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Walther M, Gottschalk O, Aurich M. Operative management of osteochondral lesions of the talus: 2024 recommendations of the working group 'clinical tissue regeneration' of the German Society of Orthopedics and Traumatology (DGOU). EFORT Open Rev 2024; 9:217-234. [PMID: 38457916 PMCID: PMC10958247 DOI: 10.1530/eor-23-0075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/10/2024] Open
Abstract
The working group 'Clinical Tissue Regeneration' of the German Society of Orthopedics and Traumatology (DGOU) issues this paper with updating its guidelines. Literature was analyzed regarding different topics relevant to osteochondral lesions of the talus (OLT) treatment. This process concluded with a statement for each topic reflecting the best scientific evidence available with a grade of recommendation. All group members rated the statements to identify possible gaps between literature and current clinical practice. Fixation of a vital bony fragment should be considered in large fragments. In children with open physis, retrograde drilling seems to work better than in adults, but even there, the revision rate reaches 50%. The literature supports debridement with bone marrow stimulation (BMS) in lesions smaller than 1.0 cm² without bony defect. The additional use of a scaffold can be recommended in lesions larger than 1.0 cm². For other scaffolds besides AMIC®/Chondro-Gide®, there is only limited evidence. Systematic reviews report good to excellent clinical results in 87% of the patients after osteochondral transplantation (OCT), but donor site morbidity is of concern, reaching 16.9%. There is no evidence of any additional benefit from autologous chondrocyte implantation (ACI). Minced cartilage lacks any supporting data. Metallic resurfacing of OLT can only be recommended as a second-line treatment. A medial malleolar osteotomy has a minor effect on the clinical outcome compared to the many other factors influencing the clinical result.
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Affiliation(s)
- Markus Walther
- Schön Klinik München Harlaching – FIFA Medical Centre of Excellence, Harlachinger Straße, Munich, Germany
- Ludwig Maximilian University Munich, Klinik für Orthopädie und Unfallchirurgie, Muskuloskelettales Zentrum München (MUM), Marchionostraße, Munich, Germany
- Justus Maximilian University Wuerzburg, König-Ludwig-Haus, Brettreichstraße, Würzburg, Germany
- Paracelsus Medizinische Privatuniversität, Strubergasse, Salzburg, Austria
- Working Group Clinical Tissue Regeneration of the German Society of Orthopaedics and Traumatology (DGOU), Berlin, Germany
| | - Oliver Gottschalk
- Schön Klinik München Harlaching – FIFA Medical Centre of Excellence, Harlachinger Straße, Munich, Germany
- Ludwig Maximilian University Munich, Klinik für Orthopädie und Unfallchirurgie, Muskuloskelettales Zentrum München (MUM), Marchionostraße, Munich, Germany
- Working Group Clinical Tissue Regeneration of the German Society of Orthopaedics and Traumatology (DGOU), Berlin, Germany
| | - Matthias Aurich
- Working Group Clinical Tissue Regeneration of the German Society of Orthopaedics and Traumatology (DGOU), Berlin, Germany
- Martin-Luther-University Halle-Wittenberg, Universitätsklinikum Halle (Saale), DOUW - Abteilung für Unfall- und Wiederherstellungschirurgie, Ernst-Grube-Straße, Halle, Germany
- BG-Klinikum Bergmannstrost Halle, Halle, Saale, Germany
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Paracha N, Idrizi A, Gordon AM, Lam AW, Abdelgawad AA, Razi AE. Utilization Trends of Total Ankle Arthroplasty and Ankle Fusion for Tibiotalar Osteoarthritis: A Nationwide Analysis of the United States Population. Foot Ankle Spec 2022:19386400221110133. [PMID: 35848212 DOI: 10.1177/19386400221110133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction: Studies evaluating utilization and trends of total ankle arthroplasty (TAA) and ankle fusion (AF) are sparse. The purpose of this study was to use a nationwide administrative claims database to compare baseline demographics between TAA and ankle arthrodesis and to determine whether patients who had a TAA have increased rates of: (1) utilization, (2) in-hospital length of stay (LOS), and (3) costs of care. Methods: PearlDiver, a nationwide claims database was queried from 2005 to December 2013 for all patients who underwent primary TAA or AF for the treatment of osteoarthritis of the ankle and foot. Baseline demographics of age, sex, geographic distribution, and the prevalence of comorbidities comprising the Elixhauser comorbidity index (ECI) were compared between patients who had TAA and AF. Linear regression was used to compare differences in utilization and in-hospital LOS between the 2 cohorts during the study interval. Annual charges and reimbursement rates for TAA were assessed during the study period. A P value less than .05 was considered to be statistically significant. Results: A total of 21 433 patients undergoing primary TAA (n = 7126) and AF (n = 14 307) were included. Patients undergoing TAA had significantly greater ECI driven by arrythmias, congestive heart failure, diabetes mellitus, electrolyte/fluid disorders, iron deficiency anemia than patients undergoing AF (P < .001). From 2005 to 2013, TAA utilization increased from 21.5% to 49.4% of procedures (P < .0001). There was reduced in-hospital LOS over the time interval for patients with TAA compared with AF (2.15 days vs. 3.11 days, P < .0001). Total ankle arthroplasty reimbursements remained stable while charges per patient increased significantly from $40 203.48 in 2005 to doubling by the end of 2013 to $86 208.59 (P < .0001). Conclusion: This study demonstrated increased use of TAA compared to AF showing decreased in-hospital LOS and increased cost of care with stagnant reimbursement rates.Level of Evidence: Level III.
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Affiliation(s)
- Noorulain Paracha
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York (NP, AI, AMG, AL, AAA, AER).,College of Medicine, State University of New York (SUNY) Downstate, Brooklyn, New York (NP, AI)
| | - Adem Idrizi
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York (NP, AI, AMG, AL, AAA, AER).,College of Medicine, State University of New York (SUNY) Downstate, Brooklyn, New York (NP, AI)
| | - Adam M Gordon
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York (NP, AI, AMG, AL, AAA, AER).,College of Medicine, State University of New York (SUNY) Downstate, Brooklyn, New York (NP, AI)
| | - Aaron W Lam
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York (NP, AI, AMG, AL, AAA, AER).,College of Medicine, State University of New York (SUNY) Downstate, Brooklyn, New York (NP, AI)
| | - Amr A Abdelgawad
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York (NP, AI, AMG, AL, AAA, AER).,College of Medicine, State University of New York (SUNY) Downstate, Brooklyn, New York (NP, AI)
| | - Afshin E Razi
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York (NP, AI, AMG, AL, AAA, AER).,College of Medicine, State University of New York (SUNY) Downstate, Brooklyn, New York (NP, AI)
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Rammelt S, Godoy-Santos AL, Schneiders W, Fitze G, Zwipp H. Foot and ankle fractures during childhood: review of the literature and scientific evidence for appropriate treatment. Rev Bras Ortop 2016; 51:630-639. [PMID: 28050532 PMCID: PMC5198067 DOI: 10.1016/j.rboe.2016.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 10/30/2015] [Indexed: 11/10/2022] Open
Abstract
Foot and ankle fractures represent 12% of all pediatric fractures. Malleolar fractures are the most frequent injuries of the lower limbs. Hindfoot and midfoot fractures are rare, but inadequate treatment for these fractures may results in compartment syndrome, three-dimensional deformities, avascular necrosis and early post-traumatic arthritis, which have a significant impact on overall foot and ankle function. Therefore, the challenges in treating these injuries in children are to achieve adequate diagnosis and precise treatment, while avoiding complications. The objective of the treatment is to restore normal anatomy and the correct articular relationship between the bones in this region. Moreover, the treatment needs to be planned according to articular involvement, lower-limb alignment, ligament stability and age. This article provides a review on this topic and presents the scientific evidence for appropriate treatment of these lesions.
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Affiliation(s)
- Stefan Rammelt
- Universitätsklinikum Carl Gustav Carus, Klinik für Unfall und Wiederherstellungschirurgie, Dresden, Germany
| | - Alexandre Leme Godoy-Santos
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Ortopedia e Traumatologia, São Paulo, SP, Brazil
| | - Wolfgang Schneiders
- Universitätsklinikum Carl Gustav Carus, Klinik für Unfall und Wiederherstellungschirurgie, Dresden, Germany
| | - Guido Fitze
- Universitätsklinikum Carl Gustav Carus, Klinik für Unfall und Wiederherstellungschirurgie, Dresden, Germany
| | - Hans Zwipp
- Universitätsklinikum Carl Gustav Carus, Klinik für Unfall und Wiederherstellungschirurgie, Dresden, Germany
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