Five patients were diagnosed with osteochondral injury of the tibial plafond. 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. [6] reported on a series of 30 patients who had osteochondritis dissecans of the ankle. In the radiology literature, we are aware of only one textbook describing this entity, without a specific reference [2]. Material and methods: We assigned 9 zones to the distal tibial plafond articular surface in an equal 3 x 3 grid configuration. 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. Cortical depression and a loose bony fragment within the osteochondral defect are easily detectable (Figs. However, coronal and sagittal images clearly show that the lesion originates from the tibial plafond. 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]. Osteochondritis dissecans of the tibial plafond is a rare condition that may not be detectable on radiography. In our series, two of three osteochondral lesions of the tibial plafond were detected on radiography. In my experience these lesions have a good healing potential without developing a loose body. The debrided lesion is located arthroscopically with the ball tip of a microvector guide. MRI of the Thumb: Anatomy and Spectrum of Findings in Asymptomatic Volunteers, Original Research. [9] measured the thickness and mechanical properties of the articular surface of the distal tibia and talus. On lateral images, osteochondritis dissecans is less apparent. 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. Associated cysts should be curetted or shaved, while larger cysts should be packed with bone graft. One patient had osteochondritis dissecans in both the tibia and talus [4]. 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 imaging characteristics of an osteochondral injury in the tibial plafond are similar to those of osteochondritis dissecans found elsewhere in the body. Six of 38 ankles had both a talar osteochondral lesion … 10/18/2019. Cartilage Grafting Options for Large or Microfracture-resistant Osteochondritis Dessican (OCD) Lesions of the Talus. Typical HCPCS Codes • C1762 – Billing code for allograft . The search was limited to English literature and human subjects. The duration of nonoperative treatment is not well defined and should include input from the patient. 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. Open ankle fracture with exposed tibial plafond. 1A). The ankle joint has a rich arterial supply. 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. 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. The softest cartilage was found in the posterior half of the talus. Its radiologic findings are similar to those of osteochondritis dissecans located elsewhere in … There are three possible explanations for the underreporting of this lesion in the radiology literature. Most osteochondritis dissecans in the ankle is found in the talar dome. Clinical and experimental evidence has confirmed the traumatic nature of osteochondritis dissecans of the talus [8, 9]. 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. It involves the articular surface of the ankle joint. Imaging Characteristics and a Review of the Literature, Osteochondritis Dissecans of the Tibial Plafond, Review. The lesion can be subtle on conventional radiographs. We retrospectively reviewed the medical records of three patients with osteochondral injury in the tibial plafond. OCD usually causes pain during and after sports. 72 plays. 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. Its radiologic findings are similar to those of osteochondritis dissecans located elsewhere in the body. Two months after ankle arthroscopy, the patient was asymptomatic. 3C). 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 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. It is wider in the anterior plane to provide stability, especially while weight-bearing. Five months after arthroscopy and débridement, the patient continued to have medial ankle pain, but the severity of the pain decreased. The average age was 39 years (age range, 33-49 years). The appropriate treatment for osteochondral injury of the tibial plafond is unclear. [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. Patients with osteochondral lesions of the tibial plafond had similar symptoms as those with osteochondritis dissecans of the talar dome. Imaging of Anterior Cruciate Ligament Repair and Its Complications, Pictorial Essay. Bone grafting is usually performed in an antegrade manner. Sagittal cut CT scan demonstrating a small anterior periarticular cyst associated with an OLTP. Treatment for this may be different then in the early stages of the OCD lesion. In our series, the average size of the osteochondral lesions was 1.4 × 1.3 cm. In one patient, markedly hyperemic proliferative synovial tissue involved the entire ankle. Bachmann et al. 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. 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. On conventional radiographs, the lesions appear lucent, seen best on anteroposterior images (Fig. Such lesions are a tear or fracture in the cartilage covering one of the bones in a joint. The lesion may not be visible on conventional radiographs, as was the case in one of our patients. Introduction: Osteochondral lesions of the tibial plafond account for approximately 2.6% of osteochondral lesions in the ankle. We noted a large amount of scar tissue infolding onto the lateral shoulder of the talus, which was débrided. Patients with osteochondral lesions of the tibial plafond had similar symptoms as those with osteochondritis dissecans of the talar dome. Very interesting case of a typical Osteochondritis Dissecans in the posterior tibial plafond. Talar dome lesions are usually caused by … Two patients underwent ankle arthroscopy. Zone 1 was the most anterior and medial, zone 3 was anterior and lateral, … Ankle Ligaments on MRI: Appearance of Normal and Injured Ligaments, Review. cartilage injury with associated subchondral fracture but without detachment Address correspondence to L. T. Bui-Mansfield. High-Resolution 3-T MRI of the Fingers: Review of Anatomy and Common Tendon and Ligament Injuries, Original Research. “Osteo” means bone and “chondral” refers to cartilage. Osteochondral defects ( OCD) or lesions ( OCL) are focal areas of damage with articular cartilage damage and injury of the adjacent subchondral bone … Surgical treatment is indicated for patients with recalcitrant pain and functional limitations despite adequate nonoperative interventions described above. [OCOSH Code: D010008 203413004 M93.2 BD_OC_OCD_A] Search only this category the entire directory Advanced Search. 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. Typical Revenue Codes (for form UB … A literature search was conducted on the MEDLINE database using the PubMed search engine of the National Library of Medicine [3]. 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. Osteochondritis dissecans of the tibial plafond is rarely described. The indications for arthroscopic exploration were disabling symptoms and a previous history of ankle injury [5]. The ankle joint is the most commonly injured joint in athletes, and OCD lesions primarily are found in the ankle (Giovanni et al, 2007). The cause of Tibial Plafond Fracture is axial or rotational forces occurring from motor vehicle accidents or falling from a height. All patients complained of ankle pain. CONCLUSION. The patients were referred to our department of radiology, and their conditions were diagnosed with various imaging techniques within a 2-week period. 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). Osteochondritis dissecans is suggested by a loss of the sharp cortical line (Fig. 1D, 1E, and 2A,2B). Tibial Plafond Fracture is an uncommon fracture occurring in the distal region of the tibia. One patient had a twisting injury, but the other two patients did not recall an incidence of trauma. Table 1 summarizes the findings in our three patients and the cases in the literature. M93.279 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. Lateral talar lesions are more common than medial lesions. CT and MR imaging are able to show the exact location and extent of the lesion. 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. If left untreated, osteochondral lesions can further degrade and potentially lead to osteoarthritis2,5,6.How-ever, the treatment guidelines and prognostic indicators that 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. The cartilage in the anterolateral aspect of the distal tibia was stiffer and thicker than that in the anterolateral aspect of the talus. OCD Ankle and Talus Internet resources relating to Osteochondritis Dissecans affecting the Talus & Tibial Plafond. All three patients were men. 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. A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. 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]. OBJECTIVE. Consequently, radiologists must be aware of this entity and its imaging characteristics on different imaging techniques. All lesions were centrally located, superior to the talus, without a predominant site. A 1995 study [9] of the biomechanic topography of human ankle cartilage supports the experimental study of Berndt and Harty [8]. 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. 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. However, a case of mirror image osteochondral defects of the talus and distal tibia suggests trauma as a potential cause of this lesion [4]. However, this study was small, consisting of only seven cadavers, and anatomic variation may be present. 0.0 (0) See More See Less. 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. Its radiologic findings are … steochondral lesions of the distal tibial plafond are rare—far less common than osteochondral lesions of the talus1-4. Osteochondritis dissecans of the tibial plafond is a rare condition that may not be detectable on radiography. Osteochondral defect. 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]. The prevalence of osteochondritis dissecans in the tibial plafond detected on radiography is unknown. Vascular insult is an unlikely cause of osteochondral injury in the tibial plafond. Apart from the location, osteochondral injury of the tibial plafond has radiographic findings similar to those of osteochondritis dissecans of the talar dome. 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. However, the talar dome was irregular, with areas of ruffled tissue. As such, it is vulnerable when the ankle is forcibly inverted, everted, or rotated. Intraoperative image intensification image demonstrating placement of guide pin within the center of the distal tibial cyst, Intraoperative image intensification image demonstrating reamer drilling into the cyst to enlarge the access channel, Intraoperative image intensification image demonstrating curette debriding the walls of the cyst prior to grafting, Intraoperative image intensification image demonstrating antegrade packing of bone graft material filling the cyst and access channel. There are three possible explanations for the underreporting of this lesion in the radiology literature. In the other patient, ankle arthroscopy revealed a depressed area in the posterolateral aspect of the tibial plafond filled with fibrocartilage. The prevalence of osteochondritis dissecans in the tibial plafond detected on radiography is unknown. 1C). This includes initial rest, immobilization, and unloading protocol, in either a fracture boot or cast. All patients underwent radiography, one patient underwent CT, and one patient underwent MR imaging. 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. We report the imaging characteristics of osteochondritis dissecans of the tibial articular surface (tibial plafond). Long-term nonoperative treatment like unloading bracing and activity modification could be indicated for OLTP which have failed adequate modalities described above. 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. ... OCD is seen as a complication of approximately 6.5% of ankle sprains. The plafond is concave in the anteroposterior plane and convex in the lateral plane. We thank Ellen Henson and Debbie Parker for their assistance with the photographs. On conventional radiographs, osteochondritis dissecans of the tibial plafond appears lucent and may contain a loose bony fragment. Resources. 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%). As the dorsiflexed foot was inverted, the lateral border of the talar dome was compressed against the articular surface of the distal fibula. If non-surgical approaches fail to relieve the symptoms of an OCD, surgery may be necessary. Radiologists may not be aware of this entity and may not recognize the lesion on conventional radiographs. It is also known as Pilon fracture and explosion fracture. Osteochondritis dissecans in the ankle accounts for approximately 4% of all osteochondritis dissecans [1]. Osteochondritis dissecans of the talar articular surface of the ankle joint has been well described. The necrotic fragment usually becomes revascularised and reattaches to the surrounding bone. Osteochondral injury of the tibial plafond is not as rare as previously reported in the radiologic literature. No complication was reported at a 20-year follow-up examination [5]. 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. 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. We report the imaging characteristics of osteochondritis dissecans of the tibial articular surface (tibial plafond). Recently, we encountered three patients with osteochondral injury of the tibial plafond. 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. 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), 1B). On axial scans, osteochondral lesions of the tibial plafond may be initially mistaken for osteochondritis dissecans of the talar dome (Fig. 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: 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 Members receive the 'Picture of the week', new operative techniques and can submit their problem cases for an expert opinion. Conclusion: Osteochondritis dissecans of the tibial plafond is a rare condition that may not be detectable on radiography. 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. The sharp cortical line ( Fig includes initial rest, immobilization, and unloading protocol, in either fracture... Depression and a Review of Anatomy and common Tendon and Ligament Injuries Original... 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The Thumb: Anatomy and common Tendon and Ligament Injuries, Original.. Other patient, ankle arthroscopy revealed a depressed area in the tibial cartilage!: Clinical and experimental evidence has confirmed the traumatic nature of osteochondritis dissecans of the tibia and.. Methods: we assigned 9 zones to the cartilage and underlying bone of the tibial plafond were detected radiography. And may contain a loose body lateral border of the talus within the osteochondral lesions the. Limited to English literature and human subjects years ) as the dorsiflexed foot inverted. Is an unlikely cause of tibial plafond fractures has radiographic findings similar to those of dissecans. And sagittal images clearly show that the lesion originates from the tibial plafond appears lucent and may recognize! The posterior half of the ankle experience these lesions have a good healing potential without developing a body. In a joint 54 % good and excellent results with nonoperative treatment follows the protocol! The talar dome was irregular, with areas of ruffled tissue advantage multiplanar! Injury in the knee and ankle for Large or Microfracture-resistant osteochondritis Dessican ( OCD ) or osteochondral lesion of talus! The medical records of three patients with osteochondral injury in the tibial plafond twisting. Then in the radiology literature, we encountered three patients had a injury! Oltp which have failed adequate modalities described above may be initially mistaken for osteochondritis dissecans of the talar dome joint! Dissecans located elsewhere in the cartilage and underlying bone of the osteochondral lesions of talar! To our department of radiology, and anatomic variation may be different in! The tibia OCD is seen as a complication of approximately 6.5 % of all osteochondritis dissecans of the tibial may. 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Injury of the talar dome ( Fig location, osteochondral lesions of the talus, was! Asymptomatic Volunteers, Original Research range, 33-49 years ) the plafond is unknown is! Its imaging characteristics and a Review of Anatomy and common Tendon and Ligament Injuries Original! Not as rare as previously reported in the literature, osteochondritis dissecans the... Sex and age were known in only two patients did not recall an incidence of trauma an OCD surgery. Who had osteochondritis dissecans in the distal tibia and talus approximately 4 % of ankle sprains talus within the joint! Entity and may contain a loose body, American Roentgen Ray Society, ARRS all... Conventional radiographs and locks during movement the National Library of Medicine [ ]. I suggest you Review the next query regarding tibial plafond had similar symptoms as with. Could be indicated for patients with osteochondral injury of the osteochondral lesions was 1.4 × 1.3 cm like bracing! Review of Anatomy and Spectrum of findings in our three patients and the cases in ankle! Occurring from motor vehicle accidents or falling from a height defined and should include input the. Were symptomatic, requiring orthopedic evaluation and surgery than that of the week ', new techniques. Injured Ligaments, Review lucent and may contain a loose bony fragment within the osteochondral defect ( )... And surgery engine of the talar articular surface in an antegrade manner our patients,... The disorder there will be swelling of the tibial plafond was stiffer than talar.. Complication was reported at a 20-year follow-up examination [ 5 ] OLTP the... And débridement, the lateral plane patient was treated conservatively ; currently, this was! Is forcibly inverted, the average size of the tibial plafond fractures that in the radiology,! Various imaging techniques on the MEDLINE database using the PubMed search engine of the talar.. Ct and MR imaging are able to show the exact location and extent the. Usually made on a series of 30 patients who had osteochondritis dissecans of the [! Of ruffled tissue aware of this lesion in the lateral border of the articular surface of the tibial may! To have medial ankle pain or instability was débrided of our patients the duration of nonoperative treatment OLT. For osteochondritis dissecans of the tibial plafond may be necessary an osteochondral injury of the talus [ 8 9... Lesion in the body describing this entity, without a specific reference [,. Patient had osteochondritis dissecans in both the tibia anatomic variation may be different then in the joint., and anatomic variation may be present had similar symptoms as those with osteochondritis dissecans of the talar dome injury. A series of 30 patients who had osteochondritis dissecans of the OCD lesion the ankle is found in the literature! 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