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Mann TS, Nery C. Osteochondral Lesion of the Talus: Quality of Life, Lesion Site, and Lesion Size. Foot Ankle Clin 2024; 29:213-224. [PMID: 38679434 DOI: 10.1016/j.fcl.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
Osteochondral lesions of the talus (OLTs) are the lesions that affect the articular cartilage and the subchondral bone of the talus. Symptoms develop between 6 and 12 months after the index trauma and are associated with degradation of quality of life. Two-thirds of the lesions (73%) are located on the medial part of the talus, 28% of the lesions are posteromedial, and 31% of the lesions are centromedial. Currently, OLT of up to 100 mm2 can behave in a more indolent condition, and above that area, the defect tends to transmit more shearing forces to adjacent cartilage and is more symptomatic.
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Affiliation(s)
- Tania Szejnfeld Mann
- Orthopedic Surgery, Federal University of São Paulo, Escola Paulista de Medicina, Sao Paulo, Brazil
| | - Caio Nery
- Orthopedics and Traumatology, UNIFESP, Federal University of São Paulo, Brazil.
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Zhou L, Ho KWK, Zheng L, Xu J, Chen Z, Ye X, Zou L, Li Y, Chang L, Shao H, Li X, Long J, Nie Y, Stoddart MJ, Lai Y, Qin L. A rabbit osteochondral defect (OCD) model for evaluation of tissue engineered implants on their biosafety and efficacy in osteochondral repair. Front Bioeng Biotechnol 2024; 12:1352023. [PMID: 38766649 PMCID: PMC11099227 DOI: 10.3389/fbioe.2024.1352023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 04/08/2024] [Indexed: 05/22/2024] Open
Abstract
Osteochondral defect (OCD) is a common but challenging condition in orthopaedics that imposes huge socioeconomic burdens in our aging society. It is imperative to accelerate the R&D of regenerative scaffolds using osteochondral tissue engineering concepts. Yet, all innovative implant-based treatments require animal testing models to verify their feasibility, biosafety, and efficacy before proceeding to human trials. Rabbit models offer a more clinically relevant platform for studying OCD repair than smaller rodents, while being more cost-effective than large animal models. The core-decompression drilling technique to produce full-thickness distal medial femoral condyle defects in rabbits can mimic one of the trauma-relevant OCD models. This model is commonly used to evaluate the implant's biosafety and efficacy of osteochondral dual-lineage regeneration. In this article, we initially indicate the methodology and describe a minimally-invasive surgical protocol in a step-wise manner to generate a standard and reproducible rabbit OCD for scaffold implantation. Besides, we provide a detailed procedure for sample collection, processing, and evaluation by a series of subsequent standardized biochemical, radiological, biomechanical, and histological assessments. In conclusion, the well-established, easy-handling, reproducible, and reliable rabbit OCD model will play a pivotal role in translational research of osteochondral tissue engineering.
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Affiliation(s)
- Liangbin Zhou
- Musculoskeletal Research Laboratory of Department of Orthopaedics and Traumatology and Innovative Orthopaedic Biomaterials and Drug Translational Research Laboratory of Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
- Department of Biomedical Engineering, Faculty of Engineering, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
- Center for Neuromusculoskeletal Restorative Medicine, Hong Kong Science Park, NT, Hong Kong SAR, China
| | - Ki-Wai Kevin Ho
- Musculoskeletal Research Laboratory of Department of Orthopaedics and Traumatology and Innovative Orthopaedic Biomaterials and Drug Translational Research Laboratory of Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Lizhen Zheng
- Musculoskeletal Research Laboratory of Department of Orthopaedics and Traumatology and Innovative Orthopaedic Biomaterials and Drug Translational Research Laboratory of Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Jiankun Xu
- Musculoskeletal Research Laboratory of Department of Orthopaedics and Traumatology and Innovative Orthopaedic Biomaterials and Drug Translational Research Laboratory of Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Ziyi Chen
- Musculoskeletal Research Laboratory of Department of Orthopaedics and Traumatology and Innovative Orthopaedic Biomaterials and Drug Translational Research Laboratory of Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Xiangdong Ye
- Department of Biochemistry and Molecular Biology, Institute of Basic Medical Sciences, College of Basic Medicine, Hubei University of Medicine, Shiyan, China
| | - Li Zou
- Musculoskeletal Research Laboratory of Department of Orthopaedics and Traumatology and Innovative Orthopaedic Biomaterials and Drug Translational Research Laboratory of Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
- Zhongshan Institute of Changchun University of Science and Technology, Zhongshan, China
| | - Ye Li
- Musculoskeletal Research Laboratory of Department of Orthopaedics and Traumatology and Innovative Orthopaedic Biomaterials and Drug Translational Research Laboratory of Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Liang Chang
- Musculoskeletal Research Laboratory of Department of Orthopaedics and Traumatology and Innovative Orthopaedic Biomaterials and Drug Translational Research Laboratory of Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Hongwei Shao
- Musculoskeletal Research Laboratory of Department of Orthopaedics and Traumatology and Innovative Orthopaedic Biomaterials and Drug Translational Research Laboratory of Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Xisheng Li
- Department of Chemical Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
- Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Jing Long
- Centre for Translational Medicine Research and Development, Shenzhen Institute of Advanced Technology, The Chinese Academy of Sciences, Shenzhen, China
| | - Yangyi Nie
- Centre for Translational Medicine Research and Development, Shenzhen Institute of Advanced Technology, The Chinese Academy of Sciences, Shenzhen, China
| | | | - Yuxiao Lai
- Centre for Translational Medicine Research and Development, Shenzhen Institute of Advanced Technology, The Chinese Academy of Sciences, Shenzhen, China
| | - Ling Qin
- Musculoskeletal Research Laboratory of Department of Orthopaedics and Traumatology and Innovative Orthopaedic Biomaterials and Drug Translational Research Laboratory of Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
- Centre for Translational Medicine Research and Development, Shenzhen Institute of Advanced Technology, The Chinese Academy of Sciences, Shenzhen, China
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Matthias A, Becher C, Ettinger S, Gottschalk O, Guenther D, Klos K, Ahrend MD, Körner D, Plaass C, Walther M. Postoperative Management of Osteochondral Lesions of the Ankle: A Survey Among German-Speaking Foot and Ankle Surgeons. Cartilage 2023:19476035231213184. [PMID: 38044500 DOI: 10.1177/19476035231213184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2023] Open
Abstract
OBJECTIVE To assess the current treatment of osteochondral lesions of the ankle (OCLA) by German-speaking foot and ankle surgeons, focusing on the management of postoperative care and rehabilitation. DESIGN A questionnaire was created by a panel of 4 experienced foot and ankle surgeons on behalf of the "Clinical Tissue Regeneration" (CTR) working group of the German Society of Orthopaedics and Trauma Surgery (DGOU), and distributed electronically to members of the CTR, participants of the German Cartilage Registry (Knorpelregister DGOU©), and members of 6 German-speaking orthopedics or sports medicine societies. Results were classified depending on the consensus within the answers (agreement ≥75% "strong tendency," 50%-74% "tendency," 25%-49% "weak tendency," <25% "no tendency"). RESULTS A total of 60 participants returned the questionnaire. The main results are as follows: regarding the frequency of surgical procedures for OCLA, refixation of the fragment, retrograde drilling, and bone marrow stimulation with or without using a matrix were performed by at least 75% of the surgeons and was considered a strong tendency. There was a strong tendency to stabilize the ankle (76.7%) and perform corrective osteotomies (51.7%). In total, 75.5% and 75% of the surgeons performed bone marrow stimulation with and without using a matrix, respectively. Corrective osteotomy and ankle stabilization were performed in 64.5% and 65.2% cases, respectively. Most participants included published recommendations on postoperative rehabilitation and the return to sports activities in their postoperative management. The main surgical procedures were considered the most critical factor in influencing the postoperative management by 81% of the participants (strong tendency). Adjunct surgical procedures such as corrective osteotomy and stabilization of the ankle were considered important by 67.8% of the respondents (tendency). CONCLUSIONS The management of OCLA varies among German-speaking foot and ankle surgeons. Therefore, guidelines remain essential to standardize the management of OCLA, to achieve improved and stable results. This survey will assist clinicians and patients with rehabilitation to return to sports after treating the ankle's cartilage injury.
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Affiliation(s)
- Aurich Matthias
- DOUW, Section of Trauma- and Reconstructive Surgery, University Hospital Halle (Saale), Halle, Germany
- BG Trauma Center Bergmannstrost Halle, Department of Trauma- and Reconstructive Surgery, Halle, Germany
| | - Christoph Becher
- Department of Orthopaedic Surgery, Hannover Medical School, Diakovere Annastift, Hannover, Germany
| | - Sarah Ettinger
- University Hospital for Orthopedic Surgery, Pius Hospital Oldenburg, Oldenburg, Germany
| | - Oliver Gottschalk
- Hospital München Harlaching, Department of Foot and Ankle Surgery, München, Germany
- Department of Orthopaedics and Trauma Surgery, Muskuloskelettal University Center Munich (MUM), Hospital of the University Munich, LMU Munich, Germany
| | - Daniel Guenther
- Department of Orthopaedic Surgery, Trauma Surgery, and Sports Medicine, Cologne Merheim Medical Center, Cologne, Germany
| | - Kajetan Klos
- Joint Center Rhein-Main, Hochheim am Main, Germany
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Jena, Jena, Germany
| | - Marc-Daniel Ahrend
- BG Trauma Center Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany
| | - Daniel Körner
- BG Trauma Center Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany
| | | | - Markus Walther
- Schön Hospital München Harlaching-FIFA Medical Centre of Excellence, Munich, Germany
- Ludwig Maximilian University Munich, Department of Orthopaedics and Trauma Surgery, Muskuloskelletal University Center Munich (MUM), Munich, Germany
- Justus Maximilian University Wuerzburg, König-Ludwig-Haus, Würzburg, Germany
- Paracelsus Medical Private Universität, Salzburg, Austria
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Klein C, Dahmen J, Emanuel KS, Stufkens S, Kerkhoffs GMMJ. Limited evidence in support of bone marrow aspirate concentrate as an additive to the bone marrow stimulation for osteochondral lesions of the talus: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2023; 31:6088-6103. [PMID: 37962614 DOI: 10.1007/s00167-023-07651-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023]
Abstract
PURPOSE Bone marrow aspirate concentrate can be used as an additive to surgical treatment of osteochondral lesions of the talus. This systematic literature review aims to study the effect of the additional use of bone marrow aspirate concentrate on top of a surgical treatment for osteochondral lesions of the talus on clinical outcomes compared to surgical treatment alone. METHODS An online literature search was conducted using PubMed (Medline), Embase (Ovid), and the Cochrane library for all studies comparing a surgical intervention with bone marrow aspirate concentrate, with a surgical intervention without bone marrow aspirate concentrate. The methodological quality was rated according to the methodological index for non-randomised studies checklist. The primary outcome measure were clinical outcomes. Secondary outcome measures consisted of revision rate, complication rate, radiographic outcome measures and histological analyses. Subgroups were created based on type of surgical intervention used in the studies. If multiple articles were included in a subgroup, a linear random-effects model was used to compare the bone marrow aspirate concentrate-augmented group with the control group. RESULTS Out of 1006 studies found, eight studies with a total of 718 patients were included. The methodological quality, assessed according to the methodological index for non-randomised studies checklist, was weak. A significantly better functional outcome measures (p < 0.05) was found in the subgroup treated with bone marrow stimulation + bone marrow aspirate concentrate compared to the group treated with bone marrow stimulation alone, based on three non-blinded studies. No significant differences regarding clinical outcomes were found in the subgroups comparing matrix-induced autologous chondrocyte implantation with matrix-induced bone marrow aspirate concentrate, osteochondral autologous transplantation alone with osteochondral autologous transplantation + bone marrow aspirate concentrate and autologous matrix-induced chondrogenesis plus peripheral blood concentrate vs. matrix-associated stem cell transplantation bone marrow aspirate concentrate. CONCLUSION There is insufficient evidence to support a positive effect on clinical outcomes of bone marrow aspirate concentrate as an additive to surgical treatment of osteochondral lesions of the talus. However, based on the safety reports and initial results, sufficiently powered, patient- and researcher-blinded, prospective randomised controlled trials are justified and recommended. Until then, we advise not to implement a therapy (addition of bone marrow aspirate concentrate) without clinical evidence that justifies the additional costs involved. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Chiel Klein
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - Jari Dahmen
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - Kaj S Emanuel
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - Sjoerd Stufkens
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - Gino M M J Kerkhoffs
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
- Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands.
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands.
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Cao J, Zhang C, Huang H, Zhang C, Yang L, Duan X. Effectiveness and safety of arthroscopy combined with radial extracorporeal shockwave therapy for osteochondritis of the talus: a prospective, single-centre, randomized, double-blind study. Bone Joint J 2023; 105-B:1108-1114. [PMID: 37777205 DOI: 10.1302/0301-620x.105b10.bjj-2023-0152.r2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/02/2023]
Abstract
Aims Arthroscopic microfracture is a conventional form of treatment for patients with osteochondritis of the talus, involving an area of < 1.5 cm2. However, some patients have persistent pain and limitation of movement in the early postoperative period. No studies have investigated the combined treatment of microfracture and shortwave treatment in these patients. The aim of this prospective single-centre, randomized, double-blind, placebo-controlled trial was to compare the outcome in patients treated with arthroscopic microfracture combined with radial extracorporeal shockwave therapy (rESWT) and arthroscopic microfracture alone, in patients with ostechondritis of the talus. Methods Patients were randomly enrolled into two groups. At three weeks postoperatively, the rESWT group was given shockwave treatment, once every other day, for five treatments. In the control group the head of the device which delivered the treatment had no energy output. The two groups were evaluated before surgery and at six weeks and three, six and 12 months postoperatively. The primary outcome measure was the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale. Secondary outcome measures included a visual analogue scale (VAS) score for pain and the area of bone marrow oedema of the talus as identified on sagittal fat suppression sequence MRI scans. Results A total of 40 patients were enrolled and randomly divided into the two groups, with 20 in each. There was no statistically significant difference in the baseline characteristics of the groups. No complications, such as wound infection or neurovascular injury, were found during follow-up of 12 months. The mean AOFAS scores in the rESWT group were significantly higher than those in the control group at three, six, and 12 months postoperatively (p < 0.05). The mean VAS pain scores in the rESWT group were also significantly lower than those in the control group at these times (p < 0.05). The mean area of bone marrow oedema in the rESWT group was significantly smaller at six and 12 months than in the control group at these times (p < 0.05). Conclusion Local shockwave therapy was safe and effective in patients with osteochondiritis of the talus who were treated with a combination of arthroscopic surgery and rESWT. Preliminary results showed that, compared with arthroscopic microfracture alone, those treated with arthroscopic microfracture combined with rESWT had better relief of pain at three months postoperatively and improved weightbearing and motor function of the ankle.
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Affiliation(s)
- Jin Cao
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Changgui Zhang
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Heqin Huang
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Chengchang Zhang
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Liu Yang
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Xiaojun Duan
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
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Kolar M, Drobnič M. Multilayered biomimetic scaffolds for cartilage repair of the talus. A systematic review of the literature. Foot Ankle Surg 2023; 29:2-8. [PMID: 36379845 DOI: 10.1016/j.fas.2022.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 10/10/2022] [Accepted: 10/30/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The aim of the present review was to analyze the available evidence in the literature on the clinical and radiological outcomes of multilayered biomimetic scaffolds in the treatment of osteochondral lesions of the talus (OLTs). DESIGN A systematic search was performed in three databases to identify clinical trials, where the multilayered biomimetic scaffolds were used for the treatment of OLTs. The PRISMA guidelines were followed. Qualitative analysis of the relevant data of the included studies was executed. The methodological quality of the analyzed studies was assessed with a modified Coleman Methodology Score (CMS). RESULTS A total of 10 studies with 87 patients were included in the analysis. Only three multilayered biomimetic scaffolds have been investigated in clinical trials for the treatment of OLTs. The worst clinical and radiological outcomes, as well as safety profile were observed for the TruFit scaffold (Smith & Nephew, Andover, MA, USA), which had already been withdrawn from the market. The other two scaffolds (MaioRegen, Finceramica, Italy; Agili-C, Cartiheal, Israel) performed significantly better in the majority of the reviewed studies, especially in the clinical aspect. The radiological findings, the improvements of MOCART scores, the completeness of lesions' fill, and the structure of regenerated tissue were much more inconsistent. CONCLUSIONS Two of the multilayered biomimetic scaffolds demonstrated an adequate potential in the treatment of complex OLTs. However, limited studies availability and their low level of medical evidence request further high-level investigations before the clinical decision making for such scaffolds in the treatment of OLTs can be defined.
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Affiliation(s)
- Matic Kolar
- Department of Orthopaedic Surgery, University Medical Centre Ljubljana, Zaloška cesta 9, 1000 Ljubljana, Slovenia; Chair of Orthopaedics, Faculty of Medicine, University of Ljubljana, Zaloška cesta 9, 1000 Ljubljana, Slovenia.
| | - Matej Drobnič
- Department of Orthopaedic Surgery, University Medical Centre Ljubljana, Zaloška cesta 9, 1000 Ljubljana, Slovenia; Chair of Orthopaedics, Faculty of Medicine, University of Ljubljana, Zaloška cesta 9, 1000 Ljubljana, Slovenia
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Griffith JF, Ling SKK, Tischer T, Weber MA. Talar Dome Osteochondral Lesions: Pre- and Postoperative Imaging. Semin Musculoskelet Radiol 2022; 26:656-669. [PMID: 36791735 DOI: 10.1055/s-0042-1760217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
We suggest a similar approach to evaluating osteochondral lesions of the talar dome both pre- and postoperatively. This review addresses the etiology, natural history, and treatment of talar dome osteochondral lesions with an emphasis on imaging appearances. High-resolution magnetic resonance imaging, ideally combining a small field-of-view surface coil with ankle traction, optimizes visibility of most of the clinically relevant features both pre- and postoperatively.
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Affiliation(s)
- James Francis Griffith
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, China
| | - Samuel K K Ling
- Department of Orthopaedic and Traumatology, The Chinese University of Hong Kong, Hong Kong, China
| | - Thomas Tischer
- Department of Orthopaedic Surgery, University Medical Centre Rostock, Rostock, Germany
| | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center Rostock Germany
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Healing Predictors of Conservative Treatment for Juvenile Osteochondritis Dissecans of the Talus. Clin J Sport Med 2022; 32:e635-e643. [PMID: 36315829 DOI: 10.1097/jsm.0000000000001049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 03/15/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate the healing response of juvenile osteochondritis dissecans (JOCD) of the talus after conservative treatment, identify healing predictors, and develop a predictive model for healing. DESIGN Retrospective study. SETTING Clinics at a tertiary-level pediatric medical center. PATIENTS Fifty-five patients (55 ankles) who presented with JOCD. INTERVENTIONS Patients were managed with cast immobilization followed by activity restriction. MAIN OUTCOME MEASURES The primary outcome measure of progressive lesion reossification was determined from the latest radiograph, after at least 6 months of nonoperative treatment. Final clinical evaluation was performed by a questionnaire and complementary telephone interview. Multivariate logistic regression was used to determine the influence of age, sex, lesion size, classification, location, duration of symptoms, containment lesion, and the occurrence of cyst-like lesions on healing potential. RESULTS After nonoperative treatment, 18 (33%) of 55 lesions had failed to progress toward healing. An older age (P = 0.034) and a completely detached but undisplaced (grade III) lesion (P < 0.001) at the time of diagnosis were predictive for the failure of conservative treatment. A multivariate logistic regression best predictor model that included age and grade resulted in the best predicted healing and yielded an area under the curve of 0.920 (P < 0.001). CONCLUSION In two-thirds of skeletally immature patients, conservative treatment resulted in the progressive healing of JOCD of the talus. For older patients with grade III lesions showing a lower healing probability, surgical treatment should be considered.
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Rikken QGH, Wolsink LME, Dahmen J, Stufkens SAS, Kerkhoffs GMMJ. 15% of Talar Osteochondral Lesions Are Present Bilaterally While Only 1 in 3 Bilateral Lesions Are Bilaterally Symptomatic. J Bone Joint Surg Am 2022; 104:1605-1613. [PMID: 35866645 DOI: 10.2106/jbjs.22.00122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The primary aim of the present study was to determine the prevalence of osteochondral lesions of the contralateral talus in patients with computed tomography (CT)-confirmed osteochondral lesions of the talus (OLT). The secondary aims were to determine if the contralateral lesions were symptomatic and to describe the demographic characteristics and radiographic presentation of patients with bilateral OLT. METHODS To identify patients with bilateral OLT, we utilized a cross-sectional database of consecutive patients with a CT-proven OLT who had undergone bilateral CT scanning at our hospital between January 1989 and June 2021. The primary outcome was the prevalence of bilateral OLT. Patients with bilateral OLT were grouped into a unilaterally symptomatic group and a bilaterally symptomatic group. Patient and lesion characteristics were compared between these groups as well as between the symptomatic and asymptomatic ankles in the unilaterally symptomatic group. Radiographic examination included lesion volume, location, and morphology. RESULTS Of 1,062 patients with OLT, 161 (15%) had bilateral OLT. Of the patients with bilateral OLT, 53 (33%) were bilaterally symptomatic. Patients who were bilaterally symptomatic were younger (p = 0.03) and more likely to present with a non-traumatic etiology (p < 0.01) in comparison with those who were unilaterally symptomatic. No differences were observed between the unilaterally and bilaterally symptomatic groups in terms of lesion morphology, volume, or location. In the unilaterally symptomatic group, lesion volume was significantly larger in symptomatic ankles in comparison with the contralateral, asymptomatic ankles (p < 0.01), but no significant differences were observed in terms of lesion morphology or location. CONCLUSIONS In patients presenting with symptomatic OLT, the prevalence of bilateral OLT was 15%, and 1 in 3 patients with bilateral OLT were symptomatic on both sides. Larger lesion volume was associated with the presence of symptoms in patients with bilateral OLT. For patients with bilateral OLT, the treating team should be aware that younger patients and patients without a history of trauma are at a higher risk for having bilateral symptoms. LEVEL OF EVIDENCE Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Quinten G H Rikken
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, the Netherlands
- Academic Center for Evidence-based Sports medicine (ACES), Amsterdam UMC, Amsterdam, the Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, the Netherlands
| | - Lisanne M E Wolsink
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, the Netherlands
- Academic Center for Evidence-based Sports medicine (ACES), Amsterdam UMC, Amsterdam, the Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, the Netherlands
| | - Jari Dahmen
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, the Netherlands
- Academic Center for Evidence-based Sports medicine (ACES), Amsterdam UMC, Amsterdam, the Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, the Netherlands
| | - Sjoerd A S Stufkens
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, the Netherlands
- Academic Center for Evidence-based Sports medicine (ACES), Amsterdam UMC, Amsterdam, the Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, the Netherlands
| | - Gino M M J Kerkhoffs
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, the Netherlands
- Academic Center for Evidence-based Sports medicine (ACES), Amsterdam UMC, Amsterdam, the Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, the Netherlands
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Arshad Z, Aslam A, Iqbal AM, Bhatia M. Should Arthroscopic Bone Marrow Stimulation Be Used in the Management of Secondary Osteochondral Lesions of the Talus? A Systematic Review. Clin Orthop Relat Res 2022; 480:1112-1125. [PMID: 35130190 PMCID: PMC9263474 DOI: 10.1097/corr.0000000000002134] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 01/19/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Osteochondral lesions of the talus are common, particularly after trauma. Arthroscopic bone marrow stimulation has emerged as the first-choice surgical treatment for small primary lesions less than 100 mm2. Individual studies on the topic are small and heterogeneous, and they have differed in their main findings; for this reason, systematically reviewing the available evidence seems important. QUESTIONS/PURPOSES In this systematic review, we asked: (1) What patient-reported outcomes and pain scores have been observed after arthroscopic bone marrow stimulation for secondary osteochondral lesions of the talus? (2) What complications were reported? (3) What demographic and clinical factors were reported to be associated with better patient-reported outcome scores? METHODS We performed a systematic review according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using Embase, EmCare, PubMed, CINAHL, and Scopus (databases last searched June 23, 2021). A two-stage title/abstract and full-text screening process was performed independently by two reviewers. Randomized control trials, cohort studies, and observational studies published in English that evaluated the outcome of arthroscopic bone marrow stimulation for secondary osteochondral lesions of the talus were included. Case reports, review articles, commentaries, abstracts, and letters to the editor were excluded. A total of 12 articles (10 case series and two retrospective comparative studies) involving 446 patients were included. Of these, 111 patients with a mean age of 33 years (range 20 to 49) received arthroscopic bone marrow stimulation for a secondary osteochondral lesion of the talus. The Methodological Index for Non-randomized Studies (MINORS) criteria were used to assess the methodologic quality of included studies. The MINORS is a numerical score ranging from 0 to 16 for studies with no comparison group and 0 to 24 for comparative studies, with higher quality studies receiving higher scores. Of the 10 noncomparative case series, the highest score was 10 of 16, with a median (range) score of 7.5 (4 to 10), while the two comparative studies scored 22 of 24 and 19 of 24, respectively. RESULTS Studies varied widely in terms of patient-reported outcome measures such as the American Orthopaedic Foot and Ankle Society score (AOFAS), with inconsistent reporting across studies regarding whether or how much patients improved; there was variation in some effect sizes with regard to improvement seeming close to or below the minimum clinically important difference (MCID). Although no perioperative complications were reported in any included studies, 34% (26 of 77, in seven studies that reported on this endpoint) of patients who underwent a revision procedure. One study found a negative association between lesion size and AOFAS and VAS score. No other studies reported on factors associated with patient-reported outcome scores, and most studies were far too small to explore relationships of this sort. CONCLUSION We found that arthroscopic bone marrow stimulation for secondary osteochondral lesions of the talus yielded inconsistent and often small improvements in patient-reported outcomes, with approximately one in three patients undergoing a revision procedure. Reported outcomes likely represent a best-case scenario, inflated by low-level study designs and major sources of bias that are known to make treatment effects seem larger than they are. Therefore, the use of arthroscopic bone marrow stimulation in such patients cannot be recommended, unless we are able to refine selection criteria to effectively identify patients who show a substantial clinical benefit. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Affiliation(s)
- Zaki Arshad
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Aiman Aslam
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Adil M. Iqbal
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Maneesh Bhatia
- Department of Trauma and Orthopaedic Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK
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Zhang Y, Liang JQ, Wen XD, Liu PL, Lu J, Zhao HM. Triplane osteotomy combined with talar non-weight-bearing area autologous osteochondral transplantation for osteochondral lesions of the talus. BMC Musculoskelet Disord 2022; 23:79. [PMID: 35065640 PMCID: PMC8783502 DOI: 10.1186/s12891-022-05043-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 01/19/2022] [Indexed: 11/26/2022] Open
Abstract
Background Traditional medial malleolar osteotomy combined with autologous osteochondral transplantation (AOT) is mostly used in the treatment of osteochondral lesions of the talus (OLTs), but with high osteotomy and donor site complications. We hypothesis a new triplane medial malleolar osteotomy combined with AOT from non-weight-bearing area of the talus could be a promising choice for OLTs. Methods We reviewed all the symptomatic OLTs patients who received AOT with triplane osteotomy of the medial malleolus between September 2015 and December 2017 in our department. According to the inclusion and exclusion criteria, 23 patients (23 ankles), including 14 males and 9 females, were included in the study. The mean age was 35.6 years. The mean size of the lesion area was 141.5 mm2. According Ferkel’s classification, including 5 type I, 11 typeIIa and 7 typeIIb. The visual analog scale (VAS) for pain during walking and the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score were used for the pre- and postoperative evaluations. In addition, the incorporation of the grafts was assessed by computed tomography (CT). Results All patients had a minimum follow-up of 22 months, with an average of 37.1 months. The mean time from osteotomy to full weight-bearing activity was 8.1 ± 2.3 weeks (range, 5–12 weeks). The mean VAS score improved from 5.6 ± 0.7 preoperatively to 0.7 ± 1.0 postoperatively (P < 0.01). The AOFAS ankle-hindfoot score improved significantly in all domains (P < 0.01). Twenty-one patients returned to sport at their previous level, and 2 returned at a lower level compared with preinjury (mean return to play, 7.4 months). According to CT, the medial malleolus recovered in all patients, and the graft was incorporated well. One patient suffered from flexor hallucis longus tendon discomfort due to internal fixation screw irritation posteromedial to the ankle. The general complication rate was 4.3% (1/23). Conclusions These results indicate that AOT combined with medial malleolus triplane osteotomy maybe a viable option for OLTs. Patients could perform weight-bearing exercise and return to sport as early as possible, with a lower rate of complications at the osteotomy site and donor site. However, the large sample well-designed prospective comparative studies are still needed.
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12
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Schwartz AM, Niu S, Mirza FA, Thomas AR, Labib SA. Surgical Treatment of Talus OCL: Mid- to Long-Term Clinical Outcome With Detailed Analyses of Return to Sport. J Foot Ankle Surg 2021; 60:1188-1192. [PMID: 34130931 DOI: 10.1053/j.jfas.2021.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/28/2021] [Accepted: 05/05/2021] [Indexed: 02/03/2023]
Abstract
Talus osteochondral lesions are a commonly underdiagnosed problem in young athletes. Talus osteochondral lesions surgical algorithm remains controversial. Current metrics suggest that conventional treatment of osteochondral lesions of the talus is promising; yet return to sport is poorly studied. Fifty-seven patients following talus osteochondral lesion surgical intervention were included in this study. About 63.1% were female with mean age 37.1 years, mean lesion size 10 × 12.5 mm, and mean follow-up 79.9 months postoperatively. Patients were divided into 4 groups by surgery performed: antegrade arthroscopic bone marrow stimulation, retrograde arthroscopic drilling, osteochondral autograft transfer, and allograft cartilage implantation. Outcome metrics include Visual Analog Scale for pain and function, Short Form-12, Foot and Ankle Disability Scale, Tegner, Marx activity scores, Naal Sports inventory, and patient satisfaction. Over 77% of patients were satisfied with surgical intervention. Each intervention significantly decreased pain and increased function, except retrograde drilling. All interventions trended toward decreased Tegner score; only antegrade drilling showed significant decrease. Based on Naal's sports inventory, 85.7% of surgically treated patients reported participating in sport activities, on average 3 times/week and 50.6 minutes/session. Traditionally, talus osteochondral lesions present a difficult problem that is marred by unsatisfactory nonoperative outcomes in typically active patients. As our surgical understanding has evolved, we've continued to improve on outcomes. Our patients demonstrated 77.2% overall satisfaction rate, a statistically significant improvement in pain and function, at an average follow-up of 79.9 months postoperatively, and a high rate of return to sport with little difference between surgical interventions.
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Affiliation(s)
| | - Shuo Niu
- Emory University School of Medicine, Atlanta, GA
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13
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Yokoe T, Tajima T, Yamaguchi N, Ota T, Nagasawa M, Morita Y, Chosa E. Internal Fixation of a Lateral Inverted Osteochondral Fracture of the Talus (LIFT) Lesion Using an Innovative Surgical Approach: Inverting the Capsulo-Lateral Fibulotalocalcaneal Ligament (LFTCL)-Fibular Periosteum Complex. J Foot Ankle Surg 2021; 60:1054-1059. [PMID: 33840566 DOI: 10.1053/j.jfas.2021.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 10/09/2020] [Accepted: 03/10/2021] [Indexed: 02/03/2023]
Abstract
Osteotomy of the distal fibula or anterolateral corner of the tibia is usually required to fix a displaced osteochondral fracture of the talus that is located central to posterior area of the lateral talar dome. However, osteotomy is an invasive procedure and is associated with complications, including nonunion, persistent pain, and hardware-related problems. Lateral inverted osteochondral fracture of the talus (LIFT) lesion is an extremely rare type of displaced osteochondral lesion of the talus. We describe a case in which a LIFT lesion was fixed using an innovative surgical approach, inverting capsulo-lateral fibulotalocalcaneal ligament (LFTCL)-fibular periosteum complex, with a favorable short-term clinical outcome.
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Affiliation(s)
- Takuji Yokoe
- Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki 889-1692, Japan.
| | - Takuya Tajima
- Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki 889-1692, Japan
| | - Nami Yamaguchi
- Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki 889-1692, Japan
| | - Tomomi Ota
- Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki 889-1692, Japan
| | - Makoto Nagasawa
- Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki 889-1692, Japan
| | - Yudai Morita
- Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki 889-1692, Japan
| | - Etsuo Chosa
- Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki 889-1692, Japan
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Lerch M, Yao D, Ettinger S, Claassen L, Plaass C, Stukenborg-Colsman C. The Ankle Spacer-a hemiarthroplasty for treatment of severe osteochondral defects of the talus. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2021; 34:79-88. [PMID: 34432092 DOI: 10.1007/s00064-021-00719-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 09/30/2020] [Accepted: 01/07/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The Ankle Spacer system has been developed as a joint-preserving option for patients with failed treatment of large talar osteochondral defects (OCDs). It is a one-piece implant system that replaces the articulating upper talus surface of the tibiotalar joint. INDICATIONS Large OCDs with failed prior surgical intervention(s) and/or multiple talar OCDs on the talar surface, posttraumatic or degenerative osteoarthritis, or avascular necrosis of the talus. CONTRAINDICATIONS Severe malalignment exceeding 7° and other ankle deformities that would not allow proper rasping of the talus, obesity, blood supply limitations, severe osteopenia, and previous or active infections. SURGICAL TECHNIQUE The surgery is carried out via a central approach to the ankle joint. The tibiotalar joint was distracted to remove the cartilage on the upper talar surface with special talus rasps and to perform microfracture of the entire talar surface. The appropriate Ankle Spacer trial was then inserted into the joint and fluoroscopy was used to check for proper trial size and positioning. After thorough cleaning of the prepared bone bed, the Ankle Spacer was inserted with a special seating instrument. POSTOPERATIVE MANAGEMENT One surgeon in our center implanted ten Ankle Spacers between April 2018 and October 2019. The first short-term data with follow-up of 3 months were collated. RESULTS No implant-related complications were recorded. American Orthopaedic Foot and Ankle Society (AOFAS) score increased from 55.5 to 79.5 points, European Foot and Ankle Society (EFAS) score increased from 5.6 to 13.5 points, and pain score decreased from 3 to 1.1 points. None of the patients' radiographs showed signs of loosening or osteoarthritis progression.
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Affiliation(s)
- Matthias Lerch
- Department for Orthopedic Surgery, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625, Hannover, Germany. .,Department for Trauma and Orthopedic Surgery, Hospital Wittmund, Dohuser Weg 10, 26409, Wittmund, Germany.
| | - Daiwei Yao
- Department for Orthopedic Surgery, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625, Hannover, Germany
| | - Sarah Ettinger
- Department for Orthopedic Surgery, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625, Hannover, Germany
| | - Leif Claassen
- Department for Orthopedic Surgery, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625, Hannover, Germany
| | - Christian Plaass
- Department for Orthopedic Surgery, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625, Hannover, Germany
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15
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Tan H, Li A, Qiu X, Cui Y, Tang W, Wang G, Ding W, Xu Y. Operative treatments for osteochondral lesions of the talus in adults: A systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e26330. [PMID: 34160396 PMCID: PMC8238309 DOI: 10.1097/md.0000000000026330] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 05/27/2021] [Indexed: 01/04/2023] Open
Abstract
PURPOSE This systematic review aimed to identify the available evidence regarding the comparative effectiveness and safety of various operative treatments in adult patients with osteochondral lesions of the talus (OLT). MATERIALS AND METHODS The PubMed, Embase, ISI Web of Knowledge, and the Cochrane Controlled Trial Register of Controlled Trials were searched from their inception date to September 2019. Two reviewers selected the randomized controlled trials (RCTs) and non-RCTs assessing the comparative effectiveness and safety of various operative treatments for OLT. The meta-analysis was performed using Revman 5.3. RESULTS Eight studies (1 RCT and 7 non-RCTs) with 375 patients were included in this review. The difference in the American Orthopaedic Foot and Ankle Society (AOFAS) score between the cartilage repair and replacement was not significant. The cartilage regeneration with or without cartilage repair had significant superiority in improving the AOFAS score compared with the cartilage repair. The difference in the magnetic resonance observation of cartilage repair tissue score between the cartilage repair and replacement and between cartilage repair and cartilage repair plus regeneration was significant. CONCLUSIONS Cartilage regeneration and cartilage repair plus regeneration had significant superiority in improving the ankle function and radiological evaluation of OLT, although the trials included did not have high-level evidence. Moreover, which treatment between the 2 was safer could not be addressed in this review as most of the trials did not report the safety outcome. Further studies are needed to define the best surgical option for treating OLT.
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Affiliation(s)
- Hongbo Tan
- Department of Orthopedic, the 920th Hospital of Joint Logistics Support Force
| | - Anxu Li
- Department of Orthopedic, the 920th Hospital of Joint Logistics Support Force
| | - Xiong Qiu
- Department of Orthopedic, the 920th Hospital of Joint Logistics Support Force
| | - Yi Cui
- Department of Orthopedic, the 920th Hospital of Joint Logistics Support Force
| | - Wenbao Tang
- Department of Orthopedic, the 920th Hospital of Joint Logistics Support Force
| | - Gang Wang
- Department of Orthopedic, the 920th Hospital of Joint Logistics Support Force
| | - Wei Ding
- College of Medicine, Yunnan University of Business Management, Kunming, China
| | - Yongqing Xu
- Department of Orthopedic, the 920th Hospital of Joint Logistics Support Force
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16
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Penner M, Younger A, Wing K, Cresswell M, Veljkovic A. Arthroscopic Repair of Talar Osteochondral Defects With Umbilical Cord Allograft: A Prospective, Single-Center, Pilot Study. Foot Ankle Spec 2021; 14:193-200. [PMID: 32172597 DOI: 10.1177/1938640020910953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cryopreserved umbilical cord (UC) allografts have been shown to promote postoperative wound healing by suppressing inflammation and reducing scar formation. The purpose of this study was to determine whether adjunctive use of UC may improve clinical and functional outcomes following arthroscopic repair of talar osteochondral defects (OCDs). A total of 10 patients with talar OCDs that failed nonoperative treatment were enrolled in this single-center, prospective, pilot study. Clinical and functional outcomes were assessed using the Ankle Osteoarthritis Scale (AOS), Foot and Ankle Ability Measure, and Visual Analog Scale (VAS) pain scale at 6, 12, 24, and 52 weeks postoperatively. Results showed a consistent improvement in all outcome measures. VAS pain scores significantly improved from 4.2 ± 2.9 to 1.3 ± 2.2 at 52 weeks (P = .015). AOS difficulty and pain scores nonsignificantly improved from 27.0 ± 24.6 and 33.1 ± 28.3 at baseline to 15.3 ± 20.5 and 14.8 ± 18.7 at 52 weeks, respectively. The clinical outcome improvement was accompanied by significant reduction in OCD defect size and associated bone marrow lesion. This pilot study suggests that adjunctive use of UC during arthroscopic repair of talar OCD may lead to clinical and functional improvement.Levels of Evidence: Level II: Prospective Cohort Study.
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Affiliation(s)
- Murray Penner
- Department of Orthopaedics (MP, AY, KW, AV).,Department of Radiology (MC), University of British Columbia, Vancouver, BC, Canada
| | - Alastair Younger
- Department of Orthopaedics (MP, AY, KW, AV).,Department of Radiology (MC), University of British Columbia, Vancouver, BC, Canada
| | - Kevin Wing
- Department of Orthopaedics (MP, AY, KW, AV).,Department of Radiology (MC), University of British Columbia, Vancouver, BC, Canada
| | - Mark Cresswell
- Department of Orthopaedics (MP, AY, KW, AV).,Department of Radiology (MC), University of British Columbia, Vancouver, BC, Canada
| | - Andrea Veljkovic
- Department of Orthopaedics (MP, AY, KW, AV).,Department of Radiology (MC), University of British Columbia, Vancouver, BC, Canada
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Guelfi M, DiGiovanni CW, Calder J, Malagelada F, Cordier G, Takao M, Batista J, Nery C, Delmi M, Dalmau-Pastor M, Carcuro G, Khazen G, Vega J. Large variation in management of talar osteochondral lesions among foot and ankle surgeons: results from an international survey. Knee Surg Sports Traumatol Arthrosc 2021; 29:1593-1603. [PMID: 33221934 DOI: 10.1007/s00167-020-06370-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 11/05/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Surgeons management of osteochondral lesions of the talus (OLT) may be different to the published guidelines because not all treatment recommendations are feasible in every country. This study aimed to assess how OLT are managed worldwide by foot and ankle surgeons. METHODS A web-based survey was distributed to the members of 21 local and international scientific societies focused on foot and ankle or sports medicine surgery. Answers with a prevalence greater than 75% of respondents were considered a "main tendency", whereas where prevalence exceeded 50% of respondents they were considered a "tendency". RESULTS A total of 1804 surgeons from 79 different countries returned the survey. The responses to 19 of 28 questions (68%) regarding management and treatment of OLT achieved a main tendency (> 75%) or a tendency (> 50%). Symptoms reported to be most suspicious for OLT were pain on weight-bearing (WB) and after activity (83%), deep localization of the pain (62%), and any history of trauma (55%). 89% of surgeons routinely obtain an MRI, 72% routinely get WB radiographs, and 50% perform a CT scan. When treated surgically, OLTs are managed in isolation by only 7% of surgeons, and combined with ligament repair or reconstruction by 79%; 67% report simultaneous excision of soft-tissue or bony impingements (64%). For lesions less than 10-15 mm in diameter, bone marrow stimulation (BMS) represents the first choice of treatment for 78% of surgeons (main tendency). No other treatment was recorded as a tendency. For lesions greater than 15 mm in diameter no tendencies were recorded. The BMS represented the most preferred treatment being the first choice of treatment for 41% of surgeons. OLT depth had little influence on treatment choice: 71% of surgeons treating small lesions and 69% treating large lesions would choose the same treatment regardless of whether the lesion had a depth lesser or greater than 5 mm. CONCLUSION The management of OLT by foot and ankle surgeons from around the world remains extremely varied. The main clinical relevance of this study is that it provides updated information with regard to the management of OLT internationally, which could be used by surgeons worldwide in their decision-making and to inform the patient about available surgical options. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Matteo Guelfi
- Foot and Ankle Unit, Casa di Cura Villa Montallegro, Genoa, Italy. .,Department of Orthopaedic Surgery "Gruppo Policlinico di Monza", Clinica Salus, Alessandria, Italy. .,Human Anatomy and Embryology Unit, Department of Morphological Sciences, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Christopher W DiGiovanni
- Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - James Calder
- Fortius Clinic and Department of Bioengineering, Imperial College, London, UK
| | - Francesc Malagelada
- Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London, UK
| | | | - Masato Takao
- Clinical and Research Institute for Foot and Ankle Surgery, Jujo Hospital, Chiba, Japan
| | - Jorge Batista
- Sports Medicine Department Club Atletico Boca Juniors, Buenos Aires and Arthroscopic Center Jorge Batista SA, Buenos Aires, Argentina
| | - Caio Nery
- Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Marino Delmi
- Clinique Des Grangettes, Chêne-Bougeries, Geneva, Switzerland
| | - Miki Dalmau-Pastor
- Human Anatomy and Embryology Unit, Department of Pathology and Experimental Therapeutics, University of Barcelona, Barcelona, Spain
| | | | - Gabriel Khazen
- Foot and Ankle Department, Hospital de Clínicas Caracas, Caracas, Venezuela
| | - Jordi Vega
- Human Anatomy and Embryology Unit, Department of Pathology and Experimental Therapeutics, University of Barcelona, Barcelona, Spain.,Foot and Ankle Unit, Hospital Quirón, Barcelona, Spain.,Foot and Ankle Unit, Orthopedic Department, iMove Tres Torres, Barcelona, Spain
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Abstract
INTRODUCTION Ankle arthroscopy has come a long way since it was thought, it is not feasible because of tight joint and anatomical characteristics of ankle joint. The same anatomical features like capsular attachment and safe accessory portals are used to access the whole joint even with a rigid arthroscope. Ankle distraction method was routinely used to access the anterior ankle. However, nowadays, anterior arthroscopy is done in dorsiflexion as this increases the anterior ankle joint volume, and thereby easy access to various anatomical structures. On the other hand, intermittent traction is used to access the posterior ankle. Initially used as a diagnostic tool, ankle arthroscopy is now used extensively as a therapeutic and reconstruction tool. New evidence is published for all inside ligament reconstructions, effective management of impingement syndromes, and osteochondral lesions. The indications are being extended to fracture management and arthrodesis. METHODOLOGY This narrative review was performed following a literature search in the Pubmed database and Medline using the following keywords: ankle arthroscopy, portals, ankle OCD, functional outcome. Related articles were then reviewed. CONCLUSION Complications rate is reduced with a better understanding of the relative anatomy of surrounding neurovascular structures and tendons with regard to the position of ankle joint. This review on ankle arthroscopy focuses on anatomy, indications, and complications. Ankle arthroscopy is a safe and elegant tool as any other joint arthroscopy.
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Chopra V, Chang D, Ng A, Kruse DL, Stone PA. Arthroscopic Treatment of Osteochondral Lesions of the Talus Utilizing Juvenile Particulated Cartilage Allograft: A Case Series. J Foot Ankle Surg 2021; 59:436-439. [PMID: 32131018 DOI: 10.1053/j.jfas.2019.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 05/08/2019] [Accepted: 09/02/2019] [Indexed: 02/03/2023]
Abstract
The treatment options for osteochondral lesions of the ankle are scarce, and newer modalities are becoming available. We describe a minimally invasive arthroscopic approach with implantation of juvenile particulated allograft to facilitate the growth of true hyaline cartilage in patients with osteochondral lesions of the talus. The purpose of this study was to subjectively review clinical outcomes using the validated Foot and Ankle Outcomes Score in patients who underwent this technique. Our technique was performed on 82 consecutive patients with average follow-up of 24 (range 9 to 86) months. We found that 28 (88%) of 32 patients who responded to the questionnaire had good or excellent results for activities of daily living; 26 (82%) of 32 patients had at least a good result for both pain and symptoms; and 25 (78%) of 32 had at least a fair result for functional sports and quality of life.
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Affiliation(s)
- Varun Chopra
- Third Year Resident, Highlands-Presbyterian/St. Luke's Podiatric Medicine and Surgery Residency Program, Denver, CO
| | - Dwayne Chang
- Attending Surgeon, Highlands-Presbyterian/St. Luke's Podiatric Medicine and Surgery Residency Program, Denver, CO
| | - Alan Ng
- Attending Surgeon, Highlands-Presbyterian/St. Luke's Podiatric Medicine and Surgery Residency Program, Denver, CO
| | - Dustin L Kruse
- Director of Research, Highlands-Presbyterian/St. Luke's Podiatric Medicine and Surgery Residency Program, Denver, CO
| | - Paul A Stone
- Program Director, Highlands-Presbyterian/St. Luke's Podiatric Medicine and Surgery Residency Program, Denver, CO.
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20
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Zhou H, Zhang C, Lin C, Jin G, Chen L, Chen C. Diffuse-Type Giant Cell Tumor of the Paratenon of Achilles Tendon Requiring Reconstruction Using Bilateral Autografts: A Case Report. J Foot Ankle Surg 2021; 59:388-393. [PMID: 32131008 DOI: 10.1053/j.jfas.2019.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 08/08/2019] [Accepted: 08/11/2019] [Indexed: 02/03/2023]
Abstract
Although a diffuse-type giant cell tumor is a rare benign lesion, when it develops it tends to localize to the tendons of the hand and foot. In this study, we report the case of a 41-year-old male patient who was diagnosed with diffuse-type paratenon giant cell tumor involving the Achilles tendon. The duration of the bilateral tumors was 8 years. He visited first affiliated Hospital of Wenzhou Medical University for medical attention. Both his Achilles tendons required removal. The reconstructed Achilles tendon was replaced using tissue derived from the knee and foot. Postoperatively, the patient recovered well and regained full range of motion in the ankle. The use of autografts may shorten patients' recovery period.
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Affiliation(s)
- Haibo Zhou
- Surgeon, Department of Orthopedic Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Chao Zhang
- Surgeon, Department of Orthopedic Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Chuicong Lin
- Surgeon, Department of Orthopedic Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Guangjian Jin
- Surgeon, Department of Orthopedic Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Lei Chen
- Surgeon, Department of Orthopedic Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Chun Chen
- Surgeon, Department of Orthopedic Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China; Surgeon, Engineering Research Center of Clinical Functional Materials and Diagnosis and Treatment Devices of Zhejiang Province, Wenzhou Institute of Biomaterials and Engineering, Wenzhou, China.
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21
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Lambers KTA, Dahmen J, Altink JN, Reilingh ML, van Bergen CJA, Kerkhoffs GMMJ. Bone marrow stimulation for talar osteochondral lesions at long-term follow-up shows a high sports participation though a decrease in clinical outcomes over time. Knee Surg Sports Traumatol Arthrosc 2021; 29:1562-1569. [PMID: 32918555 PMCID: PMC8038982 DOI: 10.1007/s00167-020-06250-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 08/21/2020] [Indexed: 01/13/2023]
Abstract
PURPOSE Although bone marrow stimulation (BMS) as a treatment for osteochondral lesions of the talus (OCLT) shows high rates of sport resumption at short-term follow-up, it is unclear whether the sports activity is still possible at longer follow-up. The purpose of this study was, therefore, to evaluate sports activity after arthroscopic BMS at long-term follow-up. METHODS Sixty patients included in a previously published randomized-controlled trial were analyzed in the present study. All patients had undergone arthroscopic debridement and BMS for OCLT. Return to sports, level, and type were assessed in the first year post-operative and at final follow-up. Secondary outcome measures were assessed by standardized questionnaires with use of numeric rating scales for pain and satisfaction and the Foot and Ankle Outcome Score (FAOS). RESULTS The mean follow-up was 6.4 years (SD ± 1.1 years). The mean level of activity measured with the AAS was 6.2 pre-injury and 3.4 post-injury. It increased to 5.2 at 1 year after surgery and was 5.8 at final follow-up. At final follow-up, 54 patients (90%) participated in 16 different sports. Thirty-three patients (53%) indicated they returned to play sport at their pre-injury level. Twenty patients (33%) were not able to obtain their pre-injury level of sport because of ankle problems and eight other patients (13%) because of other reasons. Mean NRS for pain during rest was 2.7 pre-operative, 1.1 at 1 year, and 1.0 at final follow-up. Mean NRS during activity changed from 7.9 to 3.7 to 4.4, respectively. The FAOS scores improved at 1 year follow-up, but all subscores significantly decreased at final follow-up. CONCLUSION At long-term follow-up (mean 6.4 years) after BMS for OCLT, 90% of patients still participate in sports activities, of whom 53% at pre-injury level. The AAS of the patients participating in sports remains similar pre-injury and post-operatively at final follow-up. A decrease over time in clinical outcomes was, however, seen when the follow-up scores at 1 year post-operatively were compared with the final follow-up. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Kaj T A Lambers
- Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands
- Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands
| | - Jari Dahmen
- Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands
- Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands
| | - J Nienke Altink
- Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands
- Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands
| | - Mikel L Reilingh
- Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands
- Department of Orthopedic Surgery, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Christiaan J A van Bergen
- Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands
- Department of Orthopedic Surgery, Amphia Hospital, Breda, The Netherlands
| | - Gino M M J Kerkhoffs
- Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands.
- Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherlands.
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands.
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22
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Maiorano E, Bianchi A, Hosseinzadeh MK, Malerba F, Martinelli N, Sansone V. HemiCAP® implantation after failed previous surgery for osteochondral lesions of the talus. Foot Ankle Surg 2021; 27:77-81. [PMID: 32111515 DOI: 10.1016/j.fas.2020.02.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 02/16/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND The aim of this study is to enhance data about the effectiveness of HemiCAP® implantation after failed previous surgery for osteochondral defects (OCDs). METHODS 12 consecutive patients were retrospectively included in this study. The American Orthopedic Foot and Ankle Society Score (AOFAS), the Visual Analogue Scale (VAS) score for pain, the sub-scales Pain and Disability of the Foot Function Index (FFI-P and FFI-D) Score, and the patients' satisfaction were evaluated. RESULTS AOFAS increased from poor to fair (p < 0.001), VAS score decreased from moderate to mild pain (p = 0.001), the final FFI-P and FFI-D were 37.50 ± 18.54 and 33.44 ± 16.24, respectively (p < 0.001). Five patients were not satisfied, three were moderately satisfied and four were highly satisfied. One implant repositioning, one ankle fusion (implant failing) and an additional surgery (double arthrodesis) were performed during the follow-up. Neither intra- nor postoperative complications were registered. CONCLUSION Despite the clinical improvement, pain was still present at the final follow-up. Metal resurfacing might not be considered a definitely valid alternative for treatment of OCDs after failed previous surgery. LEVEL OF EVIDENCE Level III, retrospective study.
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Affiliation(s)
- Emanuele Maiorano
- I.R.C.C.S. Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi, 4, 20161 Milan, Italy
| | - Alberto Bianchi
- I.R.C.C.S. Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi, 4, 20161 Milan, Italy
| | | | - Francesco Malerba
- I.R.C.C.S. Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi, 4, 20161 Milan, Italy
| | - Nicolò Martinelli
- I.R.C.C.S. Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi, 4, 20161 Milan, Italy.
| | - Valerio Sansone
- I.R.C.C.S. Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi, 4, 20161 Milan, Italy; Department of Orthopaedics, Università degli Studi di Milano, Via Festa del Perdono, 7, 20122 Milan, Italy
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23
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Particulate Juvenile Articular Cartilage Transfer for Talar Osteochondral Lesions. TECHNIQUES IN FOOT AND ANKLE SURGERY 2020. [DOI: 10.1097/btf.0000000000000297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Jimeno Torres E, Ibañez M, Campillo Recio D, Alberti Fito G, Mendez Gil A, Jimeno Torres JM. Retrograde Drilling With Tibial Autograft in Osteochondral Lesions of the Talar Dome. Arthrosc Tech 2020; 9:e1155-e1161. [PMID: 32874896 PMCID: PMC7451435 DOI: 10.1016/j.eats.2020.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 04/25/2020] [Indexed: 02/03/2023] Open
Abstract
Osteochondral lesions that compromise the ankle are rare, with an incidence between 0.02% and 1.5% according to different series. This location is the third in frequency, after knee and elbow. The location of the osteochondral lesion allows one to infer the producing mechanism. Lateral defects are produced by inversion and dorsiflexion of the ankle (usually anterior, affecting 3 and 6 talar zones), whereas medial defects are produced by plantar flexion, inversion, and internal rotation (most commonly posterior, affecting 4 and 7 talar zones). The injury causes pain associated with weight load, impaired function, limited range of motion, stiffness, blockage, and edema. Early diagnosis of an osteochondral lesion is particularly important because the lack of diagnosis can lead to the evolution of a small and stable lesion in a larger lesion or an unstable fragment, which can result in chronic pain, instability of the joint, and premature osteoarthritis. Multiple therapeutic strategies have been described, including conservative and surgical treatment. The purpose of this Technical Note is to describe arthroscopic-assisted retrograde drilling with tibial autograft procedure for osteochondral lesions of the talar dome.
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Affiliation(s)
| | - Maximiliano Ibañez
- Address correspondence to Maximiliano Ibañez, M.D., Department of Orthopedic Surgery and Traumatology, ICATME, Hospital Universitari Dexeus, Carrer de Sabino Arana, 5-19, 08028, Barcelona, Spain.
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25
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Weigelt L, Laux CJ, Urbanschitz L, Espinosa N, Klammer G, Götschi T, Wirth SH. Long-term Prognosis After Successful Nonoperative Treatment of Osteochondral Lesions of the Talus: An Observational 14-Year Follow-up Study. Orthop J Sports Med 2020; 8:2325967120924183. [PMID: 32537476 PMCID: PMC7268150 DOI: 10.1177/2325967120924183] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 02/14/2020] [Indexed: 11/17/2022] Open
Abstract
Background: Little is known about the long-term prognosis of osteochondral lesions of the talus (OLTs) after nonoperative treatment. Purpose: To evaluate the clinical and radiological long-term results of initially successfully treated OLTs after a minimum follow-up of 10 years. Study Design: Case series; Level of evidence, 4. Methods: Between 1998 and 2006, 48 patients (50 ankles) with OLTs were successfully treated nonoperatively. These patients were enrolled in a retrospective long-term follow-up, for which 24 patients could not be reached or were available only by telephone. A further 2 OLTs (6%) that had been treated surgically were excluded from the analysis and documented as failures of nonoperative treatment. The final study group of 22 patients (mean age at injury, 42 years; range, 10-69 years) with 24 OLTs (mean size, 1.4 cm2; range, 0.2-3.8 cm2) underwent clinical and radiological evaluation after a mean follow-up of 14 years (range, 11-20 years). Ankle pain was evaluated with a visual analog scale (VAS), ankle function with the American Orthopaedic Foot and Ankle Society (AOFAS) score, and sports activity with the Tegner score. Progression of ankle osteoarthritis was analyzed based on plain ankle radiographs at the initial presentation and the final follow-up according to the Van Dijk classification. Results: At final follow-up, the 24 cases (ie, ankles) showed a median VAS score of 0 (IQR, 0.0-2.25) and a median AOFAS score of 94.0 (IQR, 85.0-100). Pain had improved in 18 cases (75%), was unchanged in 3 cases (13%), and had increased in 3 cases (13%). The median Tegner score was 4.0 (IQR, 3.0-5.0). Persistent ankle pain had led to a decrease in sports activity in 38% of cases. At the final follow-up, 11 cases (73%) showed no progression of ankle osteoarthritis and 4 cases (27%) showed progression by 1 grade. Conclusion: Osteochondral lesions of the talus that successfully undergo an initial nonoperative treatment period have minimal symptoms in the long term, a low failure rate, and no relevant ankle osteoarthritis progression. However, a decrease in sports activity due to sports-related ankle pain was observed in more than one-third of patients.
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Affiliation(s)
- Lizzy Weigelt
- Department of Orthopedics, University Hospital Balgrist, University of Zurich, Zurich, Switzerland
| | - Christoph J Laux
- Department of Orthopedics, University Hospital Balgrist, University of Zurich, Zurich, Switzerland
| | - Lukas Urbanschitz
- Department of Orthopedics, University Hospital Balgrist, University of Zurich, Zurich, Switzerland
| | - Norman Espinosa
- Institute for Foot and Ankle Reconstruction, Zurich, Switzerland
| | - Georg Klammer
- Institute for Foot and Ankle Reconstruction, Zurich, Switzerland
| | - Tobias Götschi
- Department of Orthopedics, University Hospital Balgrist, University of Zurich, Zurich, Switzerland
| | - Stephan H Wirth
- Department of Orthopedics, University Hospital Balgrist, University of Zurich, Zurich, Switzerland
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Nakasa T, Ikuta Y, Ota Y, Kanemitsu M, Sumii J, Nekomoto A, Adachi N. Relationship of T2 Value of High-signal Line on MRI to the Fragment in Osteochondral Lesion of the Talus. Foot Ankle Int 2020; 41:698-704. [PMID: 32148074 DOI: 10.1177/1071100720910381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) is useful for evaluating the stability of an osteochondral lesion of the talus (OLT). A T2 high-signal line between the fragment and its bed on MRI is known as a reliable indicator of an unstable lesion. However, the lesion exhibits various conditions even if a T2 high-signal line is observed. The purpose of this study was to evaluate the relationship between the T2 value of a high-signal line and the condition of the area between the fragment and its bed in OLT. METHODS T2 values of the T2 high-signal line and those of joint fluid were measured from preoperative MRI images in 46 ankles with OLT and the T2 ratio (high-signal line / joint fluid) was calculated. The relationship between the T2 ratio and CT, arthroscopic, and histologic findings was examined. RESULTS The mean T2 ratio was 0.48. T2 ratios of cystic lesions (0.62) or bone absorption (0.67) in the bed were significantly higher than those without a cyst (0.40) or no absorption (0.40). The T2 ratio of an unstable lesion (0.51) was significantly lower than that of a stable lesion (0.29). In histologic findings, there were 2 separate patterns: chondral and subchondral bone separations. The T2 ratio of the chondral separation (0.60) was significantly higher than that of bone separation (0.48). CONCLUSION This study showed that the T2 ratio on a high-signal line was a predictor of stability, cyst, and bone absorption in OLT. LEVEL OF EVIDENCE Level III, comparative series.
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Affiliation(s)
- Tomoyuki Nakasa
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
- Medical Center for Translational and Clinical Research, Hiroshima University Hospital, Hiroshima Japan
| | - Yasunari Ikuta
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yuki Ota
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Munekazu Kanemitsu
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Junichi Sumii
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Akinori Nekomoto
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Wixted CM, Dekker TJ, Adams SB. Particulated juvenile articular cartilage allograft transplantation for osteochondral lesions of the knee and ankle. Expert Rev Med Devices 2020; 17:235-244. [PMID: 32090633 DOI: 10.1080/17434440.2020.1733973] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Introduction: Osteochondral lesions have been challenging to treat due to the limited regenerative capacity of native hyaline cartilage. Although surgical options are available, a newer technique, Particulated Juvenile Cartilage Allograft Transplantation (PJCAT) has shown promise for lesions of the knee and ankle. Short-term studies have been encouraging of its use, but there is still limited evidence of its long-term durability.Areas covered: This review will summarize the surgical options currently available for osteochondral lesions, outline the indications and contraindications of PJCAT, present the basic science and clinical evidence of the procedure, and describe the surgical approaches of this technique.Expert opinion: PJCAT is a promising method to treat osteochondral lesions. However, continued research is needed to document the efficacy of this technique and potential superiority over other techniques. Benefits include ease of application, potential for arthroscopic or minimally invasive delivery, no need for perpendicular access, no donor site morbidity, and delivery of viable chondrocytes in hyaline cartilage.
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Affiliation(s)
- Colleen M Wixted
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
| | - Travis J Dekker
- Department of Orthopedics, Eglin Air Force Base, Eglin AFB, FL, USA
| | - Samuel B Adams
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
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28
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Wu X, Zhou H, Yang Y. [Research progress in surgical procedures for osteochondral lesions of talus]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:1320-1325. [PMID: 31544446 DOI: 10.7507/1002-1892.201811033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To summarize the research progress of surgical procedures in osteochondral lesions of the talus (OLT). Methods By consulting the related literature of OLT in recent years, the advantages and disadvantages of various surgical treatment schemes were analyzed and summarized. Results There are many surgical treatments for OLT, including bone marrow stimulation, osteochondral transplantation, autologous chondrocyte transplantation, and biologically assisted therapy. Various schemes have different indications and limitations. With the continuous development of various technologies, the effectiveness of OLT treatment will gradually improve. Conclusion There are still many difficulties and controversies in the treatment of OLT, and there is no unified treatment plan. It is suggested that individualized operation plan should be formulated according to the specific conditions of patients.
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Affiliation(s)
- Xinbo Wu
- Department of Orthopedics, Tongji Hospital of Tongji University, Shanghai, 200065, P.R.China
| | - Haichao Zhou
- Department of Orthopedics, Tongji Hospital of Tongji University, Shanghai, 200065, P.R.China
| | - Yunfeng Yang
- Department of Orthopedics, Tongji Hospital of Tongji University, Shanghai, 200065,
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29
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Deal JB, Patzkowski JC, Groth AT, Ryan PM, Dowd TC, Osborn PM, Anderson CD, Ficke JR, Kirk KL. Early vs Delayed Weightbearing After Microfracture of Osteochondral Lesions of the Talus: A Prospective Randomized Trial. FOOT & ANKLE ORTHOPAEDICS 2019; 4:2473011419838832. [PMID: 35097322 PMCID: PMC8696723 DOI: 10.1177/2473011419838832] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background: Osteochondral lesions of the talus (OLTs) are common injuries in young, active patients. Microfracture is an effective treatment for lesions less than 150 mm2 in size. Most commonly employed postoperative protocols involve delaying weightbearing for 6 to 8 weeks (DWB), though one study suggests that early weightbearing (EWB) may not be detrimental to patient outcomes. The goal of this research is to compare outcomes following EWB and DWB protocols after microfracture for OLTs. Methods: We performed a prospective, randomized, multicenter clinical trial of subjects with unilateral, primary, unifocal OLTs treated with microfracture. Thirty-eight subjects were randomized into EWB (18 subjects) and DWB (20 subjects) at their first postsurgical visit. The EWB group began unrestricted WB at that time, whereas the DWB group were instructed to remain strictly nonweightbearing for an additional 4 weeks. Primary outcome measures were the American Academy of Orthopaedic Surgery (AAOS) Foot and Ankle score and numeric rating scale (NRS) pain score. Results: The EWB group demonstrated significant improvement in AAOS Foot and Ankle Questionnaire scores at the 6-week follow-up appointment as compared to the DWB group (83.1 ± 13.5 vs 68.7 ± 15.8, P = .017). Following this point, there were no significant differences in AAOS scores between groups. At no point were NRS pain scores significantly different between the groups. Conclusions: EWB after microfracture for OLTs was associated with improved AAOS scores in the short term. Thereafter and through 2 years’ follow-up, no statistically significant differences were seen between EWB and DWB groups. Level of Evidence: Level II, prospective randomized trial.
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Affiliation(s)
- J. Banks Deal
- U.S. Army Medical Corps, Tripler Army Medical Center, Honolulu, HI, USA
| | | | | | - Paul M. Ryan
- U.S. Army Medical Corps, Tripler Army Medical Center, Honolulu, HI, USA
| | - Thomas C. Dowd
- U.S. Army Medical Corps, San Antonio Military Medical Center, TX, USA
| | - Patrick M. Osborn
- U.S. Air Force Medical Corps, San Antonio Military Medical Center, TX, USA
| | | | - James R. Ficke
- Department of Orthopaedic Surgery, Johns Hopkins, Baltimore, MD, USA
| | - Kevin L. Kirk
- The San Antonio Orthopaedic Group, San Antonio, TX, USA
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Nakasa T, Ikuta Y, Tsuyuguchi Y, Ota Y, Kanemitsu M, Adachi N. MRI Tracking of the Effect of Bioabsorbable Pins on Bone Marrow Edema After Fixation of the Osteochondral Fragment in the Talus. Foot Ankle Int 2019; 40:323-329. [PMID: 30379095 DOI: 10.1177/1071100718809351] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND: Large osteochondral lesions of the talus (OLT) with good articular cartilage can be fixed by using bioabsorbable pins. These pins have various advantages but they can have adverse effects such as foreign body inflammation. This negative impact of pins on subchondral bone can be seen as bone marrow edema (BME) on magnetic resonance imaging (MRI). The purpose of this study was to investigate the course of change in BME on MRI, including osteolytic change around pins in OLT treated with pin fixation. METHODS: This study comprised 13 ankles in 12 patients, who underwent surgeries to fix an OLT using poly-l-lactide acid pins. MRIs were taken at preoperative, 3, 6, and 12 months after surgery. The area of BME was measured at each time point, and osteolytic change around pins was evaluated. Moreover, pin insertion angle was measured. RESULTS: BME significantly decreased from preoperative to 6 and 12 months. At 1 year, 28.1% of pins exhibited osteolytic change around them. Pin insertion angle was significantly lower in those with osteolytic change than those with no osteolytic change. At 3 and 6 months and 1 year postoperatively, BME with osteolytic change was significantly greater than those patients with no osteolytic change. The American Orthopaedic Foot & Ankle Society score significantly improved from preoperative (76.6±3.4 points) to 1 year after surgery (98.5±3.8 points). CONCLUSION: A shallow pin insertion angle was associated with osteolytic change around pins and persistence of BME on MRI, although excellent results were obtained at 1 year after surgery. LEVEL OF EVIDENCE: Level III, retrospective comparative series.
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Affiliation(s)
- Tomoyuki Nakasa
- 1 Department of Orthopaedic Surgery, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima City, Japan
| | - Yasunari Ikuta
- 1 Department of Orthopaedic Surgery, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima City, Japan
| | - Yusuke Tsuyuguchi
- 1 Department of Orthopaedic Surgery, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima City, Japan
| | - Yuki Ota
- 1 Department of Orthopaedic Surgery, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima City, Japan
| | - Munekazu Kanemitsu
- 1 Department of Orthopaedic Surgery, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima City, Japan
| | - Nobuo Adachi
- 1 Department of Orthopaedic Surgery, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima City, Japan
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Chan JJ, Guzman JZ, Vargas L, Myerson CL, Chan J, Vulcano E. Safety and Effectiveness of Talus Subchondroplasty and Bone Marrow Aspirate Concentrate for the Treatment of Osteochondral Defects of the Talus. Orthopedics 2018; 41:e734-e737. [PMID: 30052260 DOI: 10.3928/01477447-20180724-06] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 05/23/2018] [Indexed: 02/03/2023]
Abstract
Eleven patients with symptomatic talus osteochondral defects who underwent subchondroplasty with bone marrow aspirate concentrate injection were retrospectively reviewed. Foot and Ankle Outcome Score and visual analog scale pain score were recorded preoperatively and at the 1-year postoperative visit. The mean osteochondral defect size was 1.3×1.4 cm. The weight-bearing visual analog scale pain score improved from a mean of 7.8 to 1.8, and the Foot and Ankle Outcome Score improved from a mean of 67.1 to 89.6. At 1-year follow-up, 10 patients reported they would have the procedure again. Subchondroplasty and bone marrow aspirate concentrate injection offered good pain relief for talus osteochondral defects. The procedure allows immediate weight bearing postoperatively and does not compromise future treatments. [Orthopedics. 2018; 41(5):e734-e737.].
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32
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Nakasa T, Ikuta Y, Sawa M, Yoshikawa M, Tsuyuguchi Y, Ota Y, Kanemitsu M, Adachi N. Relationship Between Bone Marrow Lesions on MRI and Cartilage Degeneration in Osteochondral Lesions of the Talar Dome. Foot Ankle Int 2018; 39:908-915. [PMID: 29652193 DOI: 10.1177/1071100718766596] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND In the evaluation of osteochondral lesions of the talar dome (OLT), bone marrow lesions (BML) are commonly observed in the subchondral bone on magnetic resonance imaging (MRI). However, the significance of BML, such as the histology of the overlying cartilage, is still unclear. The purpose of this study was to investigate the relationship between the BML and cartilage degeneration in OLT. METHODS Thirty-three ankles with OLT were included in this study. All ankles underwent CT and MRI and had operative treatment. The ankles were divided into 2 groups, depending on the presence of bone sclerosis (ie, with or without) in the host bone just below the osteochondral fragment (nonsclerosis group and sclerosis group). The area of BML was compared between the 2 groups. Biopsies of the osteochondral fragment from 20 ankles were performed during surgery, and the correlation between the BML and cartilage degeneration was analyzed. The remaining 13 ankles had the CT and MRI compared with the arthroscopic findings. RESULTS The mean area of BML in the nonsclerosis group was significantly larger than that in the sclerosis group. In the histologic analysis, there was a significant and moderate correlation between the Mankin score and the area of BML. The mean Mankin score in the nonsclerosis group was significantly lower than that in the sclerosis group. CONCLUSIONS This study revealed that a large area of BML on MRI exhibited low degeneration of cartilage of the osteochondral fragment, while a small area of BML indicated sclerosis of the subchondral bone with severe degeneration of cartilage. The evaluation of BML may predict the cartilage condition of the osteochondral fragment. LEVEL OF EVIDENCE Level III, comparative series.
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Affiliation(s)
- Tomoyuki Nakasa
- 1 Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima City, Hiroshima, Japan
| | - Yasunari Ikuta
- 1 Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima City, Hiroshima, Japan
| | - Mikiya Sawa
- 1 Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima City, Hiroshima, Japan
| | - Masahiro Yoshikawa
- 1 Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima City, Hiroshima, Japan
| | - Yusuke Tsuyuguchi
- 1 Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima City, Hiroshima, Japan
| | - Yuki Ota
- 1 Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima City, Hiroshima, Japan
| | - Munekazu Kanemitsu
- 1 Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima City, Hiroshima, Japan
| | - Nobuo Adachi
- 1 Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima City, Hiroshima, Japan
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Dahmen J, Lambers KTA, Reilingh ML, van Bergen CJA, Stufkens SAS, Kerkhoffs GMMJ. No superior treatment for primary osteochondral defects of the talus. Knee Surg Sports Traumatol Arthrosc 2018; 26:2142-2157. [PMID: 28656457 PMCID: PMC6061466 DOI: 10.1007/s00167-017-4616-5] [Citation(s) in RCA: 103] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 06/19/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this systematic literature review is to detect the most effective treatment option for primary talar osteochondral defects in adults. METHODS A literature search was performed to identify studies published from January 1996 to February 2017 using PubMed (MEDLINE), EMBASE, CDSR, DARE, and CENTRAL. Two authors separately and independently screened the search results and conducted the quality assessment using the Newcastle-Ottawa Scale. Subsequently, success rates per separate study were calculated. Studies methodologically eligible for a simplified pooling method were combined. RESULTS Fifty-two studies with 1236 primary talar osteochondral defects were included of which forty-one studies were retrospective and eleven prospective. Two randomised controlled trials (RCTs) were identified. Heterogeneity concerning methodological nature was observed, and there was variety in reported success rates. A simplified pooling method performed for eleven retrospective case series including 317 ankles in the bone marrow stimulation group yielded a success rate of 82% [CI 78-86%]. For seven retrospective case series investigating an osteochondral autograft transfer system or an osteoperiosteal cylinder graft insertion with in total 78 included ankles the pooled success rate was calculated to be 77% [CI 66-85%]. CONCLUSIONS For primary talar osteochondral defects, none of the treatment options showed any superiority over others. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Jari Dahmen
- Department of Orthopedic Surgery, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ,Academic Center for Evidence based Sports medicine (ACES), Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Kaj T. A. Lambers
- Department of Orthopedic Surgery, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ,Academic Center for Evidence based Sports medicine (ACES), Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Mikel L. Reilingh
- Department of Orthopedic Surgery, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ,Academic Center for Evidence based Sports medicine (ACES), Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Christiaan J. A. van Bergen
- Department of Orthopedic Surgery, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ,Academic Center for Evidence based Sports medicine (ACES), Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ,Department of Orthopedic Surgery, Amphia Hospital, Breda, The Netherlands
| | - Sjoerd. A. S. Stufkens
- Department of Orthopedic Surgery, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ,Academic Center for Evidence based Sports medicine (ACES), Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Gino M. M. J. Kerkhoffs
- Department of Orthopedic Surgery, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ,Academic Center for Evidence based Sports medicine (ACES), Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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Di Cave E, Versari P, Sciarretta F, Luzon D, Marcellini L. Biphasic bioresorbable scaffold (TruFit Plug ®) for the treatment of osteochondral lesions of talus: 6- to 8-year follow-up. Foot (Edinb) 2017; 33:48-52. [PMID: 29126043 DOI: 10.1016/j.foot.2017.05.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Revised: 05/07/2017] [Accepted: 05/12/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND The ideal treatment of osteochondral lesions of the talus (OLT) is debatable. The TruFit plug has been investigated as a potential treatment method for osteochondral defects. This is a biphasic scaffold designed to stimulate cartilage and subchondral bone formation. The purpose of this retrospective study was to investigate the long-term functional and MRI outcomes of the TruFit Plug for the treatment of OLT. METHODS Twelve consecutive patients treated from March 2007 to April 2009 for OLT were evaluated. Clinical examination included the American Orthopaedic Foot and Ankle Society (AOFAS) ankle score and the visual analog scale (VAS) for pain. MRI scans were optained pre-treatment and at last follow-up. The Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score was used to assess cartilage incorporation. RESULTS Mean follow-up was 7.5 years (range, 6.5-8.7 years). The average age was of 38.6 years (range, 22-57 years). The sex ratio between males and females was 3:1 (9 males, 3 females). The mean AOFAS score improved from a preoperative score of 47.2±10.7 to 84.4±8 (p<0.05). According to the postoperative AOFAS scores 1 case obtained excellent results, 9 were classified as good, and 2 were fair. VAS score improved from a preoperative value of 6.9±1.4 points to 1.2±1.1 points at last follow-up (p<0.05). The MOCART score for cartilage repair tissue on postoperative MRI averaged 61.1 points (range, 25-85 points). CONCLUSIONS The long-term results suggest that the technique of Trufit Plug for OLT is safe and demonstrates good post-operative scores including improvement of pain and function, with discordant MRI results. However, randomized controlled clinical trials comparing TruFit Plug with an established treatment method are needed to improve synthetic biphasic implants as therapy for osteochondral lesions. LEVEL OF EVIDENCE Retrospective case series, Level IV.
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Affiliation(s)
- Elvira Di Cave
- Operative Unit of Orthopaedics and Traumatology, Israelite Hospital, Rome, Italy.
| | - Pierluigi Versari
- Operative Unit of Orthopaedics and Traumatology, Israelite Hospital, Rome, Italy
| | | | - David Luzon
- Operative Unit of Orthopaedics and Traumatology, Israelite Hospital, Rome, Italy
| | - Lorenzo Marcellini
- Operative Unit of Orthopaedics and Traumatology, Israelite Hospital, Rome, Italy
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Sadlik B, Kolodziej L, Blasiak A, Szymczak M, Warchal B. Biological reconstruction of large osteochondral lesions of the talar dome with a modified "sandwich" technique-Midterm results. Foot Ankle Surg 2017; 23:290-295. [PMID: 29202990 DOI: 10.1016/j.fas.2016.09.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Revised: 09/04/2016] [Accepted: 09/05/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND Surgical treatment for large osteochondral lesions of the talar dome (OLTD) must restore the convexity and curvature of the talus. Here, we present midterm results and describe the modified "sandwich" reconstruction procedure. Bone defects were restored using a biological inlay consists of autologous bone chips that were mixed with bone marrow concentrate and fibrin glue and covered with a xenogeneic collagen membrane infiltrated with bone marrow concentrate and stabilized by fibrin glue. METHODS Ten patients who were treated using a modified "sandwich" OLTD reconstruction were assessed after an average follow-up period of 46.4 (±18) months, using the clinical American Orthopaedic Foot and Ankle Society Ankle Hindfoot Scale (AOFAS) score and radiological magnetic resonance observation of cartilage repair tissue (MOCART) score. RESULTS The mean AOFAS score increased significantly from 58.3 (±8.5) points to 81.8 (±15.5) points as well the mean VAS score reduced significantly from 5.58 (±0.97) to 1.83 (±0.93) points. The average MOCART score was 69.5% (±16.7%) in the final follow-up. CONCLUSIONS The presented modified "sandwich" technique permanently recreates the convexity and curvature in large osteochondral lesions of the talar dome with a single step surgical procedure.
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Affiliation(s)
- Boguslaw Sadlik
- Biologic Joint Reconstruction Department, St Luke's Hospital, Bielsko-Biala, Poland.
| | - Lukasz Kolodziej
- Orthopaedic, Traumatology and Orthopaedic Oncology Clinic, Pomeranian Medical University, Unii Lubelskiej 1 Str., 71-252 Szczecin, Poland.
| | - Adrian Blasiak
- Biologic Joint Reconstruction Department, St Luke's Hospital, Bielsko-Biala, Poland.
| | - Mateusz Szymczak
- Orthopaedic Department, Nicolaus Copernicus Hospital, Torun, Poland.
| | - Bartłomiej Warchal
- Biologic Joint Reconstruction Department, St Luke's Hospital, Bielsko-Biala, Poland.
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Li X, Xu Y, Zhu Y, Xu X. Surgical treatment for diffused-type giant cell tumor (pigmented villonodular synovitis) about the ankle joint. BMC Musculoskelet Disord 2017; 18:450. [PMID: 29137617 PMCID: PMC5686795 DOI: 10.1186/s12891-017-1824-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 11/09/2017] [Indexed: 12/30/2022] Open
Abstract
Background Diffused-type giant cell tumor(Dt-GCT) is a rare, aggressive disorder of the joint synovium, bursa and tendon sheaths. Osseous erosions and subchondral cysts may develop as the result of synovium infiltration in Dt-GCT. We present a retrospective study of a series of patients who are diagnosed with Dt-GCT about the ankle joint, there clinical outcome is evaluated in this study. Material and method Fifteen patients with radiologically and histologically confirmed Dt-GCT about the ankle joint were identified in our foot and ankle department. Patients were managed with open synovectomy for the tumor tissue and bone grafting for bony erosions. X-rays and MRI scans were used for evaluation of the tumor and bony erosions pre- and post-operatively. Pre- and post-operative ankle function was assessed using the American Orthopedic Foot and Ankle Society –Ankle and Hindfoot (AOFAS-AH) score and the Muscularskeletal Tumor Society (MSTS) score. Results The mean follow-up duration was 37.4 months (range 25 to 50 months). There were 6 males and 9 females, with a mean age of 35 years old (range 18 to 65 years). All patients had talar erosion with the average size of 10.1*9.1*8.2 mm, distal tibia was affected in 5 patients with the average size of 6.2*5.6*5.8 mm. 7 patients had tendon involvement, 2 patients had recurrence and progression of ankle osteoarthritis. Both of them underwent ankle fusion. At the time of last follow-up, the mean AOFAS-AH score increased from 49 to 80 points (p < 0.05), the MSTS score increased from 12 to 22 points (p < 0.05). Conclusion For Dt-GCT with bony erosions, open synovectomy combined with bone grafting seems to be a safe and effective operation for the salvage of ankle joint. Fusion is recommended for failed and severe cartilage destruction of the ankle joint.
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Affiliation(s)
- Xingchen Li
- Orthopaedic Department, Ruijin Hospital, Ruijin Er Road No.197, Shanghai, 200025, China
| | - Yang Xu
- Orthopaedic Department, Ruijin Hospital, Ruijin Er Road No.197, Shanghai, 200025, China
| | - Yuan Zhu
- Orthopaedic Department, Ruijin Hospital, Ruijin Er Road No.197, Shanghai, 200025, China
| | - Xiangyang Xu
- Orthopaedic Department, Ruijin Hospital, Ruijin Er Road No.197, Shanghai, 200025, China.
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Vega J, Dalmau-Pastor M, Malagelada F, Fargues-Polo B, Peña F. Ankle Arthroscopy: An Update. J Bone Joint Surg Am 2017; 99:1395-1407. [PMID: 28816902 DOI: 10.2106/jbjs.16.00046] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Jordi Vega
- 1Foot and Ankle Unit, Hospital Quirón Barcelona, Barcelona, Spain 2Human Anatomy and Embriology Unit, Department of Pathology and Experimental Therapeutics, University of Barcelona, Barcelona, Spain 3Manresa Health Science School, University of Vic-Central University of Catalonia, Barcelona, Spain 4Foot and Ankle Unit, Department of Orthopaedic Surgery, Heatherwood and Wexham Park Hospitals, Frimley Health NHS Trust, Ascot, Berkshire, United Kingdom 5Foot and Ankle Unit, Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota
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Van Dijk CN, Vuurberg G, Batista J, d’Hooghe P. Posterior ankle arthroscopy: current state of the art. J ISAKOS 2017. [DOI: 10.1136/jisakos-2016-000082] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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D'Ambrosi R, Maccario C, Ursino C, Serra N, Usuelli FG. Combining Microfractures, Autologous Bone Graft, and Autologous Matrix-Induced Chondrogenesis for the Treatment of Juvenile Osteochondral Talar Lesions. Foot Ankle Int 2017; 38:485-495. [PMID: 28076977 DOI: 10.1177/1071100716687367] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the clinical and radiologic outcomes of patients younger than 20 years, treated with the arthroscopic-talus autologous matrix-induced chondrogenesis (AT-AMIC) technique and autologous bone graft for osteochondral lesion of the talus (OLT). METHODS Eleven patients under 20 years (range 13.3-20.0) underwent the AT-AMIC procedure and autologous bone graft for OLTs. Patients were evaluated preoperatively (T0) and at 6 (T1), 12 (T2), and 24 (T3) months postoperatively, using the American Orthopaedic Foot & Ankle Society Ankle and Hindfoot (AOFAS) score, the visual analog scale and the SF-12 respectively in its Mental and Physical Component Scores. Radiologic assessment included computed tomographic (CT) scan, magnetic resonance imaging (MRI) and intraoperative measurement of the lesion. A multivariate statistical analysis was performed. RESULTS Mean lesion size measured during surgery was 1.1 cm3 ± 0.5 cm3. We found a significant difference in clinical and radiologic parameters with analysis of variance for repeated measures ( P < .001). All clinical scores significantly improved ( P < .05) from T0 to T3. Lesion area significantly reduced from 119.1 ± 29.1 mm2 preoperatively to 77.9 ± 15.8 mm2 ( P < .05) at final follow-up as assessed by CT, and from 132.2 ± 31.3 mm2 to 85.3 ± 14.5 mm2 ( P < .05) as assessed by MRI. Moreover, we noted an important correlation between intraoperative size of the lesion and body mass index (BMI) ( P = .011). CONCLUSIONS The technique can be considered safe and effective with early good results in young patients. Moreover, we demonstrated a significant correlation between BMI and lesion size and a significant impact of OLTs on quality of life. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Riccardo D'Ambrosi
- 1 Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy.,2 IRCCS Istituto Ortopedico Galeazzi, U.O. C.A.S.C.O., Piede e Caviglia, Milan, Italy
| | - Camilla Maccario
- 1 Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy.,2 IRCCS Istituto Ortopedico Galeazzi, U.O. C.A.S.C.O., Piede e Caviglia, Milan, Italy
| | | | - Nicola Serra
- 4 Seconda Università di Napoli, Dipartimento di Radiologia, Naples, Italy
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Rehnitz C, Kuni B, Wuennemann F, Chloridis D, Kirwadi A, Burkholder I, Kauczor HU, Weber MA. Delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) and T
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mapping of talar osteochondral lesions: Indicators of clinical outcomes. J Magn Reson Imaging 2017; 46:1601-1610. [DOI: 10.1002/jmri.25731] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 03/27/2017] [Indexed: 12/17/2022] Open
Affiliation(s)
- Christoph Rehnitz
- Department of Diagnostic and Interventional Radiology; University Hospital Heidelberg; Germany
| | - Benita Kuni
- Department of Orthopedics and Trauma Surgery; University Hospital Heidelberg; Germany
| | - Felix Wuennemann
- Department of Diagnostic and Interventional Radiology; University Hospital Heidelberg; Germany
| | - Dimitrios Chloridis
- Department of Orthopedics and Trauma Surgery; University Hospital Heidelberg; Germany
| | - Anand Kirwadi
- Department of Radiology; Manchester Royal Infirmary; Manchester UK
| | - Iris Burkholder
- Department of Nursing and Health; University of Applied Sciences of the Saarland; Saarbruecken Germany
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology; University Hospital Heidelberg; Germany
| | - Marc-André Weber
- Department of Diagnostic and Interventional Radiology; University Hospital Heidelberg; Germany
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Dekker TJ, Dekker PK, Tainter DM, Easley ME, Adams SB. Treatment of Osteochondral Lesions of the Talus. JBJS Rev 2017; 5:01874474-201703000-00004. [DOI: 10.2106/jbjs.rvw.16.00065] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Repetto I, Biti B, Cerruti P, Trentini R, Felli L. Conservative Treatment of Ankle Osteoarthritis: Can Platelet-Rich Plasma Effectively Postpone Surgery? J Foot Ankle Surg 2017; 56:362-365. [PMID: 28231968 DOI: 10.1053/j.jfas.2016.11.015] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Indexed: 02/03/2023]
Abstract
Osteoarthritis is the most common and disabling of the orthopedic diseases. Currently, the conservative treatment of osteoarthritis is limited to symptomatic treatment, whose goal is to improve function and pain control. Ankle osteoarthritis is relatively uncommon, in contrast to osteoarthritis of the hip and knee, and the therapeutic options (both pharmacologic and surgical) are limited, with surgery providing poorer and less predictable results. The effectiveness of platelet-rich plasma injections for osteoarthritis is still controversial, especially so for ankle arthritis, owing to the lack of evidence in the present data. We retrospectively evaluated the mid- to long-term clinical results (mean follow-up of 17.7 months) for platelet-rich plasma injections in 20 patients (20 ankles) with ankle osteoarthritis. We evaluated the presence of pain using the visual analog scale, function using the Foot and Ankle Disability Index, and subjective satisfaction. The pre- and post-treatment scores, obtained from the clinical records and from telephone interviews during the follow-up period, were compared using the Student t test. We found a strong positive effect for 4 platelet-rich plasma injections (injected once a week) on pain (p = .0001) and function (p = .001), with 80% of patients very satisfied and satisfied, and only 2 patients (10%) required surgery because of early treatment failure. These results suggest that the use of platelet-rich plasma injection is a valid and safe alternative to postpone the need for surgery.
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Affiliation(s)
- Ilaria Repetto
- Orthopedist, Department of Surgical Sciences, Orthopaedic and Traumatologic Clinic, University of Genoa, IRCCS University Hospital San Martino IST, National Institute for Cancer Research, Genoa, Italy.
| | - Besmir Biti
- Orthopedist, Department of Surgical Sciences, Orthopaedic and Traumatologic Clinic, University of Genoa, IRCCS University Hospital San Martino IST, National Institute for Cancer Research, Genoa, Italy
| | - Paola Cerruti
- Orthopedist, Department of Surgical Sciences, Orthopaedic and Traumatologic Clinic, University of Genoa, IRCCS University Hospital San Martino IST, National Institute for Cancer Research, Genoa, Italy
| | - Roberto Trentini
- Orthopedist, Department of Surgical Sciences, Orthopaedic and Traumatologic Clinic, University of Genoa, IRCCS University Hospital San Martino IST, National Institute for Cancer Research, Genoa, Italy
| | - Lamberto Felli
- Professor, Department of Surgical Sciences, Orthopaedic and Traumatologic Clinic, University of Genoa, IRCCS University Hospital San Martino IST, National Institute for Cancer Research, Genoa, Italy
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D'Ambrosi R, Maccario C, Serra N, Liuni F, Usuelli FG. Osteochondral Lesions of the Talus and Autologous Matrix-Induced Chondrogenesis: Is Age a Negative Predictor Outcome? Arthroscopy 2017; 33:428-435. [PMID: 27956234 DOI: 10.1016/j.arthro.2016.09.030] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 09/20/2016] [Accepted: 09/26/2016] [Indexed: 02/07/2023]
Abstract
PURPOSE To assess and evaluate healing and functional outcomes after arthroscopic talus autologous matrix-induced chondrogenesis (AT-AMIC) in 2 age groups: patients older than 33 years versus patients 33 years or younger. METHODS A total of 31 patients, of whom 17 were 33 years or younger (G1) and 14 older than 33 years (G2), were evaluated. All patients were treated with AT-AMIC repair for osteochondral talar lesion. Magnetic resonance imaging (MRI) and computed tomography (CT)-scan evaluations, as well as clinical evaluations measured by the visual analog scale (VAS) score for pain, American Orthopaedic Foot and Ankle Society Ankle and Hindfoot score (AOFAS), and Short Form-12, were performed preoperatively (T0) and at 6 (T1), 12 (T2), and 24 (T3) months postoperatively. RESULTS G1 consisted of 17 patients (mean age: 25 years, standard deviation: ±5), whereas G2 consisted of 14 patients (mean age: 47 years, standard deviation: ±9). In both groups, we found a significant difference for clinical and radiological parameters with the analysis of variance for repeated measures through 4 time points (P < .001). In G1, AOFAS improved significantly between T0 and T1 (P = .025) and T1 and T2 (P = .011); CT showed a significant decrease between T1 and T2 (P = .003) and T2 and T3 (P < .0001), whereas MRI reduced significantly at each follow-up. In G2, AOFAS improved between T0 and T1 (P = .011) and T2 and T3 (P = .018); CT decreased between T1 and T2 (P = .025), whereas MRI showed a reduction between T1 and T2 (P = .029) and T2 and T3 (P = .006). AOFAS in G1 was significantly higher at T0 (P = .017), T2 (P = .036), and T3 (P = .039) compared with G2. A negative linear correlation between AOFAS and VAS at T1 (R = -0.756), T2 (R = -0.637), and T3 (R = -0.728) was found in G1, whereas in G2, AOFAS was negatively correlated with VAS at T1 (R = -0.702). CONCLUSIONS The study revealed that osteochondral lesions of the talus were characterized by similar sizes and features, both in young and old patients. We conclude that AT-AMIC can be considered a safe and reliable procedure that allows effective healing, regardless of age, with a significant clinical improvement; in particular, clinical results are related to starting conditions of the ankle. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Riccardo D'Ambrosi
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy; Chirurgia Articolare Sostitutiva e Chirurgia Ortopedica - Piede e Caviglia, Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Ortopedico Galeazzi, Milan, Italy.
| | - Camilla Maccario
- Chirurgia Articolare Sostitutiva e Chirurgia Ortopedica - Piede e Caviglia, Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Ortopedico Galeazzi, Milan, Italy
| | - Nicola Serra
- Dipartimento di Radiologia, Seconda Università degli Studi di Napoli, Naples, Italy
| | - Federico Liuni
- Chirurgia Articolare Sostitutiva e Chirurgia Ortopedica - Piede e Caviglia, Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Ortopedico Galeazzi, Milan, Italy; Dipartimento di Ortopedia e Traumatologia, Ospedale Santa Maria, Borgo Val di Taro, Parma, Italy
| | - Federico Giuseppe Usuelli
- Chirurgia Articolare Sostitutiva e Chirurgia Ortopedica - Piede e Caviglia, Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Ortopedico Galeazzi, Milan, Italy
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Li X, Zhu Y, Xu Y, Wang B, Liu J, Xu X. Osteochondral autograft transplantation with biplanar distal tibial osteotomy for patients with concomitant large osteochondral lesion of the talus and varus ankle malalignment. BMC Musculoskelet Disord 2017; 18:23. [PMID: 28103870 PMCID: PMC5244526 DOI: 10.1186/s12891-016-1367-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Accepted: 12/15/2016] [Indexed: 12/04/2022] Open
Abstract
Background Osteochondral lesions of the talus (OLTs) are amongst the most common foot and ankle disorders. Varus ankle malalignment causes stress concentration on medial side of the joint, resulting in OLTs and osteoarthritis. For large symptomatic OLTs (>10 mm), Osteochondral autograft transplantation is usually recommended. This article highlights biplanar distal tibial osteotomy as an approach and management for patients with concomitant large OLTs and varus ankle malalignment. Methods From January 2012 to July 2014, 13 patients (6 male and 7 female) underwent surgery in our faculty and their average age was 55.4 (ranging from 34 to 69) years old. Oblique medial malleolar osteotomy was performed to expose the talar lesion, followed by an osteochondral autograft transplantation and distal tibial opening-wedge osteotomy. Weight-bearing X-rays were conducted and used for the measurement of radiographic parameters such as the tibial articular surface (TAS) and tibial lateral surface (TLS) angles. Ankle function of the subjects was evaluated according to the American Orthopaedic Foot and Ankle Society-Ankle and Hindfoot score (AOFAS-AH) questionnaires and Visual Analog Scale (VAS). Results 11 patients completed the follow-up over a mean period of 21.2 months. The average area of talar lesion was 135.9 mm2 while the average depth was 11.4 mm. The mean time for osseous union was 8.5 weeks. Donor site morbidity was not recorded in any of the cases. The mean AOFAS-AH and VAS improved from 53 to 90 points (p < 0.05) and 6.7 to 1.9 points (p < 0.05) respectively. The mean TAS angle improved from 83.1 to 90.3° (p < 0.05). Conclusions Biplanar distal tibial osteotomy with the combination of osteochondral autograft transplantation could be used to address patients with concomitant large OLTs and varus ankle malalignment as this technique provides excellent visualization of the talar defect, favorable biomechanical environment for the ankle joint with high rate of good and excellent results.
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Affiliation(s)
- Xingchen Li
- Orthopaedic Department, Ruijin Hospital, Ruijin Second Road No.197, Shanghai, China
| | - Yuan Zhu
- Orthopaedic Department, Ruijin Hospital, Ruijin Second Road No.197, Shanghai, China
| | - Yang Xu
- Orthopaedic Department, Ruijin Hospital, Ruijin Second Road No.197, Shanghai, China
| | - Bibo Wang
- Orthopaedic Department, Ruijin Hospital, Ruijin Second Road No.197, Shanghai, China
| | - Jinhao Liu
- Orthopaedic Department, Ruijin Hospital, Ruijin Second Road No.197, Shanghai, China
| | - Xiangyang Xu
- Orthopaedic Department, Ruijin Hospital, Ruijin Second Road No.197, Shanghai, China.
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Gianakos AL, Yasui Y, Hannon CP, Kennedy JG. Current management of talar osteochondral lesions. World J Orthop 2017; 8:12-20. [PMID: 28144574 PMCID: PMC5241540 DOI: 10.5312/wjo.v8.i1.12] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 08/07/2016] [Accepted: 10/18/2016] [Indexed: 02/06/2023] Open
Abstract
Osteochondral lesions of the talus (OLT) occur in up to 70% of acute ankle sprains and fractures. OLT have become increasingly recognized with the advancements in cartilage-sensitive diagnostic imaging modalities. Although OLT may be treated nonoperatively, a number of surgical techniques have been described for patients whom surgery is indicated. Traditionally, treatment of symptomatic OLT have included either reparative procedures, such as bone marrow stimulation (BMS), or replacement procedures, such as autologous osteochondral transplantation (AOT). Reparative procedures are generally indicated for OLT < 150 mm2 in area. Replacement strategies are used for large lesions or after failed primary repair procedures. Although short- and medium-term results have been reported, long-term studies on OLT treatment strategies are lacking. Biological augmentation including platelet-rich plasma and concentrated bone marrow aspirate is becoming increasingly popular for the treatment of OLT to enhance the biological environment during healing. In this review, we describe the most up-to-date clinical evidence of surgical outcomes, as well as both the mechanical and biological concerns associated with BMS and AOT. In addition, we will review the recent evidence for biological adjunct therapies that aim to improve outcomes and longevity of both BMS and AOT procedures.
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Abstract
Osteochondral fractures of the ankle are typically caused by traumatic injuries of the ankle. Repetitive trauma can lead to further cartilage damage with subsequent increasing size of the lesion, ultimately leading to severe cartilage disorder and degenerative arthritis of the ankle. Arthroscopic bone marrow stimulation has been shown to be a highly successful option for patients with small osteochondral lesions. Studies show a higher failure rate for larger lesions and cystic changes that disrupt the subchondral plate. The threshold size seems to be 150 mm(2).
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Affiliation(s)
- Sean T Grambart
- Carle Physician Group, Department of Orthopedics, 1802 South Mattis Avenue, Champaign, IL 61821, USA.
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Gianakos AL, Yasui Y, Fraser EJ, Ross KA, Prado MP, Fortier LA, Kennedy JG. The Effect of Different Bone Marrow Stimulation Techniques on Human Talar Subchondral Bone: A Micro-Computed Tomography Evaluation. Arthroscopy 2016; 32:2110-2117. [PMID: 27234650 DOI: 10.1016/j.arthro.2016.03.028] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 03/17/2016] [Accepted: 03/22/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate morphological alterations, microarchitectural disturbances, and the extent of bone marrow access to the subchondral bone marrow compartment using micro-computed tomography analysis in different bone marrow stimulation (BMS) techniques. METHODS Nine zones in a 3 × 3 grid pattern were assigned to 5 cadaveric talar dome articular surfaces. A 1.00-mm microfracture awl (s.MFX), a 2.00-mm standard microfracture awl (l.MFX), or a 1.25-mm Kirschner wire (K-wire) drill hole was used to penetrate the subchondral bone in each grid zone. Subchondral bone holes and adjacent tissue areas were assessed by micro-computed tomography to analyze adjacent bone area destruction and communicating channels to the bone marrow. Grades 1 to 3 were assigned, where 1 = minimal compression/sclerosis; 2 = moderate compression/sclerosis; 3 = severe compression/sclerosis. Bone volume/total tissue volume, bone surface area/bone volume, trabecular thickness, and trabecular number were calculated in the region of interest. RESULTS Visual assessment revealed that the s.MFX had significantly more grade 1 holes (P < .001) and that the l.MFX had significantly more poor/grade 3 holes (P = .002). Bone marrow channel assessment showed a statistically significant increase in the number of channels in the s.MFX when compared with both K-wire and l.MFX holes (P < .001). Bone volume fraction for the s.MFX was significantly less than that of the l.MFX (P = .029). CONCLUSIONS BMS techniques using instruments with larger diameters resulted in increased trabecular compaction and sclerosis in areas adjacent to the defect. K-wire and l.MFX techniques resulted in less open communicating bone marrow channels, denoting a reduction in bone marrow access. The results of this study indicate that BMS using larger diameter devices results in greater microarchitecture disturbances. CLINICAL RELEVANCE The current study suggests that the choice of a BMS technique should be carefully considered as the results indicate that smaller diameter hole sizes may diminish the amount of microarchitectural disturbances in the subchondral bone.
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Affiliation(s)
| | | | | | - Keir A Ross
- Hospital for Special Surgery, New York, U.S.A
| | | | - Lisa A Fortier
- Department of Clinical Sciences, Cornell University, Ithaca, New York, U.S.A
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Affiliation(s)
- Ross Wodicka
- Southern California Orthopedic Institute, Van Nuys, CA, USA
| | - Eric Ferkel
- Southern California Orthopedic Institute, Van Nuys, CA, USA
| | - Richard Ferkel
- Southern California Orthopedic Institute, Van Nuys, CA, USA
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Beck S, Claßen T, Haversath M, Jäger M, Landgraeber S. Operative Technique and Clinical Outcome in Endoscopic Core Decompression of Osteochondral Lesions of the Talus: A Pilot Study. Med Sci Monit 2016; 22:2278-83. [PMID: 27362485 PMCID: PMC4933542 DOI: 10.12659/msm.896522] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Revitalizing the necrotic subchondral bone and preserving the intact cartilage layer by retrograde drilling is the preferred option for treatment of undetached osteochondral lesions of the talus (OLT). We assessed the effectiveness of Endoscopic Core Decompression (ECD) in treatment of OLT. MATERIAL AND METHODS Seven patients with an undetached OLT of the medial talar dome underwent surgical treatment using an arthroscopically-guided transtalar drill meatus for core decompression of the lesion. Under endoscopic visualization the OLT was completely debrided while preserving the cartilage layer covering the defect. The drill tunnel and debrided OLT were filled using an injectable bone graft substitute. Various clinical scores, radiographic imaging, and MRI were evaluated after a mean follow-up of 24.1 months. RESULTS The American Orthopedic Foot and Ankle Society Score significantly improved from 71.0±2.4 to 90.3±5.9, and the Foot and Ankle Disability Index improved from 71.8±11.1 to 91.7±4.8. Radiographically, we observed good bone remodelling of the medial talar dome contour within 3 months. In MRI, an alteration of the bony signal of the drill tunnel and the excised OLT remained for more than 12 months. CONCLUSIONS First follow-up results for the surgical technique described in this study are highly promising for treatment of undetached stable OLT grade II or transitional stage II-III according to the Pritsch classification. Even lesions larger than 150 mm2 showed good clinical scores, with full restoration of the medial talar dome contour in radiographic imaging.
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Affiliation(s)
- Sascha Beck
- Department of Trauma and Orthopaedic Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Tim Claßen
- Department of Trauma and Orthopaedic Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Marcel Haversath
- Department of Trauma and Orthopaedic Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Marcus Jäger
- Department of Trauma and Orthopaedic Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Stefan Landgraeber
- Department of Trauma and Orthopaedic Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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Abstract
Treatment of osteochondral defects (OCLs) of the talus is a challenging orthopedic surgery. Treatment of talar OCLs has evolved through the 3 "R" paradigm: reconstruction, repair, and replacement. This article highlights current state-of-the-art techniques and reviews recent advances in the literature about articular cartilage repair using various novel tissue engineering approaches, including various scaffolds, growth factors, and cell niches; which include chondrocytes and culture-expanded bone marrow-derived mesenchymal stem cells.
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Affiliation(s)
- Amgad M Haleem
- Department of Orthopedic Surgery, Oklahoma University College of Medicine Health Sciences Center, Oklahoma City, OK, USA; Department of Orthopedic Surgery, Kasr Al-Ainy Hospital, Cairo University School of Medicine, Saray El-Manial Street, El-Manial, Cairo 12411, Egypt.
| | - Mostafa M AbouSayed
- Department of Orthopedic Surgery, Kasr Al-Ainy Hospital, Cairo University School of Medicine, Saray El-Manial Street, El-Manial, Cairo 12411, Egypt; Department of Orthopedic Surgery, Albany Medical College, 1367 Washington Avenue, Albany, NY 12206, USA
| | - Mohammed Gomaa
- Department of Orthopedic Surgery, Kasr Al-Ainy Hospital, Cairo University School of Medicine, Saray El-Manial Street, El-Manial, Cairo 12411, Egypt
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