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Basciani S, Longo UG, Papalia GF, Papalia R, Marinozzi A. Arthroscopic microfracture and associated techniques in the treatment of osteochondral lesions of the talus: A systematic review and metanalysis. Foot Ankle Surg 2024; 30:219-225. [PMID: 38309989 DOI: 10.1016/j.fas.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 10/16/2023] [Accepted: 12/28/2023] [Indexed: 02/05/2024]
Abstract
BACKGROUND Osteochondral lesions of the talus are common in patients suffering even minor trauma; timely diagnosis and treatment can prevent the development of early osteoarthritis. The objectives of this systematic review and meta-analysis were to evaluate the effects of additional procedures on arthroscopic ankle microperforations for osteochondral lesions. METHODS A systematic literature search was conducted using PubMed-Medline, Cochrane Central, and Google Scholar to select clinical studies analyzing the efficacy of platelet-rich plasma (PRP), hyaluronic acid (HA), and bone marrow concentrate (BMC) procedures. Ten articles following PRISMA guidelines with a total of 464 patients were included in this review. Quality assessment using MINORS was performed, and all studies demonstrated high quality. RESULTS The results of the systematic review showed benefits in all patients undergoing infiltrative therapy with PRP, hyaluronic acid, and BMC. The best results in terms of AOFAS score and VAS scale were found in patients undergoing PRP injection. The meta-analysis showed improvements in pain relief and return to daily activities in patients undergoing arthroscopic microperforations and PRP, although not reporting statistically significant results (p = 0.42). CONCLUSION All treatment strategies reported better scores compared to the control groups. Among the various treatments analyzed, the addition of PRP appears to be the most valuable probably for the larger population receiving this treatment, showing excellent outcomes in pain reduction, clinical outcomes, and return to daily activities. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Susanna Basciani
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy
| | - Umile Giuseppe Longo
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy.
| | - Giuseppe Francesco Papalia
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy
| | - Rocco Papalia
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy
| | - Andrea Marinozzi
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy
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Johnson LG, Buck EH, Anastasio AT, Abar B, Fletcher AN, Adams SB. The efficacy of platelet-rich plasma in osseous foot and ankle pathology: a review. Regen Med 2023; 18:73-84. [PMID: 36382473 DOI: 10.2217/rme-2022-0056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The purpose of this review is to develop evidence-based practices for the use of platelet-rich plasma (PRP) to treat osseous pathologies of the lower extremity. There is moderate high-quality evidence to support the efficacy of PRP as a surgical augment to microfracture in osteochondral lesions of the talus (OLT). The literature supports a conceivable positive impact on bony union and osseous healing. There is insufficient evidence to support PRP injections in the conservative management of OLT or symptomatic ankle osteoarthritis. PRP may serve as a viable treatment method in the surgical augmentation of microfracture surgery in OLT and has promise for increasing bony union following surgical operations. Further high-quality, comparative studies with longer clinical follow-up are required.
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Affiliation(s)
- Lindsey G Johnson
- Orthopaedic Surgery Department, Duke University Medical Center, Durham, NC 27705, USA.,Campbell University School of Osteopathic Medicine, Lillington, NC 27546, USA
| | - Erin H Buck
- Campbell University School of Osteopathic Medicine, Lillington, NC 27546, USA
| | - Albert T Anastasio
- Orthopaedic Surgery Department, Duke University Medical Center, Durham, NC 27705, USA
| | - Bijan Abar
- Orthopaedic Surgery Department, Duke University Medical Center, Durham, NC 27705, USA
| | - Amanda N Fletcher
- Orthopaedic Surgery Department, Duke University Medical Center, Durham, NC 27705, USA
| | - Samuel B Adams
- Orthopaedic Surgery Department, Duke University Medical Center, Durham, NC 27705, USA
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Wen HJ, Zhu SY, Tan HB, Xu YQ. Augmented Microfracture Technique Versus Microfracture in Talar Cartilage Restoration: A Systematic Review and Meta-Analysis. J Foot Ankle Surg 2021; 60:1270-1279. [PMID: 34294533 DOI: 10.1053/j.jfas.2020.11.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 10/16/2020] [Accepted: 11/10/2020] [Indexed: 02/03/2023]
Abstract
The aim of this meta-analysis was to compare the efficacy and safety between the microfracture (MFx) and augmented microfracture (MFx+) techniques for articular cartilage defects of the talus (OLTs). PubMed and EMBASE were searched from January 1950 to October 2020. Only randomized controlled trials, quasi-randomized controlled trials, and observational studies (retrospective and prospective) applying MFx and MFx+ techniques to treat talar cartilage defects were selected. Ten trials with 492 patients were included. There was significant difference in final American Orthopaedic Foot & Ankle Society score (AOFAS) (mean difference [MD] = 7.07; 95% confidence interval [CI], 3.70-10.44; p < .01), AOFAS change (MD = 7.97; 95% CI, 4.27-11.66; p < .01), visual analog scale (VAS) change score (MD = 0.44; 95% CI, 0.29-0.59; p < .01), Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score (MD = 12.51; 95% CI, 7.16-17.86; p < .01), complication (RR = 0.33; 95% CI, 0.16-0.69; p < .01), and revision (Relative risk = 0.34; 95% CI, 0.15-0.77; p < .05), between the MFx and MFx+ groups. No significant difference was observed for final VAS pain score (MD = -0.53; 95% CI, -1.2 to 1.05; p = .13) and Tegner scale (MD = 0.31; 95% CI, -1.05 to 1.66; p = .66) in either group. Our results suggest that augmented microfracture is superior to microfracture alone in the treatment of talar OLTs based on the AOFAS, MOCART, VAS score, complication rate, and revision ratio. Therefore, microfracture with augmentation should be considered as a treatment for OLTs of talus. However, more randomized trials are still required to determine the long-term superiority of MFx+.
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Affiliation(s)
- Hong-Jie Wen
- Foot and Ankle Surgeon, Department of Orthopedic, The Second People's Hospital of Yunnan Province, the Affiliated Hospital of Yunnan University, Kunming, China
| | - Shou-Yan Zhu
- Associate Professor, Department of Radiology, The Affiliated Hospital of Yunnan University, Kunming, China
| | - Hong-Bo Tan
- Professor, Department of Orthopaedic Surgery, 920th Hospital of Joint Logistics Support Force, Kunming, China
| | - Yong-Qing Xu
- Professor, Department of Orthopaedic Surgery, 920th Hospital of Joint Logistics Support Force, Kunming, China.
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Irmak G, Gümüşderelioğlu M. Patients- and tissue-specific bio-inks with photoactivated PRP and methacrylated gelatin for the fabrication of osteochondral constructs. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2021; 125:112092. [PMID: 33965102 DOI: 10.1016/j.msec.2021.112092] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/14/2021] [Accepted: 03/24/2021] [Indexed: 02/07/2023]
Abstract
In osteochondral tissue engineering, while the biochemical and mechanical properties of hydrogels guide stem cell proliferation and differentiation, physical and chemical stimulators also affect the differentiation of stem cells. Herein, we presented a patient and tissue-specific strategy for the development of biomimetic osteochondral constructs with gradient compositions. Osteochondral constructs were fabricated by gradually printing of bio-inks consisting of therapeutic platelet-rich plasma (PRP), adipose tissue-derived mesenchymal stem cells (AdMSCs), and extracellular matrix (ECM) mimetic hydrogel, microwave-assisted methacrylated gelatin (Gel-MA). Periodic application of light in the near infrared region (600-1200 nm wavelength) was used to induce platelet activation and also AdMSCs' differentiation. Gel-MA has the same structure as type I collagen and PRP has cartilage tissue-specific bioactive components, so they provide the appropriate environment for the differentiation of AdMSCs to osteochondral tissue. Histology, immunocytochemistry, and biochemical analyses indicated enhanced glycosaminoglycan (GAG) and calcium content, mineralization, and ECM production. Furthermore, RT-PCR results indicated the expressions of bone- and cartilage-specific genes. In conclusion, the periodically photoactivated hydrogels with relatively low degradation rate and high mechanical strength, and tissue-specific biomimetic structure promoted in-vitro osteochondral tissue formation including hyaline and hypertrophic cartilage and bone phases.
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Affiliation(s)
- Gülseren Irmak
- Hacettepe University, Bioengineering Department, 06800 Beytepe, Ankara, Turkey; Hacettepe University, Chemical Engineering Department, 06800 Beytepe, Ankara, Turkey
| | - Menemşe Gümüşderelioğlu
- Hacettepe University, Bioengineering Department, 06800 Beytepe, Ankara, Turkey; Hacettepe University, Chemical Engineering Department, 06800 Beytepe, Ankara, Turkey.
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D'Hooghe P, Murawski CD, Boakye LAT, Osei-Hwedieh DO, Drakos MC, Hertel J, Lee KB, Popchak A, Wiewiorski M, van Dijk CN. Rehabilitation and Return to Sports: Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle. Foot Ankle Int 2018; 39:61S-67S. [PMID: 30215313 DOI: 10.1177/1071100718781862] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The evidence supporting best practice guidelines in the field of cartilage repair of the ankle are based on both low quality and low levels of evidence. Therefore, an international consensus group of experts was convened to collaboratively advance toward consensus opinions based on the best available evidence on key topics within cartilage repair of the ankle. The purpose of this article is to report the consensus statements on Rehabilitation and Return to Sports developed at the 2017 International Consensus Meeting on Cartilage Repair of the Ankle. METHODS Seventy-five international experts in cartilage repair of the ankle representing 25 countries and 1 territory were convened and participated in a process based on the Delphi method of achieving consensus. Questions and statements were drafted within 11 working groups focusing on specific topics within cartilage repair of the ankle, after which a comprehensive literature review was performed and the available evidence for each statement was graded. Discussion and debate occurred in cases where statements were not agreed upon in unanimous fashion within the working groups. A final vote was then held, and the strength of consensus was characterized as follows: consensus, 51% to 74%; strong consensus, 75% to 99%; unanimous, 100%. RESULTS A total of 9 statements on rehabilitation and return to sports reached consensus during the 2017 International Consensus Meeting on Cartilage Repair of the Ankle. All 9 statements reached strong consensus, with at least 86% agreement. CONCLUSIONS The rehabilitation process for an ankle cartilage injury requires a multidisciplinary and comprehensive approach. This international consensus derived from leaders in the field will assist clinicians with rehabilitation and return to sports after treatment of a cartilage injury of the ankle.
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Affiliation(s)
- Pieter D'Hooghe
- 1 Department of Orthopaedic Surgery, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Christopher D Murawski
- 2 Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Lorraine A T Boakye
- 2 Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - David O Osei-Hwedieh
- 2 Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Jay Hertel
- 4 Department of Kinesiology, University of Virginia, Charlottesville, VA, USA
| | - Keun Bae Lee
- 5 Department of Orthopedic Surgery, Chonnam National University Medical School and Hospital, Gwangju, South Korea
| | - Adam Popchak
- 2 Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Martin Wiewiorski
- 6 Department of Orthopaedic and Trauma Surgery, Kantonsspital Winterthur, Winterthur, Switzerland
| | - C Niek van Dijk
- 7 Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.,8 Ripoll y De Prado Sports Clinic: Murcia-Madrid-FIFA Medical Center of Excellence, Madrid, Spain
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