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Zhao P, Pei Z, Xing J, Gao M, Wang C, Xu Y, Zhang H, Cheng Y. Comparison of the medial midline and the anterolateral portal in ankle arthroscopy for the treatment of osteochondral lesions of the medial talus. INTERNATIONAL ORTHOPAEDICS 2024; 48:1821-1829. [PMID: 38528252 DOI: 10.1007/s00264-024-06159-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 03/20/2024] [Indexed: 03/27/2024]
Abstract
PURPOSE To compare the clinical efficacy and complication rates between the medial midline and anterolateral portals in ankle arthroscopy for treating medial osteochondral lesions of the talus (OLTs). METHODS We retrospectively analyzed patients with medial OLTs who underwent either a dual medial approach (via the medial midline and anteromedial portal) or a traditional approach (via the anterolateral and anteromedial portal) between June 2017 and January 2023. The degree of injury was evaluated by radiographs, computed tomography, and magnetic resonance imaging. Clinical outcomes were assessed using the visual analog scale (VAS), the American Orthopaedic Foot and Ankle Society (AOFAS) score, and the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) scoring system. The incidence of postoperative complications, including superficial peroneal nerve (SPN) injury, was evaluated in all patients. RESULTS There were 39 patients in total; 16 patients underwent the dual medial approach, and 23 patients underwent the traditional approach. The mean age was 39.4 ± 9.0 years, and the mean follow-up duration was 18.7 ± 6.4 months. The clinical outcomes improved significantly in both groups (*P < 0.05), but there was no significant difference between the two groups (P > 0.05). Postoperative complications were mainly SPN injury. The incidence of SPN injury was 13.0% in the traditional approach group and 0% in the dual medial approach group, with no significant difference between the two groups (P > 0.05), but a trend of reduction in SPN injury was observed in the dual medial approach group. CONCLUSION The dual medial approach can also treat medial OLTs well, providing clear visualization and more convenient operation and reducing the possibility of injury to the SPN compared with the traditional approach. Therefore, we consider that the MM portal would be a good alternative to the anterolateral portal in treating medial OLTs.
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Affiliation(s)
- Piqian Zhao
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Zijie Pei
- Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- Department of Orthopedics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Junhui Xing
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Mingyang Gao
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Changbao Wang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Yingjie Xu
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Hongtao Zhang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
| | - Yu Cheng
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
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Kawabata S, Nakasa T, Ikuta Y, Sumii J, Nekomoto A, Adachi N. High incidence of osteoarthritic changes in patients with osteochondral lesions of the talus without chronic lateral ankle instability. J Orthop Sci 2024; 29:249-255. [PMID: 36567196 DOI: 10.1016/j.jos.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 10/04/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND It is unclear whether osteochondral lesions of the talus (OLTs) without chronic lateral ankle instability (CLAI) progress to osteoarthritis, which affects the therapeutic strategy. Especially, the efficacy of conservative treatment for OLT remains controversial. Since various anatomical abnormalities have been reported, there may be abnormal movement of the talus in the mortise, causing ankle instability. We hypothesized that OLTs have frequent osteoarthritic changes even without CLAI. This study aimed to evaluate the incidence of osteoarthritic changes and stress distribution on the talus in OLT. METHODS Fifty-eight ankles with medial OLT without CLAI were retrospectively reviewed. Osteophytes and joint space narrowing on radiographs were scored using Kraus's classification and compared to ankles without OLTs. OA scores were compared between over 18 years and less than 17 years in OLTs. On computed tomography images, the area of OLTs was measured. Besides, Hounsfield Units (HU) of the talus in patients with and without OLTs were measured and compared. RESULTS Osteoarthritic changes were observed in 54 of the 58 ankles (94.8%) in the OLT patients. Osteophytes were frequently observed at the medial gutter and anterior tibial plafond. The OA score in patients aged over 18 years was significantly higher than that in patients aged less than 17 years (P < 0.05). HU values in the talus were significantly higher than those in non-OLT patients. OLTs more than 100 mm2 had a significantly higher osteoarthritic score than those less than 100 mm2. CONCLUSION Medial OLT without CLAI has frequently osteoarthritic changes, especially large lesions. Osteoarthritic changes in OLTs will progress over time, which needs to be considered when deciding whether to perform the surgical or non-surgical treatment.
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Affiliation(s)
- Shingo Kawabata
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University
| | - Tomoyuki Nakasa
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University; Medical Center for Translational and Clinical Research, Hiroshima University Hospital.
| | - Yasunari Ikuta
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University
| | - Junichi Sumii
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University
| | - Akinori Nekomoto
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University
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Yao X, Yun Z, Du Y, Xie X, Chen S, Cheng X. Synthetic bone grafting with preserved cartilage flap via a medial malleolus osteotomy approach to treat osteochondral lesion of the talus: technical note and preliminary clinical results. INTERNATIONAL ORTHOPAEDICS 2023; 47:2743-2749. [PMID: 37548695 DOI: 10.1007/s00264-023-05920-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 07/27/2023] [Indexed: 08/08/2023]
Abstract
PURPOSE Although various surgical procedures are available for osteochondral lesion of the talus (OLT), there is still no consensus on its best treatment. The purposes of this study were to describe a new surgical technique to treat OLT and to analyze its preliminary clinical results. METHODS Eight patients were enrolled in this retrospective study between March 2019 and May 2022 in the Second Affiliated Hospital of Chongqing Medical University. All patients were treated by synthetic bone grafting with preserved cartilage flap via a medial malleolus osteotomy approach. The patients' characteristics, operative time, and estimated blood loss were evaluated. Intraoperative photos, preoperative and postoperative X-ray and MRI imaging were recorded. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and visual analog scale (VAS) score were also recorded before surgery and at each follow-up. RESULTS At six months after the operation, all patients showed bone ingrowth and remodeling according to X-ray and MRI. No obvious defects or ladder was found on the cartilage surface of all patients according to MRI. The AOFAS score improved from 61.63 ± 8.85 (range, 49-74) to 91.13 ± 4.49 (range, 83-97) (p < 0.001) and VAS score improved from 5.50 ± 1.60 (range, 4-8) before surgery to 1.88 ± 0.83 (range, 1-3) (p < 0.001) at latest follow-up. In all eight patients, no wound infection, skin necrosis, or delayed healing of osteotomy was found. CONCLUSION We proposed a simple and effective technique that restored the shape of the cartilage surface by preserving the cartilage flap and restoring the natural congruency of the subchondral bone by synthetic bone grafting. We found satisfying clinical outcomes in short-term follow-up. Our new technique might be a new surgical option for the treatment of OLT and its effectiveness should be further evaluated.
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Affiliation(s)
- Xudong Yao
- Center for Joint Surgery, Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhu Yun
- Emergency Department, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yu Du
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaowei Xie
- Center for Joint Surgery, Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shirong Chen
- Center for Joint Surgery, Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiangjun Cheng
- Center for Joint Surgery, Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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Darwich A, Nörenberg D, Adam J, Hetjens S, Schilder A, Obertacke U, Gravius S, Jawhar A. A Multi-Disciplinary MRI Assessment May Optimize the Evaluation of Chondral Lesions in Acute Ankle Fractures: A Prospective Study. Diagnostics (Basel) 2023; 13:3220. [PMID: 37892043 PMCID: PMC10605548 DOI: 10.3390/diagnostics13203220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/03/2023] [Accepted: 10/04/2023] [Indexed: 10/29/2023] Open
Abstract
Chondral lesions (CL) in the ankle following acute fractures are frequently overlooked immediately after the injury or diagnosed at a later stage, leading to persistent symptoms despite successful surgery. The literature presents a wide range of discrepancies in the reported incidence of CLs in acute ankle fractures. The objective of this prospective study is to provide a precise assessment of the occurrence of chondral lesions (CLs) in acute ankle fractures through MRI scans conducted immediately after the trauma and prior to scheduled surgery. Furthermore, the study aims to highlight the disparities in the interpretation of these MRI scans, particularly concerning the size and extent of chondral damage, between radiologists and orthopedic surgeons. Over the period of three years, all patients presenting with an unstable ankle fracture that underwent operative treatment were consecutively included in this single-center prospective study. Preoperative MRIs were obtained for all included patients within 10 days of the trauma and were evaluated by a trauma surgeon and a radiologist specialized in musculoskeletal MRI blinded to each other's results. The location of the lesions was documented, as well as their size and ICRS classification. Correlations and kappa coefficients as well as the p-values were calculated. A total of 65 patients were included, with a mean age of 41 years. The evaluation of the orthopedic surgeon showed CLs in 52.3% of patients. CLs occurred mainly on the tibial articular surface (70.6%). Most talar lesions were located laterally (11.2%). The observed CLs were mainly ICRS grade 4. According to the radiologist, 69.2% of the patients presented with CLs. The most common location was the talar dome (48.9%), especially laterally. Most detected CLs were graded ICRS 3a. The correlation between the two observers was weak/fair regarding the detection and classification of CLs and moderate regarding the size of the detected CLs. To enhance the planning of surgical treatment for ankle chondral lesions (CLs), it may be beneficial to conduct an interdisciplinary preoperative assessment of the performed scans. This collaborative approach can optimize the evaluation of ankle CLs and improve overall treatment strategies.
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Affiliation(s)
- Ali Darwich
- Department of Orthopedic and Trauma Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1–3, 68167 Mannheim, Germany; (J.A.); (A.S.); (U.O.); (S.G.); (A.J.)
| | - Dominik Nörenberg
- Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1–3, 68167 Mannheim, Germany;
| | - Julia Adam
- Department of Orthopedic and Trauma Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1–3, 68167 Mannheim, Germany; (J.A.); (A.S.); (U.O.); (S.G.); (A.J.)
| | - Svetlana Hetjens
- Institute of Medical Statistics and Biomathematics, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1–3, 68167 Mannheim, Germany;
| | - Andreas Schilder
- Department of Orthopedic and Trauma Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1–3, 68167 Mannheim, Germany; (J.A.); (A.S.); (U.O.); (S.G.); (A.J.)
| | - Udo Obertacke
- Department of Orthopedic and Trauma Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1–3, 68167 Mannheim, Germany; (J.A.); (A.S.); (U.O.); (S.G.); (A.J.)
| | - Sascha Gravius
- Department of Orthopedic and Trauma Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1–3, 68167 Mannheim, Germany; (J.A.); (A.S.); (U.O.); (S.G.); (A.J.)
| | - Ahmed Jawhar
- Department of Orthopedic and Trauma Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1–3, 68167 Mannheim, Germany; (J.A.); (A.S.); (U.O.); (S.G.); (A.J.)
- Department of Orthopedics, Traumatology and Sports Medicine, Marienhaus Hospital Hetzelstift/Teaching Hospital University Mainz, Stiftstraße 10, 67434 Neustadt an der Weinstraße, Germany
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Gupta A, Aratikatla A. Allogenic Umbilical Cord Tissue as a Scaffold for Ankle Osteoarthritis. Cureus 2023; 15:e46572. [PMID: 37933357 PMCID: PMC10625671 DOI: 10.7759/cureus.46572] [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] [Accepted: 10/06/2023] [Indexed: 11/08/2023] Open
Abstract
Osteoarthritis (OA) of ankle followed by injury to the talus is one of the most common disorders of ankle. Traditional treatment modalities have limitations and do not address the etiopathogenetic cause of OA. Perinatal tissue-derived biologics such as umbilical cords have shown potential for musculoskeletal regenerative medicine applications. This article qualitatively presents the in vitro, pre-clinical, clinical, and ongoing scientific literature exploring the application of umbilical cord tissue in the context of ankle OA. We identified only one clinical study wherein allogenic umbilical cord tissue was applied as a scaffold to the degenerated cartilage in the subtalar synovial joint. Administration of umbilical cord tissue is safe and potentially efficacious in patients with ankle OA. However, more in vitro, pre-clinical studies and high-powered, multi-center, non-randomized and randomized controlled trials are warranted to further establish the safety and efficacy of umbilical cord to justify its clinical use in ankle OA patients.
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Affiliation(s)
- Ashim Gupta
- Regenerative Medicine, Regenerative Orthopaedics, Noida, IND
- Regenerative Medicine, Future Biologics, Lawrenceville, USA
- Regenerative Medicine, BioIntegrate, Lawrenceville, USA
- Orthopaedics, South Texas Orthopaedic Research Institute, Laredo, USA
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Leung M, Huang YG, Zhang C. Costal cartilage grafting in the treatment of concurrent osteochondral lesion of the talus in a trimalleolar fracture. Trauma Case Rep 2023; 46:100853. [PMID: 37304216 PMCID: PMC10248547 DOI: 10.1016/j.tcr.2023.100853] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2023] [Indexed: 06/13/2023] Open
Abstract
A 49-year-old female sustained a trimalleolar fracture concurrent with 10 years history of symptomatic osteochondral lesions of the talus. We performed a costal cartilage grafting for osteochondral lesions of the talus through the inherent medial malleolar fracture gap, followed by internal fixation of the fracture. During the follow-up, the fracture healed within the expected time, accompanied by favorable functional outcomes and pre-injury pain relief. At 3 years postoperatively, the graft merged with the bone bed of the talus, and progressive endochondral ossification was observed at the graft-bone interface. The case provides us a chance to verify whether the costal cartilage grafting is reliable for the treatment of osteochondral lesions of the talus.
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Huber T, Schwertner A, Breuer R, Charwat-Pessler CG, Rath B, Orthner E. Retrograde Drilling, Ossoscopy, and Autologous Bone Grafting: An Alternative Technique for Treatment of Osteochondral Lesion of the Talus Stage 2 and 3 in Adults. Foot Ankle Int 2023; 44:488-496. [PMID: 37208904 DOI: 10.1177/10711007231162825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
BACKGROUND Symptomatic osteochondral lesions of the talus (OLTs) often require surgical intervention. There are various surgical methods. A generally valid, stage-dependent therapeutic algorithm does not exist. The aim of our study is to show long- term results of an alternative technique that combines retrograde drilling, debridement performed under arthroscopic visualization, and autologous bone grafting. METHODS The surgical technique was performed in 24 patients with medial or lateral OLTs, and the data were analyzed retrospectively. In our technique, the affected subchondral bone was overdrilled retrogradely and resected under arthroscopic visualization (ossoscopy) without violating the cartilage. The resulting defect was filled with autologous bone from the medial tibia metaphysis. Outcome parameters were the numeric rating scale (NRS), the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, and range of motion (ROM). The Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score was assessed and a possible correlation with the clinical outcome scores was calculated. Data concerning complication rates were also collected. RESULTS The mean surface size of the OLTs was 0.9 ± 0.3 cm2. The mean follow-up was 89 months. The AOFAS score improved significantly from 57.7 points preoperatively to 88.8 points at the final follow-up (P < .0001). The pain value measured by the NRS decreased significantly from 8 to a pain level of 2. ROM improved in 37.5% of the patients for dorsiflexion and 29.2% for plantarflexion. There were no significant correlations between the MOCART score and the AOFAS score or the pain value on NRS. CONCLUSION Retrograde drilling, ossoscopy, and autologous bone grafting for OLTs is a promising technique with good long-term results. The patients' satisfaction rate, especially in OLT stages 2 and 3, was excellent. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Thorsten Huber
- Department of Orthopedics, Klinikum Wels-Grieskirchen, Wels, Austria
| | | | - Robert Breuer
- Department of Orthopedics, Klinikum Wels-Grieskirchen, Wels, Austria
| | | | - Björn Rath
- Department of Orthopedics, Klinikum Wels-Grieskirchen, Wels, Austria
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Peng J, Wang Q, Xu Y, He H. Platelet-rich plasma treatment for talar cartilage repair: a systematic review and meta-analysis. BMC Musculoskelet Disord 2023; 24:366. [PMID: 37161527 PMCID: PMC10169378 DOI: 10.1186/s12891-023-06466-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 04/26/2023] [Indexed: 05/11/2023] Open
Abstract
PURPOSE To systematically review the studies regarding to the safety, efficacy and application methods of PRP in promoting the talar cartilage repair. METHODS A systematic review was performed by searching PubMed, Web of Science, OVID and EMBASE to identify studies that compared the clinical efficacy of PRP for talar cartilage repair. Main outcome was the American Orthopedic Foot and Ankle Society (AOFAS) score for function and Visual Analog Scale (VAS) for pain was the second outcome. RESULTS A total of 10 studies were included in this systematic review, including 4 randomized controlled trials, 1 controlled trial, 3 case series and 2 cohort studies. Four RCTs were analyzed using meta-analysis. For all outcomes, statistical results favored PRP group (AOFAS: MD = 7.84; 95% CI= [-0.13, 15.80], I2 = 83%, P < 0.01; VAS: MD = 1.86; 95% CI= [0.68, 3.04], I2 = 85%, P < 0.01). There were almost no reports of adverse events related to PRP intervention. Subgroup analysis showed that whether PRP was used alone or combined with other treatments could result in high heterogeneity but no more specific factors were identified to contribute to this. CONCLUSION PRP is safe and effective for talar cartilage repair. In addition to the standardization of PRP preparation and application, it is necessary to distinguish the effects of PRP used alone or in combination with other treatments. In PRP studies, surgical treatment of talar cartilage repair remains the mainstream. The regulation of PRP in surgical applications are worth exploring. The most relative component is the mesenchymal stem cell because it is the only exposed chondrocyte precursor in the articular cavity whether it is microfracture or cell transplantation. TRIAL REGISTRATION The study was registered in the PROSPERO International prospective register of systematic reviews (CRD42022360183).
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Affiliation(s)
- Jialei Peng
- Department of Rehabilitation Medicine, Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, #37 Guoxue Street, Wuhou District, Chengdu, Sichuan, 610041, P. R. China
- School of Rehabilitation Sciences, West China School of Medicine, Sichuan University, Chengdu, 610041, P. R. China
- Rehabilitation Medicine Key Laboratory of Sichuan Province, Chengdu, 610041, P. R. China
| | - Qian Wang
- Department of Rehabilitation Medicine, Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, #37 Guoxue Street, Wuhou District, Chengdu, Sichuan, 610041, P. R. China
- School of Rehabilitation Sciences, West China School of Medicine, Sichuan University, Chengdu, 610041, P. R. China
- Rehabilitation Medicine Key Laboratory of Sichuan Province, Chengdu, 610041, P. R. China
| | - Yang Xu
- Department of Rehabilitation Medicine, Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, #37 Guoxue Street, Wuhou District, Chengdu, Sichuan, 610041, P. R. China
- School of Rehabilitation Sciences, West China School of Medicine, Sichuan University, Chengdu, 610041, P. R. China
- Rehabilitation Medicine Key Laboratory of Sichuan Province, Chengdu, 610041, P. R. China
| | - Hongchen He
- Department of Rehabilitation Medicine, Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, #37 Guoxue Street, Wuhou District, Chengdu, Sichuan, 610041, P. R. China.
- School of Rehabilitation Sciences, West China School of Medicine, Sichuan University, Chengdu, 610041, P. R. China.
- Rehabilitation Medicine Key Laboratory of Sichuan Province, Chengdu, 610041, P. R. China.
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Bai L, Zhang Y, Chen S, Bai Y, Lu J, Xu J. Analysis of factors affecting the prognosis of osteochondral lesions of the talus. INTERNATIONAL ORTHOPAEDICS 2023; 47:861-871. [PMID: 36574023 PMCID: PMC9931857 DOI: 10.1007/s00264-022-05673-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 12/16/2022] [Indexed: 12/29/2022]
Abstract
PURPOSE This study aims to analyze the correlation between the prognosis of osteochondral lesions of the talus and patient age, gender, duration of illness, and injury location, surface area, depth, and volume. METHODS A retrospective analysis of 44 patients who underwent talus osteochondral transplantation in the Department of Foot and Ankle Surgery of our hospital between January 2017 and December 2020 was performed. The clinical medical records of the patients were collected, and the location of the osteochondral lesion of the talus was determined according to the nine-division method. The surface area, depth, and volume of the osteochondral lesion of the talus were measured using mimics software in all patients. The visual analog scale (VAS), the American Orthopedic Foot and Ankle Society (AOFAS), and the SF-36 quality of life questionnaire scores were evaluated before surgery and at the last follow-up, and correlation analysis was performed. RESULTS Of 44 patients, 30 were followed up with a mean period of 24.33 ± 12.19 months. There were 18 men and 12 women, with an average age of 40.73 ± 10.57 years and an average disease duration of 28.30 ± 21.25 months. The VAS, AOFAS, and SF-36 scores of all patients at the last follow-up were significantly better than those before surgery. The degree of post-operative symptom improvement was not correlated with age, sex, duration of illness, and injury location, surface area, depth, and volume. CONCLUSION The prognosis of osteochondral lesion of the talus is not related to patient age, gender, duration of disease, or injury location, surface area, depth, and volume.
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Affiliation(s)
- Lei Bai
- Honghui Hospital, Xi'An Jiaotong University, Xi'An, 710000, Shaanxi, China
| | - Yi Zhang
- Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, 712046, Shaanxi, China
| | - ShiKai Chen
- First Clinical Medical College, Shaanxi University of Chinese Medicine, Xianyang, 712046, Shaanxi, China
| | - Yan Bai
- Kunming Medical University, Kunming, 650000, Yunnan, China
| | - Jun Lu
- Foot and Ankle Surgery Center, Honghui Hospital, Xi'An Jiaotong University, Xi'An, 710000, Shaanxi, China
| | - JunKui Xu
- Honghui Hospital, Xi'An Jiaotong University, Xi'An, 710000, Shaanxi, China.
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Zhang M, Chen D, Wang Q, Li Y, Huang S, Zhan P, Lai J, Jiang J, Chen D. Comparison of arthroscopic debridement and microfracture in the treatment of osteochondral lesion of talus. Front Surg 2023; 9:1072586. [PMID: 36713661 PMCID: PMC9880473 DOI: 10.3389/fsurg.2022.1072586] [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: 10/17/2022] [Accepted: 12/19/2022] [Indexed: 01/15/2023] Open
Abstract
Objective This study was performed to compare the clinical effect of arthroscopic debridement vs. arthroscopic microfracture in the treatment of osteochondral lesions of the talus. Methods We retrospectively reviewed patients with osteochondral lesion of talus who were admitted to our hospital from April 2020 to April 2021. The patients were divided into Group A (arthroscopic debridement group, n = 39) and Group B (arthroscopic microfracture group, n = 42), and the intraoperative details in the two groups were analyzed. The American Orthopaedic Foot and Ankle Society (AOFAS) score and visual analogue scale (VAS) score were compared between the two groups before surgery and at the last follow-up. Results The postoperative AOFAS score (Group A, 40.9-82.26; Group B, 38.12-87.38), VAS score (Group A, 6.44-3.92; Group B, 6.38-2.05) significantly improved in both groups, but the improvement was significantly greater in Group B than in Group A (P < 0.05). Among all patients, the AOFAS and VAS scores of men aged ≤30 years and patients with a low body mass index (BMI) improved more significantly (P < 0.05). Conclusion The arthroscopic microfracture for the treatment of osteochondral lesion of talus is superior to joint debridement in terms of improving ankle function, especially in relatively young men with a relatively low BMI.
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Moisan P, Lamer S, Li O, Grimard G, Nault ML. Osteochondritis Dissecans of the Talus: A New Transmalleolar Fixation Technique. VIDEO JOURNAL OF SPORTS MEDICINE 2022. [DOI: 10.1177/26350254221104100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Background: Conservative management is the first line of treatment in most osteochondritis dissecans (OCD) cases and can be sufficient for small and stable lesions in skeletally immature patients. Unstable lesions commonly require surgical interventions and may need fixation. The standard surgical approach to fix posteromedial lesions of the talus involves an osteotomy of the medial malleolus. This technique is invasive and requires multiple weeks of immobilization after the surgery. In this video, we present a minimally invasive transmalleolar approach used for the fixation of an OCD lesion of the talus. Indications: The main indication for this procedure is the failure of conservative management with persistent ankle pain and functional impairment of an unstable osteochondral lesion with poor potential for revascularization. Technique Description: There are 3 key steps to this surgery: ankle arthroscopy, retroarticular drilling, and transmalleolar fixation. The transmalleolar approach is achieved by creating a tunnel through the medial malleoli oriented toward the lesion. To do so, the surgeon combines fluoroscopy and ankle arthroscopy to first insert a Kirschner wire (K-wire) through the medial malleoli. Once the correct orientation is confirmed, a 4.5-mm cannulated drill bit is used to create the tunnel. Arthroscopic visualization is used to avoid iatrogenic cartilage damage during drilling. Once the tunnel is created, ankle dorsiflexion and plantar flexion are used to access the entire lesion and insert screws. The malleolar tunnel is then filled with a bone graft and the wound closed. The patient is immobilized for 2 weeks after which gentle range of motion is initiated. The patient remains non-weight-bearing for 2 months and is then allowed to bear weight using a boot. Results: Transmalleolar fixation for osteochondritis dissecans of the talus is a minimally invasive procedure that does not require an osteotomy of the medial talus. This approach permits early postoperative range of motion and decreases postoperative pain and edema, but the adequate positioning of the tunnel can prove challenging. Conclusion: Transmalleolar approach to the talus is minimally invasive and allows adequate fixation of certain osteochondral lesions. Studies comparing the reoperation and complication rate with the standard malleolar osteotomy are lacking and need to be performed. The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
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Affiliation(s)
| | | | - Orville Li
- CHU Sainte-Justine, Montréal, QC, Canada
| | - Guy Grimard
- CHU Sainte-Justine, Montréal, QC, Canada
- University of Montreal, Montreal, QC, Canada
| | - Marie-Lyne Nault
- CHU Sainte-Justine, Montréal, QC, Canada
- University of Montreal, Montreal, QC, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux, Hôpital du Sacré-Cœur de Montréal, Montreal, QC, Canada
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Gouty tophus as a rare cause of a Hepple stage V osteochondral lesion of the talus. Eur J Med Res 2021; 26:124. [PMID: 34666837 PMCID: PMC8524955 DOI: 10.1186/s40001-021-00597-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 10/05/2021] [Indexed: 11/29/2022] Open
Abstract
Background Talus osteochondral lesion is commonly associated with trauma, avascular necrosis or even genetic factors, but gouty tophus as a cause of Hepple stage V type talus osteochondral lesion is rare. Case presentation Here, we report a case of an 18-year-old man who complained of left medial deep ankle pain on ambulation. This young man had an extreme liking of sea food rich in purines and also sugar-sweetened drinks. He was diagnosed with a Hepple stage V type talus osteochondral lesion and was treated with medial malleolus osteotomy and an osteochondral graft. The talus osteochondral lesion was found to be a gouty tophus and was completely removed. Hypouricemic therapy was prescribed for 2 months, which allowed the patient to walk with a visual analogue score (VAS) score of 1. He was followed up for 12 months. Conclusions Young people with an extreme liking of sea food rich in purines and also sugar-sweetened drinks may be at a risk of developing gout. Acute onset of ankle atraumatic pain, swelling with a high level of serum uric acid and a talus osteochondral lesion with cyst formation should make physicians consider a diagnosis of gout.
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