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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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Sudah SY, Moverman MA, Masood R, Mojica ES, Pagani NR, Puzzitiello RN, Menendez ME, Salzler MJ. The Majority of Sports Medicine and Arthroscopy-Related Randomized Controlled Trials Reporting Nonsignificant Results Are Statistically Fragile. Arthroscopy 2023; 39:2071-2083.e1. [PMID: 36868530 DOI: 10.1016/j.arthro.2023.02.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 02/14/2023] [Accepted: 02/16/2023] [Indexed: 03/05/2023]
Abstract
PURPOSE To evaluate the robustness of sports medicine and arthroscopy related randomized controlled trials (RCTs) reporting nonsignificant results by calculating the reverse fragility index (RFI) and reverse fragility quotient (RFQ). METHODS All sports medicine and arthroscopic-related RCTs from January 1, 2010, through August 3, 2021, were identified. Randomized-controlled trials comparing dichotomous variables with a reported P value ≥ .05 were included. Study characteristics, such as publication year and sample size, as well as loss to follow-up and number of outcome events were recorded. The RFI at a threshold of P < .05 and respective RFQ were calculated for each study. Coefficients of determination were calculated to determine the relationships between RFI and the number of outcome events, sample size, and number of patients lost to follow-up. The number of RCTs in which the loss to follow-up was greater than the RFI was determined. RESULTS Fifty-four studies and 4,638 patients were included in this analysis. The mean sample size and loss to follow-up were 85.9 patients and 12.5 patients, respectively. The mean RFI was 3.7, signifying that a change of 3.7 events in one arm was needed to flip the results of the study from non-significant to significant (P < .05). Of the 54 studies investigated, 33 (61%) had a loss to follow-up greater than their calculated RFI. The mean RFQ was 0.05. A significant correlation between RFI with sample size (R2 = 0.10, P = .02) and the total number of observed events (R2 = 0.13, P < .01) was found. No significant correlation existed between RFI and loss to follow-up in the lesser arm (R2 = 0.01, P = .41). CONCLUSIONS The RFI and RFQ are statistical tools that allow the fragility of studies reporting nonsignificant results to be appraised. Using this methodology, we found that the majority of sports medicine and arthroscopy-related RCTs reporting nonsignificant results are fragile. CLINICAL RELEVANCE RFI and RFQ serve as tools that can be used to assess the validity of RCT results and provide additional context for appropriate conclusions.
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Affiliation(s)
- Suleiman Y Sudah
- Department of Orthopedics, Monmouth Medical Center, Long Branch, New Jersey
| | - Michael A Moverman
- Department of Orthopaedic Surgery, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts
| | - Raisa Masood
- Department of Orthopaedic Surgery, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts
| | - Edward S Mojica
- Department of Orthopaedic Surgery, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts
| | - Nicholas R Pagani
- Department of Orthopaedic Surgery, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts
| | - Richard N Puzzitiello
- Department of Orthopaedic Surgery, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts
| | - Mariano E Menendez
- Oregon Shoulder Institute at Southern Oregon Orthopedics, Medford, OR; Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, U.S.A
| | - Matthew J Salzler
- Department of Orthopaedic Surgery, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts.
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Woo I, Park JJ, Seok HG. The Efficacy of Platelet-Rich Plasma Augmentation in Microfracture Surgery Osteochondral Lesions of the Talus: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:4998. [PMID: 37568400 PMCID: PMC10419373 DOI: 10.3390/jcm12154998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 07/11/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023] Open
Abstract
The appropriate surgical management of osteochondral lesions of the talus (OLT) remains a challenge for foot and ankle surgeons. Currently, microfracture (MF) is the first-line operative treatment for small osteochondral lesions. However, the fibrous cartilage regenerated after MF is mechanically inferior to hyaline cartilage regeneration and is susceptible to deterioration over time. Thus, this meta-analysis aimed to elucidate the efficacy of platelet-rich plasma (PRP) augmentation compared with MF only or other adjuvant supplementations combined with the PRP + MF group (others) for the management of OLT. We searched the PubMed, Embase, Web of Science, and Cochrane Library databases for studies that compared the clinical outcomes of patients who underwent MF only and those who underwent PRP or other adjuvant materials such as hyaluronic acid or BST-CarGel. After the screening, four randomized controlled trials and one quasi-randomized controlled trial were included in this review. We used the following tools for clinical evaluation: the American Orthopedic Foot and Ankle Society (AOFAS) score, Ankle-Hindfoot Scale score, Visual Analog Scale (VAS) score for pain, and the Foot and Ankle Ability Measure (FAAM) score. The standardized mean difference (SMD) was used to analyze the differences in outcomes between groups. Patients in the PRP + MF group had superior final VAS and AOFAS scores to the MF only group. (both p < 0.01) However, no significant improvements between baseline and final follow-up were noted in either score. In addition, there was no remarkable difference in the overall FAAM pain measures between the two groups. The PRP + MF and others groups revealed no significant effect differences in the clinical scores. The results of this analysis suggest that PRP + MF would be more favorable and effective than MF only or additional adjuvant supplementation.
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Affiliation(s)
| | | | - Hyun-Gyu Seok
- Department of Orthopedic Surgery, Yeungnam University Medical Center, Daegu 42415, Republic of Korea; (I.W.); (J.J.P.)
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Mahdavi-Jouibari F, Parseh B, Kazeminejad E, Khosravi A. Hopes and opportunities of stem cells from human exfoliated deciduous teeth (SHED) in cartilage tissue regeneration. Front Bioeng Biotechnol 2023; 11:1021024. [PMID: 36860887 PMCID: PMC9968979 DOI: 10.3389/fbioe.2023.1021024] [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: 08/16/2022] [Accepted: 01/30/2023] [Indexed: 02/17/2023] Open
Abstract
Cartilage lesions are common conditions, affecting elderly and non-athletic populations. Despite recent advances, cartilage regeneration remains a major challenge today. The absence of an inflammatory response following damage and the inability of stem cells to penetrate into the healing site due to the absence of blood and lymph vessels are assumed to hinder joint repair. Stem cell-based regeneration and tissue engineering have opened new horizons for treatment. With advances in biological sciences, especially stem cell research, the function of various growth factors in the regulation of cell proliferation and differentiation has been established. Mesenchymal stem cells (MSCs) isolated from different tissues have been shown to increase into therapeutically relevant cell numbers and differentiate into mature chondrocytes. As MSCs can differentiate and become engrafted inside the host, they are considered suitable candidates for cartilage regeneration. Stem cells from human exfoliated deciduous teeth (SHED) provide a novel and non-invasive source of MSCs. Due to their simple isolation, chondrogenic differentiation potential, and minimal immunogenicity, they can be an interesting option for cartilage regeneration. Recent studies have reported that SHED-derived secretome contains biomolecules and compounds that efficiently promote regeneration in damaged tissues, including cartilage. Overall, this review highlighted the advances and challenges of cartilage regeneration using stem cell-based therapies by focusing on SHED.
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Affiliation(s)
- Forough Mahdavi-Jouibari
- Department of Medical Biotechnology, Faculty of Advanced Medical Technologies, Golestan University of Medical Sciences, Gorgan, Iran
| | - Benyamin Parseh
- Stem Cell Research Center, Golestan University of Medical Sciences, Gorgan, Iran,Faculty of Advanced Medical Technologies, Golestan University of Medical Sciences, Gorgan, Iran
| | - Ezatolah Kazeminejad
- Stem Cell Research Center, Golestan University of Medical Sciences, Gorgan, Iran,Dental Research Center, Golestan University of Medical Sciences, Gorgan, Iran,*Correspondence: Ezatolah Kazeminejad, Dr. ; Ayyoob Khosravi,
| | - Ayyoob Khosravi
- Stem Cell Research Center, Golestan University of Medical Sciences, Gorgan, Iran,Department of Molecular Medicine, Faculty of Advanced Medical Technologies, Golestan University of Medical Sciences, Gorgan, Iran,*Correspondence: Ezatolah Kazeminejad, Dr. ; Ayyoob Khosravi,
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5
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Hurley DJ, Davey MS, Hurley ET, Murawski CD, Calder JDF, D'Hooghe P, van Bergen CJA, Walls RJ, Ali Z, Altink JN, Batista J, Bayer S, Berlet GC, Buda R, Dahmen J, DiGiovanni CW, Ferkel RD, Gianakos AL, Giza E, Glazebrook M, Guillo S, Hangody L, Haverkamp D, Hintermann B, Hogan MV, Hua Y, Hunt K, Jamal MS, Karlsson J, Kearns S, Kerkhoffs GMMJ, Lambers K, Lee JW, McCollum G, Mercer NP, Mulvin C, Nunley JA, Paul J, Pearce C, Pereira H, Prado M, Raikin SM, Savage-Elliott I, Schon LC, Shimozono Y, Stone JW, Stufkens SAS, Sullivan M, Takao M, Thermann H, Thordarson D, Toale J, Valderrabano V, Vannini F, van Dijk CN, Walther M, Yasui Y, Younger AS, Kennedy JG. Paediatric ankle cartilage lesions: Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle. J ISAKOS 2022; 7:90-94. [PMID: 35774008 DOI: 10.1016/j.jisako.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 04/03/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND The evidence supporting best practice guidelines in the field of cartilage repair of the ankle are based on both low quality and low levels of evidence. Therefore, an international consensus group of experts was convened to collaboratively advance toward consensus opinions based on the best available evidence on key topics within cartilage repair of the ankle. The purpose of this article is to report the consensus statements on "Pediatric Ankle Cartilage Lesions" developed at the 2019 International Consensus Meeting on Cartilage Repair of the Ankle. METHODS Forty-three international experts in cartilage repair of the ankle representing 20 countries convened to participate in a process based on the Delphi method of achieving consensus. Questions and statements were drafted within four working groups focusing on specific topics within cartilage repair of the ankle, after which a comprehensive literature review was performed and the available evidence for each statement was graded. Discussion and debate occurred in cases where statements were not agreed upon in unanimous fashion within the working groups. A final vote was then held, and the strength of consensus was characterised as follows: consensus: 51-74%; strong consensus: 75-99%; unanimous: 100%. RESULTS A total of 12 statements on paediatric ankle cartilage lesions reached consensus during the 2019 International Consensus Meeting on Cartilage Repair of the Ankle. Five achieved unanimous support, and seven reached strong consensus (>75% agreement). All statements reached at least 84% agreement. CONCLUSIONS This international consensus derived from leaders in the field will assist clinicians with the management of paediatric ankle cartilage lesions.
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Affiliation(s)
- Daire J Hurley
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Martin S Davey
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Eoghan T Hurley
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Christopher D Murawski
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
| | - James D F Calder
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Pieter D'Hooghe
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - Raymond J Walls
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Zakariya Ali
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - J Nienke Altink
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jorge Batista
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Steve Bayer
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Gregory C Berlet
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Roberto Buda
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jari Dahmen
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - Richard D Ferkel
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Arianna L Gianakos
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Eric Giza
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Mark Glazebrook
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Stéphane Guillo
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Laszlo Hangody
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Daniel Haverkamp
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Beat Hintermann
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - MaCalus V Hogan
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Yinghui Hua
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Kenneth Hunt
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - M Shazil Jamal
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jón Karlsson
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Stephen Kearns
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Gino M M J Kerkhoffs
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Kaj Lambers
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jin Woo Lee
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Graham McCollum
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Nathaniel P Mercer
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Conor Mulvin
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - James A Nunley
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jochen Paul
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Christopher Pearce
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Helder Pereira
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Marcelo Prado
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Steven M Raikin
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Ian Savage-Elliott
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Lew C Schon
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Yoshiharu Shimozono
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - James W Stone
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Sjoerd A S Stufkens
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Martin Sullivan
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Masato Takao
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Hajo Thermann
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - David Thordarson
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - James Toale
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Victor Valderrabano
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Francesca Vannini
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - C Niek van Dijk
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Markus Walther
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Youichi Yasui
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Alastair S Younger
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - John G Kennedy
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Brulc U, Drobnič M, Kolar M, Stražar K. A prospective, single-center study following operative treatment for osteochondral lesions of the talus. Foot Ankle Surg 2022; 28:714-719. [PMID: 34518042 DOI: 10.1016/j.fas.2021.08.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/22/2021] [Accepted: 08/21/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND (1) To evaluate patient-reported outcomes and revision surgeries after various operative interventions for osteochondral lesions of the talus (OLT) in a prospective single center series over 10 years, and (2) to identify predicting factors related to subjective ankle status and quality of life pre- and postoperatively. METHODS Ninety-nine patients underwent operative treatment due to primary or recurrent OLT, with an average follow up 3.5 (1.8) years. Treatment outcome was followed clinically (FAOS, EQ-5D, Tegner activity scale) and by pursuing any serious adverse events or graft failures. RESULTS There were 80 responding patients (81%) for the study. The mean lesion size was 2.0 (1.1) cm2. All FAOS values increased from preoperative to final follow-up values (Symptoms 60-68, Pain 58-69, ADL 71-80, Sport 36-54, QoL 30-45). EQ-5D increased from 0.49 to 0.62, while Tegner activity scale change from 3.2 to 3.4. There were 19 (24%) serious adverse events recorded; 13 (16%) of them were graft-related. Graft survival rates were 100% at 1 year, 94% (males)/93% (females) at 2 years, and 77% (males)/47% (females) at 5 years. Female gender, higher BMI, and higher Kellgren-Lawrence ankle OA score were negative predictors for preoperative patient-reported ankle joint status. The foremost improvement after operative intervention was observed in patients with large osteochondral lesions without postoperative adverse events. CONCLUSION Various operative interventions for OLT significantly improved patients' ankle status and quality of life. High graft survival rates were demonstrated over first two years, but notable decline was confirmed thereafter, especially in female patients.
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Affiliation(s)
- Urban Brulc
- Chair of Orthopaedics, Faculty of Medicine, University of Ljubljana, Kongresni trg 12, 1000 Ljubljana, Slovenia; Sanatorij MD Medicina, Bohoričeva ulica 5, 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, Kongresni trg 12, 1000 Ljubljana, Slovenia
| | - 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, Kongresni trg 12, 1000 Ljubljana, Slovenia
| | - Klemen Stražar
- Department of Orthopaedic Surgery, University Medical Centre Ljubljana, Zaloška cesta 9, 1000 Ljubljana, Slovenia; Chair of Orthopaedics, Faculty of Medicine, University of Ljubljana, Kongresni trg 12, 1000 Ljubljana, Slovenia
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7
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Allahabadi S, Johnson B, Whitney M, Oji D, Chou L, Lau BC. Short-term outcomes following dehydrated micronized allogenic cartilage versus isolated microfracture for treatment of medial talar osteochondral lesions. Foot Ankle Surg 2022; 28:642-649. [PMID: 34366249 DOI: 10.1016/j.fas.2021.07.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/08/2021] [Accepted: 07/17/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Osteochondral lesions of the talus (OLTs) have been traditionally treated with bone marrow stimulation techniques such as microfracture. However, conventional microfracture results in a biomechanically weaker repair tissue of predominantly type I collagen. Acellular micronized cartilage matrix (MCM) serves as a bioactive scaffold to restore hyaline cartilage. The purpose was to compare short-term outcomes after microfracture with and without augmentation with MCM for medial-sided OLTs. METHODS A retrospective review was performed between 2010-2019 for medial-sided OLTs undergoing treatment with either microfracture augmented with MCM or isolated microfracture. The MCM was hydrated with either bone marrow aspirate concentrate (BMAC) or platelet-rich plasma (PRP). Outcomes included visual analogue scale (VAS) pain scores, Foot and Ankle Activity Measure (FAAM) scores, return-to-daily activities, and return-to-sport. RESULTS 48 patients (14 MCM with PRP, 6 MCM with BMAC; 28 isolated microfracture) with average age 35.5 years (range: 13.8-67.2 years) and mean follow-up 4.0 ± 3.4 years (range,.13-10.7) were included. There was no difference in average lesion size between MCM and microfracture groups (64.0 ± 49.4 mm2 versus 57.3 ± 44.2 mm2, P = .63) and a trend toward larger lesion size for BMAC compared to PRP (106.5 ± 59.2 versus 45.9 ± 32.1 mm2, P = .056). There was no difference in time to return-to-activity (83.5 ± 18.8 versus 87.3 ± 49.1 days) or return-to-sports (151.9 ± 62.2 versus 165 ± 99.2 days) with MCM versus isolated microfracture. However, the MCM group had a significantly greater improvement in VAS pain score at final follow-up (4.9 ± 2.2 versus 2.7 ± 2.6, P = .0032) and significantly higher post-operative FAAM-Activities of Daily Living subscale scores (97.2 ± 8.2 versus 79.7 ± 32.8, P = .033). CONCLUSIONS Augmenting microfracture with MCM hydrated with PRP or BMAC may result in beneficial changes in pain scores and activities of daily living, but similar return-to-activities and return-to-sport times compared to microfracture alone in management of medial OLT. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Sachin Allahabadi
- University of California, San Francisco, Department of Orthopaedic Surgery, San Francisco, CA, USA
| | - Brianna Johnson
- Stanford University, Department of Orthopaedic Surgery, Palo Alto, CA, USA
| | - Malinda Whitney
- Stanford University, Department of Orthopaedic Surgery, Palo Alto, CA, USA
| | - David Oji
- Stanford University, Department of Orthopaedic Surgery, Palo Alto, CA, USA
| | - Loretta Chou
- Stanford University, Department of Orthopaedic Surgery, Palo Alto, CA, USA
| | - Brian C Lau
- Duke Sport Science Institute, Division of Sports Medicine, Department of Orthopaedic Surgery, Duke University, Durham, NC, USA.
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8
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Stephens AR, Garcia BN, Rogers MJ, Zhang C, Himbert C, McFarland MM, Presson AP, Kazmers NH, Tyser AR. Scaphotrapeziotrapezoid Arthrodesis: Systematic Review. J Hand Surg Am 2022; 47:218-227.e2. [PMID: 35033404 DOI: 10.1016/j.jhsa.2021.09.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 05/10/2021] [Accepted: 09/21/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE Scaphotrapeziotrapezoid (STT) arthrodesis surgery is used for various types of wrist pathologies. The objective of our study was to perform a systematic review of complications and outcomes after STT arthrodesis. METHODS Several major databases were used to perform a systematic literature review in order to obtain articles reporting complications and outcomes following STT arthrodesis. The primary purpose was to identify rates of nonunion and conversion to total wrist arthrodesis. Secondary outcomes included wrist range of motion, grip strength, and Disabilities of the Arm Shoulder and Hand scores. A multivariable analysis was performed to evaluate factors associated with the primary and secondary outcomes of interest. RESULTS Out of the 854 records identified in the primary literature search, 30 studies were included in the analysis. A total of 1,429 procedures were performed for 1,404 patients. The pooled nonunion rate was 6.3% (95% CI, 3.5-9.9) and the rate of conversion to total wrist arthrodesis following the index STT was 4.2% (95% CI, 2.2-6.7). The mean pooled wrist flexion was 40.7° (95% CI, 30.8-50.5) and extension was 49.7° (95% CI, 43.5-55.8). At final follow-up, the mean pooled grip strength was 75.9% (95% CI, 69.3-82.5) of the nonsurgical contralateral hand. Compared with all other known indications, Kienbock disease had a statistically significant lower nonunion rate (14.1% vs 3.3%, respectively). Mixed-effects linear regression using patient-level data revealed that increasing age was significantly associated with complications, independent of occupation and diagnosis. CONCLUSIONS Our study demonstrated a low failure rate and conversion to total wrist arthrodesis after STT arthrodesis and acceptable postoperative wrist range of motion and strength when compared to the contralateral hand. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
| | | | - Miranda J Rogers
- Department of Orthopaedics, University of Utah, Salt Lake City, UT
| | - Chong Zhang
- Division of Public Health, University of Utah, Salt Lake City, UT
| | | | - Mary M McFarland
- Eccles Health Sciences Library, University of Utah, Salt Lake City, UT
| | | | | | - Andrew R Tyser
- Department of Orthopaedics, University of Utah, Salt Lake City, UT.
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9
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Ettinger S, Gottschalk O, Kostretzis L, Plaas C, Körner D, Walther M, Becher C. One-year follow-up data from the German Cartilage Registry (KnorpelRegister DGOU) in the treatment of chondral and osteochondral defects of the talus. Arch Orthop Trauma Surg 2022; 142:205-210. [PMID: 33047231 DOI: 10.1007/s00402-020-03631-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 09/30/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Chondral and osteochondral lesions of the talus (OLTs) remain a challenging issue with numerous operative treatments proposed to date. The aim of this study was to evaluate 1-year follow-up data in the German Cartilage Registry (KnorpelRegister DGOU). METHODS Among 401 patients in the database, 114 patients with a complete 1-year Foot and Ankle Outcome (FAOS) score for subscale Pain as the primary variable were included. A total of 12 different surgical treatments were performed. However, 8 techniques were carried out in negligible numbers of patients (n = 1-3), leaving 89 patients treated with the following techniques: arthroscopic antegrade bone marrow stimulation (group A; n = 32), autologous chondrocyte implantation with autologous cancellous bone grafting (group B; n = 9), matrix-augmented bone marrow stimulation (group C; n = 22), and matrix-augmented bone marrow stimulation with autologous cancellous bone grafting (group D; n = 26). Group differences and possible influencing variables such as age and sex were evaluated. Level of significance was set at p < 0.05 for all statistical tests. RESULTS All four treatment groups showed significant improvement of the FAOS scores at 1 year postoperatively compared with their preoperative scores. No significant differences were found with respect to score changes among the groups. A positive correlation between FAOS subscale Pain improvement and defect size volume and negative correlations between increasing age and FAOS subscales Sports/Rec and QoL were found. Concomitant ankle stabilization led to greater improvement in FAOS subscales Symptoms and ADL than in patients with no stabilization. FAOS subscale Pain showed greater improvement in women than in men. CONCLUSION All analyzed treatment options were effective for treatment of OLTs. In particular, large defects appeared to benefit from treatment. In the presence of concomitant ankle instability, a stabilizing procedure appeared to have a positive impact on the outcome.
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Affiliation(s)
- S Ettinger
- Orthopädische Klinik der Medizinischen Hochschule Hannover (MHH) im Diakovere Annastift, Anna-von-Borries-Str. 1-7, 30625, Hannover, Germany
| | - O Gottschalk
- Zentrum für Fuss- and Sprunggelenkchirurgie, (MHA) Schön Klinik München Harlaching, Harlachinger Str. 51, 81547, München, Germany
| | - L Kostretzis
- International Center for Orthopedics, ATOS Clinic Heidelberg, Bismarckstr. 9-15, 69115, Heidelberg, Germany
| | - C Plaas
- Orthopädische Klinik der Medizinischen Hochschule Hannover (MHH) im Diakovere Annastift, Anna-von-Borries-Str. 1-7, 30625, Hannover, Germany
| | - D Körner
- Department of Traumatology and Reconstructive Surgery, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Schnarrrenbergstr. 95, 72076, Tübingen, Germany
| | - M Walther
- Zentrum für Fuss- and Sprunggelenkchirurgie, (MHA) Schön Klinik München Harlaching, Harlachinger Str. 51, 81547, München, Germany
| | - C Becher
- Orthopädische Klinik der Medizinischen Hochschule Hannover (MHH) im Diakovere Annastift, Anna-von-Borries-Str. 1-7, 30625, Hannover, Germany. .,International Center for Orthopedics, ATOS Clinic Heidelberg, Bismarckstr. 9-15, 69115, Heidelberg, Germany.
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10
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Murawski CD, Jamal MS, Hurley ET, Buda R, Hunt K, McCollum G, Paul J, Vannini F, Walther M, Yasui Y, Ali Z, Altink JN, Batista J, Bayer S, Berlet GC, Calder JD, Dahmen J, Davey MS, D’Hooghe P, DiGiovanni CW, Ferkel RD, Gianakos AL, Giza E, Glazebrook M, Hangody L, Haverkamp D, Hintermann B, Hua Y, Hurley DJ, Karlsson J, Kearns S, Kennedy JG, Kerkhoffs GM, Lambers K, Lee JW, Mercer NP, Mulvin C, Nunley JA, Pearce C, Pereira H, Prado M, Raikin SM, Savage-Elliott I, Schon LC, Shimozono Y, Stone JW, Stufkens SA, Sullivan M, Takao M, Thermann H, Thordarson D, Toale J, Valderrabano V, van Bergen CJ, Niek van Dijk C, Walls RJ, Younger AS, Hogan MV. Terminology for Osteochondral Lesions of the Ankle Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle. J ISAKOS 2022; 7:62-66. [DOI: 10.1016/j.jisako.2021.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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11
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Spennacchio P, Seil R, Mouton C, Scheidt S, Cucchi D. Anatomic reconstruction of lateral ankle ligaments: is there an optimal graft option? Knee Surg Sports Traumatol Arthrosc 2022; 30:4214-4224. [PMID: 35916928 PMCID: PMC9668940 DOI: 10.1007/s00167-022-07071-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 07/11/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Different graft options are available for the reconstruction of lateral ankle ligaments to treat chronic ankle instability (CAI), which fall in two categories: allografts and autografts. This study aims to provide an updated comparison of the clinical outcomes after stabilisation procedures using allografts and autografts, to correctly advise the clinician during the choice of the best material to be used for the reconstruction of the lateral ligamentous complex of the ankle. METHODS A systematic review was performed to analyse the use of autografts and allografts for anatomic reconstruction of the lateral ligamentous complex of the ankle in CAI patients. The presence of a postoperative assessment through outcome measures with proofs of validation in the CAI population or patient's subjective evaluation on the treatment were necessary for inclusion. The quality of the included studies was assessed through the modified Coleman Methodology Score (mCMS). Relevant clinical outcome data were pooled to provide a synthetic description of the results in different groups or after different procedures. RESULTS Twenty-nine studies (autograft: 19; allograft: 9; both procedures: 1) accounting for 930 procedures (autograft: 616; allograft: 314) were included. The average mCMS was 55.9 ± 10.5 points. The Karlsson-Peterson scale was the most frequently reported outcome scale, showing a cumulative average post- to preoperative difference of 31.9 points in the autograft group (n = 379, 33.8 months follow-up) and of 35.7 points in the allograft group (n = 227, 25.8 months follow-up). Patient satisfaction was good or excellent in 92.8% of autograft (n = 333, 65.2 months follow-up) and in 92.3% of allograft procedures (n = 153, 25.0 months follow-up). Return to activity after surgery and recurrence of instability were variably reported across the studies with no clear differences between allograft and autograft highlighted by these outcomes. CONCLUSIONS The systematic analysis of validated CAI outcome measures and the patient's subjective satisfaction does not support a specific choice between autograft and allograft for the reconstruction of the ankle lateral ligamentous complex in CAI patients. Both types of grafts were associated to a postoperative Karlsson-Peterson score superior to 80 points and to a similar rate of patient's subjective satisfaction. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Pietro Spennacchio
- Department of Orthopaedic Surgery, Centre Hospitalier de Luxembourg-Clinique d’Eich, Luxembourg, Luxembourg
| | - Romain Seil
- Department of Orthopaedic Surgery, Centre Hospitalier de Luxembourg-Clinique d’Eich, Luxembourg, Luxembourg ,Sports Medicine Research Laboratory, Luxembourg Institute of Health, Luxembourg, Luxembourg
| | - Caroline Mouton
- Department of Orthopaedic Surgery, Centre Hospitalier de Luxembourg-Clinique d’Eich, Luxembourg, Luxembourg ,Sports Medicine Research Laboratory, Luxembourg Institute of Health, Luxembourg, Luxembourg
| | - Sebastian Scheidt
- Department of Orthopaedics and Trauma Surgery, Universitätsklinikum Bonn, Bonn, Germany
| | - Davide Cucchi
- Department of Orthopaedics and Trauma Surgery, Universitätsklinikum Bonn, Bonn, Germany.
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12
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Nott E, Matheny LM, Clanton TO, Lockard C, Douglass BW, Tanghe KK, Matta N, Brady AW. Accessibility and Thickness of Medial and Lateral Talar Body Cartilage for Treatment of Ankle and Foot Osteochondral Lesions. Foot Ankle Int 2021; 42:1330-1339. [PMID: 34049457 DOI: 10.1177/10711007211015189] [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: 02/01/2023]
Abstract
BACKGROUND The purposes of this study were to determine (1) if cartilage thicknesses on the talar dome and medial/lateral surfaces of the talus were similar, (2) whether there was sufficient donor cartilage surface area on the medial and lateral talar surfaces to repair talar dome cartilage injuries of the talus, and (3) whether the cartilage surface could be increased following anterior talofibular ligament (ATFL) and sectioning of the tibionavicular and tibiospring portion of the anterior deltoid. METHODS Medial and lateral approaches were utilized in 8 cadaveric ankles to identify the accessible medial, lateral, and talar dome cartilage surfaces in 3 conditions: (1) intact, (2) ATFL release, and (3) superficial anterior deltoid ligament release. The talus was explanted, and the cartilage areas were digitized with a coordinate measuring machine. Cartilage thickness was quantified using a laser scanner. RESULTS The mean cartilage thickness was 1.0 ± 0.1 mm in all areas tested. In intact ankles, the medial side of the talus showed a larger total area of available cartilage than the lateral side (152 mm2 vs 133 mm2). ATFL release increased the available cartilage area on the medial and lateral sides to 167 mm2 and 194 mm2, respectively. However, only the lateral talar surface had sufficient circular graft donor cartilage available for autologous osteochondral transplantation (AOT) procedures of the talus. After ATFL and deltoid sectioning, there was an increase in available graft donor cartilage available for AOT procedures. CONCLUSION The thickness of the medial and lateral talar cartilage surfaces is very similar to that of the talar dome cartilage surface, which provides evidence that the medial and lateral surfaces may serve as acceptable AOT donor cartilage. The surface area available for AOT donor site grafting was sufficient in the intact state; however, sectioning the ATFL and superficial anterior deltoid ligament increased the overall lateral talar surface area available for circular grafting for an AOT procedure that requires a larger graft. These results support the idea that lateral surfaces of the talus may be used as donor cartilage for an AOT procedure since donor and recipient sites are similar in cartilage thickness, and there is sufficient cartilage surface area available for common lesion sizes in the foot and ankle. CLINICAL RELEVANCE This anatomical study investigates the feasibility of talar osteochondral autografts from the medial or lateral talar surfaces exposed with standard approaches. It confirms the similar cartilage thickness of the talar dome and the ability to access up to an 8- to 10-mm donor graft from the lateral side of the talus after ligament release. This knowledge may allow better operative planning for use of these surfaces for osteochondral lesions within the foot and ankle, particularly in certain circumstances of a revision microfracture.
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Affiliation(s)
- Erik Nott
- The Steadman Clinic, Vail, CO, USA.,The Steadman Philippon Research Institute, Vail, CO, USA
| | | | | | - Carly Lockard
- The Steadman Philippon Research Institute, Vail, CO, USA
| | | | - Kira K Tanghe
- The Steadman Philippon Research Institute, Vail, CO, USA
| | - Nicholas Matta
- The Steadman Philippon Research Institute, Vail, CO, USA
| | - Alex W Brady
- The Steadman Philippon Research Institute, Vail, CO, USA
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13
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Smyth NA, Murawski CD, Hannon CP, Kaplan JR, Aiyer AA. The Use of a Synthetic Cartilage Implant for Hallux Rigidus: A Systematic Review. Foot Ankle Spec 2021; 14:366-371. [PMID: 32618201 DOI: 10.1177/1938640020937160] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background. Hallux rigidus is a common pathology afflicting the foot, for which various joint salvage techniques have been described with a multitude of different implants. Recently, a synthetic cartilage implant composed of polyvinyl alcohol (PVA) received FDA premarket approval for the treatment of arthritis of the great toe. The purpose of this study was to (1) systematically review the clinical evidence supporting the use of a PVA implant in hallux rigidus and (2) determine the strength of the recommendation that can be made supporting the use of a PVA implant by evaluating the quality of evidence available. Methods. A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. Using the terms "cartiva OR polyvinyl alcohol OR synthetic cartilage OR hemiarthroplasty AND hallux rigidus OR great toe arthritis OR first toe arthritis" we searched the PubMed/Medline database. The quality of the included studies was evaluated using the American Academy of Orthopaedic Surgeons Clinical Practice Guideline and Systematic Review Methodology. Results. Seven studies met the inclusion criteria, 6 of these were derived from a single randomized controlled trial. A moderate recommendation can be given for the use of a PVA implant for hallux rigidus based on short-term outcomes. A limited recommendation can be given for the use of a PVA implant for hallux rigidus based on mid-term outcomes. Conclusion. There are limited studies available detailing the outcomes of a PVA implant for hallux rigidus; however, the results that are available demonstrate a high level of evidence.Levels of Evidence: Level I: Systematic review.
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Affiliation(s)
- Niall A Smyth
- Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, Florida (NAS).,Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (CDM).,Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA (CPH).,Orthopaedic Specialty Institute, Orange, California (JRK).,Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, Miami, Florida (AAA)
| | - Christopher D Murawski
- Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, Florida (NAS).,Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (CDM).,Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA (CPH).,Orthopaedic Specialty Institute, Orange, California (JRK).,Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, Miami, Florida (AAA)
| | - Charles P Hannon
- Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, Florida (NAS).,Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (CDM).,Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA (CPH).,Orthopaedic Specialty Institute, Orange, California (JRK).,Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, Miami, Florida (AAA)
| | - Jonathan R Kaplan
- Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, Florida (NAS).,Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (CDM).,Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA (CPH).,Orthopaedic Specialty Institute, Orange, California (JRK).,Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, Miami, Florida (AAA)
| | - Amiethab A Aiyer
- Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, Florida (NAS).,Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (CDM).,Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA (CPH).,Orthopaedic Specialty Institute, Orange, California (JRK).,Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, Miami, Florida (AAA)
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14
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Allahabadi S, Feeley SE, Lansdown DA, Pandya NK, Feeley BT. Influential Articles on Pediatric and Adolescent Anterior Cruciate Ligament Injuries: A Bibliometric Analysis. Orthop J Sports Med 2021; 9:23259671211010772. [PMID: 34164558 PMCID: PMC8191091 DOI: 10.1177/23259671211010772] [Citation(s) in RCA: 3] [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: 09/22/2020] [Accepted: 02/09/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The understanding of pediatric anterior cruciate ligament (ACL) injuries and optimal treatment has evolved significantly. Influential articles have been previously evaluated using article citations to determine impact. PURPOSE To identify and characterize the 50 most cited and recent influential articles relating to pediatric and adolescent ACL injuries, to examine trends in publication characteristics, and to evaluate correlations of study citations with quality of evidence. STUDY DESIGN Cross-sectional study. METHODS The top 50 most cited articles on pediatric and adolescent ACL injuries were gathered using the Web of Science and Scopus online databases by averaging the number of citations from each database. Articles from recent years were also aggregated and sorted by citation density (citations/year). Publication and study characteristics were recorded. Level of evidence and methodologic quality were assessed where applicable using the modified Coleman Methodology Score (mCMS), modified Jadad scale, and Methodological Index for Non-Randomized Studies (MINORS). Spearman correlation was used to evaluate the association between citation data and level of evidence or methodologic quality scorings. RESULTS The top 50 cited papers had a mean of 117.5 ± 58.8 citations (range, 58.5-288.5 citations), with a mean citation density of 9.4 ± 5.4 citations per year (range, 2.9-25.8 citations/year); 80% were published in 2000 or later, and 6% were considered basic science. Articles were mainly level 4 evidence (27/42; 64.3%), and none was level 1. There were moderate, significant associations between publication year and level of evidence (r S = -0.45; P = .0030) and citation density and publication year (r S = 0.59; P < .001). Mean methodologic quality scores were as follows: mCMS, 53 ± 7.2 (range, 39-68); modified Jadad scale, 3.2 ± 1.1 (range, 2-6); and MINORS, 11.2 ± 3.2 (range, 6-20). There was a significant, strong correlation between rank of mean citations and modified Jadad scale (r S = 0.76; P < .0001), suggesting poorer score associated with more mean citations. CONCLUSION Influential articles on pediatric and adolescent ACL injuries were relatively recent, with a low proportion of basic science-type articles. Most of the studies had a lower evidence level and poor methodologic quality scores. Higher methodologic quality did not correlate positively with citation data.
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Affiliation(s)
- Sachin Allahabadi
- Department of Orthopaedic Surgery, University of California, San Francisco; San Francisco, California, USA
| | - Sonali E. Feeley
- Department of Orthopaedic Surgery, University of California, San Francisco; San Francisco, California, USA
| | - Drew A. Lansdown
- 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 T. Feeley
- Department of Orthopaedic Surgery, University of California, San Francisco; San Francisco, California, USA
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15
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Pontoh LAP, Ismail HD, Fiolin J, Yausep OE. Pain Following Single-bundle versus Double-bundle Anterior Cruciate Ligament Reconstruction: A Systematic Review. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.5995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Double-bundle (DB) anterior cruciate ligament reconstruction (ACLR) has been known to result in better functional outcomes, joint stability, and lower revision rates compared to single-bundle (SB) ACLR. However, given the increased invasiveness and damage to the surrounding tissue area, it is proposed that it may be associated with increased pain.
AIM: This review aims to gather all studies and literature that reported pain as an outcome when comparing SB versus DB ACLR.
METHODS: Literature searching was conducted across seven search engines for studies reporting pain as an outcome and comparing SB versus DB ACLR.
RESULTS: Eight studies met the eligibility criteria and were included in the study. Overall, the studies show variable findings regarding pain in DB compared to SB ACLR, with the only statistically significant results from two studies indicating that DB ACLR is associated with more pain than SB ACLR.
CONCLUSION: Based on the limited evidence available, no conclusions can be made regarding the pain experienced between people receiving either procedure. This constitutes a need for additional studies with increased follow-up time periods, larger sample size, and better study design.
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16
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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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17
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Autologous osteochondral transplantation for osteochondral lesions of the talus: high rate of return to play in the athletic population. Knee Surg Sports Traumatol Arthrosc 2021; 29:1554-1561. [PMID: 32856096 DOI: 10.1007/s00167-020-06216-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 08/06/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE (1) To determine the rate of return to play following autologous osteochondral transplantation (AOT) for osteochondral lesions of the talus (OLT) and (2) report subsequent rehabilitation protocols. METHODS A systematic review of the PubMed, Embase, and The Cochrane Library databases was performed according to the PRISMA guidelines based on specific eligibility criteria. Return to play data was meta-analysed and subsequent rehabilitation protocols were summarised. Level of evidence and quality of evidence (Zaman's criteria) were also evaluated. RESULTS Nine studies that totalled 205 ankles were included for review. The mean follow-up was 44.4 ± 25.0 (range 16-84) months. The mean OLT size was 135.4 ± 56.4 mm2. The mean time to return to play was 5.8 ± 2.6 months. The mean rate of return to play was 86.3% (range 50-95.2%), with 81.8% of athletes returning to pre-injury status. Based on the fixed-effect model, the rate of return to play was 84.07%. Significant correlation was found between increase age and decrease rate of return to play (R2 = 0.362, p = 0.00056). There was no correlation between OLT sizes and rate of return to play (R2 = 0.140, p = 0.023). The most common time to ankle motion post-surgery was immediately and the most common time to full weight-bearing was 12 weeks. CONCLUSIONS This systematic review indicated a high rate of return to play following AOT in the athletic population. Size of OLT was not found to be a predictor of return to play, whereas advancing age was a predictor. Rehabilitation protocols were largely inconsistent and were primarily based on individual surgeon protocols. However, the included studies were of low level and quality of evidence. LEVEL OF EVIDENCE Level IV.
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Walther M, Valderrabano V, Wiewiorski M, Usuelli FG, Richter M, Baumfeld TS, Kubosch J, Gottschalk O, Wittmann U. Is there clinical evidence to support autologous matrix-induced chondrogenesis (AMIC) for chondral defects in the talus? A systematic review and meta-analysis. Foot Ankle Surg 2021; 27:236-245. [PMID: 32811744 DOI: 10.1016/j.fas.2020.07.011] [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: 05/10/2020] [Revised: 06/10/2020] [Accepted: 07/29/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND The aim of this study is to systematically review the literature on clinical outcomes of patients who have undergone autologous matrix-induced chondrogenesis (AMIC) for treatment of osteochondral lesions of the talus (OCL) and compare the studies' outcomes. METHODS Pubmed and Embase were searched in January 2020 for articles concerning OCL surgery. Studies were included if they had a minimum 1-year follow-up and the primary measures were functional outcomes. The meta-analysis compared the Visual Analogic Score (VAS), the American Orthopedic Foot and Ankle Score (AOFAS), and the Foot Function Index (FFI) between baseline and follow-up of 1-2years, and 3-5years. A random effects model was used to evaluate outcome changes. RESULTS The search returned 15 studies, with a total of 492 patients. The VAS improved 4.45 and 4.6 points from baseline to the 1-2year and 3-5yearfollow-up, respectively (p<0.001). AOFAS improved 31.59 and 32.47 points from baseline to the 1-2year and 3-5yearfollow-up, respectively (p<0.001). The FFI showed a significant improvement of 30.93 points from baseline to year 3-5 (p<0.001). A total of 6 patients with revision surgeries have been reported within the follow up period. It was not possible to correlate clinical features like lesion size, surgical approach, and bone marrow stimulation technique to the reported outcome. CONCLUSION Surgical treatment of OCL via the AMIC procedure provided significant improvement in the functional outcome and pain scores when compared to the pre-operative values. Improvements were observed up to 5years post-operatively.
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Affiliation(s)
- Markus Walther
- Schön Klinik München Harlaching - FIFA Medical Centre, Harlachinger Straße 51, 81547 München, Germany.
| | - Victor Valderrabano
- Swiss Ortho Center Schmerzklinik Basel, Swiss Medical Network, Hirschgässlein 15, 4010 Basel, Switzerland.
| | - Martin Wiewiorski
- Kantonspital Winterthur, Zeughausstrasse 73, 8400 Winterthur, Switzerland.
| | - Federico Giuseppe Usuelli
- Istituto Ortopedico Galeazzi, USPeC - Unità Specialistica Piede e Caviglia, Foot and Ankle Department, Italy.
| | - Martinus Richter
- Klinik for Foot and Ankle Surgery, Rummelsberg 71, 90592 Schwarzenbruck, Germany.
| | - Tiago Soares Baumfeld
- Hospital Felicio Rocho, Department of Orthopaedics, Av. do Contorno, 9530 Belo Horizonte, MG, Brazil.
| | - Johanna Kubosch
- Department of Orthopedics and Trauma Surgery, Medical Center, Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany.
| | - Oliver Gottschalk
- Department of General, Trauma and Reconstructive Surgery, University Hospital, LMU, Munich, Germany; Schön Klinik München Harlaching - FIFA Medical Centre, Harlachinger Straße 51, 81547 München, Germany.
| | - Udo Wittmann
- Consult AG, Tramstrasse 10, 8050 Zürich, Switzerland.
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Roth KE, Ossendorff R, Klos K, Simons P, Drees P, Salzmann GM. Arthroscopic Minced Cartilage Implantation for Chondral Lesions at the Talus: A Technical Note. Arthrosc Tech 2021; 10:e1149-e1154. [PMID: 33981564 PMCID: PMC8085507 DOI: 10.1016/j.eats.2021.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 01/10/2021] [Indexed: 02/03/2023] Open
Abstract
In the past few years, autologous chondrocyte implantation has been shown to be the most suitable cartilage reconstructive technique with the best tissue quality. Although this method is part of the standard surgical repertoire in the knee joint, it has so far not been an established method in the ankle because there are no prospective randomized controlled studies to prove a significant advantage over alternative methods of cartilage repair. The methods most frequently used in this context (e.g., marrow stimulation techniques) can, however, at most generate hyaline-like and thus biomechanically inferior regenerates. Minced cartilage implantation, on the other hand, is a relatively simple and cost-effective 1-step procedure with promising biological potential and-at least in the knee joint-satisfactory clinical results. We present an arthroscopic surgical technique by which the surgeon can apply autologous chondrocytes in a 1-step procedure (AutoCart; Arthrex, Munich, Germany) to treat articular cartilage defects in the ankle joint.
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Affiliation(s)
| | - Robert Ossendorff
- Department for Orthopaedics and Trauma, University Hospital Bonn, Bonn, Germany
| | | | | | - Philipp Drees
- Department for Orthopaedics and Trauma, University Hospital Mainz, Mainz, Germany
| | - Gian M. Salzmann
- Gelenkzentrum Rhein-Main, Hochheim, Germany
- Schulthess Clinic, Zurich, Switzerland
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Mok TN, He Q, Panneerselavam S, Wang H, Hou H, Zheng X, Pan J, Li J. Open versus arthroscopic ankle arthrodesis: a systematic review and meta-analysis. J Orthop Surg Res 2020; 15:187. [PMID: 32448398 PMCID: PMC7247192 DOI: 10.1186/s13018-020-01708-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 05/13/2020] [Indexed: 12/26/2022] Open
Abstract
Background Osteoarthritis (OA) is a growing health concern that affects approximately 27 million people in the USA and is associated with a $185 billion annual cost burden. Choosing between open surgery and arthroscopic arthrodesis for ankle arthritis is still controversial. This study compared arthroscopic arthrodesis and open surgery by performing a systematic review and meta-analysis. Methods For the systematic review, a literature search was conducted in 4 English databases (PubMed, Embase, Medline and the Cochrane Library) from inception to February 2020. Three prospective cohort studies and 7 retrospective cohort studies, enrolling a total of 507 patients with ankle arthritis, were included. Results For fusion rate, the pooled data showed a significantly higher rate of fusion during arthroscopic arthrodesis compared with open surgery (odds ratio 0.25, 95% CI 0.11 to 0.57, p = 0.0010). Regarding estimated blood loss, the pooled data showed significantly less blood loss during arthroscopic arthrodesis compared with open surgery (WMD 52.04, 95% CI 14.14 to 89.94, p = 0.007). For tourniquet time, the pooled data showed a shorter tourniquet time during arthroscopic arthrodesis compared with open surgery (WMD 22.68, 95% CI 1.92 to 43.43, p = 0.03). For length of hospital stay, the pooled data showed less hospitalisation time for patients undergoing arthroscopic arthrodesis compared with open surgery (WMD 1.62, 95% CI 0.97 to 2.26, p < 0.00001). The pooled data showed better recovery for the patients who underwent arthroscopic arthrodesis compared with open surgery at 1 year (WMD 14.73, 95% CI 6.66 to 22.80, p = 0.0003). Conclusion In conclusion, arthroscopic arthrodesis was associated with a higher fusion rate, smaller estimated blood loss, shorter tourniquet time, and shorter length of hospitalisation than open surgery.
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Affiliation(s)
- Tsz Ngai Mok
- Department of Sport Medicine, First Affiliated Hospital of Jinan University, Guangzhou, 510630, Guangdong, China.,International School, Jinan University, Guangzhou, 510632, Guangdong, China
| | - Qiyu He
- Department of Sport Medicine, First Affiliated Hospital of Jinan University, Guangzhou, 510630, Guangdong, China.,International School, Jinan University, Guangzhou, 510632, Guangdong, China
| | | | - Huajun Wang
- Department of Sport Medicine, First Affiliated Hospital of Jinan University, Guangzhou, 510630, Guangdong, China
| | - Huige Hou
- Department of Sport Medicine, First Affiliated Hospital of Jinan University, Guangzhou, 510630, Guangdong, China
| | - Xiaofei Zheng
- Department of Sport Medicine, First Affiliated Hospital of Jinan University, Guangzhou, 510630, Guangdong, China
| | - Jinghua Pan
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Jinan University, Guangzhou, 510630, Guangdong, China.
| | - Jieruo Li
- Department of Sport Medicine, First Affiliated Hospital of Jinan University, Guangzhou, 510630, Guangdong, China.
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21
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Yausep OE, Madhi I, Trigkilidas D. Platelet rich plasma for treatment of osteochondral lesions of the talus: A systematic review of clinical trials. J Orthop 2020; 18:218-225. [PMID: 32071508 PMCID: PMC7013135 DOI: 10.1016/j.jor.2020.01.046] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 01/26/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The ankle is the second most frequent site, following the knee, that requires cartilage repair. Osteochondral lesion of the talus (OLT) is common among athletes and is a result of talar cartilage detachment with or without subchondral bone fragmentation after a traumatic event. Treatment strategies for OLT can be classified as reparative or replacement interventions, with the former taking precedence. Recent studies show that the growth factors and bioactive components in platelet rich plasma (PRP) could improve cartilage regeneration. The prospect of using autologous blood to obtain a product that could enhance regeneration in damaged cartilage has been regarded as innovative, as it could circumvent the need for a replacement, and potentially join the ranks of first line reparative interventions against cartilage diseases. METHODS Literature searches were performed across seven search engines for randomized controlled trials using PRP to treat patients with OLT. Outcomes extracted included ankle function and pain measures. Level of evidence and methodological quality were evaluated using relevant guidelines. RESULTS Four studies met the eligibility criteria and were systematically appraised. Two studies scored Level 1 and 2 scored Level 2 based on the LOE assessment. MQOE evaluation revealed one study with excellent quality, and three with good quality. Overall results showed that PRP, as an adjunct to microfracture surgery, significantly improved function and reduced pain compared to microfracture surgery alone. Intra-articular PRP injection also demonstrated significantly enhanced recovery of function, and decreased pain scores compared to HA. CONCLUSION PRP improves joint function, and reduces pain in patients with OLT regardless of the method of implementation. In addition, inter-study comparison demonstrated that patients that received surgery along with PRP injections improved more than those that received PRP only. The studies that corroborate this conclusion have high levels of evidence with satisfactory methodological quality. LEVEL OF EVIDENCE Level 2, systematic review of Level 1 and 2 studies.
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Affiliation(s)
| | - Imad Madhi
- Orthopedic Division, South Tyneside District Hospital, South Shields, United Kingdom
| | - Dionysios Trigkilidas
- Orthopedic Division, South Tyneside District Hospital, South Shields, United Kingdom
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22
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Bi AS, Kane LT, Butler BA, Stover MD. Outcomes following extra-articular fractures of the scapula: A systematic review. Injury 2020; 51:602-610. [PMID: 32014261 DOI: 10.1016/j.injury.2020.01.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 01/24/2020] [Accepted: 01/26/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Scapular neck and body fractures are typically treated nonoperatively, with operative treatment traditionally focused on intraarticular fractures or double disruptions of the shoulder suspensory complex. The objective of this study was to systematically examine and compile the existing literature in regard to operative and conservative treatment of extraarticular fractures of the scapula. METHODS A comprehensive search of multiple electronic databases was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement to find outcome data on fractures of the scapular neck and body. All studies from 1988 to 2018 that met inclusion criteria were reviewed independently and graded based on the modified Coleman Methodology Score. Outcomes of interest were compiled and analyzed for adjusted means. RESULTS 42 manuscripts with a total of 669 patients were included for analysis from an initial search of 335 results. There was an average age of 41.2 years, 78.1% were male, 98.8% had a blunt force mechanism, and 66.7% had other injures outside the scapula at time of presentation. In total, there were 120 patients with scapular body fractures, 95 with scapular neck fractures, 130 with floating shoulder injuries including a scapular neck or body fracture, and 324 with an unspecified extraarticular scapular fracture. 464 patients were treated operatively, with a mean union rate of 99.4%, Constant score of 84.4, and end forward elevation of 158°. 205 total patients were treated non-operatively, with a mean union rate of 85.1%, Constant score of 79.0, and end forward elevation of 153°. CONCLUSION Patients with extraarticular fractures of the scapula have excellent outcomes following either nonoperative or operative management. There is a need for high quality comparative studies to determine the optimal treatment strategy for these injuries.
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Affiliation(s)
- Andrew S Bi
- Department of Orthopaedic Surgery, New York University Langone Medical Center, 301 E 17th St, New York, NY 10003, United States.
| | - Liam T Kane
- Department of Orthopaedic Surgery, Northwestern Feinberg School of Medicine, 676 N. Saint Clair, Suite 1350, Chicago, IL 60611, United States
| | - Bennet A Butler
- Department of Orthopaedic Surgery, R Adams Cowley Shock Trauma Center, 22 S Greene St, Baltimore, MD 21201, United States
| | - Michael D Stover
- Department of Orthopaedic Surgery, Northwestern Feinberg School of Medicine, 676 N. Saint Clair, Suite 1350, Chicago, IL 60611, United States
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23
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Nesello PFT, Baroni AC, Selistre LDS. Level of Evidence and Industry Sponsorship Associated with Favorable Outcomes in Publications on Platelet-Rich-Plasma Therapy in Musculoskeletal Disorders. Rev Bras Ortop 2019; 55:263-268. [PMID: 32616969 PMCID: PMC7316539 DOI: 10.1055/s-0039-1700834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 10/16/2018] [Indexed: 10/25/2022] Open
Abstract
Platelet-rich plasma is derived from centrifuging whole blood. There is increasing interest in the sports medicine and athlete community about providing endogenous growth factors directly to the injury site, using autologous blood products such as platelet-rich plasma. The aim of the present study is to evaluate the association between research financing, conflict of interests, level of evidence and author affiliation with the interpretation of results in articles published on platelet-rich plasma therapy in musculoskeletal ailments. A review of the current literature was performed. The outcome was classified as favorable or unfavorable. The declaration of conflict of interests and the type of funding was extracted from each article. The financing was classified as industry-sponsored; not industry-sponsored; or unidentifiable. The level of evidence was categorized from I to IV. Higher positive outcomes were observed in 134 studies with industry sponsorship compared with not industry-sponsored studies (odds ratio [OR]: 0.26; 95% confidence interval [95%CI]: 0.08-0.85; p < 0.05). Compared with level of evidence I, levels II and IV increase the probability of positive outcomes by 12.42 times ( p < 0.01) and 10.97 times ( p < 0.01) respectively. Proportionally, industry-sponsored studies are more likely to present positive results, as well as articles with a lower quality of evidence.
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Affiliation(s)
- Pietro Felice Tomazini Nesello
- Instituto de Medicina do Esporte e Ciências Aplicadas ao Movimento Humano, Universidade de Caxias do Sul, Caxias do Sul, RS, Brasil
| | - Allan Cassio Baroni
- Instituto de Medicina do Esporte e Ciências Aplicadas ao Movimento Humano, Universidade de Caxias do Sul, Caxias do Sul, RS, Brasil
| | - Luciano da Silva Selistre
- Departamento de Bioestatística, Hospital Geral, Universidade de Caxias do Sul, Caxias do Sul, RS, Brasil
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24
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Hurley ET, Shimozono Y, McGoldrick NP, Myerson CL, Yasui Y, Kennedy JG. High reported rate of return to play following bone marrow stimulation for osteochondral lesions of the talus. Knee Surg Sports Traumatol Arthrosc 2019; 27:2721-2730. [PMID: 29582098 DOI: 10.1007/s00167-018-4913-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 03/20/2018] [Indexed: 12/11/2022]
Abstract
PURPOSE The purpose of this study is to systematically review the literature and to evaluate the reported rehabilitation protocols, return to play guidelines and subsequent rates and timing of return to play following bone marrow stimulation (BMS) for osteochondral lesions of the talus (OLT). METHODS MEDLINE, EMBASE and the Cochrane Library were searched according to the PRISMA guidelines in September 2017. The rate and timing of return to play was assessed. The rehabilitation protocols were recorded, including time to start range of motion, partial weight-bearing and complete weight-bearing. RESULTS Fifty-seven studies with 3072 ankles were included, with a mean age of 36.9 years (range 23-56.8 years), and a mean follow-up of 46.0 months (range 1.5-141 months). The mean rate of return to play was 86.8% (range 60-100%), and the mean time to return to play was 4.5 months (range 3.5-5.9 months). There was large variability in the reported rehabilitation protocols. Range of motion exercises were most often allowed to begin in the first week (46.2%), and second week postoperatively (23.1%). The most commonly reported time to start partial weight-bearing was the first week (38.8%), and the most frequently reported time of commencing full weight-bearing was 6 weeks (28.8%). Surgeons most often allowed return to play at 4 months (37.5%). CONCLUSIONS There is a high rate of return following BMS for OLT with 86.8% and the mean time to return to play was 4.5 months. There is also a significant deficiency in reported rehabilitation protocols, and poor quality reporting in return to play criteria. Early weightbearing and early postoperative range of motion exercises appear to be advantageous in accelerated return to sports. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Eoghan T Hurley
- Hospital for Special Surgery, 523 East 72nd Street, Suite 507, New York, NY, 10021, USA
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Yoshiharu Shimozono
- Hospital for Special Surgery, 523 East 72nd Street, Suite 507, New York, NY, 10021, USA
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Niall P McGoldrick
- Department of Trauma and Orthopaedic Surgery, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Charles L Myerson
- Hospital for Special Surgery, 523 East 72nd Street, Suite 507, New York, NY, 10021, USA
- Tulane University School of Medicine, New Orleans, LA, USA
| | - Youichi Yasui
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - John G Kennedy
- Hospital for Special Surgery, 523 East 72nd Street, Suite 507, New York, NY, 10021, USA.
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Arthroscopic microfracture vs. arthroscopic autologous matrix-induced chondrogenesis for the treatment of articular cartilage defects of the talus. Knee Surg Sports Traumatol Arthrosc 2019; 27:2731-2736. [PMID: 30392029 DOI: 10.1007/s00167-018-5278-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 10/29/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE Microfracture is an established method to treat osteochondral defects of the talus. The value of the addition of an acellular matrix is still under debate. This study compared the results of arthroscopic microfracture vs. arthroscopic autologous matrix-induced chondrogenesis using a collagen I/III matrix (AMIC) in the management of articular cartilage defects of the talus. METHODS Patients with a minimum follow-up of 5 years after arthroscopic management for an articular cartilage defect of the talus with either microfracture alone or an additional acellular matrix were matched according to age, sex and BMI. The Hannover Scoring System for the ankle (HSS) and a Visual analog scale (VAS) for pain, function and satisfaction were used to evaluate the clinical outcome. Postoperative MRI was used to assess cartilage repair tissue based on the degree of defect repair and filling of the defect, integration to border zone, surface of the repair tissue, structure of the repair tissue, and subchondral bone alterations. RESULTS Thirty-two patients (16 microfracture, 16 AMIC) were included. No significant between-group differences were observed in demographic data and preoperative score values. Both groups showed statistically significant improvement when comparing the pre- and postoperative score values. No statistically significant differences were identified between the median values of the groups with the HSS (microfracture: 82 (range 71-96) points; AMIC 88 (range 40-98) points). Accordingly, no significant differences were observed for the VAS pain (microfracture: 0.95 (range 0-3.8); AMIC: 1.0 (range 0-8.5)), VAS function (microfracture: 8.4 (range 3.5-10); AMIC: 9.0 (range 1.5-10)) and VAS satisfaction (microfracture: 8.9 (range 2.8-10); AMIC: 9.45 (range 1.5-10)). MRI showed regeneration of tissue in the treated area without differences between the two groups. CONCLUSION Good clinical results were observed for arthroscopic microfracture with or without an additional acellular collagen I/III matrix in the treatment for articular cartilage defects of the talus. It appears that for defects as treated in this study, it is not worthwhile adding the collagen I/III matrix to the microfractures. LEVEL OF EVIDENCE III.
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Murphy EP, McGoldrick NP, Curtin M, Kearns SR. A prospective evaluation of bone marrow aspirate concentrate and microfracture in the treatment of osteochondral lesions of the talus. Foot Ankle Surg 2019; 25:441-448. [PMID: 30321966 DOI: 10.1016/j.fas.2018.02.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 02/12/2018] [Accepted: 02/14/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND The term osteochondral lesion (OCL) refers to a defect involving the chondral surface and or subchondral bone. These lesions are associated with ankle injuries with bony and soft tissue and cause pain, decreased range of motion, swelling and impact adversely on quality of life. To date the standard treatment has been isolated microfracture (BMS). The aim of this study was to compare the outcomes of BMS alone to BMS augmented with bone marrow aspirate concentrate (BMAC) in the treatment of ankle OCLs. METHODS This study was a prospective cohort study carried out from 2010-2015 in a single surgeon's practice. Patients from 2010-2012 were treated with microfracture alone while patients from 2013-2015 were treated with micro fracture augmented with bone marrow aspirate concentrate and fibrin glue. Self-reported patient outcome measures were measured. Complications, revision rates, and visual analogue pain scores were compared. RESULTS 101 patients were included in the study. 52 patients were in the microfracture group while 49 patients were in the microfracture/BMAC group. The minimum follow-up for both groups was 36 months. Both groups had a statistically significant improvement in pain scores, quality of life scores, participation in sport and activities of daily living. The revision rate was 28.8% in the microfracture group versus 12.2% in the microfracture/BMAC group, which was statistically significant, p=0.0145. The majority of the lesions were less than 1.5cm2 in diameter in both cohorts. CONCLUSIONS Microfracture and bone marrow aspirate concentrate appears to be a safe and effective treatment option for osteochondral lesions of the talus. The addition of bone marrow aspirate concentrate does not result in any increase in ankle or donor site morbidity. It is a well-tolerated therapy which decreases revision rates for treatment of the osteochondral lesions when compared to microfracture alone. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Evelyn P Murphy
- Department of Trauma and Orthopaedics, Galway University Hospital, Saolta Hospital Group, Ireland.
| | - Niall P McGoldrick
- Department of Trauma and Orthopaedics, Galway University Hospital, Saolta Hospital Group, Ireland.
| | - Mark Curtin
- Department of Trauma and Orthopaedics, Galway University Hospital, Saolta Hospital Group, Ireland.
| | - Stephen R Kearns
- Department of Trauma and Orthopaedics, Galway University Hospital, Saolta Hospital Group, Ireland.
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Jackson AT, Drayer NJ, Samona J, Dukes CA, Chen CS, Arrington EA, Ryan PM. Osteochondral Allograft Transplantation Surgery for Osteochondral Lesions of the Talus in Athletes. J Foot Ankle Surg 2019; 58:623-627. [PMID: 31010770 DOI: 10.1053/j.jfas.2018.11.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Indexed: 02/03/2023]
Abstract
Osteochondral lesions of the talus (OLTs) continue to be a challenge for the treating surgeon, especially when lesions are refractory to marrow stimulation techniques. The purpose of this study is to evaluate the outcomes of lesions treated with osteochondral allograft transplantation. A review was performed of 30 athletes with 31 OLTs that were refractory to marrow stimulation or predicted to be refractory based on size and location of the lesion. Results were evaluated in terms of occupational outcomes and numeric pain scales. Lesions treated had a mean area of 1.37 (range 0.36 to 3.3) cm2. Overall excellent outcomes were achieved in 11 (35%) ankles. Nineteen (61%) ankles achieved good or excellent occupational outcomes, and 12 (39%) ankles demonstrated poor occupational outcomes and the patients were unable to continue their previous active occupations. Patients were found to have a mean pain scale score of 3 (range 0 to 7) of 10 at a mean of 21 (range 10 to 24) months after operative management. Osteochondral allograft transplantation is an option for the treatment of selected athletes with large OLTs, as well as lesions that are refractory to marrow stimulation techniques. The results of this study may help active young patients and their surgeons to better understand outcomes and options in their shared decision-making process.
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Affiliation(s)
- Andrew T Jackson
- Orthopaedic Surgeon, Department of Orthopaedic Surgery, Madigan Army Medical Center, Tacoma, WA
| | - Nicholas J Drayer
- Orthopaedic Surgeon, Department of Orthopaedic Surgery, Madigan Army Medical Center, Tacoma, WA
| | - Jason Samona
- Orthopaedic Surgeon, Department of Orthopaedic Surgery, Hurley Medical Center, Flint, MI
| | - Chase A Dukes
- Orthopaedic Surgeon, Department of Orthopaedic Surgery, Madigan Army Medical Center, Tacoma, WA
| | - Christopher S Chen
- Orthopaedic Surgeon, Department of Orthopaedic Surgery, Madigan Army Medical Center, Tacoma, WA
| | - Edward A Arrington
- Associate Professor of Surgery, Department of Orthopaedic Surgery, Madigan Army Medical Center, Tacoma, WA
| | - Paul M Ryan
- Associate Professor of Surgery, Department of Orthopaedic Surgery, Tripler Army Medical Center, Honolulu, HI.
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Concentrated Bone Marrow Aspirate May Decrease Postoperative Cyst Occurrence Rate in Autologous Osteochondral Transplantation for Osteochondral Lesions of the Talus. Arthroscopy 2019; 35:99-105. [PMID: 30424945 DOI: 10.1016/j.arthro.2018.06.047] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 06/15/2018] [Accepted: 06/19/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To clarify if the use of concentrated bone marrow aspirate (CBMA) would affect both postoperative functional outcomes and magnetic resonance imaging (MRI) outcomes compared with those of autologous osteochondral transplantation (AOT) alone; in addition, to assess the efficacy of CBMA reducing the presence of postoperative cyst formation following AOT in the treatment of osteochondral lesions of the talus. METHODS Fifty-four (92%) of 59 eligible patients who underwent AOT between 2004 and 2008 were retrospectively assessed at a minimum of 5-year follow-up. Twenty-eight patients were treated with AOT and CBMA (AOT/CBMA group) and 26 patients were treated with AOT alone (AOT-alone group). Clinical outcomes were evaluated using the Foot and Ankle Outcome Scores (FAOS) and Short-Form 12 (SF-12) preoperatively and at final follow-up. Postoperative MRI was evaluated with the modified Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) scoring system. Cyst formation was also evaluated on postoperative MRI. RESULTS The mean FAOS and SF-12 significantly improved in both the AOT/CBMA and AOT-alone groups, but there were no statistical differences between groups in FAOS (80.5 vs 75.5, P = .225) and SF-12 (71.1 vs 69.6, P = .756) at final follow-up. Additionally, there was no difference in the mean MOCART score (80.4 vs 84.3, P = .484); however, AOT/CBMA did result in a statistically lower rate of cyst formation (46.4% vs 76.9%, P = .022). No significant differences were found in the mean postoperative FAOS and SF-12 between patients with and without cysts postoperatively. CONCLUSIONS CBMA reduced postoperative cyst occurrence rate in patients treated with AOT; however, CBMA did not result in significant differences in medium term functional outcomes and MOCART score in patients who underwent AOT. LEVEL OF EVIDENCE Level III, retrospective comparative trial.
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Migliorini F, Rath B, Tingart M, Baroncini A, Quack V, Eschweiler J. Autogenic mesenchymal stem cells for intervertebral disc regeneration. INTERNATIONAL ORTHOPAEDICS 2018; 43:1027-1036. [PMID: 30415465 DOI: 10.1007/s00264-018-4218-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 10/29/2018] [Indexed: 12/17/2022]
Abstract
PURPOSE A systematic review of the literature was conducted to clarify the outcomes of autologous mesenchymal stem cells (MSC) injections for the regeneration of the intervertebral disc (IVD). METHODS The following databases were accessed: PubMed, Medline, CINAHL, Cochrane, Embase and Google Scholar bibliographic databases. Articles including previous or planned surgical interventions were excluded. Only articles reporting percutaneous autologous MSC injection to regenerate IVD in humans were included. We referred to the Coleman Methodology Score for the methodological quality assessment. The statistical analysis was performed using Review Manager Software 5.3. RESULTS After the databases search and cross-references of the bibliographies, seven studies were included in the present work. The funnel plot detected low risk of publication bias. The Coleman Methodology Score reported a good result, scoring 61.07 points. A total of 98 patients were enrolled, with 122 treated levels. All the patients underwent conservative therapies prior to injection. A remarkable improvement in the quality of life were reported after the treatment. The average Oswestry Disability Index (ODI) improved from "severe disability" to "minimal disability" at one year follow-up. The visual analogue scale (VAS) showed an improvement of ca. 30% at one year follow-up. Only one case of herniated nucleus pulposus was reported. No other adverse events at the aspiration or injection site were observed. CONCLUSIONS This systematic review of the literature proved MSC injection to be a safe and feasible option for intervertebral disc regeneration in the early-degeneration stage patients. Irrespective of the source of the MSCs, an overall clinical and radiological improvement of the patients has been evidenced, as indeed a very low complication rate during the follow-up.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedics, RWTH Aachen University Clinic, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Björn Rath
- Department of Orthopaedics, RWTH Aachen University Clinic, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Markus Tingart
- Department of Orthopaedics, RWTH Aachen University Clinic, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Alice Baroncini
- Department of Spine Surgery, Eifelklinik St. Brigida, Kammerbruchstraße 8, 52152, Simmerath, Germany
| | - Valentin Quack
- Department of Orthopaedics, RWTH Aachen University Clinic, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Jörg Eschweiler
- Department of Orthopaedics, RWTH Aachen University Clinic, Pauwelsstraße 30, 52074, Aachen, Germany
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Shimozono Y, Hurley ET, Myerson CL, Kennedy JG. Good clinical and functional outcomes at mid-term following autologous osteochondral transplantation for osteochondral lesions of the talus. Knee Surg Sports Traumatol Arthrosc 2018; 26:3055-3062. [PMID: 29572556 DOI: 10.1007/s00167-018-4917-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 03/20/2018] [Indexed: 12/11/2022]
Abstract
PURPOSE Autologous osteochondral transplantation is an established treatment for large-sized osteochondral lesions of the talus (OLT) with excellent short term outcomes. However, few studies assess the outcomes of autologous osteochondral transplantation at mid-term follow-up. The purpose of the current systematic review was to evaluate the clinical outcomes of the autologous osteochondral transplantation procedure in the treatment of OLT at mid-term and long-term follow-up. METHODS A systematic search of the MEDLINE, EMBASE and Cochrane Library databases was performed in October 2017 based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Included studies were evaluated with regard to level of evidence (LOE) and quality of evidence (QOE) using the Coleman Methodology Score. Clinical outcomes, and complications were also evaluated. RESULTS Eleven studies, with 500 ankles were included at a mean 62.8 months follow-up. Seven studies used the American Orthopaedic Foot and Ankle Society (AOFAS) score. The weighted mean preoperative AOFAS score was 55.1 ± 6.1, and the postoperative score was 86.2 ± 4.5, with 87.4% of patients (132 of 151) being reported as excellent or good results. In total, 53 of the 500 patients (10.6%) had complications. The most common complication was donor site morbidity with 18 patients (3.6%) at final follow-up. Thirty-one patients (6.2%) underwent reoperations, and 5 ankles (1.0%) were regarded as failed autologous osteochondral transplantation. CONCLUSION The current systematic review demonstrated that good clinical and functional outcomes can be expected following autologous osteochondral transplantation for the treatment of OLT, with a low failure rate. The results from this study show patients can be reasonably counselled to expect good clinical outcomes in the mid-term. MRI and radiographs showed restoration of articular surface as well as a minimal presence of osteoarthritis at mid-term follow-up. However, as low level and quality of evidence and the variability of the data may confound the data, further well-designed studies are necessary to determine the effectiveness of autologous osteochondral transplantation in the treatment for OLT. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Yoshiharu Shimozono
- Hospital for Special Surgery, 523 East 72nd Street, Suite 507, New York, NY, 10021, USA
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Eoghan T Hurley
- Hospital for Special Surgery, 523 East 72nd Street, Suite 507, New York, NY, 10021, USA
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Charles L Myerson
- Hospital for Special Surgery, 523 East 72nd Street, Suite 507, New York, NY, 10021, USA
- Tulane University School of Medicine, New Orleans, LA, USA
| | - John G Kennedy
- Hospital for Special Surgery, 523 East 72nd Street, Suite 507, New York, NY, 10021, USA.
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Reilingh ML, Murawski CD, DiGiovanni CW, Dahmen J, Ferrao PNF, Lambers KTA, Ling JS, Tanaka Y, Kerkhoffs GMMJ. Fixation Techniques: Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle. Foot Ankle Int 2018; 39:23S-27S. [PMID: 30215310 DOI: 10.1177/1071100718781096] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The evidence supporting best practice guidelines in the field of cartilage repair of the ankle is based on both low quality and low levels of evidence. Therefore, an international consensus group of experts was convened to collaboratively advance toward consensus opinions based on the best available evidence on key topics within cartilage repair of the ankle. The purpose of this article is to report the consensus statements on "Fixation Techniques" developed at the 2017 International Consensus Meeting on Cartilage Repair of the Ankle. METHODS Seventy-five international experts in cartilage repair of the ankle representing 25 countries and 1 territory were convened and participated in a process based on the Delphi method of achieving consensus. Questions and statements were drafted within 11 working groups focusing on specific topics within cartilage repair of the ankle, after which a comprehensive literature review was performed and the available evidence for each statement was graded. Discussion and debate occurred in cases where statements were not agreed upon in unanimous fashion within the working groups. A final vote was then held, and the strength of consensus was characterized as follows: consensus, 51% to 74%; strong consensus, 75% to 99%; and unanimous, 100%. RESULTS A total of 15 statements on fixation techniques reached consensus during the 2017 International Consensus Meeting on Cartilage Repair of the Ankle. All 15 statements achieved strong consensus, with at least 82% agreement. CONCLUSIONS This international consensus derived from leaders in the field will assist clinicians with using fixation techniques in the treatment of osteochondral lesions of the talus.
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Affiliation(s)
- Mikel L Reilingh
- 1 Department of Orthopaedic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Christopher D Murawski
- 2 Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Jari Dahmen
- 1 Department of Orthopaedic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Paulo N F Ferrao
- 4 Orthopaedic Department, University of the Witwatersrand, Johannesburg, South Africa
| | - Kaj T A Lambers
- 1 Department of Orthopaedic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Jeffrey S Ling
- 5 Prince of Wales Hospital Clinical School, The University of New South Wales, Sydney, New South Wales, Australia
| | - Yasuhito Tanaka
- 6 Department of Orthopedic Surgery, Nara Medical University, Nara, Japan
| | - Gino M M J Kerkhoffs
- 1 Department of Orthopaedic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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D'Hooghe P, Murawski CD, Boakye LAT, Osei-Hwedieh DO, Drakos MC, Hertel J, Lee KB, Popchak A, Wiewiorski M, van Dijk CN. Rehabilitation and Return to Sports: Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle. Foot Ankle Int 2018; 39:61S-67S. [PMID: 30215313 DOI: 10.1177/1071100718781862] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The evidence supporting best practice guidelines in the field of cartilage repair of the ankle are based on both low quality and low levels of evidence. Therefore, an international consensus group of experts was convened to collaboratively advance toward consensus opinions based on the best available evidence on key topics within cartilage repair of the ankle. The purpose of this article is to report the consensus statements on Rehabilitation and Return to Sports developed at the 2017 International Consensus Meeting on Cartilage Repair of the Ankle. METHODS Seventy-five international experts in cartilage repair of the ankle representing 25 countries and 1 territory were convened and participated in a process based on the Delphi method of achieving consensus. Questions and statements were drafted within 11 working groups focusing on specific topics within cartilage repair of the ankle, after which a comprehensive literature review was performed and the available evidence for each statement was graded. Discussion and debate occurred in cases where statements were not agreed upon in unanimous fashion within the working groups. A final vote was then held, and the strength of consensus was characterized as follows: consensus, 51% to 74%; strong consensus, 75% to 99%; unanimous, 100%. RESULTS A total of 9 statements on rehabilitation and return to sports reached consensus during the 2017 International Consensus Meeting on Cartilage Repair of the Ankle. All 9 statements reached strong consensus, with at least 86% agreement. CONCLUSIONS The rehabilitation process for an ankle cartilage injury requires a multidisciplinary and comprehensive approach. This international consensus derived from leaders in the field will assist clinicians with rehabilitation and return to sports after treatment of a cartilage injury of the ankle.
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Affiliation(s)
- Pieter D'Hooghe
- 1 Department of Orthopaedic Surgery, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Christopher D Murawski
- 2 Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Lorraine A T Boakye
- 2 Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - David O Osei-Hwedieh
- 2 Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Jay Hertel
- 4 Department of Kinesiology, University of Virginia, Charlottesville, VA, USA
| | - Keun Bae Lee
- 5 Department of Orthopedic Surgery, Chonnam National University Medical School and Hospital, Gwangju, South Korea
| | - Adam Popchak
- 2 Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Martin Wiewiorski
- 6 Department of Orthopaedic and Trauma Surgery, Kantonsspital Winterthur, Winterthur, Switzerland
| | - C Niek van Dijk
- 7 Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.,8 Ripoll y De Prado Sports Clinic: Murcia-Madrid-FIFA Medical Center of Excellence, Madrid, Spain
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Rothrauff BB, Murawski CD, Angthong C, Becher C, Nehrer S, Niemeyer P, Sullivan M, Valderrabano V, Walther M, Ferkel RD, Adams SB, Andrews CL, Batista JP, Baur OL, Bayer S, Berlet GC, Boakye LAT, Brown AJ, Buda R, Calder JD, Canata GL, Carreira DS, Clanton TO, Dahmen J, D’Hooghe P, DiGiovanni CW, Dombrowski ME, Drakos MC, Ferrao PNF, Fortier LA, Glazebrook M, Giza E, Gomaa M, Görtz S, Haleem AM, Hamid KS, Hangody L, Hannon CP, Haverkamp D, Hertel J, Hintermann B, Hogan MV, Hunt KJ, Hurley ET, Karlsson J, Kearns SR, Kennedy JG, Kerkhoffs GMMJ, Kim HJ, Kong SW, Labib SA, Lambers KTA, Lee JW, Lee KB, Ling JS, Longo UG, Marangon A, McCollum G, Mitchell AW, Mittwede PN, Nunley JA, O’Malley MJ, Osei-Hwedieh DO, Paul J, Pearce CJ, Pereira H, Popchak A, Prado MP, Raikin SM, Reilingh ML, Schon LC, Shimozono Y, Simpson H, Smyth NA, Sofka CM, Spennacchio P, Stone JW, Takao M, Tanaka Y, Thordarson DB, Tuan R, van Bergen CJ, van Dijk CN, van Dijk PA, Vannini F, Vaseenon T, Wiewiorski M, Xu X, Yasui Y, Yinghui H, Yoshimura I, Younger ASE, Zhang Z. Scaffold-Based Therapies: Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle. Foot Ankle Int 2018; 39:41S-47S. [PMID: 30215312 DOI: 10.1177/1071100718781864] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The evidence supporting best practice guidelines in the field of cartilage repair of the ankle are based on both low quality and low levels of evidence. Therefore, an international consensus group of experts was convened to collaboratively advance toward consensus opinions based on the best available evidence on key topics within cartilage repair of the ankle. The purpose of this article is to report the consensus statements on "Scaffold-Based Therapies" developed at the 2017 International Consensus Meeting on Cartilage Repair of the Ankle. METHODS Seventy-five international experts in cartilage repair of the ankle representing 25 countries and 1 territory were convened and participated in a process based on the Delphi method of achieving consensus. Questions and statements were drafted within 11 working groups focusing on specific topics within cartilage repair of the ankle, after which a comprehensive literature review was performed and the available evidence for each statement was graded. Discussion and debate occurred in cases where statements were not agreed upon in unanimous fashion within the working groups. A final vote was then held, and the strength of consensus was characterized as follows: consensus, 51% to 74%; strong consensus, 75% to 99%; unanimous, 100%. RESULTS A total of 9 statements on scaffold-based therapies reached consensus during the 2017 International Consensus Meeting on Cartilage Repair of the Ankle. One achieved unanimous support, 8 reached strong consensus (greater than 75% agreement), and 1 was removed because of redundancy in the information provided. All statements reached at least 80% agreement. CONCLUSIONS This international consensus derived from leaders in the field will assist clinicians with applying scaffold-based therapies as a treatment strategy for osteochondral lesions of the talus. LEVEL OF EVIDENCE Level V, expert opinion.
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Affiliation(s)
- Benjamin B Rothrauff
- 1 Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Christopher D Murawski
- 1 Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Chayanin Angthong
- 2 Department of Orthopaedics, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Christoph Becher
- 3 Department of Orthopedic Surgery, Hannover Medical School, Hannover, Germany
| | - Stefan Nehrer
- 4 Orthopedic Foot & Ankle Center, Westerville, OH, USA
| | - Philipp Niemeyer
- 5 Centre for Regenerative Medicine and Orthopedics, Danube University Krems, Krems an der Donau, Austria
| | | | - Victor Valderrabano
- 7 Orthopaedic Department, Swiss Ortho Center, Schmerzklinik Basel, Swiss Medical Network, Basel, Switzerland
| | - Markus Walther
- 8 Center of Foot and Ankle Surgery, Schön Klinik München Harlaching, Munich, Germany
| | - Richard D Ferkel
- 9 Southern California Orthopedic Institute, Los Angeles, CA, USA
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Mittwede PN, Murawski CD, Ackermann J, Görtz S, Hintermann B, Kim HJ, Thordarson DB, Vannini F, Younger ASE. Revision and Salvage Management: Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle. Foot Ankle Int 2018; 39:54S-60S. [PMID: 30215315 DOI: 10.1177/1071100718781863] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The evidence supporting best practice guidelines in the field of cartilage repair of the ankle are based on both low quality and low levels of evidence. Therefore, an international consensus group of experts was convened to collaboratively advance toward consensus opinions based on the best available evidence on key topics within cartilage repair of the ankle. The purpose of this article was to report on the consensus statements on "Revision and Salvage Management" developed at the 2017 International Consensus Meeting on Cartilage Repair of the Ankle. METHODS Seventy-five international experts in cartilage repair of the ankle representing 25 countries and 1 territory were convened and participated in a process based on the Delphi method of achieving consensus. Questions and statements were drafted within 11 working groups focusing on specific topics within cartilage repair of the ankle, after which a comprehensive literature review was performed and the available evidence for each statement was graded. Discussion and debate occurred in cases where statements were not agreed on in unanimous fashion within the working groups. A final vote was then held, and the strength of consensus was characterized as follows: consensus, 51% to 74%; strong consensus, 75% to 99%; unanimous, 100%. RESULTS A total of 8 statements on revision and salvage management reached consensus during the 2017 International Consensus Meeting on Cartilage Repair of the Ankle. One achieved unanimous support and 7 reached strong consensus (greater than 75% agreement). All statements reached at least 85% agreement. CONCLUSIONS This international consensus derived from leaders in the field will assist clinicians with revision and salvage management in the cartilage repair of the ankle.
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Affiliation(s)
- Peter N Mittwede
- 1 Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Christopher D Murawski
- 1 Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jakob Ackermann
- 2 Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Simon Görtz
- 3 Orthopedic & Spine Institute at Banner University Medical Center, Phoenix, AZ, USA
| | - Beat Hintermann
- 4 Clinic of Orthopaedic Surgery, Kantonsspital Baselland, Liestal, Switzerland
| | - Hak Jun Kim
- 5 Department of Orthopaedic Surgery, Korea University Ansan Hospital, Ansan, Korea
| | - David B Thordarson
- 6 Department of Orthopaedic Surgery, Cedars Sinai Medical Center, Los Angeles, CA, USA
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van Bergen CJA, Baur OL, Murawski CD, Spennacchio P, Carreira DS, Kearns SR, Mitchell AW, Pereira H, Pearce CJ, Calder JDF. Diagnosis: History, Physical Examination, Imaging, and Arthroscopy: Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle. Foot Ankle Int 2018; 39:3S-8S. [PMID: 30215306 DOI: 10.1177/1071100718779393] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The evidence supporting best practice guidelines in the field of cartilage repair of the ankle are based on both low quality and low levels of evidence. Therefore, an international consensus group of experts was convened to collaboratively advance toward consensus opinions based on the best available evidence on key topics within cartilage repair of the ankle. The purpose of this article is to report the consensus statements on "Diagnosis: History, Physical Examination, Imaging, and Arthroscopy" developed at the 2017 International Consensus Meeting on Cartilage Repair of the Ankle. METHODS Seventy-five international experts in cartilage repair of the ankle representing 25 countries and 1 territory were convened and participated in a process based on the Delphi method of achieving consensus. Questions and statements were drafted within 11 working groups focusing on specific topics within cartilage repair of the ankle, after which a comprehensive literature review was performed and the available evidence for each statement was graded. Discussion and debate occurred in cases where statements were not agreed upon in unanimous fashion within the working groups. A final vote was then held, and the strength of consensus was characterized as follows: consensus: 51 - 74%; strong consensus: 75 - 99%; unanimous: 100%. RESULTS A total of 12 statements on the diagnosis of cartilage injuries of the ankle reached consensus during the 2017 International Consensus Meeting on Cartilage Repair of the Ankle. Two achieved unanimous support and 10 reached strong consensus (greater than 75% agreement). All statements reached at least 86% agreement. CONCLUSIONS This international consensus derived from leaders in the field will assist clinicians in the diagnosis of cartilage injuries of the ankle.
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Affiliation(s)
| | - Onno L Baur
- 2 Department of Radiology and Nuclear Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - Christopher D Murawski
- 3 Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | | | - Stephen R Kearns
- 6 Department of Trauma and Orthopaedic Surgery, University College Hospital Galway, Galway, Ireland
| | | | - Helder Pereira
- 8 Orthopaedic Department, Centro Hospitalar Póvoa de Varzim, Vila do Conde, Portugal
| | - Christopher J Pearce
- 9 National University Heath System, Division of Foot and Ankle Surgery, Singapore
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van Dijk PAD, Murawski CD, Hunt KJ, Andrews CL, Longo UG, McCollum G, Simpson H, Sofka CM, Yoshimura I, Karlsson J. Post-treatment Follow-up, Imaging, and Outcome Scores: Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle. Foot Ankle Int 2018; 39:68S-73S. [PMID: 30215316 DOI: 10.1177/1071100718781861] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The evidence supporting best practice guidelines in the field of cartilage repair of the ankle are based on both low quality and low levels of evidence. Therefore, an international consensus group of experts was convened to collaboratively advance toward consensus opinions based on the best available evidence on key topics within cartilage repair of the ankle. The purpose of this article is to report the consensus statements on Post-treatment Follow-up, Imaging and Outcome Scores developed at the 2017 International Consensus Meeting on Cartilage Repair of the Ankle. METHODS Seventy-five international experts in cartilage repair of the ankle representing 25 countries and 1 territory were convened and participated in a process based on the Delphi method of achieving consensus. Questions and statements were drafted within 11 working groups focusing on specific topics within cartilage repair of the ankle, after which a comprehensive literature review was performed and the available evidence for each statement was graded. Discussion and debate occurred in cases where statements were not agreed on in unanimous fashion within the working groups. A final vote was then held, and the strength of consensus was characterized as follows: consensus, 51% to 74%; strong consensus, 75% to 99%; unanimous, 100%. RESULTS A total of 12 statements on Post-treatment Follow-up, Imaging, and Outcome Scores reached consensus during the 2017 International Consensus Meeting on Cartilage Repair of the Ankle. All 12 statements reached strong consensus (greater than 75% agreement). CONCLUSIONS This international consensus derived from leaders in the field will assist clinicians with post-treatment follow-up, imaging, and outcome scores after management of a cartilage injury of the ankle in the general population. Moreover, healing, rehabilitation, and final outcomes can be optimized for the individual patient.
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Affiliation(s)
- Pim A D van Dijk
- 1 Department of Orthopaedic Surgery and Orthopaedic Research Center Amsterdam, Academic Medical Center, University of Amsterdam, the Netherlands.,2 Academic Center for Evidence based Sports medicine (ACES), Amsterdam, the Netherlands.,3 Amsterdam Collaboration on Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, the Netherlands
| | - Christopher D Murawski
- 4 Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Kenneth J Hunt
- 5 Department of Orthopaedic Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Carol L Andrews
- 6 Department of Radiology, Division of Musculoskeletal Imaging, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Umile Giuseppe Longo
- 7 Department of Trauma and Orthopaedic Surgery, University Campus Bio-Medico of Rome, Rome, Italy
| | - Graham McCollum
- 8 Department of Orthopaedic Surgery, University of Cape Town, UCT Private Academic Hospital, Kingsbury Hospital, Cape Town, South Africa
| | | | - Carolyn M Sofka
- 10 Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Ichiro Yoshimura
- 11 Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Jón Karlsson
- 12 Department of Orthopaedics, Sahlgrenska University Hospital, Sahlgrenska Academy, Gothenburg University, Göteborg, Sweden
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Dombrowski ME, Yasui Y, Murawski CD, Fortier LA, Giza E, Haleem AM, Hamid K, Tuan R, Zhang Z, Schon LC, Hogan MV. Conservative Management and Biological Treatment Strategies: Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle. Foot Ankle Int 2018; 39:9S-15S. [PMID: 30215314 DOI: 10.1177/1071100718779390] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The evidence supporting best practice guidelines in the field of cartilage repair of the ankle are based on both low quality and low levels of evidence. Therefore, an international consensus group of experts was convened to collaboratively advance toward consensus opinions based on the best available evidence on key topics within cartilage repair of the ankle. The purpose of this article is to report the consensus statements on "Conservative Management and Biological Treatment Strategies" developed at the 2017 International Consensus Meeting on Cartilage Repair of the Ankle. METHODS Seventy-five international experts in cartilage repair of the ankle representing 25 countries and 1 territory were convened and participated in a process based on the Delphi method of achieving consensus. Questions and statements were drafted within 11 working groups focusing on specific topics within cartilage repair of the ankle, after which a comprehensive literature review was performed and the available evidence for each statement was graded. Discussion and debate occurred in cases where statements were not agreed upon in unanimous fashion within the working groups. A final vote was then held, and the strength of consensus was characterized as follows: consensus, 51% to 74%; strong consensus, 75% to 99%; unanimous, 100%. RESULTS A total of 12 statements on Conservative Management and Biological Treatment Strategies reached consensus during the 2017 International Consensus Meeting on Cartilage Repair of the Ankle. Ten statements reached strong consensus (greater than 75% agreement), and 2 achieved consensus. CONCLUSIONS This international consensus derived from leaders in the field will assist clinicians with conservative management and biological treatment strategies for osteochondral lesions of the talus.
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Affiliation(s)
- Malcolm E Dombrowski
- 1 Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Youichi Yasui
- 2 Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Christopher D Murawski
- 1 Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Lisa A Fortier
- 3 Department of Clinical Sciences, Cornell University, Ithaca, NY, USA
| | - Eric Giza
- 4 Department of Orthopaedics, University of California Davis, Sacramento, CA, USA
| | - Amgad M Haleem
- 5 Department of Orthopedic Surgery, Oklahoma University Health Sciences Center, Oklahoma City, OK, USA
| | - Kamran Hamid
- 6 Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Rocky Tuan
- 1 Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Zijun Zhang
- 7 Medstar Union Memorial Hospital, Baltimore, MD, USA
| | - Lew C Schon
- 7 Medstar Union Memorial Hospital, Baltimore, MD, USA
| | - MaCalus V Hogan
- 1 Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,8 Foot an Ankle Injury Research (FAIR) Group, Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Hannon CP, Bayer S, Murawski CD, Canata GL, Clanton TO, Haverkamp D, Lee JW, O'Malley MJ, Yinghui H, Stone JW. Debridement, Curettage, and Bone Marrow Stimulation: Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle. Foot Ankle Int 2018; 39:16S-22S. [PMID: 30215307 DOI: 10.1177/1071100718779392] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The evidence supporting best practice guidelines in the field of cartilage repair of the ankle are based on both low quality and low levels of evidence. Therefore, an international consensus group of experts was convened to collaboratively advance toward consensus opinions based on the best available evidence on key topics within cartilage repair of the ankle. The purpose of this article is to report the consensus statements on "Debridement, Curettage and Bone Marrow Stimulation" developed at the 2017 International Consensus Meeting on Cartilage Repair of the Ankle. METHODS Seventy-five international experts in cartilage repair of the ankle representing 25 countries and 1 territory were convened and participated in a process based on the Delphi method of achieving consensus. Questions and statements were drafted within 11 working groups focusing on specific topics within cartilage repair of the ankle, after which a comprehensive literature review was performed and the available evidence for each statement was graded. Discussion and debate occurred in cases where statements were not agreed upon in unanimous fashion within the working groups. A final vote was then held, and the strength of consensus was characterized as follows: consensus, 51% to 74%; strong consensus, 75% to 99%; unanimous, 100%. RESULTS A total of 14 statements on debridement, curettage, and bone marrow stimulation reached consensus during the 2017 International Consensus Meeting on Cartilage Repair of the Ankle. One achieved unanimous support, 12 reached strong consensus (greater than 75% agreement), and 1 achieved consensus. All statements reached at least 72% agreement. CONCLUSIONS This international consensus derived from leaders in the field will assist clinicians with debridement, curettage and bone marrow stimulation as a treatment strategy for osteochondral lesions of the talus.
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Affiliation(s)
- Charles P Hannon
- 1 Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Steve Bayer
- 2 Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Christopher D Murawski
- 2 Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | | | - Daniel Haverkamp
- 5 Department of Orthopaedic Surgery, Slotervaart Hospital, Amsterdam, the Netherlands
| | - Jin Woo Lee
- 6 Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Martin J O'Malley
- 7 Foot and Ankle Service, Hospital for Special Surgery, New York, NY, USA
| | - Hua Yinghui
- 8 Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - James W Stone
- 9 The Orthopedic Institute of Wisconsin, Franklin, WI, USA
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Smyth NA, Murawski CD, Adams SB, Berlet GC, Buda R, Labib SA, Nunley JA, Raikin SM. Osteochondral Allograft: Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle. Foot Ankle Int 2018; 39:35S-40S. [PMID: 30215308 DOI: 10.1177/1071100718781097] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The evidence supporting best practice guidelines in the field of cartilage repair of the ankle is based on both low quality and low levels of evidence. Therefore, an international consensus group of experts was convened to collaboratively advance toward consensus opinions based on the best available evidence on key topics within cartilage repair of the ankle. The purpose of this article is to report the consensus statements on "Osteochondral Allograft" developed at the 2017 International Consensus Meeting on Cartilage Repair of the Ankle. METHODS Seventy-five international experts in cartilage repair of the ankle representing 25 countries and 1 territory were convened and participated in a process based on the Delphi method of achieving consensus. Questions and statements were drafted within 11 working groups focusing on specific topics within cartilage repair of the ankle, after which a comprehensive literature review was performed and the available evidence for each statement was graded. Discussion and debate occurred in cases where statements were not agreed upon in unanimous fashion within the working groups. A final vote was then held, and the strength of consensus was characterized as follows: consensus, 51% to 74%; strong consensus, 75% to 99%; and unanimous, 100%. RESULTS A total of 15 statements on osteochondral allograft reached consensus during the 2017 International Consensus Meeting on Cartilage Repair of the Ankle. One achieved unanimous support and 14 reached strong consensus (greater than 75% agreement). All statements reached at least 85% agreement. CONCLUSIONS This international consensus derived from leaders in the field will assist clinicians with osteochondral allograft as a treatment strategy for osteochondral lesions of the talus.
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Affiliation(s)
- Niall A Smyth
- 1 Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Christopher D Murawski
- 2 Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Samuel B Adams
- 3 Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | | | - Roberto Buda
- 5 Clinic of Orthopaedics and Traumatology, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Sameh A Labib
- 6 Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - James A Nunley
- 3 Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Steven M Raikin
- 7 The Rothman Institute, Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
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Hurley ET, Murawski CD, Paul J, Marangon A, Prado MP, Xu X, Hangody L, Kennedy JG, Adams SB, Andrews CL, Angthong C, Batista JP, Baur OL, Bayer S, Becher C, Berlet GC, Boakye LAT, Brown AJ, Buda R, Calder JD, Canata GL, Carreira DS, Clanton TO, Dahmen J, D’Hooghe P, DiGiovanni CW, Dombrowski ME, Drakos MC, Ferkel RD, Ferrao PNF, Fortier LA, Glazebrook M, Giza E, Gomaa M, Görtz S, Haleem AM, Hamid KS, Hannon CP, Haverkamp D, Hertel J, Hintermann B, Hogan MV, Hunt KJ, Karlsson J, Kearns SR, Kerkhoffs GMMJ, Kim HJ, Kong SW, Labib SA, Lambers KTA, Lee JW, Lee KB, Ling JS, Longo UG, McCollum G, Mitchell AW, Mittwede PN, Nehrer S, Niemeyer P, Nunley JA, O’Malley MJ, Osei-Hwedieh DO, Pearce CJ, Pereira H, Popchak A, Raikin SM, Reilingh ML, Rothrauff BB, Schon LC, Shimozono Y, Simpson H, Smyth NA, Sofka CM, Spennacchio P, Stone JW, Sullivan M, Takao M, Tanaka Y, Thordarson DB, Tuan R, Valderrabano V, van Bergen CJ, van Dijk CN, van Dijk PA, Vannini F, Vaseenon T, Walther M, Wiewiorski M, Yasui Y, Yinghui H, Yoshimura I, Younger ASE, Zhang Z. Osteochondral Autograft: Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle. Foot Ankle Int 2018; 39:28S-34S. [PMID: 30215309 DOI: 10.1177/1071100718781098] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Treatment guidelines for cartilage lesions of the talus have been based on both low quality and low levels of evidence. Therefore, an international consensus group of experts was convened to collaboratively advance toward consensus opinions on key topics regarding cartilage lesions of the talus. The purpose of this consensus article is to explain the process and delineate the consensus statements derived from this consensus meeting on the use of "osteochondral autograft" for osteochondral lesions of the talus. METHODS Seventy-five international experts in cartilage repair of the ankle representing 25 countries and 1 territory were convened and participated in a process based on the Delphi method of achieving consensus. Questions and statements were drafted within 11 working groups focusing on specific topics within cartilage repair of the ankle, after which a comprehensive literature review was performed and the available evidence for each statement was graded. Discussion and debate occurred in cases where statements were not agreed upon in unanimous fashion within the working groups. A final vote was then held, and the strength of consensus was characterized as follows: consensus, 51% to 74%; strong consensus, 75% to 99%; and unanimous, 100%. RESULTS A total of 14 statements on osteochondral autograft reached consensus during the 2017 International Consensus Meeting on Cartilage Repair of the Ankle. Two achieved unanimous support, 11 reached strong consensus (greater than 75% agreement), and 1 achieved consensus. All statements reached at least 67% agreement. CONCLUSIONS This international consensus derived from leaders in the field will assist clinicians with osteochondral autograft as a treatment strategy for osteochondral lesions of the talus.
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Affiliation(s)
- Eoghan T Hurley
- 1 Department of Orthopaedic Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Christopher D Murawski
- 2 Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jochen Paul
- 3 Rennbahnklinik, Muttenz, Basel, Switzerland
| | | | - Marcelo P Prado
- 5 Orthopedics Department, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Xiangyang Xu
- 6 Orthopaedic Department, Ruijin Hospital, Shanghai, China
| | - Laszlo Hangody
- 7 Orthopaedics and Trauma Department, Uzsoki Hospital, Budapest, Hungary.,8 Department of Traumatology, Semmelweis University, Budapest, Hungary
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Shimozono Y, Brown AJ, Batista JP, Murawski CD, Gomaa M, Kong SW, Vaseenon T, Takao M, Glazebrook M. Subchondral Pathology: Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle. Foot Ankle Int 2018; 39:48S-53S. [PMID: 30215311 DOI: 10.1177/1071100718781866] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [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 The evidence supporting best practice guidelines in the field of cartilage repair of the ankle are based on both low quality and low levels of evidence. Therefore, an international consensus group of experts was convened to collaboratively advance toward consensus opinions based on the best available evidence on key topics within cartilage repair of the ankle. The purpose of this article is to report the consensus statements on "Subchondral Pathology" developed at the 2017 International Consensus Meeting on Cartilage Repair of the Ankle. METHODS Seventy-five international experts in cartilage repair of the ankle representing 25 countries and 1 territory were convened and participated in a process based on the Delphi method of achieving consensus. Questions and statements were drafted within 11 working groups focusing on specific topics within cartilage repair of the ankle, after which a comprehensive literature review was performed and the available evidence for each statement was graded. Discussion and debate occurred in cases where statements were not agreed upon in unanimous fashion within the working groups. A final vote was then held, and the strength of consensus was characterized as follows: consensus, 51% to 74%; strong consensus, 75% to 99%; unanimous, 100%. RESULTS A total of 9 statements on subchondral pathology reached consensus during the 2017 International Consensus Meeting on Cartilage Repair of the Ankle. No statements achieved unanimous support, but all statements reached strong consensus (greater than 75% agreement). All statements reached at least 81% agreement. CONCLUSIONS This international consensus statements regarding subchondral pathology of the talus derived from leaders in the field will assist clinicians in the assessment and management of this difficult pathology.
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Affiliation(s)
- Yoshiharu Shimozono
- 1 Foot and Ankle Service, Hospital for Special Surgery, New York, NY, USA
- 2 Teikyo University School of Medicine, Department of Orthopaedic Surgery, Tokyo, Japan
- 3 Kyoto University Graduate School of Medicine, Department of Orthopaedic Surgery, Kyoto, Japan
| | - Alexandra J Brown
- 1 Foot and Ankle Service, Hospital for Special Surgery, New York, NY, USA
| | - Jorge P Batista
- 4 Centro Artroscópico Jorge Batista, Buenos Aires, Argentina
| | - Christopher D Murawski
- 5 Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Mohamed Gomaa
- 6 Department of Orthopedic Surgery, Kasr Al-Ainy Hospital, Cairo University School of Medicine, Cairo, Egypt
| | | | - Tanawat Vaseenon
- 8 Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Masato Takao
- 9 Clinical and Research Institute for Foot and Ankle Surgery, Chiba, Japan
| | - Mark Glazebrook
- 10 Dalhousie University & Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
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Ruta DJ, Villarreal AD, Richardson DR. Orthopedic Surgical Options for Joint Cartilage Repair and Restoration. Phys Med Rehabil Clin N Am 2018; 27:1019-1042. [PMID: 27788899 DOI: 10.1016/j.pmr.2016.06.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The limited natural capacity for articular cartilage to regenerate has led to a continuously broadening array of surgical interventions. Used once patients' symptoms are not relieved by nonoperative management, these share the goals of joint preservation and restoration. Techniques include bone marrow stimulation, whole-tissue transplantation, and cell-based strategies, each with its own variations. Many of these interventions are performed arthroscopically or with extended-portal techniques. Indications, operative techniques, unique benefits, and limitations are presented.
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Affiliation(s)
- David J Ruta
- St. Luke's Department of Orthopedics & Sports Medicine, Duluth, MN, USA.
| | - Arturo D Villarreal
- Department of Orthopaedic Surgery & Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, TN, USA
| | - David R Richardson
- Department of Orthopaedic Surgery & Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, TN, USA
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Murphy EP, Fenelon C, McGoldrick NP, Kearns SR. Bone Marrow Aspirate Concentrate and Microfracture Technique for Talar Osteochondral Lesions of the Ankle. Arthrosc Tech 2018; 7:e391-e396. [PMID: 29868410 PMCID: PMC5982938 DOI: 10.1016/j.eats.2017.10.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 10/31/2017] [Indexed: 02/03/2023] Open
Abstract
Osteochondral lesions of the talus refer to a chondral or subchondral defect of the articular cartilage and potentially the underlying bone. Ankle sprains are an extremely common injury; approximately 27,000 ankle sprains occur per day in America. Fifty percent of these can lead to a cartilage injury to the ankle. There has been a high quoted rate of failure with conservative measures of up to 45% in some series. Surgical options are largely broken down into 2 groups, namely, reparative or regenerative treatments. The reparative techniques include debridement and bone marrow stimulation techniques such as microdrilling and microfracture. Regenerative techniques include autologous osteochondral transplants. However, there are disadvantages in terms of donor site morbidity and the development of subchondral bone cysts over time. The aim of this video is to demonstrate a technique for microfracture and augmentation with bone marrow aspirate concentration and Tisseel fibrin glue. This video details the indications for performing microfracture, the indications for using bone marrow stimulation techniques, and the contraindications. Patient positioning, setup, preparation of the lesion, harvesting of the bone marrow aspirate concentrate, and application of the bone marrow aspirate are detailed.
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Affiliation(s)
- Evelyn P. Murphy
- Address correspondence to Evelyn P. Murphy, M.B.B.Ch., M.Ch., M.R.C.S., Department of Orthopaedics/Trauma, Galway University Hospital, Saolta Hospital Group, Galway, Ireland.
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Rivera JC, Beachler JA. Distraction arthroplasty compared to other cartilage preservation procedures in patients with post-traumatic arthritis: a systematic review. Strategies Trauma Limb Reconstr 2018; 13:61-67. [PMID: 29363012 PMCID: PMC6042220 DOI: 10.1007/s11751-018-0305-2] [Citation(s) in RCA: 6] [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: 02/08/2017] [Accepted: 01/13/2018] [Indexed: 02/07/2023] Open
Abstract
Post-traumatic arthritis (PTA) is characterized by the deterioration of articular cartilage temporally associated with an articular injury. With a paucity of literature comparing joint preservation techniques, we performed a systematic review of the literature intending to describe and summarize the results of ankle distraction arthroplasty as it compares with studies on tibio-talar microfracture, allograft, and autograft for ankle joint preservation in the post-traumatic population under 50 years of age. Research databases were searched and abstracts screened for relevance on our topic of interest. Abstracts meeting screening criteria with high interobserver reliability underwent full-manuscript review and coding for pertinent citation, study level, treatment, and outcome variables. Outcome variables for patient-reported pain scales, validated outcome measurement tools, radiographic progression, reoperation/re-treatment rates, and complication rates were recorded. Out of 105 unique citations, 10 publications were included. The distraction arthroplasty studies had 36 out of 181 patients requiring reoperation for complications (19.9%), while other joint-preserving procedures studies had 40 out of 177 patients requiring reoperations for complications (22.6%). Clinical outcome scores at mean follow-up time ranging from 2 to 10 years between studies were similar. Reported results for a variety of cartilage preservation procedures, including distraction arthroplasty, are satisfactory and reoperation rates for complication are similar. Limitations in available data and underlying study quality affect synthesis of the results therein. While distraction arthroplasty is an option for cartilage preservation in patients with PTA of the ankle, the technique is highly specialized which may affect the external validity. Level of evidence: III.
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Affiliation(s)
- Jessica C Rivera
- Department of Orthopaedic Surgery, San Antonio Military Medical Center, Joint Base San Antonio, Fort Sam Houston, TX, 78234, USA.
| | - Jason A Beachler
- Department of Orthopaedic Surgery, San Antonio Military Medical Center, Joint Base San Antonio, Fort Sam Houston, TX, 78234, USA
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Yasui Y, Ramponi L, Seow D, Hurley ET, Miyamoto W, Shimozono Y, Kennedy JG. Systematic review of bone marrow stimulation for osteochondral lesion of talus - evaluation for level and quality of clinical studies. World J Orthop 2017; 8:956-963. [PMID: 29312855 PMCID: PMC5745439 DOI: 10.5312/wjo.v8.i12.956] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Revised: 05/27/2017] [Accepted: 08/16/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To clarify the quality of the studies indicating lesion size and/or containment as prognostic indicators of bone marrow stimulation (BMS) for osteochondral lesions of the talus (OLT).
METHODS Two reviewers searched the PubMed/MEDLINE and EMBASE databases using specific terms on March 2015 in accordance with the Preferred Reporting Items for Systemic Reviews and Meta-Analyses guidelines. Predetermined variables were extracted for all the included studies. Level of evidence (LOE) was determined using previously published criteria by the Journal of Bone and Joint Surgery and methodological quality of evidence (MQOE) was evaluated using the Modified Coleman Methodology Score.
RESULTS This review included 22 studies. Overall, 21 of the 22 (95.5%) included studies were level IV or level III evidences. The remaining study was a level II evidence. MQOE analysis revealed 14 of the 22 (63.6%) included studies having fair quality, 7 (31.8%) studies having poor quality and only 1 study having excellent quality.
CONCLUSION The evidence supporting the use of lesion size and containment as prognostic indicators of BMS for OLTs has been shown to be of low quality.
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Affiliation(s)
- Youichi Yasui
- 2nd Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo 173-8606, Japan
- Hospital for Special Surgery, New York, NY 10021, United States
| | - Laura Ramponi
- Hospital for Special Surgery, New York, NY 10021, United States
- 2nd Rizzoli Orthopaedic Institute, Bologna 4136, Italy
| | - Dexter Seow
- Hospital for Special Surgery, New York, NY 10021, United States
- 2nd Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Eoghan T Hurley
- Hospital for Special Surgery, New York, NY 10021, United States
- 2nd Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Wataru Miyamoto
- Hospital for Special Surgery, New York, NY 10021, United States
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo 173-8606, Japan
| | | | - John G Kennedy
- Hospital for Special Surgery, New York, NY 10021, United States
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Yasui Y, Wollstein A, Murawski CD, Kennedy JG. Operative Treatment for Osteochondral Lesions of the Talus: Biologics and Scaffold-Based Therapy. Cartilage 2017; 8:42-49. [PMID: 27994719 PMCID: PMC5154422 DOI: 10.1177/1947603516644298] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Numerous basic science articles have published evidence supporting the use of biologic augmentation in the treatment of osteochondral lesions of the talus (OLT). However, a comprehensive evaluation of the clinical outcomes of those treatment modalities in OLT has yet to be published. The purpose of this review is to provide an evidence-based overview of clinical outcomes following biologic augmentation to surgical treatments for OLT. DESIGN A comprehensive literature review was performed. Two commonly used surgical techniques for the treatment of OLT-bone marrow stimulation and osteochondral autograft transfer-are first introduced. The review describes the operative indications, step-by- step operative procedure, clinical outcomes, and concerns associated with each treatment. A review of the currently published basic science and clinical evidence on biologic augmentation in the surgical treatments for OLT, including platelet-rich plasma, concentrated bone marrow aspirate, and scaffold-based therapy follows. RESULTS Biologic agents and scaffold-based therapies appear to be promising agents, capable of improving both clinical and radiological outcomes in OLT. Nevertheless, variable production methods of these biologic augmentations confound the interpretation of clinical outcomes of cases treated with these agents. CONCLUSIONS Current clinical evidence supports the use of biologic agents in OLT cases. Nonetheless, well-designed clinical trials with patient-specific, validated and objective outcome measurements are warranted to develop standardized clinical guidelines for the use of biologic augmentation for the treatment of OLT in clinical practice.
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Affiliation(s)
- Youichi Yasui
- Hospital for Special Surgery, New York, NY, USA
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Adi Wollstein
- Hospital for Special Surgery, New York, NY, USA
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Christopher D. Murawski
- Hospital for Special Surgery, New York, NY, USA
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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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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Lubowitz JH. Editorial Commentary: Cartilage Clinical Research Challenges Show No Signs of Abatement. Arthroscopy 2016; 32:223. [PMID: 26743424 DOI: 10.1016/j.arthro.2015.11.001] [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: 11/03/2015] [Accepted: 11/03/2015] [Indexed: 02/02/2023]
Abstract
Medical research methods are generally poor, including methods found in recent research, research from academic institutions, and research supported by commercial funding. A solution is for systematic review authors to avoid additional review of prior publications with poor methods, and focus instead on returning to original scientific research (with improved methods) to address gaps in our clinical knowledge.
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