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Let's go to the case.

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And the first case that I'd like to show you today at, uh,

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by the way, it's not a one case.

0:08

It's a set of, uh, two cases, uh, that I'm,

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talk a little bit about the osteochondral lesions

0:15

and the mechanism of lesions of the osteochondral lesions

0:19

that we see, uh, in the ankle.

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Uh, and the first case, this one,

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let me get the history of the patient.

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20 years old male with ankle sprain one week ago.

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And we can see, uh, men some, uh,

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classic findings in this case.

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Uh, first let's go to the, to the obvious ones.

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Uh, we can see, uh, a complete tear

0:43

of the anterior te fibular ligament.

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There is also a tear

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of the calcan fibular ligament at the medial side.

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There is also, uh, uh, a high signal intensity.

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Uh, the deltoid ligament is not a tear,

0:56

but, uh, probably, uh, a contusion.

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And by the way, uh, I spr slash contusion.

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And we can see also an edema at the medial, uh, wall

1:08

or the medial portion of the TAUs

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and some, some kind of edema also at the,

1:14

at the medial malus.

1:16

And this, uh, all these settings, it's symbolized to us

1:20

that is an inversion, uh, uh, it's, uh,

1:24

an inversion mechanism of injury.

1:26

Uh, there was inversion of this ankle,

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and this patient also has this lesion right here.

1:34

We can see that there is a, a kind of a denomination of not,

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not just the chondral, uh, the, the, the, the, the,

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it's not just a chondral lesion,

1:44

but also a denomination of the, of the subc chondral bone,

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right here at the lateral, uh, ler dome.

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And this is a classical lesion.

1:57

It's a classical o osteochondral lesion that we find

2:00

at the lateral, uh, ler dome.

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Uh, it's caused by an, uh, inversion, uh, mechanism

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of injury with, uh, uh, with, uh, Dorsey, with, with,

2:13

with blunt, with dorsiflexion.

2:15

I'm gonna show you a PowerPoint in a little bit,

2:18

but it happens with, uh, an inversion mechanism of lesion

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and dorsiflexion of the foot with axle load when it happens.

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That's the kind of lesion that we can see at the lateral,

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uh, part of the Taylor Dome.

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Okay? So this is the first case of this, uh, of, of,

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of this part of the, the, the case

2:40

that I would like to show you.

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And now I want to show another case for you.

2:45

Uh, and the second case, it's a companion case, let's say,

2:49

uh, we can say that, uh, this one, uh, we can,

2:55

it's a 27-year-old male with a persistent pain

2:58

after, uh, anco sprain six months ago.

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So let's take a look at the Taylor Dome.

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And now here we can see a lesion at the medial,

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uh, part of the Taylor Dome at this lesion right here.

3:15

You can see that this lesion, it's not acute

3:18

as the first one.

3:19

Uh, there is a chondral defect right here.

3:23

There is a lesion of the subc chondral plate right here

3:27

that we can see that it's, uh, it's thinner right here.

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And there is an edema in this area right here.

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We can also see that, uh, this me,

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this medial tailored lesion.

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It's a little bit, uh, larger

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and it's a little bit deeper than the lesion

3:44

that we saw on the lateral, uh, tailored dom.

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And this is the normal, uh, finding that when we deal

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with the, uh,

3:54

with osteochondral lesions at the Taylor Domme, the

3:59

different from the lesions at the lateral Taylor Dome

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that occur with inversion of the foot

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and, uh, dorsiflexion the lesions of the medial Taylor dom.

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They, they, they, they occur with, uh, inversion

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of inversion of the foot, but with dorsiflexion

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and with this, with this dorsal flexion, the part

4:21

of the tailor dome that, uh, becomes entrapped

4:24

inside articulation is the medial side.

4:27

Okay, so now I'd like to show, uh, uh,

4:32

just a, a, a PowerPoint explaining this mechanism

4:36

of lesion for you.

4:38

So this is our first case,

4:40

and talking about the mechanism of lesion.

4:43

Uh, what happened is this inversion mechanism of injury,

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right at the, uh, with axial load at the lateral side.

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This what happened here.

4:53

It's a sheer force, a sheer force

4:55

that occurs at the lateral side,

4:57

and the sheer force occurs with dorsiflexion, uh,

5:01

and the lesions at the lateral side, they are smaller

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and shallower than the lesions of the medial side.

5:08

Uh, on the other side, the lesions of the medial side

5:11

of the tailored dome, they occur with plantar flexion,

5:14

inversion with plantar flexion.

5:16

And the kind of lesion here, it's not a sheer force,

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it's a compression force.

5:23

And that's why the lesions of the medial side, they tend

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to be, uh, larger

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and deeper than the lesions of the lateral side.

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And another, uh, factor that, uh,

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complicates the lesions of the medial side, it's

5:38

that the central medial region of the Taylor Dome, it's less

5:43

vascularized, right?

5:44

So, uh, just, uh, talking about a, a paper

5:48

that they did a comparison,

5:50

and most of the lesions they occur at the medial side in

5:53

comparison with the lateral side. And, uh, some

5:56

Papers at the literature, they reach this 90 to 10%,

6:01

uh, rate between lesions of the medial side

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and the lateral side of the Taylor dome.

6:07

So depending on the reference, so this was my first case.