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Nery C, Prado M, Brauer G, Lemos AV. Retrograde Autologous Osteochondral Transplantation in Treating Osteochondral Lesion of Distal Tibial Plafond: A Case Report and Technical Tips. Foot Ankle Int 2021; 42:1081-1092. [PMID: 34024151 DOI: 10.1177/10711007211004132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Caio Nery
- UNIFESP-Federal University of São Paulo/Foot and Ankle Surgery-"Albert Einstein" Jewish Hospital, São Paulo, Brazil
| | - Marcelo Prado
- Foot and Ankle Surgery-"Albert Einstein" Jewish Hospital, São Paulo, Brazil
| | - Glenda Brauer
- Foot and Ankle Surgery-"Albert Einstein" Jewish Hospital, São Paulo, Brazil
| | - André Vitor Lemos
- Head of the Foot and Ankle Clinic-UNIFESP-Federal University of São Paulo/Foot and Ankle Surgery-"Albert Einstein" Jewish Hospital, São Paulo, Brazil
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Rikken QGH, Dahmen J, Altink JN, Buck TMF, Stufkens SAS, Kerkhoffs GMMJ. Surgical Treatment of Osteochondral Lesions of the Tibial Plafond: A Systematic Review and Meta-Analysis. JBJS Rev 2021; 9:01874474-202107000-00001. [PMID: 34223828 DOI: 10.2106/jbjs.rvw.20.00190] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND The literature on osteochondral lesions of the tibial plafond (OLTPs) is sparse. The aim of this study was therefore to provide an overview of clinical and radiological outcomes following treatment of OLTPs. METHODS We performed a systematic search of the MEDLINE, Embase, and Cochrane library databases. The review was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines and included all original articles on treatment outcomes for OLTPs. The methodological quality of the articles was assessed using the Methodological Index for Non-Randomized Studies (MINORS). Baseline patient and lesion characteristics were pooled and weighted according to the number of lesions per study. The primary outcome was any clinical or patient-reported outcome measure pooled by treatment method when separable data were available. Secondary outcomes were complications, reoperation rates, radiological outcomes, and sport outcomes. RESULTS The search yielded 2,079 articles, of which 10 studies (1 prospective case series, 1 retrospective comparative study, and 8 retrospective case series) with a total of 175 patients were included. The overall methodological quality of the studies was low. All patients were treated surgically; 96% of the lesions were primary cases (i.e., first-time surgery) and 58% were solitary tibial lesions (i.e., no opposing talar lesion). Arthroscopic bone marrow stimulation was the most frequently used treatment strategy (51%), followed by cartilage transplantation (17%), chondrogenesis-inducing techniques (11%), osteochondral transplantation (3%), retrograde drilling (3%), and mixed (i.e., inseparable) treatments (15%). The clinical outcomes of the different surgical therapies were considered to be moderate to good. The pooled postoperative AOFAS (American Orthopaedic Foot & Ankle Society) score for bone marrow stimulation and osteochondral transplantation was 54.8 (95% confidence interval [CI], 49.5 to 85.0) (n = 14) and 85.3 (95% CI, 56 to 100) (n = 3), respectively. Overall, complications and reoperations were rarely reported. The pooled complication and reoperation rates could only be calculated for bone marrow stimulation and were 5% and 7%, respectively. CONCLUSIONS Surgical interventions for OLTPs appear to yield moderate to good clinical outcomes. Bone marrow stimulation resulted in a moderate AOFAS score. Complications and reintervention rates were found to be low. The current evidence in the literature is limited because of the underreporting of clinical, radiological, and sport data and the heterogenous outcome scores reported. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Q G H Rikken
- Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, 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
| | - J Dahmen
- Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, 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
| | - J N Altink
- Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, 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
| | - T M F Buck
- Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, 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
| | - S A S Stufkens
- Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, 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
| | - G M M J Kerkhoffs
- Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, 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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Allahabadi S, Allahabadi S, Allala R, Garg K, Pandya NK, Lau BC. Osteochondral Lesions of the Distal Tibial Plafond: A Systematic Review of Lesion Locations and Treatment Outcomes. Orthop J Sports Med 2021; 9:2325967121997120. [PMID: 33948443 PMCID: PMC8053772 DOI: 10.1177/2325967121997120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 12/11/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Osteochondral lesions of the tibial plafond (OLTPs) remain less common than osteochondral lesions of the talus (OLTs), but recognition of the condition has increased. PURPOSE To systematically evaluate the literature on lesion locations and treatment outcomes of OLTPs, whether in isolation or in combination with OLTs. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS A search was performed using the PubMed, Embase, and CINAHL databases for studies on lesion locations or with imaging or treatment outcomes of OLTPs. Case reports and reports based on expert opinion were excluded. Lesion locations as well as outcome measure results were aggregated. The Methodological Index for Non-randomized Studies score was used to assess methodological quality when applicable. RESULTS Included in this review were 10 articles, all published in 2000 or later. Most studies were evidence level 4, and the mean Methodological Index for Non-randomized Studies score was 8.6 (range, 8-10). Overall, 174 confirmed OLTP cases were identified, and the mean patient age was 38.8 years. Of the 157 lesions with confirmed locations, the most common was central-medial (32/157; 20.4%). Of 6 studies on treatment outcomes, all but 1 evaluated bone marrow stimulation techniques. Microfracture of small lesions (<150 mm2) was the most common treatment utilized. Imaging and functional outcomes appeared favorable after treatment. The data did not support differences in outcomes between isolated OLTPs and OLTPs with coexisting OLTs. CONCLUSION Osteochondral lesions of the distal tibia most commonly occurred at the central-medial tibial plafond. Microfracture of small lesions was the most common treatment utilized, and clinical and magnetic resonance imaging results were favorable, although data were heterogeneous. Areas for future research include the following: the effect of patient factors and additional pathologies on outcomes; larger or deeper lesion treatment; more direct comparisons of outcomes between kissing or coexisting lesions and isolated lesions; and head-to-head comparison of treatments, such as microfracture, bone marrow-derived cell transplantation, and osteochondral autografts/allografts.
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Affiliation(s)
- Sachin Allahabadi
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Sameer Allahabadi
- School of Medicine, Texas Christian University, and University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Ruthvik Allala
- School of Medicine, Texas Christian University, and University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Kartik Garg
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Nirav K. Pandya
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Brian C. Lau
- Division of Sports Medicine, Department of Orthopaedic Surgery, Duke Sport Science Institute, Duke University, Durham, North Carolina, USA
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Lee W, Tran S, Cooper MT, Park JS, Perumal V. Clinical Outcomes of Osteochondral Lesions of the Tibial Plafond Following Arthroscopic Microfracture. Foot Ankle Int 2019; 40:1018-1024. [PMID: 31130008 DOI: 10.1177/1071100719850145] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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 outcomes and the level of sports activity following arthroscopic microfracture for osteochondral lesions of the tibial plafond. METHODS A retrospective review was conducted for patients who underwent arthroscopic microfracture surgery for osteochondral lesions of the tibial plafond from January 2014 to June 2017. For functional evaluation, the visual analog scale (VAS) pain score, Foot and Ankle Ability Measure (FAAM) score, and Short Form-12 (SF-12) general health questionnaire were used. We also investigated the level of sports activity before and after the surgery. Sixteen patients were included in this study, and the mean follow-up period was 29.8 months. RESULTS The mean VAS score improved from 8.3 (range, 6-10) preoperatively to 1.8 (range, 0-4) postoperatively. The mean FAAM score was improved from 57.6 (range, 6.0-88.9) for the activities of daily living subscale and 34.5 (range, 3.1-92.6) for the sports subscale to 84.3 (range, 46.4-100.0) and 65.2 (range, 23.3-55.1) for each subscale, respectively, at the final follow-up. There were also improvements in the SF-12 score, from 36.3 (range, 23.3-55.1) preoperatively to 46.0 (range, 18.9-56.6) postoperatively for the SF-12 PCS, and from 41.3 (range, 14.2-65.0) preoperatively to 52.6 (range, 32.8-60.8) postoperatively for the SF-12 MCS. All functional scores showed significant differences clinically and statistically at the final follow-up. The level of sports activity after the surgery was significantly lower than their level before the surgery (P = .012). CONCLUSION Arthroscopic microfracture provided satisfactory clinical outcomes for osteochondral lesions of the tibial plafond. Though all the patients in this study were able to return to sports activity after the surgery, the postoperative level of sports activity was significantly lower than their preoperative level. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Wonyong Lee
- 1 Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Sterling Tran
- 2 University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Minton T Cooper
- 1 Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Joseph S Park
- 1 Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Venkat Perumal
- 1 Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA, USA
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Baldassarri M, Perazzo L, Ricciarelli M, Natali S, Vannini F, Buda R. Regenerative treatment of osteochondral lesions of distal tibial plafond. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2018; 28:1199-1207. [PMID: 29476376 DOI: 10.1007/s00590-018-2161-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 02/13/2018] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Osteochondral lesions of the distal tibial plafond (OLTP) are rare and far less common than osteochondral lesions of the talus. Literature data do not report clinical records with significant number of cases and follow-up. The aim of our study was to evaluate clinical and MRI outcomes following arthroscopic treatment of distal tibia osteochondral lesions and to report our results with treating these rare lesions. METHODS Between October 2010 and November 2011, a consecutive series of 27 patients, 15 males and 12 females, were treated arthroscopically with the one-step BMDCT for OLTPs. Exclusion criteria were: age < 18 or > 50 years, patients with severe osteoarthritis (stage III according to Van Dijk classification), presence of kissing lesions of the ankle and patients with rheumatoid or hemophilic arthritis. All patients were evaluated through X-rays; MRI was performed preoperatively and at the final follow-up with MOCART score; clinical evaluation was assessed by AOFAS score at various follow-ups of 12, 24, 36, 60 and 72 months. RESULTS No complications were observed post-surgery or during the rehabilitation period. The AOFAS score improved from 52.4 preoperatively to 80.6 at the mean final follow-up. All the patients were satisfied with the procedure. In 14 cases the MRI showed a complete filling of the osteochondral defect, in three patients a hypertrophic tissue was observed, and in the other two patients an incomplete repair of the lesion associated with a persistent slight subchondral edema was reported. A topographic study was also performed. CONCLUSIONS Osteochondral lesions of the distal tibia represent a challenge for the orthopedic surgeon because of their difficulty diagnostic and rarities. The high incidence of good outcome in our series indicates that the one-step BMDCT could be a valid option for the treatment of this rare type of lesions. Further studies with a longer follow-up and more accurate imaging studies are necessary to confirm these results.
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Affiliation(s)
- Matteo Baldassarri
- I Clinic, Rizzoli Orthopedic Institute of Bologna, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy.
| | - Luca Perazzo
- I Clinic, Rizzoli Orthopedic Institute of Bologna, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Marco Ricciarelli
- I Clinic, Rizzoli Orthopedic Institute of Bologna, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Simone Natali
- I Clinic, Rizzoli Orthopedic Institute of Bologna, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Francesca Vannini
- I Clinic, Rizzoli Orthopedic Institute of Bologna, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Roberto Buda
- I Clinic, Rizzoli Orthopedic Institute of Bologna, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
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Okamura K, Sugimoto K, Isomoto S, Samoto N, Yoneda A, Tsukada N, Tanaka Y. Osteochondral lesion of the tibial plafond treated with a retrograde osteochondral autograft: a report of two cases. ASIA-PACIFIC JOURNAL OF SPORT MEDICINE ARTHROSCOPY REHABILITATION AND TECHNOLOGY 2017; 8:8-12. [PMID: 29264273 PMCID: PMC5721921 DOI: 10.1016/j.asmart.2016.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Revised: 11/27/2016] [Accepted: 11/28/2016] [Indexed: 11/30/2022]
Abstract
Background Osteochondral lesions (OCLs) of the tibial plafond (OLTPs) are rare, and few studies provide treatment recommendations. We describe two cases of an OLTP that were treated with retrograde osteochondral autograft. Case Reports The first case was a 27-year-old basketball player and the second case was a 38-year-old soccer player. We harvested osteochondral autografts from the nonweight-bearing area of the lateral femoral condyle of the patient’s ipsilateral knees. The grafts were reversed and inserted into the bone tunnel reaching the OLTPs starting proximally and moving distally. The first patient was able to play professional basketball 14 months after the procedure and continues to play 5 years and 6 months later. The second patient was able to play recreational soccer 9 months after the procedure and continues to play 4 years later. Conclusion Use of the retrograde osteochondral autograft produced satisfactory results including the return to sports. The retrograde osteochondral autograft can be considered recommendable for treating OLTPs.
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Affiliation(s)
- Kensuke Okamura
- Department of Orthopaedic Surgery, Nara Prefecture General Medical Center, Nara, Japan
| | - Kazuya Sugimoto
- Department of Orthopaedic Surgery, Nara Prefecture General Medical Center, Nara, Japan
| | - Shinji Isomoto
- Department of Orthopaedic Surgery, Nara Prefecture General Medical Center, Nara, Japan
| | - Norihiro Samoto
- Department of Orthopaedic Surgery, Nara Prefecture General Medical Center, Nara, Japan
| | - Azusa Yoneda
- Department of Orthopaedic Surgery, Nara Prefecture General Medical Center, Nara, Japan
| | - Naoki Tsukada
- Department of Orthopaedic Surgery, Nara Prefecture General Medical Center, Nara, Japan
| | - Yasuhito Tanaka
- Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Japan
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Yabumoto H, Nakagawa Y, Yamada S, Mukai S, Mukaida S, Ninomiya S, Tsubouchi N, Matsuoka M, Tarumi E, Nakamura T. Osteochondral autograft transfer for post-traumatic osteochondral defects of the anterolateral surface of the distal tibial plafond. Trauma Case Rep 2016; 3:18-25. [PMID: 29942840 PMCID: PMC6011856 DOI: 10.1016/j.tcr.2016.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2016] [Indexed: 11/01/2022] Open
Abstract
Post-traumatic osteochondral defects of the distal tibial plafond may be a more common cause of pain and osteoarthritis than previously recognized. However, the literature on the surgical treatment of osteochondral defects of the distal tibial plafond is significantly limited. This case report presents the operative technique and clinical outcome of osteochondral autograft transfer for an osteochondral defect on the anterolateral surface of the distal tibial plafond. A case of transfer of osteochondral autograft plugs to repair the anterolateral surface of the distal tibial plafond and prevent progression of forward displacement of the talus in a 25-year-old man who presented with pain in his right ankle, following a history of trauma.
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Affiliation(s)
- Hiromitsu Yabumoto
- Department of Orthopaedic Surgery, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan
| | - Yasuaki Nakagawa
- Department of Orthopaedic Surgery, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan
| | - Shigeru Yamada
- Department of Orthopaedic Surgery, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan
| | - Syogo Mukai
- Department of Orthopaedic Surgery, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan
| | - Seiji Mukaida
- Department of Orthopaedic Surgery, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan
| | - Shuzo Ninomiya
- Department of Orthopaedic Surgery, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan
| | - Naoya Tsubouchi
- Department of Orthopaedic Surgery, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan
| | - Masayuki Matsuoka
- Department of Orthopaedic Surgery, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan
| | - Eri Tarumi
- Department of Orthopaedic Surgery, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan
| | - Takashi Nakamura
- Department of Orthopaedic Surgery, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan
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Wunning J, Allen-Wilson N, Horton E, Sharpe J. Medial Malleolar Osteotomy and Osteochondral Autograft Transfer for Osteochondritis Dissecans of the Distal Tibial Plafond. Foot Ankle Spec 2015; 8:314-9. [PMID: 25212997 DOI: 10.1177/1938640014548419] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
UNLABELLED The literature on the surgical treatment of osteochondritis dissecans of the distal tibial plafond is significantly limited. The purpose of this case study is to present a novel surgical technique to repair osteochondritis dissecans of the distal medial tibial plafond. A retrospective chart and radiographic review of a 15-year-old male was performed with a 24-month follow-up along with a review of the literature. A right angled medial malleolar osteotomy provides adequate exposure, width, and depth of the medial distal tibial plafond allowing for the successful transfer of osteochondral autograft plugs. LEVELS OF EVIDENCE Therapeutic, Level IV: Case report.
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Affiliation(s)
- Jeffrey Wunning
- University Hospitals Richmond Medical Center, Richmond Heights, Ohio
| | | | - Elizabeth Horton
- University Hospitals Richmond Medical Center, Richmond Heights, Ohio
| | - Jonathan Sharpe
- University Hospitals Richmond Medical Center, Richmond Heights, Ohio
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Ross KA, Hannon CP, Deyer TW, Smyth NA, Hogan M, Do HT, Kennedy JG. Functional and MRI outcomes after arthroscopic microfracture for treatment of osteochondral lesions of the distal tibial plafond. J Bone Joint Surg Am 2014; 96:1708-15. [PMID: 25320197 DOI: 10.2106/jbjs.m.01370] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Osteochondral lesions of the distal tibial plafond are uncommon compared with talar lesions. The objective of this study was to assess functional and magnetic resonance imaging (MRI) outcomes following microfracture for tibial osteochondral lesions. METHODS Thirty-one tibial osteochondral lesions in thirty-one ankles underwent arthroscopic microfracture. The Foot and Ankle Outcome Score (FAOS) and Short Form-12 (SF-12) general health questionnaire were used to obtain patient-reported functional outcome scores preoperatively and postoperatively. MRI scans were assessed postoperatively with use of the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score for twenty-three ankles. RESULTS The average age was thirty-seven years (range, fifteen to sixty-eight years), and the average lesion area was 38 mm(2) (range, 7.1 to 113 mm(2)). Twelve ankles had a kissing lesion on the opposing surface of the talus, and two ankles had a concomitant osteochondral lesion elsewhere on the talus. FAOS and SF-12 scores were significantly improved (p < 0.01) at the time of follow-up, at an average of forty-four months. The average postoperative MOCART score was 69.4 (range, 10 to 95), with a lower score in the ankles with kissing lesions (62.8) than in the ankles with an isolated lesion (73.6). Increasing age negatively impacted improvement in SF-12 (p < 0.01) and MOCART (p = 0.04) scores. Increasing lesion area was negatively correlated with MOCART scores (p = 0.04) but was not associated with FAOS or SF-12 scores. Lesion location and the presence of kissing lesions showed no association with functional or MRI outcomes. CONCLUSIONS Arthroscopic microfracture provided functional improvements, but the optimal treatment strategy for tibial osteochondral lesions remains unclear. The repair tissue assessed on MRI was inferior to normal hyaline cartilage. The MRI outcomes appeared to deteriorate with increasing lesion area, and both functional and MRI outcomes appeared to deteriorate with increasing age. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Keir A Ross
- Department of Orthopaedic Surgery, Foot and Ankle Service, Hospital for Special Surgery, 523 East 72nd Street, East River Professional Building, 5th Floor, Room 507, New York, NY 10021. E-mail address for K. Ross: . E-mail address for J.G. Kennedy:
| | - Charles P Hannon
- Department of Orthopaedic Surgery, Foot and Ankle Service, Hospital for Special Surgery, 523 East 72nd Street, East River Professional Building, 5th Floor, Room 507, New York, NY 10021. E-mail address for K. Ross: . E-mail address for J.G. Kennedy:
| | - Timothy W Deyer
- East River Medical Imaging, Department of Radiology, 523 East 72nd Street, New York, NY 10021
| | - Niall A Smyth
- Department of Orthopaedic Surgery, Foot and Ankle Service, Hospital for Special Surgery, 523 East 72nd Street, East River Professional Building, 5th Floor, Room 507, New York, NY 10021. E-mail address for K. Ross: . E-mail address for J.G. Kennedy:
| | - MaCalus Hogan
- Department of Orthopaedic Surgery, Foot and Ankle Service, Hospital for Special Surgery, 523 East 72nd Street, East River Professional Building, 5th Floor, Room 507, New York, NY 10021. E-mail address for K. Ross: . E-mail address for J.G. Kennedy:
| | - Huong T Do
- Department of Orthopaedic Surgery, Foot and Ankle Service, Hospital for Special Surgery, 523 East 72nd Street, East River Professional Building, 5th Floor, Room 507, New York, NY 10021. E-mail address for K. Ross: . E-mail address for J.G. Kennedy:
| | - John G Kennedy
- Department of Orthopaedic Surgery, Foot and Ankle Service, Hospital for Special Surgery, 523 East 72nd Street, East River Professional Building, 5th Floor, Room 507, New York, NY 10021. E-mail address for K. Ross: . E-mail address for J.G. Kennedy:
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Cuttica DJ, Smith WB, Hyer CF, Philbin TM, Berlet GC. Arthroscopic treatment of osteochondral lesions of the tibial plafond. Foot Ankle Int 2012; 33:662-8. [PMID: 22995234 DOI: 10.3113/fai.2012.0662] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Osteochondral lesions of the distal tibial plafond (OLTPs) are an uncommon problem. The purpose of this study was to evaluate clinical outcomes following arthroscopic treatment of OLTPs. METHODS Retrospective chart review was performed on all patients treated arthroscopically for OLTPs. Treatment consisted of generalized synovectomy followed by curettage of the lesion and microfracture. If a cartilage cap was intact, antegrade drilling was performed. Cystic defects were treated with curettage of the cyst and filling of any defect with bone graft. RESULTS A total of 13 patients were included. Nine patients had isolated lesions, while four had lesions of the distal tibial plafond and talar dome. Average followup was 156 (range, 38 to 402 ± 117.9) weeks and average patient age was 32.9 (range, 14 to 50 ± 11.8) years. Eleven of 13 patients were available for followup modified AOFAS score. The average preoperative score was 35.2 (range, 24 to 49 ± 7.1). The average postoperative modified AOFAS score was 50.4 (range, 33 to 56 ± 7.6). There were four patients (30.8%) with a poor outcome. CONCLUSION OLTPs can be challenging to treat. Arthroscopic treatment can lead to improved outcomes. However, the higher incidence of poor outcomes in our series may indicate less predictability in the treatment of OLTPs and that outcomes may not be equivalent to previous reported studies on OLTPs or osteochondral lesions of the talus.
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11
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Synthetic osteochondral grafting of ankle osteochondral lesions. Foot Ankle Surg 2012; 18:114-8. [PMID: 22443998 DOI: 10.1016/j.fas.2011.04.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Revised: 04/01/2011] [Accepted: 04/07/2011] [Indexed: 02/04/2023]
Abstract
BACKGROUND The treatment of osteochondral lesions, especially those with a cystic component or those that have failed the standard arthroscopic procedures can be challenging. Synthetic grafts have several potential advantages over other second line treatments including the fact that only one operation is required and no other joint is violated. METHOD We report the results of the first series of synthetic grafts used in the treatment of osteochondral lesions of the ankle with a minimum of one year follow up. RESULTS There was significant improvement in the American Orthopaedic Foot & Ankle Society (AOFAS) Hindfoot and Ankle Osteoarthritis Scale (AOS) scores and all patients were satisfied with the results of surgery. Magnetic Resonance Imaging (MRI) scans at one year have demonstrated resolution of the bony cysts and surrounding bone marrow oedema but, worryingly, continued to show high signal on the T2 weighted images within the plugs themselves. Qualitative T2 mapping has suggested a fibrous rather than hyaline appearance of the cartilage portions of the plugs. CONCLUSIONS The clinical results have been encouraging but more patients and longer follow up are required before firm conclusions can be drawn.
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