Prevalence of Vitamin D Deficiency in Patients With Talar Osteochondral Lesions

Osteochondral Lesions of the Talus: Evaluation of Risk Factors and Their Impact on Postoperative Outcomes

Osteochondral lesions of the talus (OLT), also known as talar osteochondritis dissecans, is minor fracture to the articular cartilage of the talas subchondral bone it is associated with. The literature regarding its impact on patient demographics on post-operative associations of OLT-related repairs is lacking. The American College of Surgeons National Surgical Improvement Program (NSQIP) database was retrospectively reviewed, collecting data on patients with an OLT procedure between the 2008 through 2016. Univariate analysis was utilized to compare patient demographics, potential risk factors, comorbidities, hospital, and operative variables. Finally, Logistic regressions were utilized, adjusting associations of its risk factors and respective associations in a postoperative manner. A total of 491 patients with an OLT were collected for analysis. Hypertension requiring medication was a risk factor for readmission (P = 0.039) and longer lengths of stay (P = 0.021). The American Society of Anesthesiologists (ASA) classification significantly predicted increased rates of longer lengths of stay, with ASA class III being more likely than ASA class I (odds ratio [OR]: 4.8; 95% confidence interval [CI]: [1.7-14.2]; P = 0.004) or ASA class II (OR: 3.0; 95% CI [1.2-7.4]; P = 0.016) for patients to remain in hospital for longer than one day. Furthermore, patients who underwent an OLT with ASA class III underwent greater than average lengths of stay than ASA class I patients (0.54 ± 0.9 vs. 0.14 ± 0.5 days, respectively; P = 0.011). Hypertension requiring medication and ASA classification predicted, in a positive manner, postoperative complications occurring in patients with an OLT. Despite being related with extended lengths of stay, only hypertension requiring medication were associated with increased rates of readmission. Orthopaedic surgeons may use these findings to counsel patients on their risk factors and subsequently prepare themselves for peri- and post-operative complications.

Design of Medical Image Detail Enhancement Algorithm for Ankle Joint Talar Osteochondral Injury

Medical imaging modalities, such as magnetic resonance imaging (MRI) and computerized tomography (CT), have allowed medical researchers and clinicians to examine the structural and functional features of the human body, thereby assisting the clinical diagnosis. However, due to the highly controlled imaging environment, the imaging process often creates noise, which seriously affects the analysis of the medical images. In this study, a medical imaging enhancement algorithm is presented for ankle joint talar osteochondral injury. The gradient operator is used to transform the image into the gradient domain, and fuzzy entropy is employed to replace the gradient to determine the diffusion coefficient of the gradient field. The differential operator is used to discretize the image, and a partial differential enhancement model is constructed to achieve image detail enhancement. Three objective evaluation indexes, namely, signal-to-noise ratio (SNR), information entropy (IE), and edge protection index (EPI), were employed to evaluate the image enhancement capability of the proposed algorithm. Experimental results show that the algorithm can better suppress noise while enhancing image details. Compared with the original image, the histogram of the transformed image is more uniform and flat and the gray level is clearer.

Prevalence of and Risk Factors for Hypovitaminosis D in Patients with Rotator Cuff Tears

Backgroud

It has been reported that vitamin D may play an important role in rotator cuff tears. However, there has been limited information about the prevalence of and risk factors for hypovitaminosis D in patients with rotator cuff tears. Therefore, the purpose of current study was to investigate the prevalence of and risk factors for hypovitaminosis D in patients with rotator cuff tears.

Methods

One hundred seventy-six patients (age, 61.9 ± 8.90 years) who underwent arthroscopic rotator cuff repair for a full-thickness tear were enrolled in this retrospective study. Preoperative serum vitamin D levels (25-hydroxyvitamin D) were measured. Hypovitaminosis D was defined as a serum concentration of 25-hydroxyvitamin D < 20 ng/mL. We investigated whether age, sex, height, weight, body mass index, bone mineral density, alcohol consumption, smoking status, and outdoor occupation were associated with hypovitaminosis D.

Results

The prevalence of hypovitaminosis D in patients with rotator cuff tears was 44.3% (78/176). The mean serum concentration of 25-hydroxyvitamin D of total patients was 24.7 ± 13.7 ng/mL. A higher serum level of vitamin D was significantly associated with older age (p < 0.001). Young age was an independent risk factor for hypovitaminosis D. The prevalence of hypovitaminosis D was also lower in patients with an outdoor occupation than in those with an indoor occupation (19.0% vs. 31.4%, p = 0.001).

Conclusions

The prevalence of hypovitaminosis D in patients with rotator cuff tears was 44.3%. Age had a significant positive correlation with the serum concentration of 25-hydroxyvitamin D. Young age and indoor working were independent risk factors for hypovitaminosis D in patients with rotator cuff tears. Therefore, the possibility of hypovitaminosis D should be considered for young and indoor working patients who have rotator cuff tears.

Prevalence of hypovitaminosis D in patients with juvenile osteochondritis dissecans

BACKGROUND

Juvenile osteochondritis dissecans (JOCD) is an acquired joint disease of unknown etiology that affects skeletally immature patients and has the potential to progress to osteoarthritis. Recent studies have reported a high prevalence of vitaminD deficiency in patients with osteochondral lesions. The aim of our study was to determine serum vitaminD levels in patients diagnosed with JOCD.

METHODS

Serum 25(OH)D levels of 31 patients (22 males) presenting 40 lesions (29 JOCD of the knee, and 11 of the ankle) were evaluated. The average age was 11.9±2.9years. HypovitaminosisD was defined as a value less than 30ng/mL and was divided into vitaminD insufficiency (20 to 30ng/mL) and vitaminD deficiency (<20ng/mL).

RESULTS

HypovitaminosisD was present in 45.2% of the evaluated patients (32.2% insufficiency and 13% deficiency). No significant differences were found in the mean values and incidence of hypovitaminosis between those patients in which the sample was taken in warm or cold season (P=.267 and P=.875, respectively). Patients who required surgery had a higher incidence of hypovitaminosis than those treated conservatively (60% versus 31%, P=.054). There was no correlation in the incidence of hypovitaminosis with sex, location, stability of the lesion, or if the lesion was uni- or bilateral.

CONCLUSION

In our series, almost half of the patients diagnosed with JOCD presented abnormal serum levels of vitaminD. A two-fold incidence of hypovitaminosis was observed in patients requiring surgical treatment compared to patients managed conservatively. The association found in this study does not imply causation, but it should be considered within the set of actions for the treatment of these injuries.

Vitamin D and the athlete-patient: state of the art

Vitamin D deficiency is common in athletes. The conventional measurement of vitamin D levels provides a general indicator of body stores. However, there are nuances in its interpretation as values of 25(OH)D do not correlate absolutely with the amount of 'bioavailable' vitamin to the cells. Vitamin D should be regarded as a hormone and influences between 5% and 10% of our total genome. Determining the precise effect of the vitamin, isolated from the actions of other cofactors, is not straightforward and restricts our complete understanding of all of its actions. Deficiency has harmful effects on not only bone and muscle but also wider areas, including immunity and respiratory and neurological activities. More caution should be applied regarding the ability of supranormal vitamin D levels to elevate athletic performance. Hopefully, future research will shed more light on optimal levels of vitamin D and supplementation regimes, and improved understanding of its intracellular control of our genetic mechanisms and how extrinsic influences modify its activity.

Vitamin D in the Foot and Ankle: A Review of the Literature

BACKGROUND

Vitamin D is an essential vitamin that targets several tissues and organs and plays an important role in calcium homeostasis. Vitamin D deficiency is common, particularly at higher latitudes, where there is reduced exposure to ultraviolet B radiation. We reviewed the role of vitamin D and its deficiency in foot and ankle pathology.

METHODS

The effects of vitamin D deficiency have been extensively studied, but only a small portion of the literature has focused on the foot and ankle. Most evidence regarding the foot and ankle consists of retrospective studies, which cannot determine whether vitamin D deficiency is, in fact, the cause of the pathologies being investigated.

RESULTS

The available evidence suggests that insufficient vitamin D levels may result in an increased incidence of foot and ankle fractures. The effects of vitamin D deficiency on fracture healing, bone marrow edema syndrome, osteochondral lesions of the talus, strength around the foot and ankle, tendon disorders, elective foot and ankle surgery, and other foot and ankle conditions are less clear.

CONCLUSIONS

Based on the available evidence, we cannot recommend routine testing or supplementation of vitamin D in patients with foot and ankle pathology. However, supplementation is cheap, safe, and may be of benefit in patients at high risk for deficiency. When vitamin D is supplemented, the evidence suggests that calcium should be co-supplemented. Further high-quality research is needed into the effect of vitamin D in the foot and ankle. Cost-benefit analyses of routine testing and supplementation of vitamin D for foot and ankle pathology are also required.

Retrograde Drilling for Osteochondral Lesion of the Talus in Juvenile Patients

Background:

Retrograde drilling (RD) is generally used for treating osteochondral lesion of the talus (OLT) with a stable osteochondral fragment and nearly normal articular cartilage surface. Previous studies that included participants of various ages have reported good clinical results. This study aimed to clarify the clinical outcomes of RD for OLT in juvenile patients whose bone-forming ability and physical activity might affect the healing process.

Methods:

This retrospective study included 8 juvenile patients who underwent RD for OLT (5 boys and 3 girls, mean age 14.9 years, mean follow-up 2 years, 7 medial and 1 central lesion). American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score and ankle activity score were evaluated, and arthroscopic findings were graded according to the International Cartilage Research Society (ICRS) classification system. The condition of the underlying bone was assessed on preoperative computed tomographic images. The stability, incorporation, and subsidence of the osteochondral fragment, articular surface congruity, and the area of the bone marrow lesion (BML) were evaluated using magnetic resonance imaging (MRI).

Results:

AOFAS ankle-hindfoot score and ankle activity score significantly improved postoperatively. Arthroscopically, the lesions were classified as ICRS grade 0 or 1. Bone sclerosis or multiple small cysts of the underlying bone were observed in all patients. MRI demonstrated no signs of osteochondral fragment instability or subsidence, good or fair fragment incorporation, good articular surface congruity, or slight irregularity. The postoperative BML was reduced; however, these BMLs were still detectable at 1 year after surgery.

Conclusion:

Our data suggested that RD is an option for treating juvenile patients with OLT refractory to nonoperative treatment at short-term follow-up. Although bone sclerosis or multiple small cysts were identified in the underlying bone preoperatively and the BML under the osteochondral fragment remained postoperatively, clinical status such as pain and physical activity level were improved by RD.

Level of Evidence:

Level IV, retrospective case series.

Vitamin D Deficiency in Patients With Idiopathic and Traumatic Osteochondritis Dissecans of the Talus

BACKGROUND

Low vitamin D levels are common in patients with foot and ankle disorders. We have previously demonstrated that juveniles diagnosed with osteochondritis dissecans (OCD) have a high prevalence of vitamin D deficiency. Moreover, there is evidence that OCD might be related to vitamin D deficiency in general. However, whether or not hypovitaminosis D is associated with OCD of the talus has yet to be elucidated.

METHODS

The aim of this study was to determine serum vitamin D levels [25(OH)D] of patients diagnosed with traumatic and idiopathic OCD of the talus. The vitamin D status of patients was measured and correlated to age, sex, season, etiology, laterality, degree of disease, and nicotine abuse. Moreover, parathyroid hormone and serum calcium levels of patients were obtained to assess for severe vitamin D deficiency and secondary hyperparathyroidism. Between January 2015 and December 2017, 65 patients with a mean age of 38.9 years and a total of 68 lesions were identified.

RESULTS

In total, 75.4% of patients had low vitamin D levels with a mean overall 25(OH)D level of 24.2 ng/mL. Specifically, 35.4% of patients were vitamin D deficient; another 40% were vitamin D insufficient, and only 24.6% of patients presented with sufficient vitamin D levels. Statistical analysis showed no significant difference comparing vitamin D levels of patients with idiopathic OCD to patients with traumatic OCD.

CONCLUSION

We could not find any significant differences in the vitamin D status of patients with OCD of the talus compared with patients with foot and ankle disorders in general. However, we found that vitamin D deficiency was frequent in patients presenting with traumatic and idiopathic OCD of the talus. We believe it might be beneficial to routinely assess and treat the vitamin D status of patients.

LEVEL OF EVIDENCE

Level III, retrospective comparative study.

Surgical Considerations for Vitamin D Deficiency in Foot and Ankle Surgery

Vitamin D deficiency affects nearly one-sixth of the world's population and is common in patients undergoing foot and ankle surgery. Vitamin D is critical for calcium homeostasis and plays an important role in the maintenance of bone health. Patients undergoing foot and ankle procedures can be evaluated preoperatively with vitamin D level testing, and deficiencies can be addressed with either preoperative or postoperative supplementation. Current data suggest that patients with adequate vitamin D levels may have better outcomes, but the details are not yet clear. Vitamin D supplementation is well tolerated with rare side effects.