The patient on the right has edema in the medial talus. stage I. injury limited to articular cartilage; MRI findings: subchondral edema; x-ray findings: none; stage II. When the patient is treated, the edema will vanish, but the spurring may still be present. In this case there is a lot of edema in the navicular bone. The term Stieda process is used, when the lateral tubercle is very prominent. • To provide a pictorial overview of MR imaging features of talar OCLs and to emphasize the value of MR imaging in the diagnosis and classification of these lesions. In this article a systematic approach is presented on how to describe a standard MRI of the ankle. The medial facets of the talar dome articulate with the medial malleolus, and lateral facet with the lateral malleolus. This patient has bone marrow edema in both the medial malleolus and the medial talus. This image shows an extreme case of insertion tendinopathy of the Achilles tendon. Copyright © 2008 Elsevier Inc. All rights reserved. FIGURE 71-1 Osteochondral lesion of the talus. The patient in the middle has thickening and architecture distortion representing a partial tear (grade 2). Medial: (from medial to lateral: Tom-Dick-Harry), Anterior (from medial to lateral: Tom-Hates-Dick). In the foot and ankle many accessory ossicles can be seen. Most of the time the ATFL is injured as well. Note that the periosteum and flexor retinaculum are also thickened. This patient had a Weber C fracture, which is a grade 4 pronation exorotation injury in the Lauge-Hansen classification. There is subtle thickening of the cortex and some infiltration of the subperiosteum. Much of this bone is covered with cartilage. This patient has an unfused prominent lateral tubercle with a fibrous connection to the talus, therefore it is a partly fused os trigonum. The right image shows massive joint effusion as a reaction to degenerative osteochondral defects in the tibiotalar joint. On the image in the middle there is a deltoid ligament injury with separation of the periosteum or "periosteal stripping". Non-surgical: Osteochondral lesions of the ankle can be treated with injections of Platelet-rich plasma and hyaluronic acid, which results in a decrease in pain scores and an increase in function for at least 6 months. On long TE images (like T2) this artifact does also occur but less pronounced. OCD usually causes pain during and after sports. Here another patient with an os trigonum. MR can show edema around the insertion of the plantar fascia on the calcaneus and spurring. Osteochondral defect of talus – Usually occurring from a sprained ankle, the cartilage of the anklebone becomes bruised, can crack and may lead to the formation of a cyst on the talus bone. Edema is present in the bed of the defect (asterisk). This patient has edema in the calcaneus as a result of a stress fracture. Split tears of the peroneus longus are less common. This is edema due to a ligamentous avulsion injury. The lateral ligaments also show edema and thickening. The superficial layer of the deltoid ligament is connected to the navicular bone anteriorly and the calcaneus posteriorly. The Spring ligament is oriented obliquely and has a close relation with the deltoid ligament and the posterior tibial tendon. by Kiley D. Perrich et al. It is difficult to differentiate between grade 1 and 2 injuries, because the edema will blur the normal striped pattern. The fibers are interposed with fatty tissue, giving it a striped pattern on MR. They are usually asymptomatic, but can be a cause of impingement in specific patient groups (dancers, athletes). Some components are always present, while others are variable and not always seen on a standard MR. The blood supply to the talus is not as rich as many other bones in the body, and as a result injuries to the talus sometimes are more difficult to heal than similar injuries in other bones. No fracture line is visible. Too much fluid is indicative of bursitis. It has a transverse orientation and is best seen on axial images. The anterior syndesmosis is also thickened but shows low signal. The talus is the bottom bone of the ankle joint. Posterior tibial tendon dysfunction is more common in women and in people older than 40 years of age. Then continue reading. As the foot undergoes dorsiflexion, the peroneus brevis tendon is repeatedly compressed between the peroneus longus tendon and the lateral malleolus, predisposing to tear. • To discuss concomitant MR findings. The bone right underneath the cartilage will also be injured. In this case there is fibrous thickening of the capsule (arrow). An osteochondral lesion is seen at the posterior weightbearing surface of the medial femoral condyle. This injury usually results from overuse, especially in runners. Stress fractures of the calcaneus are a frequently unrecognized source of heel pain. Isolated injury is very rare. Here a normal PTFL and a grade 2 tear. Achilles tendinopathy is most likely due to a series of microtears that weaken the tendon and cause swelling of the tendon (image on the right). This joint permits much of the up (dorsiflexion) and down (plantarflexion) motion of the foot and ankle. Usually this is best appreciated on fatsat images. The extensor tendons are rarely injured. When the capsule is thickened, it may cause impingement or synovitis, which can be seen in the image in the middle. The left image shows a normal fluid accumulation in the tibiotalar joint, talocalcaneal joint en retrocalcaneal bursa. The peroneus brevis tendon is injury-prone, because it is positioned inbetween the fibula and peroneus longus tendon. Joints: screen for effusion and look at the joint capsule for thickening. In the foot and ankle many accessory ossicles can be seen. The image on the right shows fiber discontinuity making it a full thickness or grade 3 tear. Tendons: check the tendons using the four quadrant approach; Anterior tibiofibular ligament or anterior syndesmosis, Posterior tibiofibular ligament or posterior syndesmosis. Start your exam with fatsat images of the bones to screen for edema. Thickening of the Achilles is seen with paratenonitis. Scroll through the coronal images. The patient on the left has subtle edema around the ATFL-ligament, while the ligament itself looks normal. Some examples of accessory muscles. The effusion can run alongside the flexor hallucis longus tendon (FHL), since this tendon sheath is continuous with the joint. Split tears are associated with inversion injuries, most likely due to greater force on these tendons after ligamentous injury. Here three patients with various stages of OCD. It results in pain and swelling on the medial aspect of the ankle and an acquired flatfoot deformity. Noncontrast MR imaging is the standard of care imaging modality for diagnosing and classifying osteochondral lesions, but equivocal or difficult lesions can be assessed more specifically with direct MR arthrography or in conjunction with multidetector CT. Once an OCL has been identified, the imager should make every effort to determine whether it is stable or potentially unstable. The advent of new procedures for repairing cartilage in knee and ankle joints has increased the need for accurate noninvasive methods to objectively evaluate the success of repair. Terminology Osteochondral defect is a broad term that des... Osteochondral defects (OCD) or lesions (OCL) are focal areas of damage with articular cartilage damage and injury of the adjacent subchondral bone plate and subchondral cancellous bone. Copyright © 2020 Elsevier B.V. or its licensors or contributors. Bones: screen on fatsat images for bone marrow edema. This patient has multiple stress fractures of the calcaneus. The articular cartilage imaging group of the International Cartilage Repair Society has issued detailed recommendations with r… A small amount of fluid around the tendon therefore can be normal. Rupture of the Achilles tendon usually occurs in the part of the tendon situated within 6 centimeters of the insertion to the calcaneus. Cartilage is a connective tissue that covers the bones between joints. Noncontrast MR imaging is the standard of care imaging modality for diagnosing and classifying osteochondral lesions… The plantar fascia is a thick aponeurosis which supports the arch on the plantar side of the foot. When it is injured, there has to be injury to the other lateral ligaments. Osteochondral defect is mainly used when a patient is older or when a particular trauma is thought to be the cause of the defect. On the fatsat images edema is present in the os trigonum and surrounding soft tissue. More proximal, edema is seen around the membrana interossei. Here another example of thickening of the capsule. The pathogenesis of these disorders is different, but the clinical presentation and imaging features are not always distinctive. Other terms that refer to the same general process are osteochondral defects (OCD), osteochondritis dissecans, and transchondral fracture. This can be a cause of Achilles tendinopathy. This process can evolve into cyst formation. The patient on the right has a full thickness tear (grade 3). The posterior tibial tendon is the most commonly injured tendon. Two examples of diffuse joint effusion in the tibiotalar joint. Bone marrow edema is only an indication that there is something abnormal in the bone or connected structures. In the middle and right we see two examples of cashew nut deformity, indicative of partial split rupture. The two most common injuries are tendinopathy and rupture. The images show tendinopathy of the PTT, aswell as injury to the spring ligament. This case is shown to demonstrate the great variety of ossicles and tubercles on the posterior side of the talus. B and C clearly show disruption of fibers, so these are grade 3 injuries. In addition, the flexor retinaculum is thickened. CONCLUSION: AMIC for osteochondral talar lesions led to significant pain reduction, recovery of ankle function, and successful return to sport. An osteochondral lesion of the talus (OLT) is an area of abnormal, damaged cartilage and bone on the top of the talus bone (the lower bone of the ankle joint). Patients typically present with chronic ankle pain and swelling, and some have mechanical symptoms. Acute injury presents as edema and thickening, while an old injury presents with thickening and low signal intensity due to scar formation. Treatment Non-surgical or surgical treatment may be recommended for the management of osteochondral injuries of the ankle joint. The ankle joint is lined by the joint capsule. Here two patients with bone marrow edema. 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