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Liu H, Liu L, Li M, Huang F, Li P, Liu S. Clinical comprehensive of microfracture, autologous chondrocyte implantation, and periosteum-covered iliac bone grafting for Hepple stage IV-V lesions. Medicine (Baltimore) 2024; 103:e39586. [PMID: 39312372 PMCID: PMC11419553 DOI: 10.1097/md.0000000000039586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 08/15/2024] [Indexed: 09/25/2024] Open
Abstract
Chronic ankle pain significantly impairs daily activities and athletic performance with osteochondral lesions of the talus (OLT) in Hepple stages IV and V, which are often causative factors. This study aimed to assess the efficacy and safety of autologous osteochondral transplantation (AOT) for the treatment of these conditions. This retrospective study was conducted from May 2020 to May 2023 at Cangzhou Traditional Chinese and Western Medicine Combined Hospital, including patients with a diagnosis of Hepple stage IV or V OLT confirmed by magnetic resonance imaging (MRI) and arthroscopy. Surgical interventions involved arthroscopic debridement, followed by AOT or limited arthrotomy based on the location and size of the lesion. Preoperative and postoperative evaluations used the Visual Analog Scale, American Orthopedic Foot and Ankle Society Ankle-Hindfoot Scale, MRI-Based Cartilage Repair Tissue Scoring, and the International Knee Documentation Committee Knee Evaluation Form. Statistical analysis was conducted using paired-sample t tests to compare the preoperative and postoperative data. Twenty patients were included, revealing significant postoperative improvements in Visual Analog Scale, American Orthopedic Foot and Ankle Society, and MRI-based cartilage repair tissue scores (P < .05). The radiographic findings suggested effective cartilage regeneration. No adverse effects were observed in the donor knee sites, as confirmed by the stable pre- and postoperative International Knee Documentation Committee Knee Evaluation Form scores. Recovery of physical abilities was achieved on average within 7.3 weeks for daily activities and 13.4 weeks for sports activities. AOT effectively treats Hepple stage IV-V OLT, improves ankle function, promotes cartilage regrowth, and allows quick resumption of daily and athletic activities without compromising donor-site integrity.
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Affiliation(s)
- Heda Liu
- Department of Foot and Ankle Surgery, Cangzhou Traditional Chinese and Western Medicine Combined Hospital, Cangzhou, Hebei Province, China
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Mercurio M, Minici R, Spina G, Cofano E, Laganà D, Familiari F, Galasso O, Gasparini G. Clinical and Radiological Outcomes of combined Arthroscopic Microfracture and Mesenchymal Stem Cell Injection Versus Isolated Microfracture for Osteochondral Lesions of the Talus: A Meta-Analysis of Comparative Studies. J Foot Ankle Surg 2024:S1067-2516(24)00210-2. [PMID: 39182822 DOI: 10.1053/j.jfas.2024.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 08/01/2024] [Accepted: 08/17/2024] [Indexed: 08/27/2024]
Abstract
We aimed to systematically evaluate the clinical and radiological outcomes reported in comparative studies evaluating combined arthroscopic microfracture and mesenchymal stem cell (MSC) injection versus isolated microfracture for osteochondral lesions of the talus (OLT). A total of 5 studies were included. Demographics, American Orthopaedic Foot and Ankle Society (AOFAS) score, Tegner activity scale score, Foot and Ankle Outcome Scale (FAOS), visual analogue scale (VAS), and Magnetic Resonance Observation of Cartilage Repair Tissue Score (MOCART) were analyzed. A total of 348 patients were evaluated, 171 of whom underwent combined microfracture and MSC injection and 177 of whom underwent isolated microfracture. The frequency-weighted mean ages were 38.9 ± 13.5 and 36.9 ± 11.4 years and the mean follow-up were 36.7 ± 13.3 and 36.2 ± 16.2 months in the combined microfracture and MSC injection and isolated microfracture groups, respectively. The combined microfracture and MSC injection group showed significantly better postoperative AOFAS score (81.5 ± 7.4 vs 68.2 ± 5.1, p < .001), and MOCART score (74.3 ± 16.3 vs 63.9 ± 15.5, p < .001) with differences beyond the minimum clinically important difference. The combination of arthroscopic microfracture and MSC injection significantly improved functionality and radiological outcomes compared to those of isolated microfracture for OLT.
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Affiliation(s)
- Michele Mercurio
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Renato Dulbecco" University Hospital, 88100, Catanzaro, Italy; Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, Magna Graecia University, 88100 Catanzaro, Italy.
| | - Roberto Minici
- Radiology Unit, Department of Experimental and Clinical Medicine, "Magna Græcia" University, "Renato Dulbecco" University Hospital, 88100 Catanzaro, Italy
| | - Giovanna Spina
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Renato Dulbecco" University Hospital, 88100, Catanzaro, Italy
| | - Erminia Cofano
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Renato Dulbecco" University Hospital, 88100, Catanzaro, Italy
| | - Domenico Laganà
- Radiology Unit, Department of Experimental and Clinical Medicine, "Magna Græcia" University, "Renato Dulbecco" University Hospital, 88100 Catanzaro, Italy
| | - Filippo Familiari
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Renato Dulbecco" University Hospital, 88100, Catanzaro, Italy; Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, Magna Graecia University, 88100 Catanzaro, Italy
| | - Olimpio Galasso
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Renato Dulbecco" University Hospital, 88100, Catanzaro, Italy; Department of Medicine, Surgery and Dentistry, University of Salerno, 84081, Baronissi, Salerno, Italy
| | - Giorgio Gasparini
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Renato Dulbecco" University Hospital, 88100, Catanzaro, Italy; Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, Magna Graecia University, 88100 Catanzaro, Italy
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Khan I, Ranjit S, Welck M, Saifuddin A. The role of imaging in the diagnosis, staging, and management of the osteochondral lesions of the talus. Br J Radiol 2024; 97:716-725. [PMID: 38321227 PMCID: PMC11027257 DOI: 10.1093/bjr/tqae030] [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: 08/27/2022] [Revised: 07/12/2023] [Accepted: 01/29/2024] [Indexed: 02/08/2024] Open
Abstract
Osteochondral lesions of the talus (OLT) represent an abnormality of the articular cartilage and sub-chondral bone. The abnormality is typically associated with trauma though the exact aetiology remains unknown. Multiple staging systems have been developed to classify the abnormality and management can vary from conservative treatment to different surgical options. Early diagnosis is essential for optimal outcome and all imaging modalities have a role to play in patient management. The aim of this article is to review the pathology, classification, multimodality imaging appearances of OLT, and how the imaging affects patient management.
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Affiliation(s)
- Imran Khan
- Department of Radiology, University Hospitals of Leicester NHS Trust, LE5 4PW, Leicester, United Kingdom
| | - Srinath Ranjit
- Foot and Ankle Reconstruction Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, United Kingdom
| | - Matt Welck
- Foot and Ankle Reconstruction Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, United Kingdom
| | - Asif Saifuddin
- Department of Radiology, Royal National Orthopaedic Hospital NHS Trust, Brockley Hill, Stanmore, Middlesex, HA7 4LP, United Kingdom
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Barrached M, Tebbaa El Hassali A, Sohaib EM, Abdeljaouad N, Yacoubi H. Mosaicplasty in the Treatment of Osteochondral Lesions of the Talus: A Report of Two Cases. Cureus 2024; 16:e54345. [PMID: 38500922 PMCID: PMC10945609 DOI: 10.7759/cureus.54345] [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: 02/16/2024] [Indexed: 03/20/2024] Open
Abstract
Osteochondral damage to the talus is one of the most frequent causes of ankle pain. In contrast to other joints in the lower limb, osteochondral damage of the talus is often attributed to traumatic events. One option of treatment is mosaicplasty, which has proved to be a feasible choice for the treatment of osteochondral lesions of the talus; it has the potential to alleviate ankle pain and facilitate engagement in daily activities as well as sports. We present two different cases of osteochondral lesions of the talus, illustrating how this pathology can present clinically. Both cases involve males with no notable pathological antecedents. The first was the victim of a traffic accident, the second was the victim of a sports accident; they were admitted for the management of chronic ankle pain unimproved by analgesic treatment. Radiological findings revealed a talus osteochondral lesion in both patients, treated with an osteochondral autograft from the homolateral knee. Both patients progressed well, with the resumption of daily activities and sports. The notable result of current research is that mosaicplasty has been shown to have good results in those with large osteochondral lesions who want to return to normal activity.
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Affiliation(s)
- Mohammed Barrached
- Department of Traumatology and Orthopedics, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Mohammed Ist University, Oujda, MAR
| | - Achraf Tebbaa El Hassali
- Department of Traumatology and Orthopedics, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Mohammed Ist University, Oujda, MAR
| | - El Mahjoubi Sohaib
- Department of Traumatology and Orthopedics, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Mohammed Ist University, Oujda, MAR
| | - Najib Abdeljaouad
- Department of Traumatology and Orthopedics, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Mohammed Ist University, Oujda, MAR
| | - Hicham Yacoubi
- Department of Traumatology and Orthopedics, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Mohammed Ist University, Oujda, MAR
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Lee TY, Chen PY, Yang KC, Tzeng IS, Ming Chang C, Wang CC. Comparison of Knot-Tying Techniques During the Arthroscopic Broström-Gould Procedure: Semiconstrained Freehand Versus Knot Pusher Techniques. Orthop J Sports Med 2024; 12:23259671231218649. [PMID: 38274016 PMCID: PMC10809873 DOI: 10.1177/23259671231218649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 06/29/2023] [Indexed: 01/27/2024] Open
Abstract
Background The arthroscopic Broström technique with or without Gould modification has been used to treat patients with anterior talofibular ligament injury who failed nonoperative management and progressed to chronic lateral ankle instability. However, some patients develop limited range of motion over the ankle joint postoperatively. Purpose/Hypothesis To compare the clinical outcomes and midterm functional performance of knot-tying techniques between using a knot pusher and a semiconstrained freehand tie during arthroscopic Broström-Gould procedure with inferior extensor retinaculum (IER) augmentation. It was hypothesized that the semiconstrained freehand tie would provide better plantarflexion of the ankle joint compared with the knot pusher. Study Design Cohort study; Level of evidence, 3. Methods Included were 135 consecutive patients with mild-to-moderate lateral ankle instability (mean age, 42.7 years; range, 16-78 years) who underwent an arthroscopic Broström-Gould procedure from March 1, 2016, to April 30, 2022. The patients were divided into 2 groups according to the tying technique used in the Gould modification: surgical tie using a knot pusher (KP group; n = 30) or a semiconstrained freehand tie (FT group; n = 105). Radiographic parameters and ultrasound dynamic testing were examined during the preoperative assessment. Preoperative and 2-year postoperative assessments comprised American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale, visual analog scale for pain, and 12-Item Short Form Survey (SF-12) scores. Results The 2 groups had no differences in age, sex, or severity distribution in the preoperative assessment. American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale, visual analog scale pain, and SF-12 scores were significantly better at the postoperative evaluation (all P < .05) in both groups. No significant difference was noted between groups in outcome scores. In the KP group, however, 7 out of 30 patients (23.3%) developed ankle stiffness with tightness when performing plantarflexion movement. No patients in the FT group reported similar symptoms. Conclusion For mild-to-moderate chronic lateral ankle instability, we propose an arthroscopic Broström procedure with the addition of IER augmentation using a semiconstrained freehand tie to avoid overtightening the IER. This ensures favorable patient satisfaction and clinical outcomes without limitation of plantarflexion of the ankle joint and avoids the possible complication of stiffness with plantarflexion.
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Affiliation(s)
- Tung-Ying Lee
- Department of Orthopedic Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Pei-Yu Chen
- Department of Orthopedic Surgery, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Kai-Chiang Yang
- School of Dental Technology, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - I-Shiang Tzeng
- Department of Research, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Chia Ming Chang
- Department of Orthopedic Surgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Chen-Chie Wang
- Department of Orthopedic Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
- Department of Orthopedics, School of Medicine, Tzu Chi University, Hualien, Taiwan
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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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Barbier O. Osteochondral lesions of the talar dome. Orthop Traumatol Surg Res 2023; 109:103452. [PMID: 36273506 DOI: 10.1016/j.otsr.2022.103452] [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: 10/14/2021] [Revised: 01/11/2022] [Accepted: 03/10/2022] [Indexed: 02/03/2023]
Abstract
Ankle pain and/or instability is a frequent, non-specific reason for consultation, and may reveal an osteochondral lesion of the talar dome (OLTD). There are 2 types of OLTD: (1) posteromedial, usually idiopathic, wide and deep, featuring isolated pain with severe functional impact; (2) anterolateral, often implicating trauma and associated in 30% of cases with lateral ligament involvement, in a clinical presentation associating pain and instability. The aim of the present study was to review the issue of OLTD, with 5 questions: HOW TO ESTABLISH THE DIAGNOSIS, WITH WHAT WORK-UP?: There are no specific clinical signs. A diagnosis of OLTD should be considered in all cases of painful and/or unstable ankle and especially in case of history of sprain. The clinical work-up screens systematically for laxity or associated hindfoot malalignment. CT-arthrography is the gold-standard, enabling morphologic analysis of OLTD. WHAT CLASSIFICATIONS SHOULD BE USED?: CT-arthrography determines length, depth and any cartilage dissection, classifying OLTD in 3 grades. Grade 1 is a lesion<10mm in length and<5mm in depth. Grade 2 is>10mm in length and/or>5mm in depth with intact cartilage around the lesion. Grade 3 is the same as grade 2 but with overlying cartilage dissection. WHAT ARE THE CURRENT TREATMENT INDICATIONS?: After failure of 6 months' well-conducted medical treatment (sports rest, analgesics, physiotherapy), surgical options in France today comprise microfracture in grade 1 OLTD, raising the fragment, freshening the floor of the lesion and fixing the fragment (known as "lift, drill, fill, fix" (LDFF)) in grade 2, and mosaicplasty in grade 3. WHAT ARE THE PROSPECTS FOR FUTURE TREATMENTS AND THEIR ROLES?: Treatments are progressing and improving. Ideal treatment should restore hyaline cartilage to prevent secondary osteoarthritis. Matrix and cell culture techniques need to be validated. WHAT RESULTS CAN BE EXPECTED AND WHAT SHOULD PATIENTS BE TOLD?: Management according to grade secures AOFAS scores≥80/100 in 80% of cases, whatever the grade. Return to sport is feasible in 80% of case, at a mean 6 months. Progression is satisfactory after treatment adapted to the lesion. LEVEL OF EVIDENCE: V, expert opinion.
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Affiliation(s)
- Olivier Barbier
- Service de chirurgie orthopédique et traumatologie, HIA Sainte-Anne, 2, boulevard Sainte-Anne, 83000 Toulon, France.
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Lucchesi G, Bonnel F, Mainard N, Orlando N, Sacco R, Dimeglio A, Boutry N, Canavese F. Interrelations Between the Too-Long Anterior Calcaneal Process, Hind and Mid-tarsal Bone Volumes, Angles and Osteochondral Lesion of the Dome of the Talus: Analysis by Software Slicer of 69 CT Scan of Feet. Indian J Orthop 2022; 56:2228-2236. [PMID: 36507201 PMCID: PMC9705673 DOI: 10.1007/s43465-022-00768-4] [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: 03/01/2022] [Accepted: 10/20/2022] [Indexed: 11/17/2022]
Abstract
Introduction Although the association between Too-Long Anterior Calcaneal Process (TLACP) and osteochondral lesion of the dome of the talus (OCL) has been hypothesized, no study has investigated the interrelations between TLACP, hind and mid-tarsal volumes and angles and the development of OCL. The main goals of this work are: (1) to measure the volume of the calcaneum, talus, navicular and cuboid in subjects with and without TLACP; (2) to evaluate the angular relationships between talus, calcaneum and navicular in subjects with and without TLACP; (3) to assess whether TLACP has an effect on the volume of OCL. Methods This is a retrospective study of 69 CT scans of 54 consecutive children aged 11-15 years who had undergone a CT scan due to symptomatology suggestive of TLACP. The 3D Slicer software allowed to calculate the volume of the talus, calcaneum, navicular, cuboid, TLACP and OCL (in cm3). The PACS system was used to perform the angular measurements (in degrees) between talus, calcaneum and navicular in the frontal, axial and sagittal plane. Results Amid the 69 CT scans, 49 were found to have pathologies related to TLACP (71%, TLACP Group) and 20/69 were normal (29%, Control Group). The mean hind and mid-tarsal bone volumes of the TLACP group were comparable to those of the control group. There were 40 (81.6%) OCLs detected exclusively in pathological feet (TLACP group); 32 lesions were medial (80%), and 8 lesions were lateral (20%). According to Ferkel and Sgaglione CT Staging System, there were 22 (55%) stage 1 lesions, 5 (12.5%) stage 2A, 3 (7.5%) stage 2B and 10 (25%) stage three lesions. Only the angle between the talus and calcaneum in the frontal plane was significantly lower in pathological feet with respect to the control group (p < 0.001). In pathological feet, the talus was supinated, and the calcaneus pronated. Conclusions TLACP tend to stiffen the foot, modifying its biomechanics and leading to supination of the talus and pronation of the calcaneum. This induces an overpressure at the medial side of the talus where we observed a greater frequency of medial OCL with larger volume than lateral OCL. Level of Evidence III.
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Affiliation(s)
- Giovanni Lucchesi
- Ortopediatria Center for Education, Research and Patient Care in Paediatric Orthopedics, Bologna, Italy
| | - François Bonnel
- Faculty of Medicine, University of Montpellier, 2 Rue de l’École de Médecine, 34090 Montpellier, France
| | - Nicolas Mainard
- Department of Pediatric Orthopedic Surgery, Jeanne de Flandre Hospital, Lille University Centre, 59000 Lille, France
| | | | | | - Alain Dimeglio
- Faculty of Medicine, University of Montpellier, Montpellier, France
| | - Nathalie Boutry
- Department of Pediatric Imaging, Hôpital Jeanne de Flandre, CHU Lille, Avenue Eugène Avinée, F-59000 Lille, France
| | - Federico Canavese
- Department of Pediatric Orthopedic Surgery, Jeanne de Flandre Hospital, Lille University Centre, 59000 Lille, France
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Wartelle J, Hocquet B, Lucchesi G, Coursier R, Boutry N, Budzik JF, Fron D, Bourelle S, Nectoux E, Canavese F. The too-long anterior process and osteochondral lesion of the talus: Is there an anatomical predisposition? A case-control study on 135 feet. Foot Ankle Surg 2022; 28:1076-1082. [PMID: 35346595 DOI: 10.1016/j.fas.2022.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 02/10/2022] [Accepted: 03/07/2022] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The too-long anterior process (TLAP) increases mechanical stress on the hindfoot and could lead to osteochondral lesions of the talus (OLT) by localized hyper-pressure. The purpose of this study is to investigate an association between TLAP and OLT in children. METHODS This is a retrospective, multicenter, case-control study conducted between 2010 and 2020. The OLT group was compared to a control group (CoG). TLAP is characterized by a distance between the anteromedial process of the calcaneus and the navicular bone (CN) of< 5 mm. RESULTS Forty-three feets were included in the OLT group and 92 in the CoG. The OLT group had a lower CN distance on CT than the CoG, a median of 2.8 mm versus 3.75 mm (p = 0.002); 86% of patients (37 feet/43) in the OLT group had a CN distance of< 5 mm (OR=3.0 [1.1; 9.5], p = 0.023) compared to 67% in the CoG. DISCUSSION The OLT group had an increased risk of developing TLAP compared to the CoG. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Juliette Wartelle
- Department of Paediatric Surgery and Orthopaedics, Jeanne de Flandre Hospital, Lille University Hospital, Lille, France.
| | - Bastien Hocquet
- Department of Paediatric Surgery and Orthopaedics, Jeanne de Flandre Hospital, Lille University Hospital, Lille, France.
| | - Giovanni Lucchesi
- Orthopaedic Clinic, Departement of Surgery and Translational Medecine, University of Florence, Florence, Italy.
| | - Raphaël Coursier
- Department of Paediatric Surgery and Orthopaedics, Lille Catholic University Hospital Group, Lille, France.
| | - Nathalie Boutry
- Department of Pediatric Radiology, Jeanne de Flandre Hospital, Lille University Hospital, Lille, France.
| | - Jean-Francois Budzik
- Department of Radiology, Lille Catholic University Hospital Group, Lille, France.
| | - Damien Fron
- Department of Paediatric Surgery and Orthopaedics, Jeanne de Flandre Hospital, Lille University Hospital, Lille, France.
| | - Sophie Bourelle
- Department of Paediatric Surgery and Orthopaedics, American Memorial Hospital, Reims University Hospital, Reims, France.
| | - Eric Nectoux
- Department of Paediatric Surgery and Orthopaedics, Jeanne de Flandre Hospital, Lille University Hospital, Lille, France.
| | - Federico Canavese
- Department of Paediatric Surgery and Orthopaedics, Jeanne de Flandre Hospital, Lille University Hospital, Lille, France.
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Manzi J, Arzani A, Hamula MJ, Manchanda K, Dhanaraj D, Chapman CB. Long-term Patient-Reported Outcome Measures Following Particulated Juvenile Allograft Cartilage Implantation for Treatment of Difficult Osteochondral Lesions of the Talus. Foot Ankle Int 2021; 42:1399-1409. [PMID: 34112022 DOI: 10.1177/10711007211014173] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Conventional methods are not suitable for difficult to treat osteochondral lesions of the talus (OCLTs). The role of particulated juvenile allograft articular cartilage implantation is not well elucidated for long-term patient outcomes. METHODS Thirteen patients with difficult-to-treat OCLTs underwent arthroscopy-assisted implantation of particulated juvenile articular cartilage graft into defects from 2010 to 2012 by the same surgeon. "Difficult to treat" was defined as having at least 3 of the following features or 2 if both variables described lesion characteristics: (1) lesions size of 107 mm2 or greater, (2) shoulder lesions, (3) patients who failed microfracture, (4) patient aged ≥40 years, or (5) patient body mass index (BMI) >25. Patients were evaluated using physical examination, patient interviews, and outcome score measures. Patients had follow-up at 2 years, 4 years, and between 6 and 10 years at their most recent follow-up. Differences in functional outcome scores were compared before and after surgery. RESULTS Patients (age: 46.5 ± 11.8 years, BMI: 28.5 ± 6.1) had, on average, most recent follow-up of 8.0 years (range 72-113 months). Average visual analog scale for pain score decreased for patients by 3.9 points (95% confidence interval [CI] 2.18-5.60), when compared to preoperative assessment. Foot and Ankle Ability Measure (FAAM) Activities of Daily Living (ADL) and Sports subscale scores also improved from 46.5 to 80.9 (95% CI 21.35-47.43), and from 18.8 to 57.9 (95% CI 21.05-57.10), respectively. Short Form-36 Health Survey physical component scores showed significant improvement by an average of 45.5 points (95% CI 32.42-58.50). American Orthopaedic Foot & Ankle Society Ankle-Hindfoot Scale scores improved from 55.2 to 80.3 (95% CI 12.459-37.741). CONCLUSION These results demonstrate positive patient-reported long-term outcomes for a cohort of patients with difficult OCLTs, followed over the course of 6-10 years after treatment with arthroscopy-assisted particulated juvenile articular cartilage implantation. LEVEL OF EVIDENCE Level II, prospective cohort study.
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Affiliation(s)
- Joseph Manzi
- Weill Cornell Medical College, New York, NY, USA
| | | | | | - Kshitij Manchanda
- Miami Orthopedics & Sports Medicine Institute, Coral Gables, FL, USA
| | - Dinesh Dhanaraj
- Penn Medicine Princeton Medical Center, Plainsboro Township, NJ, USA
| | - Cary B Chapman
- Miami Orthopedics & Sports Medicine Institute, Coral Gables, FL, USA
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Lopes R, Geffroy L, Padiolleau G, Ngbilo C, Baudrier N, Mainard D, Benoist J, Leiber Wackenheim F, Cordier G, Dubois Ferriere V, Freychet B, Barbier O, Amouyel T. Proposal of a new CT arthrographic classification system of osteochondral lesions of the talus. Orthop Traumatol Surg Res 2021; 107:102890. [PMID: 33713874 DOI: 10.1016/j.otsr.2021.102890] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 08/19/2020] [Accepted: 09/16/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Surgical treatment of osteochondral lesions of the talus (OLT) is warranted if medical treatments fail, achieving good results in around 85% of cases. Numerous classification systems, based on all possible imaging modalities (radiography, MRI, CT scan, scintigraphy, and CT arthrography), have been proposed to guide surgical treatments, but none has proven to be superior. A recent study demonstrated the prognostic value of CT arthrography by accurately describing the subchondral bone plate. A systematic review of the literature has brought new criteria to predict good outcome following bone marrow stimulation surgical techniques: lesions should measure less than 1 centimeter in size and 5 millimeters in depth. Based on these data, we are proposing a new simple, 3-stage CT arthrographic classification system of OLT. MATERIALS AND METHODS After a brief overview of the classification, 60 CT-arthrographies of ankles with OLT were organized according to this new CT arthrographic classification system by four surgeons (two juniors and two seniors). Two imaging assessments were performed one month apart. Statistical analysis was performed using the Fleiss' kappa coefficient to determine the inter- and intraobserver agreement. RESULTS An excellent inter- and intraobserver agreement was found with overall Fleiss' kappa coefficients of 0.897 and 0.847, respectively. CONCLUSION The results of our study showed an excellent inter- and intraobserver agreement for this new CT arthrographic classification system of OLT. The principal advantage of this new classification system, based on the latest data in the literature, is its ability to easily distinguish lesions that are more amenable to bone marrow stimulation techniques. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Ronny Lopes
- Santé Atlantique, avenue Claude Bernard, 44800 Saint-Herblain, France.
| | - Loïc Geffroy
- Santé Atlantique, avenue Claude Bernard, 44800 Saint-Herblain, France
| | | | - Cédric Ngbilo
- Centre Orthopédique SANTY, 24, avenue Paul Santy, 69008 Lyon, France
| | - Nicolas Baudrier
- CHU Ambroise Paré, 9, avenue Charles de Gaulle, 92100 Boulogne-Billancourt, France
| | - Didier Mainard
- CHU Nancy, 29, avenue du Maréchal de Lattre de Tassigny, 54035 Nancy, France
| | - Jonathan Benoist
- CH Saint Grégoire, 6, boulevard de la Boutière, 35760 Saint-Grégoire, France
| | | | - Guillaume Cordier
- Clinique du sport, 4, rue Georges Negrevergne, 33700 Mérignac, France
| | | | - Benjamin Freychet
- Centre Orthopédique SANTY, 24, avenue Paul Santy, 69008 Lyon, France
| | - Olivier Barbier
- Hôpital d'instruction des Armées Sainte Anne, 2, boulevard Sainte-Anne, 83000 Toulon, France
| | - Thomas Amouyel
- Service d'orthopédie 1, hôpital Roger Salengro, CHRU, place de Verdun, 59037 France
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12
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Doğar F, Uzun E, Gürbüz K, Topak D, Akar M, Bilal Ö, Güney A. Comparison of Arthroscopic Treatment Methods in Talar Osteochondral Lesions: A Multicenter, Prospective, Randomized Clinical Trial. J Am Podiatr Med Assoc 2021; 111:470039. [PMID: 34478532 DOI: 10.7547/20-218] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The aim of the present study was to contribute new and updated information to the literature by comparing the clinical and radiologic results of arthroscopic microfracture, platelet-rich plasma (PRP) after arthroscopic microfracture, and BST-Cargel scaffold application after arthroscopic microfracture in the treatment of talar osteochondral lesions. METHODS Sixty-two talar osteochondral lesion patients (31 women and 31 men) who underwent ankle arthroscopy in two different centers were randomized into three groups. The first group consisted of patients who underwent only arthroscopic microfracture (MF) (n = 22); the second group consisted of patients who underwent the PRP procedure after arthroscopic MF (PRP; n = 19); and the third group consisted of patients who underwent the BST-Cargel procedure after arthroscopic MF was (BST-Cargel; n = 21). The talar osteochondral lesions in the three groups were classified according to magnetic resonance and arthroscopic images. American Orthopedic Foot and Ankle Society, Foot and Ankle Ability Measurement (overall pain, 15-minute walking, running function), and visual analog scale scores were evaluated preoperatively and postoperatively, and postoperative return time to sports activities was performed. RESULTS Compared to the preoperative score, postoperative American Orthopedic Foot and Ankle Society score increased 48.80 ± 9.60 in the BST-Cargel group, whereas there was an increase of 46.68 ± 3.65 in the PRP group and 29.63 ± 3.69 in the MF group, which were statistically significant (P < .05).There was a statistically significant postoperative change in the visual analog scale scores of the patients in all three groups compared to the preoperative scores (P < .05). At the end of the follow-up, the Foot and Ankle Ability Measurement overall pain, 15-minute walking, and running function results of all three groups increased significantly postoperatively compared to the preoperative values (P < .005). CONCLUSIONS BST-Cargel application with microfracture is a method that can be applied easily and safely with arthroscopy to lesions larger than 1.5 cm2 regardless of the size of the cartilage defect, and it has been found to be superior to the other two methods in terms of pain, functional score, radiologic recovery, and return to sports activities.
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13
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Jungesblut OD, Berger-Groch J, Hoffmann M, Schroeder M, Krajewski KL, Stuecker R, Rupprecht M. Electromagnetic navigation reduces radiation exposure for retrograde drilling in osteochondrosis dissecans of the talus. BMC Musculoskelet Disord 2021; 22:135. [PMID: 33536008 PMCID: PMC7860038 DOI: 10.1186/s12891-021-04010-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 01/24/2021] [Indexed: 11/26/2022] Open
Abstract
Background Retrograde drilling in osteochondrosis dissecans (OCD) is a widely used surgical intervention. A radiation-free electromagnetic navigation system (ENS)-based method was compared with the standard freehand fluoroscopic (SFF) method regarding clinical applicability. Methods We performed a clinical cohort study at a department of Orthopaedics in a Level 1 children’s hospital with 40 patients (20 SFF and 20 ENS). Retrograde drilling of the talar dome was used in patients with unstable medial OCD (MRI stage 2 according to Hepple’s revised classification; stage 2 according to the International Cartilage Repair Society). The outcome measurements were: (a) Intraoperative fluoroscopy exposure and length of surgery and (b) Postoperative serial follow-up MRIs every 6 months. Results 22 female and 18 male patients aged 13.8 ± 1.6 years (range: 11–17 years) were included. Using the ENS technique, length of surgery was significantly reduced to 20.2 ± 6.4 min compared to 36.1 ± 11.8 min (p < 0.01) for the SFF technique. The average x-ray radiation time for the SFF technique was 23.5 ± 13.5 sec and 1.9 ± 1.7 sec for the ENS technique (p < 0.01). Radiation exposure was significantly reduced from 44.6 ± 19.7 mSv (SFF technique) to 5.6 ± 2.8 mSv (ENS technique) (p < 0.01). Intraoperative perforation of cartilage occurred once in the SFF group. Correct placement of the drilling channel was verified in all patients on follow-up MRI after six months and a timely healing was seen after two years. Conclusions The ENS method provides for a significant reduction in length of surgery and radiation exposure. ENS was without intraoperative cartilage perforation. The clinical and radiological follow-up parameters are comparable for SFF- and ENS-guided retrograde drilling. Trial registration WF – 085/20, 05/2020 “retrospectively registered” https://www.aerztekammer-hamburg.org/ethik_kommission.html.
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Affiliation(s)
- Oliver D Jungesblut
- Department of Pediatric Orthopedics, Altonaer Children's Hospital, Bleickenallee 38, 22763, Hamburg, Germany.,Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Josephine Berger-Groch
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Michael Hoffmann
- Department of Trauma-, Orthopaedic Surgery and Sports Medicine , Asklepios Hospital St. Georg , Lohmühlenstr. 5, 20099, Hamburg, Germany
| | - Malte Schroeder
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Kara L Krajewski
- Department of Pediatric Orthopedics, Altonaer Children's Hospital, Bleickenallee 38, 22763, Hamburg, Germany
| | - Ralf Stuecker
- Department of Pediatric Orthopedics, Altonaer Children's Hospital, Bleickenallee 38, 22763, Hamburg, Germany.,Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Martin Rupprecht
- Department of Pediatric Orthopedics, Altonaer Children's Hospital, Bleickenallee 38, 22763, Hamburg, Germany.,Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
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14
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Li J, Wei Y, Wei M. Finite Element Analysis of the Effect of Talar Osteochondral Defects of Different Depths on Ankle Joint Stability. Med Sci Monit 2020; 26:e921823. [PMID: 32820745 PMCID: PMC7456163 DOI: 10.12659/msm.921823] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background Talus cartilage injury leads to changes in biomechanics of the ankle joint and ultimately affects ankle joint function, but which talus cartilage defects require surgery is still uncertain. This research used a finite element method to simulate the effect of different depth of talus cartilage defects on the stress and stability of the ankle joint in a certain area. Material/Methods A three-dimensional finite element model with different depths of osteochondral defects was created to simulate and calculate joint stress and displacement of the articular surface of the distal tibia and the proximal talus while the ankle joint was in the push-off, midstance, and heel-strike phases. Results The equivalent stress of the proximal talus did not change significantly at a defect depth of 1 mm, whereas the equivalent stress of the upper talus increased significantly at a defect depth of ≥3 mm or more, reaching a maximum value at a defect depth of 10 mm. The equivalent stress of the tibial cartilage and the equivalent stress and displacement in the corresponding forces in the midstance phase and heel-strike phase were significantly different from those in the normal group, but the difference in stress in each defect group was not obvious. Conclusions The effect of cartilage defects of the talus on biomechanics of the ankle is clear, especially in the midstance and push-off phases. When the defect reaches the subchondral bone (at a depth of 3 mm), the most obvious change in ankle joint stability occurs, and it does not increase linearly with the increase in depth of the defect.
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Affiliation(s)
- Jia Li
- Department of Orthopedics, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China (mainland)
| | - Yu Wei
- Department of Orthopedics, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China (mainland)
| | - Min Wei
- Department of Orthopedics, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China (mainland)
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15
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Schwartz AM, Runge WO, Hsu AR, Bariteau JT. Fractures of the Talus: Current Concepts. FOOT & ANKLE ORTHOPAEDICS 2020; 5:2473011419900766. [PMID: 35097362 PMCID: PMC8697161 DOI: 10.1177/2473011419900766] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Talus fractures continue to represent a challenging and commonly encountered group of injuries. Its near-complete articular cartilage surface, and its role in force transmission between the leg and foot, makes successful treatment of such injuries a mandatory prerequisite to regained function. Familiarity with the complex bony, vascular, and neurologic anatomy is crucial for understanding diagnostic findings, treatment indications, and surgical techniques to maximize the likelihood of anatomic bony union. This review details the structure and function of the talus, a proper diagnostic workup, the treatment algorithm, and post-treatment course in the management of talus fractures.
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Affiliation(s)
- Andrew M Schwartz
- Department of Orthopedics, Emory University School of Medicine, Atlanta, GA, USA
| | - William O Runge
- Department of Orthopedics, Emory University School of Medicine, Atlanta, GA, USA
| | - Andrew R Hsu
- Department of Orthopaedic Surgery, University of California-Irvine, Orange, CA, USA
| | - Jason T Bariteau
- Department of Orthopedics, Emory University School of Medicine, Atlanta, GA, USA
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16
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Zhang K, Crum RJ, Samuelsson K, Cadet E, Ayeni OR, de Sa D. In-Office Needle Arthroscopy: A Systematic Review of Indications and Clinical Utility. Arthroscopy 2019; 35:2709-2721. [PMID: 31416656 DOI: 10.1016/j.arthro.2019.03.045] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 03/13/2019] [Accepted: 03/16/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE This review explores the current literature regarding both the clinical indications and utility of minimally invasive in-office needle arthroscopy (IONA) relative to conventional imaging modalities. METHODS In compliance with R-AMSTAR (Revised Assessment of Multiple Systematic Reviews) and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines, 3 databases (MEDLINE, Embase, and PubMed) were searched in July 2018, in addition to the conference abstract databases of 5 prominent meetings between 2013 and 2018, for studies using IONA for diagnostic purposes. Study quality was assessed with the Methodological Index for Non-Randomized Studies (MINORS) criteria. RESULTS Among 932 conference abstracts and 369 studies identified, 11 publications involving 404 patients (395 knees and 9 shoulders) were included, with 9 clinical studies and 2 cost analyses. The median Methodological Index for Non-Randomized Studies (MINORS) score was 9 for noncomparative and 23 for comparative studies. Among the 9 clinical studies, IONA had a superior sensitivity, specificity, positive predictive value, and negative predictive value to magnetic resonance imaging (MRI) in the evaluation of knee osteoarthritis, anterior cruciate ligament insufficiency, and meniscal tears. IONA was comparable or inferior to MRI in the same parameters for the diagnosis of osteochondral defects and rotator cuff tears. In the 2 cost analyses, IONA had lower costs when used in place of MRI for treatment algorithms involving medial meniscal tears and rotator cuff tears but not lateral meniscal tears. CONCLUSIONS IONA holds potential for cost savings and improved diagnostic accuracy relative to MRI, primarily for intra-articular meniscal, ligamentous, and chondral defects of the knee. However, its current indications for use in other joints are limited to rotator cuff tears in the shoulder, making its diagnostic value in other joints much more limited. The current quality and breadth of evidence are significantly lacking, with numerous practical shortcomings. To improve acceptance of IONA, priority should be placed on establishing defined protocols, indications, contraindications, and patient perspectives for the procedure. LEVEL OF EVIDENCE Level IV, systematic review of Level II, III, and IV studies.
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Affiliation(s)
- Kailai Zhang
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Raphael J Crum
- Pittsburgh School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | | | - Edwin Cadet
- Raleigh Orthopaedic Clinic, Raleigh, North Carolina, U.S.A
| | | | - Darren de Sa
- Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada.
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17
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Maglio M, Tschon M, Sicuro L, Lolli R, Fini M. Osteochondral tissue cultures: Between limits and sparks, the next step for advanced in vitro models. J Cell Physiol 2018; 234:5420-5435. [DOI: 10.1002/jcp.27457] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 08/29/2018] [Indexed: 01/01/2023]
Affiliation(s)
- Melania Maglio
- Laboratory of Preclinical and Surgical Studies, Rizzoli RIT Department IRCCS Rizzoli Orthopaedic Institute Bologna Italy
| | - Matilde Tschon
- Laboratory of Preclinical and Surgical Studies, Rizzoli RIT Department IRCCS Rizzoli Orthopaedic Institute Bologna Italy
| | - Laura Sicuro
- Laboratory of Preclinical and Surgical Studies, Rizzoli RIT Department IRCCS Rizzoli Orthopaedic Institute Bologna Italy
| | - Roberta Lolli
- Laboratory of Preclinical and Surgical Studies, Rizzoli RIT Department IRCCS Rizzoli Orthopaedic Institute Bologna Italy
| | - Milena Fini
- Laboratory of Biomechanics and Technology Innovation IRCCS IRCCS Rizzoli Orthopaedic Institute Bologna Italy
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18
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D'Ambrosi R, Maccario C, Serra N, Ursino C, Usuelli FG. Relationship between symptomatic osteochondral lesions of the talus and quality of life, body mass index, age, size and anatomic location. Foot Ankle Surg 2018; 24:365-372. [PMID: 29409207 DOI: 10.1016/j.fas.2017.04.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Revised: 03/03/2017] [Accepted: 04/11/2017] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The aim of the study was to assess the relationship between symptomatic osteochondral lesions of the talus (OLTs) and age, body mass index (BMI), quality of life (QOL), size and anatomic location. METHODS Fifty-two patients with chronic OLTs were analyzed including BMI, Visual Analogue Scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS), Short-Form Health Survey (SF-12 divided into Mental (MCS) and Physical (PCS) score) and the 12-Item General Health Questionnaire (GHQ-12). Every patient underwent magnetic resonance imaging (MRI) and computed tomography (CT) examinations. We carried out a sub-analysis by dividing the talus into 6 areas, 3 vertical (medial, central and lateral group) and 3 horizontal (anterior, middle and posterior group). RESULTS There were 31 (60%) male and 21 (40%) female patients. Mean MCS and PCS resulted respectively 43.9 and 35.2. OLTs were located as follows: medial 20 (38.50%); central 13 (24.0%); and lateral 19 (36.50%); anterior 24 (46.15%); middle 16 (30.77%); and posterior 12 (23.08%). No significant differences were found among different groups with the exception of the anterior and posterior group for MCS (p=0.021). In the central group we identified a negative correlation (R=-0.672) between aging and AOFAS and a positive correlation between BMI and lesion size. We found a positive correlation between CT and MRI in each group. CONCLUSIONS OLTs impact patients' quality of life particularly in the physical component. Additionally, in patients with central lesions we found a positive linear correlation between lesion size and BMI and a worsening of the ankle with increasing age.
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Affiliation(s)
- Riccardo D'Ambrosi
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy; IRCCS Istituto Ortopedico Galeazzi, U.O. CASCO - Piede e Caviglia, Milan, Italy.
| | - Camilla Maccario
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy; IRCCS Istituto Ortopedico Galeazzi, U.O. CASCO - Piede e Caviglia, Milan, Italy
| | - Nicola Serra
- Seconda Università di Napoli, Dipartimento di Radiologia, Naples, Italy
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Abstract
Particulated juvenile allograft cartilage (PJAC) has significant promise and is currently supported by several studies. Potential benefits of this new technique include single-stage procedure, simplicity in the surgical technique, implantation of juvenile tissue, and a lack of donor site morbidity. This article discusses the imaging, surgical options, and postoperative management of PJAC.
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Abstract
Large, symptomatic, focal chondral, and osteochondral lesions of the ankle are treated with osteochondral autograft/allograft transplantation (OAT) procedure, a reconstructive bone grafting technique that uses one or more cylindrical osteochondral grafts from an area of low impact or allograft source and transplants them into the prepared defect site on the talus. This technique allows defects to be filled with mature, hyaline articular cartilage. Acute or chronic chondral or osteochondral lesions can be debilitating; provided here is a review of osteochondral autograft or allograft transplantation. OAT shows a trend toward greater longevity and durability and improved outcomes in high-demand patients.
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Affiliation(s)
- Alan Ng
- PMSR/RRA, Highlands/Presbyterian St. Luke's Podiatric Surgical Residency Program, 1719 East 19th Avenue, Denver, CO 80218, USA; Private Practice, Advanced Orthopedic and Sports Medicine Specialists, 8101 East Lowry Boulevard #230, Denver, CO 80230, USA.
| | - Kaitlyn Bernhard
- PMSR/RRA, Highlands/Presbyterian St. Luke's Podiatric Surgical Residency Program, 1719 East 19th Avenue, Denver, CO 80218, USA
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21
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Sochacki KR, Jack RA, Cosculluela PE. Osteochondral Lesions of the Talus: Osteochondral Allograft Transplantation. OPER TECHN SPORT MED 2017. [DOI: 10.1053/j.otsm.2017.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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22
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D'Ambrosi R, Maccario C, Ursino C, Serra N, Usuelli FG. Combining Microfractures, Autologous Bone Graft, and Autologous Matrix-Induced Chondrogenesis for the Treatment of Juvenile Osteochondral Talar Lesions. Foot Ankle Int 2017; 38:485-495. [PMID: 28076977 DOI: 10.1177/1071100716687367] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the clinical and radiologic outcomes of patients younger than 20 years, treated with the arthroscopic-talus autologous matrix-induced chondrogenesis (AT-AMIC) technique and autologous bone graft for osteochondral lesion of the talus (OLT). METHODS Eleven patients under 20 years (range 13.3-20.0) underwent the AT-AMIC procedure and autologous bone graft for OLTs. Patients were evaluated preoperatively (T0) and at 6 (T1), 12 (T2), and 24 (T3) months postoperatively, using the American Orthopaedic Foot & Ankle Society Ankle and Hindfoot (AOFAS) score, the visual analog scale and the SF-12 respectively in its Mental and Physical Component Scores. Radiologic assessment included computed tomographic (CT) scan, magnetic resonance imaging (MRI) and intraoperative measurement of the lesion. A multivariate statistical analysis was performed. RESULTS Mean lesion size measured during surgery was 1.1 cm3 ± 0.5 cm3. We found a significant difference in clinical and radiologic parameters with analysis of variance for repeated measures ( P < .001). All clinical scores significantly improved ( P < .05) from T0 to T3. Lesion area significantly reduced from 119.1 ± 29.1 mm2 preoperatively to 77.9 ± 15.8 mm2 ( P < .05) at final follow-up as assessed by CT, and from 132.2 ± 31.3 mm2 to 85.3 ± 14.5 mm2 ( P < .05) as assessed by MRI. Moreover, we noted an important correlation between intraoperative size of the lesion and body mass index (BMI) ( P = .011). CONCLUSIONS The technique can be considered safe and effective with early good results in young patients. Moreover, we demonstrated a significant correlation between BMI and lesion size and a significant impact of OLTs on quality of life. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Riccardo D'Ambrosi
- 1 Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy.,2 IRCCS Istituto Ortopedico Galeazzi, U.O. C.A.S.C.O., Piede e Caviglia, Milan, Italy
| | - Camilla Maccario
- 1 Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy.,2 IRCCS Istituto Ortopedico Galeazzi, U.O. C.A.S.C.O., Piede e Caviglia, Milan, Italy
| | | | - Nicola Serra
- 4 Seconda Università di Napoli, Dipartimento di Radiologia, Naples, Italy
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Rehnitz C, Kuni B, Wuennemann F, Chloridis D, Kirwadi A, Burkholder I, Kauczor HU, Weber MA. Delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) and T
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mapping of talar osteochondral lesions: Indicators of clinical outcomes. J Magn Reson Imaging 2017; 46:1601-1610. [DOI: 10.1002/jmri.25731] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 03/27/2017] [Indexed: 12/17/2022] Open
Affiliation(s)
- Christoph Rehnitz
- Department of Diagnostic and Interventional Radiology; University Hospital Heidelberg; Germany
| | - Benita Kuni
- Department of Orthopedics and Trauma Surgery; University Hospital Heidelberg; Germany
| | - Felix Wuennemann
- Department of Diagnostic and Interventional Radiology; University Hospital Heidelberg; Germany
| | - Dimitrios Chloridis
- Department of Orthopedics and Trauma Surgery; University Hospital Heidelberg; Germany
| | - Anand Kirwadi
- Department of Radiology; Manchester Royal Infirmary; Manchester UK
| | - Iris Burkholder
- Department of Nursing and Health; University of Applied Sciences of the Saarland; Saarbruecken Germany
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology; University Hospital Heidelberg; Germany
| | - Marc-André Weber
- Department of Diagnostic and Interventional Radiology; University Hospital Heidelberg; Germany
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Darton Y, Gallien V, Henrion É, Dupuis M, Richard I. Osteochondral lesions and partial fractures of the talus in paleopathology. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2017; 16:31-39. [PMID: 28290308 DOI: 10.1016/j.ijpp.2016.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Revised: 12/18/2016] [Accepted: 12/27/2016] [Indexed: 06/06/2023]
Affiliation(s)
- Yves Darton
- CEPAM (UMR 7264, CNRS/UNS), Pôle universitaire Saint-Jean d'Angély, SJA3, 24 avenue des Diables Bleus, F-06357, Nice Cedex 4, France
| | - Véronique Gallien
- CEPAM (UMR 7264, CNRS/UNS), Pôle universitaire Saint-Jean d'Angély, SJA3, 24 avenue des Diables Bleus, F-06357, Nice Cedex 4, France; NRAP Grand Ouest, Centre Archéologique, 20 rue Hippolyte Foucault, F-72000, Le Mans, France
| | - Élise Henrion
- Service départemental d'archéologie, Conseil Général des Alpes-de-Haute-Provence, 13 rue du Docteur Romieu-B.P.216, F-04003, Digne-les-Bains Cedex, France
| | - Mathias Dupuis
- Service départemental d'archéologie, Conseil Général des Alpes-de-Haute-Provence, 13 rue du Docteur Romieu-B.P.216, F-04003, Digne-les-Bains Cedex, France
| | - Isabelle Richard
- INRAP Grand Est Nord, Centre Archéologique de Saint-Martin-sur-le-Pré, 38 rue des Dats, F-51520, Saint-Martin-sur-le-Pré, France
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Körner D, Gueorguiev B, Niemeyer P, Bangert Y, Zinser W, Aurich M, Walther M, Becher C, Ateschrang A, Schröter S. Parameters influencing complaints and joint function in patients with osteochondral lesions of the ankle-an investigation based on data from the German Cartilage Registry (KnorpelRegister DGOU). Arch Orthop Trauma Surg 2017; 137:367-373. [PMID: 28168643 DOI: 10.1007/s00402-017-2638-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Patients with osteochondral lesions of the ankle represent a heterogeneous population with traumatic, posttraumatic and idiopathic forms of this pathology, where the etiology of the idiopathic form is principally unknown. The aim of this study was to classify the heterogeneous patient population according to the patients' complaints and joint function. Data from the German Cartilage Registry (KnorpelRegister DGOU) was analyzed for this purpose to investigate whether traumatic and posttraumatic lesions cause more complaints and loss of joint function than idiopathic lesions. Moreover, it was sought to determine if lesion localization, defective area, stage, patient age, gender, and body mass index (BMI) are related to patients' complaints and loss of joint function. MATERIALS AND METHODS A 117 patients with osteochondral lesions of the ankle were operated in 20 clinical centers in the period between October 2014 and January 2016. Data collection was performed by means of a web-based Remote Data Entry system at the time of surgery. Patients' complaints and joint function were assessed with online questionnaires using the German versions of the Foot and Ankle Ability Measure (FAAM) and the Foot and Ankle Outcome Score (FAOS), followed by statistical data evaluation. RESULTS No significant difference was indicated between the groups with traumatic/posttraumatic lesions and idiopathic lesions with regard to most of the patients' complaints and joint function, excluding the category Life quality of the FAOS score, where patients with idiopathic lesions had a significantly better quality of life (p = 0.02). No significant association was detected between lesion localization, defective area, patient age, gender, and BMI on the one hand, and patients' complaints and joint function on the other. Similarly, no significant association was found between lesion stage according to the International Cartilage Repair Society (ICRS) classification and patients' complaints and joint function. However, a higher lesion stage according to the classification of Berndt and Harty, modified by Loomer, was significantly associated with more complaints and loss of joint function in some categories of the FAAM and FAOS scores (p ≤ 0.04). CONCLUSIONS Etiology of the lesion, lesion localization, defective area, lesion stage according to the ICRS classification, patient age, gender, and BMI do not seem to be of considerable relevance for prediction of patients' complaints and loss of joint function in osteochondral lesions of the ankle. Using the classification of Berndt and Harty, modified by Loomer, seems to be more conclusive.
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Affiliation(s)
- Daniel Körner
- Department of Traumatology and Reconstructive Surgery, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Schnarrrenbergstr. 95, 72076, Tübingen, Germany.
| | | | - Philipp Niemeyer
- Department of Orthopedics and Trauma Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,OCM Klinik Munich, Munich, Germany
| | - Yannic Bangert
- Department of Orthopedics and Trauma Surgery, Heidelberg University Hospital, Ruprecht Karls University Heidelberg, Heidelberg, Germany
| | - Wolfgang Zinser
- Department of Orthopedics and Trauma Surgery, St. Vinzenz Hospital Dinslaken, Dinslaken, Germany
| | - Matthias Aurich
- Department of Orthopedics and Trauma Surgery, Sana Kliniken Leipziger Land, Borna, Germany
| | - Markus Walther
- Department of Foot and Ankle Surgery, Schön Klinik Munich Harlaching, Munich, Germany
| | - Christoph Becher
- International Center for Hip, Knee and Foot Surgery, ATOS Klinik Heidelberg, Heidelberg, Germany
| | - Atesch Ateschrang
- Department of Traumatology and Reconstructive Surgery, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Schnarrrenbergstr. 95, 72076, Tübingen, Germany
| | - Steffen Schröter
- Department of Traumatology and Reconstructive Surgery, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Schnarrrenbergstr. 95, 72076, Tübingen, Germany
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Osteochondral Allograft Transfer for Treatment of Osteochondral Lesions of the Talus: A Systematic Review. Arthroscopy 2017; 33:217-222. [PMID: 27546173 DOI: 10.1016/j.arthro.2016.06.011] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 05/29/2016] [Accepted: 06/02/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study is to present a systematic review of the literature regarding the use of fresh bulk osteochondral allograft transfer for treatment of large osteochondral lesions of the talus (OCLT) in an effort to characterize the functional outcomes, complications, and reoperation rates. METHODS A search of the PubMed, CINAHL, Embase, and Cochrane Databases was performed between January 1, 1990, and March 1, 2016, and included all articles related to outcomes after fresh talar allograft transplantation for OCLT. Inclusion criteria were series (1) published in the English language, (2) using fresh talar allograft, and (3) reporting at least one outcome measure of interest including American Orthopaedic Foot and Ankle Society (AOFAS) score, pain visual analog scale (VAS) score, reoperation rate, and rate of allograft collapse. Weighted averages of outcome data were used. RESULTS Five studies involving 91 OCLT met the inclusion criteria. The mean age of the cohort was 39 years (range, 15 to 74), and 53% were male. Fresh talar allograft was transplanted into 71 medial, 18 lateral, and 2 central OCLT. At a mean follow-up of 45 ± 3.3 (range, 6 to 91) months, AOFAS scores improved from 48 preoperatively to 80 postoperatively. Pain VAS scores improved from 7.1 preoperatively to 2.7 postoperatively. Twenty-three of the 91 (25%) patients required at least one reoperation, for a total of 28 operations. The most common indications for reoperation were development of moderate to severe osteoarthritis (14%), pain due to hardware (9%), extensive graft collapse (3%), and delayed or nonunion of osteotomy site (1%). Ultimately 12 (13.2%) of the cases were considered failures, with 8 (8.8%) resulting in tibiotalar arthrodesis or ankle replacement. CONCLUSIONS Fresh bulk allograft transplantation can substantially improve functional status as well as effectively prevent or delay the eventual need for ankle arthrodesis or replacement. However, patients must be carefully selected and counseled on the morbidity of the procedure as well as the high incidence of clinical failure (13%) and need for reoperation (25%) and revision surgery (8.8%). LEVEL OF EVIDENCE Level IV, systematic review of Level IV studies.
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Canata GL, Casale V. Arthroscopic debridement and bone marrow stimulation for talar osteochondral lesions: current concepts. J ISAKOS 2017. [DOI: 10.1136/jisakos-2016-000099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Barbier O. Regarding "Autologous Osteochondral Transplantation for Osteochondral Lesions of the Talus: Does Previous Bone Marrow Stimulation Negatively Affect Clinical Outcome?". Arthroscopy 2016; 32:1491. [PMID: 27495855 DOI: 10.1016/j.arthro.2016.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 05/12/2016] [Indexed: 02/02/2023]
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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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de l'Escalopier N, Barbier O, Mainard D, Mayer J, Ollat D, Versier G. Outcomes of talar dome osteochondral defect repair using osteocartilaginous autografts: 37 cases of Mosaicplasty®. Orthop Traumatol Surg Res 2015; 101:97-102. [PMID: 25599924 DOI: 10.1016/j.otsr.2014.11.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Revised: 11/05/2014] [Accepted: 11/21/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND The indications of osteochondral autograft implantation using the Mosaicplasty(®) technique were only recently extended to osteochondral lesions of the talus (OLT), a site for which no medium- or long-term outcome data are available. Our objective here was to evaluate medium-term outcomes in case-series of patients who underwent Mosaicplasty(®) for OLT repair. HYPOTHESIS Mosaicplasty(®) provides good medium-term outcomes with low morbidity when used for OLT repair. PATIENTS ET METHODS We retrospectively reviewed cases of Mosaicplasty(®) for OLT repair, performed in combination with malleolar osteotomy on the side of the OLT, at either of two centres, between 1997 and 2013. Pre-operative clinical data were collected from the medical records and all patients were re-evaluated. We studied 37 patients with a mean age of 33 years. RESULTS Mean follow-up at re-evaluation was 76 months. Mean AOFAS score at re-evaluation was 83 (range, 9-100). A work-related cause to the OLT was associated with significantly poorer outcomes (P=0.01). AOFAS values were significantly better in patients whose OLT size was 0.5 to 1cm(2). The Ogilvie-Harris score at last follow-up was good or excellent in 78% of patients. No patient experienced morbidity related to the malleolar osteotomy. Persistent patellar syndrome was noted in 6 patients. DISCUSSION In our case-series, Mosaicplasty(®) for OLT repair provided good medium-term outcomes in 78% of patients. Nevertheless, the donor-site morbidity should be borne in mind. Mosaicplasty(®) deserves to be viewed as a reference standard method for OLT repair. LEVEL OF EVIDENCE IV, retrospective study.
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Affiliation(s)
- N de l'Escalopier
- Service de chirurgie orthopédique, HIA Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France.
| | - O Barbier
- Service de chirurgie orthopédique, HIA Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France
| | - D Mainard
- Service de chirurgie orthopédique et traumatologie, Hôpital Central, 29, avenue de Lattre-de-Tassigny, 54000 Nancy, France
| | - J Mayer
- Service de chirurgie orthopédique et traumatologie, Hôpital Central, 29, avenue de Lattre-de-Tassigny, 54000 Nancy, France
| | - D Ollat
- Service de chirurgie orthopédique, HIA Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France
| | - G Versier
- Service de chirurgie orthopédique, HIA Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France
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Savage-Elliott I, Ross KA, Smyth NA, Murawski CD, Kennedy JG. Osteochondral lesions of the talus: a current concepts review and evidence-based treatment paradigm. Foot Ankle Spec 2014; 7:414-22. [PMID: 25100765 DOI: 10.1177/1938640014543362] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
UNLABELLED Osteochondral lesions of the talar dome are increasingly diagnosed and are a difficult pathology to treat. Conservative treatment yields best results in pediatric patients, often leaving surgical options for adult populations. There is a paucity of long-term data and comparisons of treatment options. Arthroscopic bone marrow stimulation is a common first-line treatment for smaller lesions. Despite promising short to medium term clinical results, bone marrow stimulation results in fibrocartilagenous tissue that incurs differing mechanical and biological properties compared with normal cartilage. Autologous osteochondral transplantation has demonstrated promising clinical results in the short to medium term for larger, cystic lesions and can restore the contact pressure of the joint. However, concerns remain over postoperative cyst formation and donor site morbidity. Recent developments have emphasized the usefulness of biological adjuncts such as platelet-rich plasma and concentrated bone marrow aspirate, as well as particulate juvenile cartilage, in augmenting reparative and replacement strategies in osteochondral lesion treatment. The purpose of this article is to review diagnosis and treatment of talar osteochondral lesions so that current practice guidelines can be more efficiently used given the available treatment strategies. A treatment paradigm based on current evidence is described. LEVELS OF EVIDENCE Therapeutic, Level V, Expert Opinion.
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Affiliation(s)
- Ian Savage-Elliott
- Foot and Ankle Service, Hospital for Special Surgery, New York, New York
| | - Keir A Ross
- Foot and Ankle Service, Hospital for Special Surgery, New York, New York
| | - Niall A Smyth
- Foot and Ankle Service, Hospital for Special Surgery, New York, New York
| | | | - John G Kennedy
- Foot and Ankle Service, Hospital for Special Surgery, New York, New York
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Baums MH, Schultz W, Kostuj T, Klinger HM. Cartilage repair techniques of the talus: An update. World J Orthop 2014; 5:171-179. [PMID: 25035819 PMCID: PMC4095009 DOI: 10.5312/wjo.v5.i3.171] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Accepted: 05/19/2014] [Indexed: 02/06/2023] Open
Abstract
Symptomatic chondral or osteochondral defects of the talus reduce the quality of life of many patients. Although their pathomechanism is well understood, it is well known that different aetiologic factors play a role in their origin. Additionally, it is well recognised that the talar articular cartilage strongly differs from that in the knee. Despite this fact, many recommendations for the management of talar cartilage defects are based on approaches that were developed for the knee. Conservative treatment seems to work best in paediatric and adolescent patients with osteochondritis dissecans. However, depending on the size of the lesions, surgical approaches are necessary to treat many of these defects. Bone marrow stimulation techniques may achieve good results in small lesions. Large lesions may be treated by open procedures such as osteochondral autograft transfer or allograft transplantation. Autologous chondrocyte transplantation, as a restorative procedure, is well investigated in the knee and has been applied in the talus with increasing popularity and promising results but the evidence to date is poor. The goals of the current article are to summarise the different options for treating chondral and osteochondral defects of the talus and review the available literature.
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Hannon CP, Smyth NA, Murawski CD, Savage-Elliott I, Deyer TW, Calder JDF, Kennedy JG. Osteochondral lesions of the talus: aspects of current management. Bone Joint J 2014; 96-B:164-71. [PMID: 24493179 DOI: 10.1302/0301-620x.96b2.31637] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Osteochondral lesions (OCLs) occur in up to 70% of sprains and fractures involving the ankle. Atraumatic aetiologies have also been described. Techniques such as microfracture, and replacement strategies such as autologous osteochondral transplantation, or autologous chondrocyte implantation are the major forms of surgical treatment. Current literature suggests that microfracture is indicated for lesions up to 15 mm in diameter, with replacement strategies indicated for larger or cystic lesions. Short- and medium-term results have been reported, where concerns over potential deterioration of fibrocartilage leads to a need for long-term evaluation. Biological augmentation may also be used in the treatment of OCLs, as they potentially enhance the biological environment for a natural healing response. Further research is required to establish the critical size of defect, beyond which replacement strategies should be used, as well as the most appropriate use of biological augmentation. This paper reviews the current evidence for surgical management and use of biological adjuncts for treatment of osteochondral lesions of the talus.
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Affiliation(s)
- C P Hannon
- Hospital for Special Surgery, 523 East 72nd Street, 5th Floor Rm 514, New York, USA
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Chiang C, Au MK. Mosaicplasty for osteochondral lesions of the talus: a report of two cases. J Am Podiatr Med Assoc 2013; 103:81-6. [PMID: 23328858 DOI: 10.7547/1030081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Two women (24 and 27 years old) noted pain in the affected ankle of several years' duration. Radiography and magnetic resonance imaging revealed osteochondral lesions of the talus in both patients. The lesion sites measured 1.3 × 1.0 × 0.4 cm (0.52 cm(3)) and 2.0 × 1.9 × 0.5 cm (1.9 cm(3)). Each patient received a medial malleolar osteotomy with mosaicplasty. Donor plugs were obtained from the ipsilateral knee in both patients. Surgery was performed successfully in both patients without complications. At 2-year follow-up, both patients had recovered good ankle function, with no donor site morbidity. American Orthopedic Foot and Ankle Society ankle/hindfoot scores improved in the affected ankles from 16 to 84 in case 1 and from 43 to 87 in case 2. Mosaicplasty is effective in treating stage III or IV osteochondral lesions of the talus and results in good-to-excellent recovery of function.
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Affiliation(s)
- Chieh Chiang
- Department of Orthopedic Surgery, Cheng-Hsin General Hospital, Taipei, Taiwan.
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Woelfle JV, Reichel H, Nelitz M. Indications and limitations of osteochondral autologous transplantation in osteochondritis dissecans of the talus. Knee Surg Sports Traumatol Arthrosc 2013; 21:1925-30. [PMID: 23552666 DOI: 10.1007/s00167-013-2483-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Accepted: 03/21/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE Osteochondral autologous transplantation (OAT) from the ipsilateral femoral lateral condyle in osteochondritis dissecans (OD) of the talus has shown good clinical results in the past. To further define, indications and limitations of OAT various factors have been discussed which might influence the clinical outcome. METHODS In this study, the clinical outcome of OAT of 32 patients (mean follow-up 29 months) was evaluated by means of the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale, ankle pain on the visual analogue scale (VAS), and Hospital for Special Surgery (HSS) Patella score. We then analysed the statistical correlation between clinical outcome and various variables such as age, pre-existing osteoarthritis, or size of the lesion. RESULTS Median AOFAS score was 86 (range 68-100), median ankle pain on VAS was 2.0 (range 0-5.5), and median HSS Patella score was 95 (range 35-100). Advanced age (above 40 years of age) was associated with a significantly lower HSS Patella score (80 vs. 97.5, p = 0.035). None of the other variables (obesity, pre-existing osteoarthritis, size of the lesion, necessity of malleolar osteotomy, localization of the lesion, and number of previous surgeries) influenced the clinical outcome adversely. CONCLUSIONS Osteochondral autologous transplantation in OD of the talus is a safe procedure with good clinical results. As advanced age is associated with higher donor-site morbidity, indication for OAT in older patients should be carefully considered. As none of the other variables affected the clinical outcome of OAT adversely, there is no contraindication for OAT, for example, in osteochondral lesions requiring more than one osteochondral grafts, lateral lesions, patients with BMI >25, pre-existing osteoarthritis, or failed previous surgery. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Julia V Woelfle
- Department of Orthopaedic Surgery, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany.
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Woelfle JV, Reichel H, Javaheripour-Otto K, Nelitz M. Clinical outcome and magnetic resonance imaging after osteochondral autologous transplantation in osteochondritis dissecans of the talus. Foot Ankle Int 2013; 34:173-9. [PMID: 23413055 DOI: 10.1177/1071100712467433] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Osteochondral autologous transplantation (OAT) has been performed for years for osteochondritis dissecans of the knee with good clinical results. In osteochondritis dissecans of the talus, however, OAT represents a challenge to the orthopaedic surgeon as frequently malleolar osteotomy has to be performed for exposure of the talus and the harvesting of the osteochondral graft usually requires an arthrotomy of the knee. METHODS In this study, we evaluated the clinical outcome of OAT in 32 patients (mean follow-up 29 months) by means of the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale, ankle pain on the visual analogue scale (VAS), HSS Patella Score, and magnetic resonance imaging (MRI) of the osteochondral graft. RESULTS Median AOFAS score was 86, median ankle pain on VAS was 2.0, and median HSS Patella score was 95. Complications included 1 case of delayed wound healing and 1 case of nonunion of the malleolar osteotomy requiring revision surgery. MRI findings were abnormal in 14 out of 28 cases; however, with the numbers available in our study no correlation to clinical outcome could be detected. CONCLUSION OAT in osteochondritis dissecans of the talus was a safe procedure with good clinical results. As abnormal MRI finding was not necessarily diagnostically conclusive, MRI might be of limited value in postoperative follow-up. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Julia V Woelfle
- Department of Orthopaedic Surgery, University of Ulm, Ulm, Germany.
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Thawait SK, Thawait GK, Frassica FJ, Andreisek G, Carrino JA, Chhabra A. A systematic approach to magnetic resonance imaging evaluation of epiphyseal lesions. Magn Reson Imaging 2012; 31:418-31. [PMID: 23102949 DOI: 10.1016/j.mri.2012.08.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2012] [Revised: 08/19/2012] [Accepted: 08/30/2012] [Indexed: 12/14/2022]
Abstract
Magnetic Resonance Imaging (MRI) is the preferred modality of choice to image epiphyseal lesions. It provides excellent soft tissue resolution and extent of disease. A wide spectrum of tumor and tumor like lesions can involve the epiphysis. Early and accurate diagnosis as well as appropriate management of epiphyseal lesions is critical as these conditions may lead to disabling complications such as, limb length discrepancy, angular or joint surface deformities and secondary osteoarthritis. In this article, we discuss the role of conventional sequences, such as T1W, fluid sensitive T2W and intravenous (IV) Gadolinium enhanced sequences as well as the additional value of problem solving MRI sequences such as, chemical shift and diffusion weighted imaging. Based on the imaging findings on various MRI sequences and lesion characteristics, a systematic approach directed to the diagnoses of epiphyseal lesions is presented and discussed. MRI features of clinically and biopsy proven examples of the epiphyseal lesions, such as osteomyelitis, intra-osseous abscess, infiltrative malignancy, metastases, transient osteoporosis, subchondral insufficiency fracture, avascular necrosis, osteochondral fracture, osteochondritis dissecans, eosinophilic granuloma and geode are demonstrated. Using this systematic approach, the reader will be able to better characterize epiphyseal lesions with a potential to positively affect patient management.
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Affiliation(s)
- Shrey K Thawait
- Department of Radiology, Yale University-Bridgeport hospital, Bridgeport, CT 06610, USA.
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Retrograde drilling of talar osteochondritis dissecans lesions: a feasibility and accuracy analysis of a novel electromagnetic navigation method versus a standard fluoroscopic method. Arthroscopy 2012; 28:1547-54. [PMID: 22683373 DOI: 10.1016/j.arthro.2012.03.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Revised: 03/05/2012] [Accepted: 03/05/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE A novel method using an electromagnetic navigation system (ENS) was developed, and its feasibility and accuracy for retrograde drilling procedures were evaluated and compared with the standard freehand fluoroscopic method in an experimental setting. METHODS A controlled laboratory study of 16 standard freehand fluoroscopically guided and 16 electromagnetically navigated retrograde drilling procedures was performed on 4 cadaveric human ankle joints. Four artificial cartilage lesions were consecutively set, 2 on the medial and 2 on the lateral talar dome. Drilling accuracy was measured in terms of the distance from the final position of the drill bit to the tip of the probe hook and the distance between the tip of the drill bit and the center of the cartilage lesion on the articular cartilage surface. Intraoperative fluoroscopy exposure times were documented, as were readjustments of drilling directions or complete restarts. All procedures were timed with a stopwatch. RESULTS Successful retrograde drilling was accomplished in 12 cases with the standard fluoroscopy-guided technique and in all 16 ENS-guided procedures. The overall mean time for the fluoroscopy-guided procedures was 660.00 ± 239.87 seconds and the overall mean time for the ENS method was 308.06 ± 54.03 seconds, providing a mean time benefit of 420.13 seconds. The mean distance from the final position of the drill bit to the tip of the probe hook was 3.25 ± 1.29 mm for the standard method and 2.19 ± 0.54 mm for the ENS method, and the mean distance between the tip of the drill bit and the center of the cartilage lesion on the articular cartilage surface was 2.50 ± 0.97 mm for the standard method and 0.88 ± 0.81 mm for the ENS method. CONCLUSIONS Compared with the standard fluoroscopic technique, the ENS method used in this study showed higher accuracy and a shorter procedure time and required no X-ray radiation. CLINICAL RELEVANCE The novel method considerably improves on the standard operating procedure in terms of safety, operation time, and radiation exposure.
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High-resolution MR imaging of talar osteochondral lesions with new classification. Skeletal Radiol 2012; 41:387-99. [PMID: 21826613 DOI: 10.1007/s00256-011-1246-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Revised: 07/17/2011] [Accepted: 07/18/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE Retrospective review of high-resolution MR imaging features of talar dome osteochondral lesions and development of new classification system based on these features. MATERIAL AND METHODS Over the past 7 years, 70 osteochondral lesions of the talar dome from 70 patients (49 males, 21 females, mean age 42 years, range 15-62 years) underwent high-resolution MR imaging with a microscopy coil at 1.5 T. Sixty-one (87%) of 70 lesions were located on the medial central aspect and ten (13%) lesions were located on the lateral central aspect of the talar dome. Features evaluated included cartilage fracture, osteochondral junction separation, subchondral bone collapse, bone:bone separation, and marrow change. Based on these findings, a new five-part grading system was developed. Signal-to-noise characteristics of microscopy coil imaging at 1.5 T were compared to dedicated ankle coil imaging at 3 T. RESULTS Microscopy coil imaging at 1.5 T yielded 20% better signal-to-noise characteristics than ankle coil imaging at 3 T. High-resolution MR revealed that osteochondral junction separation, due to focal collapse of the subchondral bone, was a common feature, being present in 28 (45%) of 61 medial central osteochondral lesions. Reparative cartilage hypertrophy and bone:bone separation in the absence of cartilage fracture were also common findings. Complete osteochondral separation was uncommon. A new five-part grading system incorporating features revealed by high-resolution MR imaging was developed. CONCLUSIONS High-resolution MRI reveals clinically pertinent features of talar osteochondral lesions, which should help comprehension of symptomatology and enhance clinical decision-making. These features were incorporated in a new MR-based grading system. Whenever possible, symptomatic talar osteochondral lesions should be assessed by high-resolution MR imaging.
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Reilingh ML, van Dijk CN. Comments on: "osteochondral lesions of the talus: current concept" by O. Laffenêtre published in Orthop Traumatol Surg Res 2010;96: 554-66. Orthop Traumatol Surg Res 2011; 97:461-2; author reply 463. [PMID: 21596641 DOI: 10.1016/j.otsr.2011.03.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Accepted: 03/04/2011] [Indexed: 02/02/2023]
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