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This term covers a wide spectrum of pathologies including sub chondral contusion, osteochondritis dissecans, osteochondral fracture and osteoarthritis resulting from longstanding disease.
Cartilage damage may have a variable imaging appearance ranging from a small fissure, a distinct defect, flap formation or delamination. The majority of those lesions occur in active patients and are related to trauma.
The location of the lesion at the talus is related to the mechanism of the injury and direction of the applied force Figure 1. Figure 1 Location of the OCL according to the mechanism of trauma.
The red arrow indicates the direction of the applied force. The articular cartilage layer of the talocrural joint is indicated in blue. The articular surface of the talus is large and its blood supply is critical in the watershed areas [ 1 ] explaining an impaired healing process and predisposition to posttraumatic necrosis in those vulnerable areas.
Accurate staging of cartilage lesions is of utmost importance, as this will have a major impact on the treatment strategy and ultimate prognosis. Unstable lesions — if left untreated — predispose for early osteoarthritis. Arthroscopic evaluation of the cartilage is regarded as the gold standard [ 2 ], but due to its invasiveness and the need for anesthesia, it should be reserved for preoperatively well-documented cases and combined with surgical treatment procedures.
This underscores the value of preoperative imaging. Normal Anatomy of Talocrural Joint Schematic drawing shows the basic anatomy of the talocrural joint Figure 2a. On plain films, the subchondral bone is seen as a thin layer of compact bone with a smooth surface and a uniform adjacent trabecular bone Figure 2b.
MRI allows for distinguishing normal cartilage from subchondral bone as well as evaluating the adjacent bone marrow, ligaments and other surrounding soft tissues Figure 2c.
Compared to the articular cartilage of the knee, cartilage of the ankle joint is very thin and the spatial resolution of MRI may be insufficient for detection of small lesions. Therefore, for more accurate evaluation of cartilage covering of articular surfaces of the talar dome and distal tibia and fibula, direct arthrographic techniques combined with CT and MRI may be useful Figure 2d.
Figure 2 Anatomy of the talocrural joint. Schematic drawing of the normal talocrural joint a. Articular cartilage covering the articular surfaces bluecortical bone blacknormal bone marrow yellow and ligaments brown. Conventional radiography, Mortise View b. Smooth articular surfaces arrows of the talocrural joint with normal trabecular bone appearance stars.
MRI coronal PD fat suppressed image 1. CBCT-Arthrography CBCT-A of the talocrural joint, coronal reformatted image d showing smooth cartilage lining covering the normal subchondral bone of the talus arrow and tibia arrowhead.
The presence of intraarticular contrast and high spatial resolution improves visualization of the cartilage surfaces compared to routine MRI on 1.Jun 17, · ionizing radiation on meiotic spindles, 34 oocytes were divided up and then exposed to 0, 74, or Gy of ionizing radiation.
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