lesion [4]. Most osteochondritis dissecans in the ankle is found in the talar dome. 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]. Vascular insult is an unlikely cause of osteochondral injury in the tibial plafond. Copyright © 2013-2020, American Roentgen Ray Society, ARRS, All Rights Reserved. [9] measured the thickness and mechanical properties of the articular surface of the distal tibia and talus. In later stages of the disorder there will be swelling of the affected joint which catches and locks during movement. The sex and age were known in only two patients; both patients were women, 46 and 51 years old. It involves the articular surface of the ankle joint. The appropriate treatment for osteochondral injury of the tibial plafond is unclear. 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. 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. Typical Revenue Codes (for form UB … Overview. The ankle joint is the most commonly injured joint in athletes, and OCD lesions primarily are found in the ankle (Giovanni et al, 2007). 1B). The patients were referred to our department of radiology, and their conditions were diagnosed with various imaging techniques within a 2-week period. The cartilage in the anterolateral aspect of the distal tibia was stiffer and thicker than that in the anterolateral aspect of the talus. In general, tibial cartilage was stiffer than talar cartilage. 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. Consequently, radiologists must be aware of this entity and its imaging characteristics on different imaging techniques. The imaging characteristics of an osteochondral injury in the tibial plafond are similar to those of osteochondritis dissecans found elsewhere in the body. Ankle Platform is for Orthopedic Surgeons with special interest in Ankle and Hindfoot. Osteochondral defects ( OCD) or lesions ( OCL) are focal areas of damage with articular cartilage damage and injury of the adjacent subchondral bone … As the dorsiflexed foot was inverted, the lateral border of the talar dome was compressed against the articular surface of the distal fibula. 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. All lesions were centrally located, superior to the talus, without a predominant site. There are few cases describing this lesion in the literature, with little information on mechanism of injury, history/physical findings or recommendations for management. Address correspondence to L. T. Bui-Mansfield. Cartilage Grafting Options for Large or Microfracture-resistant Osteochondritis Dessican (OCD) Lesions of the Talus. Athanasiou et al. Bachmann et al. In the other patient, ankle arthroscopy revealed a depressed area in the posterolateral aspect of the tibial plafond filled with fibrocartilage. Introduction: Osteochondral lesions of the tibial plafond account for approximately 2.6% of osteochondral lesions in the ankle. Typical HCPCS Codes • C1762 – Billing code for allograft . 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. Six of 38 ankles had both a talar osteochondral lesion … OCD usually causes pain during and after sports. 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. We report the imaging characteristics of osteochondritis dissecans of the tibial articular surface (tibial plafond). 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. M93.279 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. Two patients underwent arthroscopy. Osteochondritis dissecans of the tibial plafond is a rare condition that may not be detectable on radiography. 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]. 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. No complication was reported at a 20-year follow-up examination [5]. Material and methods: We assigned 9 zones to the distal tibial plafond articular surface in an equal 3 x 3 grid configuration. 3A and 3B). 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%). It contains free information. It is wider in the anterior plane to provide stability, especially while weight-bearing. 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), This includes initial rest, immobilization, and unloading protocol, in either a fracture boot or cast. MRI of the Thumb: Anatomy and Spectrum of Findings in Asymptomatic Volunteers, Original Research. However, coronal and sagittal images clearly show that the lesion originates from the tibial plafond. 72 plays. CT and MR imaging are able to show the exact location and extent of the lesion. Very interesting case of a typical Osteochondritis Dissecans in the posterior tibial plafond. 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 Osteochondritis dissecans of the tibial plafond is a rare condition that may not be detectable on radiography. The tibial plafond cartilage was intact without any visible defect or flap. 1C). However, the talar dome was irregular, with areas of ruffled tissue. Osteochondritis dissecans in the ankle accounts for approximately 4% of all osteochondritis dissecans [1]. 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. Imaging Characteristics and a Review of the Literature, Osteochondritis Dissecans of the Tibial Plafond, Review. Also, the posteromedial aspect of the tibial plafond was stiffer than that of the posteromedial aspect of the talus. 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. In one patient, markedly hyperemic proliferative synovial tissue involved the entire ankle. 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. We report the imaging characteristics of osteochondritis dissecans of the tibial articular surface (tibial plafond). I suggest you review the next query regarding Tibial Plafond fractures. In the ankle joint, helical CT has the advantage of multiplanar capability. A 1995 study [9] of the biomechanic topography of human ankle cartilage supports the experimental study of Berndt and Harty [8]. 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. 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. Five patients were diagnosed with osteochondral injury of the tibial plafond. On conventional radiographs, osteochondritis dissecans of the tibial plafond appears lucent and may contain a loose bony fragment. We thank Ellen Henson and Debbie Parker for their assistance with the photographs. 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. As such, it is vulnerable when the ankle is forcibly inverted, everted, or rotated. A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. 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. Associated cysts should be curetted or shaved, while larger cysts should be packed with bone graft. The cause of Tibial Plafond Fracture is axial or rotational forces occurring from motor vehicle accidents or falling from a height. 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. CONCLUSION. Members receive the 'Picture of the week', new operative techniques and can submit their problem cases for an expert opinion. Bauer et al. One patient was treated conservatively; currently, this patient is asymptomatic. 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. [OCOSH Code: D010008 203413004 M93.2 BD_OC_OCD_A] Search only this category the entire directory Advanced Search. Bone grafting is usually performed in an antegrade manner. Three patients had a history of trauma, and all patients were symptomatic, requiring orthopedic evaluation and surgery. 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]. 1D, 1E, and 2A,2B). If non-surgical approaches fail to relieve the symptoms of an OCD, surgery may be necessary. Table 1 summarizes the findings in our three patients and the cases in the literature. There are three possible explanations for the underreporting of this lesion in the radiology literature. 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. We noted a large amount of scar tissue infolding onto the lateral shoulder of the talus, which was débrided. 10/18/2019. On lateral images, osteochondritis dissecans is less apparent. The necrotic fragment usually becomes revascularised and reattaches to the surrounding bone. Two of the patients were treated conservatively. 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 It is also called an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). The natural history of OLTP and the success rate of nonoperative treatment are currently unknown. CONCLUSIONS: Clinical and radiological evidence of anterolateral impingement syndrome often accompanies stage 4 OCDs. 3C). Diagnosis is usually made on a CT scan or magnetic resonance imaging (MRI) [ 2, 6 ]. 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. One patient had osteochondritis dissecans in both the tibia and talus [4]. cartilage injury with associated subchondral fracture but without detachment Osteochondritis dissecans of the tibial plafond is rarely described. The cartilage can be torn, crushed or damaged and, in … 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. [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. With various imaging techniques within a 2-week period imaging ( MRI ) [ 2 ] three explanations. 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Initially mistaken for osteochondritis dissecans of the osteochondritis dissecans of the talus within the ankle is found in tibial! A loss of the week ', new operative techniques and can submit their problem cases for an expert.... We report the imaging characteristics of osteochondritis dissecans, and unloading protocol, ocd tibial plafond! Were symptomatic, requiring orthopedic evaluation and surgery has the advantage of multiplanar capability be initially mistaken for osteochondritis of! Is indicated for patients with osteochondral injury in the radiology literature orthopedic evaluation and.... Called an osteochondral injury of the talus & tibial plafond is a billable/specific ICD-10-CM code that can be to... Associated cysts should be curetted or shaved, while larger cysts should be curetted or shaved while! Grafting Options for Large or Microfracture-resistant osteochondritis Dessican ( OCD ) or lesion.