1
|
Suh JW, Kwon JH, Lee DH, Jung JU, Park HW. Outcomes of Osteochondral Autologous Transplantation with Ipsilateral Lateral Talar Autograft for Medial Osteochondral Lesions of the Talus. Clin Orthop Surg 2024; 16:620-627. [PMID: 39092295 PMCID: PMC11262937 DOI: 10.4055/cios23327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 01/27/2024] [Accepted: 01/27/2024] [Indexed: 08/04/2024] Open
Abstract
Background Osteochondral autologous transplantation (OAT) has been widely used in the treatment of osteochondral lesion of the talus (OLT). Previous studies have reported successful outcomes following the use of osteochondral autogenous grafts from the intercondylar notch of the knee or a non-weight-bearing region of the femoral condyle. However, donor-site morbidity of the knee joint has been observed in several cases. This study aimed to investigate the outcomes and safety of OAT with autografts from the ipsilateral lateral talar articular facet as an alternative donor site for medial OLT. Methods Among 40 patients who underwent OAT, 29 patients were excluded. Eleven patients who underwent OAT with an osteochondral graft harvested from the ipsilateral lateral talar articular facet from 2011 to 2022 were retrospectively analyzed. The size of OLT was measured on ankle magnetic resonance imaging, including coronal length, sagittal length, depth, and area. Clinical outcomes were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale and a visual analog scale (VAS). Weight-bearing ankle radiographs were obtained postoperatively and at 1 year after surgery. Results The average follow-up time after surgery was 64.7 months (range, 14-137 months). The average diameter of lesions was 8.8 mm (range, 8-9.9 mm). The average size of lesions was 51.2 mm2 (range, 33.6-71.3 mm2) , and all lesions included subchondral cysts. The average depth of lesions was 7.3 mm (range, 6.2-9.1 mm). Graft sizes ranged from 8 to 10 mm in diameter (8 mm, n = 1; 10 mm, n = 10) All measured clinical outcomes improved postoperatively, including the AOFAS scores (preoperative, 55.4 ± 9.0; 1-year follow-up, 92.1 ± 7.6; p = 0.001) and VAS scores (preoperative, 5.5 ± 0.7; 1-year follow-up, 1.9 ± 0.8; p = 0.001). All weight-bearing ankle radiographs of the graft and donor sites did not reveal arthritic change in the ankle joint, lateral talar dome collapse, and graft-site delayed union or nonunion at 1 year after surgery. Conclusions For a single medial OLT, harvesting autografts from the ipsilateral lateral talar articular facet without knee donor-site morbidities can be a good alternative in OAT for OLT.
Collapse
Affiliation(s)
- Jae Wan Suh
- Department of Orthopedic Surgery, Dankook University College of Medicine, Cheonan, Korea
| | - Joo Han Kwon
- Department of Orthopedic Surgery, Dankook University College of Medicine, Cheonan, Korea
| | - Dae Hee Lee
- Department of Orthopedic Surgery, Dankook University College of Medicine, Cheonan, Korea
| | - Jae Uk Jung
- Department of Orthopedic Surgery, Dankook University College of Medicine, Cheonan, Korea
| | - Hyun-Woo Park
- Department of Orthopedic Surgery, Dankook University College of Medicine, Cheonan, Korea
| |
Collapse
|
2
|
Hollander JJ, Dahmen J, Emanuel KS, Stufkens SA, Kennedy JG, Kerkhoffs GM. The Frequency and Severity of Complications in Surgical Treatment of Osteochondral Lesions of the Talus: A Systematic Review and Meta-Analysis of 6,962 Lesions. Cartilage 2023; 14:180-197. [PMID: 37144397 PMCID: PMC10416205 DOI: 10.1177/19476035231154746] [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: 09/24/2022] [Revised: 01/18/2023] [Accepted: 01/18/2023] [Indexed: 05/06/2023] Open
Abstract
OBJECTIVE The primary aim was to determine and compare the complication rate of different surgical treatment options for osteochondral lesions of the talus (OLTs). The secondary aim was to analyze and compare the severity and types of complications. DESIGN A literature search was performed in MEDLINE (PubMed), EMBASE (Ovid), and the Cochrane Library. Methodological quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS). Primary outcome was the complication rate per surgical treatment option. Secondary outcomes included the severity (using the Modified Clavien-Dindo-Sink Complication Classification System for Orthopedic Surgery) and types of complications. The primary outcome, the severity, and the sub-analyses were analyzed using a random effects model. A moderator test for subgroup-analysis was used to determine differences. The types of complications were presented as rates. RESULTS In all, 178 articles from the literature search were included for analysis, comprising 6,962 OLTs with a pooled mean age of 35.5 years and follow-up of 46.3 months. Methodological quality was fair. The overall complication rate was 5% (4%-6%; treatment group effect, P = 0.0015). Analysis resulted in rates from 3% (2%-4%) for matrix-assisted bone marrow stimulation to 15% (5%-35%) for metal implants. Nerve injury was the most observed complication. CONCLUSIONS In 1 out of 20 patients treated surgically for an OLT, a complication occurs. Metal implants have a significantly higher complication rate compared with other treatment modalities. No life-threatening complications were reported.
Collapse
Affiliation(s)
- Julian J. Hollander
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
- Academic Center for Evidence Based Sports Medicine, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports, International Olympic Committee Research Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - Jari Dahmen
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
- Academic Center for Evidence Based Sports Medicine, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports, International Olympic Committee Research Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - Kaj S. Emanuel
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
- Academic Center for Evidence Based Sports Medicine, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports, International Olympic Committee Research Center, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Orthopedic Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Sjoerd A.S. Stufkens
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
- Academic Center for Evidence Based Sports Medicine, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports, International Olympic Committee Research Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - John G. Kennedy
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Gino M.M.J. Kerkhoffs
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
- Academic Center for Evidence Based Sports Medicine, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports, International Olympic Committee Research Center, Amsterdam UMC, Amsterdam, The Netherlands
| |
Collapse
|
3
|
Yokoe T, Tajima T, Yamaguchi N, Morita Y, Chosa E. Retrograde Autologous Talar Osteocancellous Bone Grafting for the Treatment of Osteochondral Lesions of the Talus: A Technical Note. J Clin Med 2023; 12:jcm12103431. [PMID: 37240537 DOI: 10.3390/jcm12103431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/09/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
Osteochondral lesions of the talus (OLT) are common injuries in young athletes. Various kinds of surgical procedures are available for orthopaedic surgeons, but which surgical technique is the best remains controversial. Many surgical procedures require malleolar osteotomy to obtain appropriate surgical exposure to the OLT because of the anatomic characteristics of the ankle joint. However, malleolar osteotomy is invasive and has a potential risk of complications, such as tibial chondral damage and pseudoarthrosis. This article aims to introduce a novel surgical procedure for the treatment of OLTs: retrograde autologous talar osteocancellous bone grafting without the need for osteotomy and harvesting a graft from anywhere other than the talus. First, an arthroscopic evaluation is performed to verify the location, size, and cartilage quality of the OLT as well as concomitant lesions. After confirming the position of the guide pin using a guide device arthroscopically, a talar osteocancellous bone plug is harvested using a coring reamer. The OLT of the harvested talar bone plug is removed, and under arthroscopy, the talar osteocancellous bone plug is retrogradely inserted into the talar bone tunnel. To stabilize the implanted bone plug, one or two bioabsorbable pins are inserted from the lateral wall of the talus while applying counterforce to the articular surface of the bone plug. The present surgical technique can minimally invasively address the OLT without the need for malleolar osteotomy and harvesting a graft from the knee joint or iliac bone.
Collapse
Affiliation(s)
- Takuji Yokoe
- Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki 889-1692, Japan
| | - Takuya Tajima
- Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki 889-1692, Japan
| | - Nami Yamaguchi
- Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki 889-1692, Japan
| | - Yudai Morita
- Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki 889-1692, Japan
| | - Etsuo Chosa
- Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki 889-1692, Japan
| |
Collapse
|
4
|
Migliorini F, Maffulli N, Eschweiler J, Götze C, Hildebrand F, Betsch M. Prognostic factors for the management of chondral defects of the knee and ankle joint: a systematic review. Eur J Trauma Emerg Surg 2022; 49:723-745. [PMID: 36344653 PMCID: PMC10175423 DOI: 10.1007/s00068-022-02155-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 10/21/2022] [Indexed: 11/09/2022]
Abstract
Abstract
Purpose
Different surgical techniques to manage cartilage defects are available, including microfracture (MFx), autologous chondrocyte implantation (ACI), osteoarticular auto- or allograft transplantation (OAT), autologous matrix-induced chondrogenesis (AMIC). This study investigated the patient-related prognostic factors on the clinical outcomes of surgically treated knee and ankle cartilage defects.
Methods
This study followed the PRISMA statement. In May 2022, the following databases were accessed: PubMed, Google Scholar, Embase, and Scopus. All the studies investigating the outcomes of surgical management for knee and/or talus chondral defects were accessed. Only studies performing mesenchymal stem cells transplantation, OAT, MFx, ACI, and AMIC were considered. A multiple linear model regression analysis through the Pearson Product–Moment Correlation Coefficient was used.
Results
Data from 184 articles (8905 procedures) were retrieved. Female sex showed a positive moderate association with visual analogue scale at last follow-up (P = 0.02). Patient age had a negative association with the American Orthopaedic Foot and Ankle Score (P = 0.04) and Lysholm Knee Scoring Scale (P = 0.03). BMI was strongly associated with graft hypertrophy (P = 0.01). Greater values of VAS at baseline negatively correlate with lower values of Tegner Activity Scale at last follow-up (P < 0.0001).
Conclusion
The clinical outcomes were mostly related to the patients’ performance status prior surgery. A greater BMI was associated with greater rate of hypertrophy. Female sex and older age evidenced fair influence, while symptom duration prior to the surgical intervention and cartilage defect size evidenced no association with the surgical outcome. Lesion size and symptom duration did not evidence any association with the surgical outcome.
Collapse
|
5
|
Campbell ML, Lenz AL, Peterson AC, DeKeyser GJ, Haller JM, O'Neill DC. Dual Approach to Talar Dome Increases Access for Fracture Care Without Osteotomy. Foot Ankle Int 2022; 43:1474-1481. [PMID: 36000204 DOI: 10.1177/10711007221115719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND There is no consensus surgical treatment algorithm for talar body fractures, with authors recommending both soft tissue-only and osteotomy-based approaches. This study evaluates talar dome access via dual approaches to the talar dome through anterolateral transligamentous (ATL) and modified posteromedial (mPM) approaches. METHODS Ten cadaveric legs (5 matched pairs) were included. An mPM approach, between flexor hallucis longus and Achilles tendon, and an ATL approach, utilizing the anterolateral interval with transection of anterior talofibular ligament and calcaneofibular ligament, were performed on each specimen. Order of approach was alternated within each pair. Accessible dome surface area (DSA) was outlined by drilling with a 1.6-mm Kirschner wire at the visualized talar dome margin both with and without 4 mm of tibiotalar distraction using an external fixator. Specimens were analyzed by computed tomography (CT). Primary outcome was accessible DSA. Student t tests compared DSA accessed by different exposure methods. RESULTS An initial mPM approach exposed 25.6% and 33.6% of DSA without and with distraction (P = .002). An initial ATL approach accessed 47.0% and 58.1% of DSA without and with distraction, respectively (P = .003). Accessibility via dual approaches was 71.7% and 93% of DSA without and with distraction with an initial ATL approach and 71.3% and 87.5% of DSA without and with distraction with an initial mPM approach (P = .96 and .37, respectively). The central talar dome was inaccessible in an almond-shaped area, tapered at the medial and lateral ends. Anterior, lateral, and posterior articular margins were able to be fully exposed, often with overlapping exposure between posterior and anterior approaches, with distraction reliably improving lateral visualization. CONCLUSION Dual approaches provided access to greater than 70% and 85% of talar DSA without and with distraction, respectively. Order of approach did not significantly affect exposure and thus should be determined by surgeon discretion. These results may promote soft tissue-only treatment strategies in talar body fracture care with an extensile exposure of the talar dome surface. Careful preoperative planning optimizes the advantages of this approach. LEVEL OF EVIDENCE Level IV, case series.
Collapse
Affiliation(s)
- Megan L Campbell
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Amy L Lenz
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Andrew C Peterson
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Graham J DeKeyser
- Department of Orthopaedic Surgery, University of Washington, Seattle, WA, USA
| | - Justin M Haller
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Dillon C O'Neill
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| |
Collapse
|
6
|
Migliorini F, Maffulli N, Baroncini A, Eschweiler J, Knobe M, Tingart M, Schenker H. Allograft Versus Autograft Osteochondral Transplant for Chondral Defects of the Talus: Systematic Review and Meta-analysis. Am J Sports Med 2022; 50:3447-3455. [PMID: 34554880 PMCID: PMC9527449 DOI: 10.1177/03635465211037349] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND It is unclear whether the results of osteochondral transplant using autografts or allografts for talar osteochondral defect are equivalent. PURPOSE A systematic review of the literature was conducted to compare allografts and autografts in terms of patient-reported outcome measures (PROMs), MRI findings, and complications. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS This study was conducted according to the PRISMA guidelines. The literature search was conducted in February 2021. All studies investigating the outcomes of allograft and/or autograft osteochondral transplant as management for osteochondral defects of the talus were accessed. The outcomes of interest were visual analog scale (VAS) score for pain, American Orthopaedic Foot and Ankle Society (AOFAS) score, and Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score. Data concerning the rates of failure and revision surgery were also collected. Continuous data were analyzed using the mean difference (MD), whereas binary data were evaluated with the odds ratio (OR) effect measure. RESULTS Data from 40 studies (1174 procedures) with a mean follow-up of 46.5 ± 25 months were retrieved. There was comparability concerning the length of follow-up, male to female ratio, mean age, body mass index, defect size, VAS score, and AOFAS score (P > .1) between the groups at baseline. At the last follow-up, the MOCART (MD, 10.5; P = .04) and AOFAS (MD, 4.8; P = .04) scores were better in the autograft group. The VAS score was similar between the 2 groups (P = .4). At the last follow-up, autografts demonstrated lower rate of revision surgery (OR, 7.2; P < .0001) and failure (OR, 5.1; P < .0001). CONCLUSION Based on the main findings of the present systematic review, talar osteochondral transplant using allografts was associated with higher rates of failure and revision compared with autografts at midterm follow-up.
Collapse
Affiliation(s)
- Filippo Migliorini
- Department of Orthopedic, Trauma, and Reconstructive Surgery, RWTH Aachen University Hospital, Aachen, Germany,Filippo Migliorini, MD, PhD, MBA, Department of Orthopedic, Trauma, and Reconstructive Surgery, RWTH Aachen University Hospital, Pauwelsstraße 31, 52074 Aachen, Germany ()
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy,School of Pharmacy and Bioengineering, Keele University School of Medicine, Stoke on Trent, England,Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, London, England
| | - Alice Baroncini
- Department of Orthopedic, Trauma, and Reconstructive Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Jörg Eschweiler
- Department of Orthopedic, Trauma, and Reconstructive Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Matthias Knobe
- Department of Orthopedics and Trauma Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Markus Tingart
- Department of Orthopedic, Trauma, and Reconstructive Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Hanno Schenker
- Department of Orthopedic, Trauma, and Reconstructive Surgery, RWTH Aachen University Hospital, Aachen, Germany
| |
Collapse
|
7
|
Meisterhans M, Valderrabano V, Wiewiorski M. Medial oblique malleolar osteotomy for approach of medial osteochondral lesion of the talus. Arch Orthop Trauma Surg 2022:10.1007/s00402-022-04598-9. [PMID: 36063209 DOI: 10.1007/s00402-022-04598-9] [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: 04/19/2022] [Accepted: 08/21/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE The medial malleolar osteotomy is commonly performed to gain access to the medial talar dome for treatment of osteochondral lesions of the talus. The primary aim of this study was to assess osseous healing based on postoperative radiographs to determine consolidation, non-union and malreduction rates. METHODS Sixty-seven cases were reviewed where an oblique uniplanar medial malleolar osteotomy was performed to gain access to the medial talar dome for addressing an osteochondral lesion. Two, respectively three fully threaded 3.5 mm corticalis screws were used to fixate the osteotomy. Postoperative radiographs were reviewed to assess consolidation, non-union, malreduction and dislocation of the osteotomy. RESULTS Out of 67 patients, 66 patients had a consolidation of the osteotomy. 23.9% of the cases showed malreduction of the osteotomy. One patient suffered a non-union, which required a revision surgery. No significant difference was shown between two and three screws used for fixation in terms of malreduction and consolidation of the osteotomy. Eighty-four percent of the patients underwent hardware removal due to pain or medial impingement. CONCLUSION The oblique medial malleolar osteotomy is a safe and relatively simple procedure with a high consolidation rate and low revision providing excellent exposure of the talus. The moderately high malreduction rate and required hardware removal surgery by most of the patients are relevant factors which should be considered before performing this surgery. LEVEL OF EVIDENCE Level III, retrospective cohort study.
Collapse
Affiliation(s)
- Michel Meisterhans
- Orthopaedic and Trauma Department, Kantonsspital Winterthur, Winterthur, Switzerland.
| | - Victor Valderrabano
- Swiss Ortho Center, Schmerzklinik Basel, Swiss Medical Network, Hirschgässlein 15, 4010, Basel, Switzerland
| | - Martin Wiewiorski
- WinOrtho, Privatklinik Lindberg, Swiss Medical Network, Schickstrasse 11, 8400, Winterthur, Switzerland
| |
Collapse
|
8
|
Anwander H, Vetter P, Kurze C, Farn CJ, Krause FG. Evidence for operative treatment of talar osteochondral lesions: a systematic review. EFORT Open Rev 2022; 7:460-469. [PMID: 35900197 PMCID: PMC9297053 DOI: 10.1530/eor-21-0101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Purpose
Operative treatment of talar osteochondral lesions is challenging with various treatment options. The aims were (i) to compare patient populations between the different treatment options in terms of demographic data and lesion size and (ii) to correlate the outcome with demographic parameters and preoperative scores.
Methods
A systemic review was conducted according to the PRISMA guidelines. The electronic databases Pubmed (MEDLINE) and Embase were screened for reports with the following inclusion criteria: minimum 2-year follow-up after operative treatment of a talar osteochondral lesion in at least ten adult patients and published between 2000 and 2020.
Results
Forty-five papers were included. Small lesions were treated using BMS, while large lesions with ACI. There was no difference in age between the treatment groups. There was a correlation between preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score and change in AOFAS score (R = −0.849, P < 0.001) as well as AOFAS score at follow-up (R = 0.421, P = 0.008). Preoperative size of the cartilage lesion correlates with preoperative AOFAS scores (R= −0.634, P = 0.001) and with change in AOFAS score (R = 0.656, P < 0.001) but not with AOFAS score at follow-up. Due to the heterogeneity of the studies, a comparison of the outcome between the different operative techniques was not possible.
Conclusion
Patient groups with bigger lesions and inferior preoperative scores did improve the most after surgery.
Level of evidence
IV.
Collapse
Affiliation(s)
- Helen Anwander
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Philipp Vetter
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christophe Kurze
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Chui J Farn
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Orthopedic Surgery, National Taiwan University Hospital, Taiwan, Republic of China
| | - Fabian G Krause
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| |
Collapse
|
9
|
Wan DD, Huang H, Hu MZ, Dong QY. Results of the osteochondral autologous transplantation for treatment of osteochondral lesions of the talus with harvesting from the ipsilateral talar articular facets. INTERNATIONAL ORTHOPAEDICS 2022; 46:1547-1555. [PMID: 35332372 DOI: 10.1007/s00264-022-05380-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 03/13/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE There are few studies on the clinical outcomes of osteochondral autologous transplantation (OAT) harvesting from local talar non-weight-bearing articular facets for the treatment of osteochondral lesions of the talus (OLTs). The purpose of this study was to review the short- to midterm outcomes of our patients who were treated with OAT harvesting from ipsilateral talar articular facets for OLTs. METHODS Between December 2010 and November 2018, 24 patients were enrolled in this study. There were 16 males and eight females with an average age of 39.1 years and a follow-up period of 50.9 months. The clinical results were evaluated according to the American Orthopedic Foot & Ankle Society (AOFAS) ankle-hindfoot score and the visual analogue scale (VAS) score. Pre-operative plain radiographs and magnetic resonance imaging (MRI) scans, post-operative radiographs, and X-ray and computed tomography (CT) scans at the last follow-up were observed. RESULTS There was a significant improvement in the AOFAS score from 61.3 ± 19.0 pre-operatively to 84.9 ± 9.2 post-operatively (P < 0.001). The VAS score improved from 6.1 ± 2.3 to 2.0 ± 1.4 at the last follow-up (P < 0.001). Twenty-one patients (87.5%) were satisfied with their clinical results. By the last follow-up CT scan, there was bone cyst formation at the donor sites in three patients, at the recipient sites in five patients and at both sites in five patients. Two patients (8.3%) underwent re-operation with arthroscopic debridement because of medial gutter hypertrophic soft tissue impingement. CONCLUSION OAT harvesting from the ipsilateral talar articular facet showed satisfactory results. The mean post-operative VAS score and AOFAS ankle-hindfoot score improved significantly. Post-operative impingement around the osteotomy site was the main complication and reason for re-operation after the index procedure. In addition, bone cysts at the recipient and/or donor site(s) were found with a large percentage under CT. Therefore, longer follow-up is necessary to determine the long-term clinical results for this technique.
Collapse
Affiliation(s)
- Dong Dong Wan
- Department of Orthopedic Surgery, Tianjin First Central Hospital, Tianjin, 300192, China
| | - Heng Huang
- Department of Hand and Foot Surgery, The Affiliated Hospital of Qingdao University, 1677, Wutaishan Road, Huang Dao Area, Qing Dao City, Shan Dong Province, 266000, China
| | - Mao Zhong Hu
- Department of Orthopedic Surgery, Tianjin First Central Hospital, Tianjin, 300192, China
| | - Quan Yu Dong
- Department of Hand and Foot Surgery, The Affiliated Hospital of Qingdao University, 1677, Wutaishan Road, Huang Dao Area, Qing Dao City, Shan Dong Province, 266000, China.
| |
Collapse
|
10
|
Arthroscopic evaluation after osteochondral autogenous transfer with osteotomy of medial malleolus for osteochondral lesion of the talar dome. Foot Ankle Surg 2022; 28:25-29. [PMID: 33574007 DOI: 10.1016/j.fas.2021.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 11/30/2020] [Accepted: 01/11/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND The purpose of this study was to investigate the second-look arthroscopic evaluation after osteochondral autogenous transfer (OAT) for osteochondral lesion of the talar dome (OLT) with the criteria of the International Cartilage Repair Society (ICRS). METHODS Ten patients (twelve ankles) with OLT underwent OAT with osteotomy of the medial malleolus. Clinical outcomes were evaluated using the American Orthopedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale. The condition of the transplanted cartilage was evaluated at the time of second-look arthroscopy using the ICRS Cartilage Repair Assessment. RESULTS The AOFAS ankle-hindfoot scale was significantly improved from 65.1 ± 1.9 points before surgery to 98.1 ± 2.8 points at the time of second-look arthroscopy (p < 0.01). The ICRS Cartilage Repair Assessment was 11.4 points on average (9-12 points). CONCLUSIONS The OAT for OLT is considered to be a useful treatment even if invasion by medial malleolus osteotomy is added. LEVEL OF EVIDENCE Level IV, Case series.
Collapse
|
11
|
van Diepen PR, Dahmen J, Altink JN, Stufkens SA, Kerkhoffs GM. Location Distribution of 2,087 Osteochondral Lesions of the Talus. Cartilage 2021; 13:1344S-1353S. [PMID: 32909458 PMCID: PMC8808869 DOI: 10.1177/1947603520954510] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE The primary aim of this study was to evaluate the exact location distribution in patients with osteochondral lesions of the talus (OLTs) using a 9-grid scheme. The secondary aim is to match lesion location to lesion size, arthroscopic or open operation, and trauma occurrence. METHODS A systematic review was performed in the databases PubMed, EMBASE, and Cochrane. Search terms consisted of "talus" and "osteochondral lesion." Two independent reviewers evaluated search results and conducted the quality assessment using the Methodological Index for Non-Randomized Studies (MINORS). Primary outcome measure was OLT location in the 9 zone-grid. Secondary outcome measures were OLT size in 9-zones, preoperative radiological modality use, demographic lesion size variables as well as open or arthroscopic treatment. RESULTS Fifty-one articles with 2,087 OLTs were included. Heterogeneity concerning methodological nature was observed and methodological quality was low. The posteromedial (28%) and centromedial (31%) zones combined as one location was the location with the highest incidence of OLTs with a rate of 59%. Individual OLT size was reported for only 153 lesions (7%). Preoperative combination of X-ray and magnetic resonance imaging (MRI), and/or computed tomography (CT) was reported in 20 studies (43%). Trauma was reported in 78% of patients. Furthermore, 67% was treated arthroscopically and 76% received primary OLT treatment. CONCLUSION The majority of OLTs are located in the posteromedial and centromedial zone, while the largest OLTs were reported in the centrocentral zone. Further research is required to identify the prognostic impact of location occurrence on the outcomes following OLT treatment.
Collapse
Affiliation(s)
- Pascal R. van Diepen
- Department of Orthopedic Surgery,
Amsterdam UMC, Amsterdam Movement Sciences, University of Amsterdam, Amsterdam, the
Netherlands,Academic Center for Evidence-Based
Sports medicine (ACES), Amsterdam, the Netherlands,Amsterdam Collaboration for Health and
Safety in Sports (ACHSS), AMC/VUMC IOC Research Center, Amsterdam, the
Netherlands
| | - Jari Dahmen
- Department of Orthopedic Surgery,
Amsterdam UMC, Amsterdam Movement Sciences, University of Amsterdam, Amsterdam, the
Netherlands,Academic Center for Evidence-Based
Sports medicine (ACES), Amsterdam, the Netherlands,Amsterdam Collaboration for Health and
Safety in Sports (ACHSS), AMC/VUMC IOC Research Center, Amsterdam, the
Netherlands
| | - J. Nienke Altink
- Department of Orthopedic Surgery,
Amsterdam UMC, Amsterdam Movement Sciences, University of Amsterdam, Amsterdam, the
Netherlands,Academic Center for Evidence-Based
Sports medicine (ACES), Amsterdam, the Netherlands,Amsterdam Collaboration for Health and
Safety in Sports (ACHSS), AMC/VUMC IOC Research Center, Amsterdam, the
Netherlands
| | - Sjoerd A.S. Stufkens
- Department of Orthopedic Surgery,
Amsterdam UMC, Amsterdam Movement Sciences, University of Amsterdam, Amsterdam, the
Netherlands,Academic Center for Evidence-Based
Sports medicine (ACES), Amsterdam, the Netherlands,Amsterdam Collaboration for Health and
Safety in Sports (ACHSS), AMC/VUMC IOC Research Center, Amsterdam, the
Netherlands
| | - Gino M.M.J. Kerkhoffs
- Department of Orthopedic Surgery,
Amsterdam UMC, Amsterdam Movement Sciences, University of Amsterdam, Amsterdam, the
Netherlands,Academic Center for Evidence-Based
Sports medicine (ACES), Amsterdam, the Netherlands,Amsterdam Collaboration for Health and
Safety in Sports (ACHSS), AMC/VUMC IOC Research Center, Amsterdam, the
Netherlands,Gino M.M.J. Kerkhoffs, Department of
Orthopedic Surgery, Academic Medical Center, University of Amsterdam,
Meibergdreef 9, Amsterdam, 1105 AZ, the Netherlands.
| |
Collapse
|
12
|
Padiolleau G, Amouyel T, Barbier O, De L'Escalopier N, Cordier G, Baudrier N, Benoist J, Dubois-Ferrière V, Leiber F, Morvan A, Mainard D, Maynou C, Lopes R. Safety of malleolar osteotomies in surgery for osteochondral lesions of the talus. Orthop Traumatol Surg Res 2021; 107:103070. [PMID: 34547541 DOI: 10.1016/j.otsr.2021.103070] [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] [Received: 05/27/2021] [Revised: 07/23/2021] [Accepted: 07/27/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED The talus is a central bone in the hindfoot that is difficult to access surgically. Performing a medial or lateral malleolar osteotomy in the management of an osteochondral lesion of the talus (OLT) is a feared procedure amongst surgeons and their patients. The objective of this study was to assess the complications inherent to malleolar osteotomies in the treatment of OLTs. HYPOTHESIS The use of a standardized protocol concerning the technical performance and osteosynthesis of malleolar osteotomies results in fewer postoperative complications than a non-standardized protocol. MATERIALS AND METHOD This is a comparative study comprising a prospective multicenter non-randomized series with a standardized protocol for performing malleolar osteotomies, and a multicenter retrospective series without a standardized protocol. We included all patients aged 16 to 65 years with symptomatic OLTs, resistant to more than 6-months of well-conducted medical treatment, for whom surgery was considered. The minimum follow-up was 1 year for the prospective study, and 5 years for the retrospective study. A total of 86 and 97 patients were included in the prospective and retrospective studies, respectively. Of these 183 patients, 86 patients (33 prospective and 53 retrospective) underwent medial or lateral malleolar osteotomies as part of their surgery for OLT. Complications specific to the osteotomy procedures such as scar tissue, surgical site infection, non-union, articular malunion, neurological lesions or surgical revision, were investigated. RESULTS No specific complication was found to be associated to the malleolar osteotomy. No surgical revision was directly linked to the osteotomy procedure. No significant difference was found between the two series. DISCUSSION There was no evidence of morbidity related specifically to medial or lateral malleolar osteotomies. A standardized protocol, subject to rigorous technical implementation, does not improve results after malleolar osteotomy. The fear associated with this malleolar osteotomy procedure seems unfounded. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
| | - Thomas Amouyel
- Hôpital Salengro, Service de chirurgie orthopédique, 2, avenue Oscar-Lambret, 59000 Lille, France
| | - Olivier Barbier
- Hôpital d'Instruction des Armées Sainte Anne, Service de chirurgie orthopédique, 2, boulevard Sainte Anne, 83000 Toulon, France
| | - Nicolas De L'Escalopier
- Hôpital d'Instruction des Armées Percy, service de Chirurgie Orthopédique, Traumatologique et Réparatrice des membres, 101, avenue Henri-Barbusse, 92140 Clamart, France
| | - Guillaume Cordier
- Centre de Chirurgie Orthopédique et Sportive, 2, rue Georges Negrevergne, 33700 Mérignac, France
| | - Nicolas Baudrier
- Hôpital Ambroise Paré, Service de chirurgie orthopédique, 9, avenue Charles de Gaulle, 92100 Boulogne-Billancourt, France
| | - Jonathan Benoist
- Institut locomoteur de l'ouest, 7, boulevard de la Boutière, 35760 Saint-Grégoire, France
| | - Victor Dubois-Ferrière
- Centre Assal de Médecine et de Chirurgie du pied, avenue de Beau-Séjour 6, 1206 Genova, Switzerland
| | - Frédéric Leiber
- Clinique de l'Orangerie, 29, allée de la Robertsau, 67000 Strasbourg, France
| | - Antoine Morvan
- Centre de Chirurgie Orthopédique et Sportive, 2, rue Georges Negrevergne, 33700 Mérignac, France
| | - Didier Mainard
- Hôpital Central, 29, avenue du maréchal de Lattre de Tassigny, 54000 Nancy, France
| | - Carlos Maynou
- Hôpital Salengro, Service de chirurgie orthopédique, 2, avenue Oscar-Lambret, 59000 Lille, France
| | - Ronny Lopes
- Centre PCNA, avenue Claude-Bernard, 44800 Saint-Herblain, France
| | -
- 15, rue Ampère, 92500 Rueil Malmaison, France
| |
Collapse
|
13
|
Bruns J, Habermann C, Werner M. Osteochondral Lesions of the Talus: A Review on Talus Osteochondral Injuries, Including Osteochondritis Dissecans. Cartilage 2021; 13:1380S-1401S. [PMID: 33423507 PMCID: PMC8808845 DOI: 10.1177/1947603520985182] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
This is a review on talus osteochondritis dissecans and talus osteochondral lesions. A majority of the osteochondral lesions are associated with trauma while the cause of pure osteochondritis dissecans is still much discussed with a possible cause being repetitive microtraumas associated with vascular disturbances causing subchondral bone necrosis and disability. Symptomatic nondisplaced osteochondral lesions can often be treated conservatively in children and adolescents while such treatment is less successful in adults. Surgical treatment is indicated when there is an unstable cartilage fragment. There are a large number of different operative technique options with no number one technique to be recommended. Most techniques have been presented in level II to IV studies with a low number of patients with short follow ups and few randomized comparisons exist. The actual situation in treating osteochondral lesions in the ankle is presented and discussed.
Collapse
Affiliation(s)
- Juergen Bruns
- Wilhelmsburger Krankenhaus Gross-Sand,
Hamburg, Germany,Juergen Bruns, Wilhelmsburger Krankenhaus
Gross-Sand, Groß Sand 3, Hamburg, 21107, Germany.
| | | | | |
Collapse
|
14
|
Nott E, Matheny LM, Clanton TO, Lockard C, Douglass BW, Tanghe KK, Matta N, Brady AW. Accessibility and Thickness of Medial and Lateral Talar Body Cartilage for Treatment of Ankle and Foot Osteochondral Lesions. Foot Ankle Int 2021; 42:1330-1339. [PMID: 34049457 DOI: 10.1177/10711007211015189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purposes of this study were to determine (1) if cartilage thicknesses on the talar dome and medial/lateral surfaces of the talus were similar, (2) whether there was sufficient donor cartilage surface area on the medial and lateral talar surfaces to repair talar dome cartilage injuries of the talus, and (3) whether the cartilage surface could be increased following anterior talofibular ligament (ATFL) and sectioning of the tibionavicular and tibiospring portion of the anterior deltoid. METHODS Medial and lateral approaches were utilized in 8 cadaveric ankles to identify the accessible medial, lateral, and talar dome cartilage surfaces in 3 conditions: (1) intact, (2) ATFL release, and (3) superficial anterior deltoid ligament release. The talus was explanted, and the cartilage areas were digitized with a coordinate measuring machine. Cartilage thickness was quantified using a laser scanner. RESULTS The mean cartilage thickness was 1.0 ± 0.1 mm in all areas tested. In intact ankles, the medial side of the talus showed a larger total area of available cartilage than the lateral side (152 mm2 vs 133 mm2). ATFL release increased the available cartilage area on the medial and lateral sides to 167 mm2 and 194 mm2, respectively. However, only the lateral talar surface had sufficient circular graft donor cartilage available for autologous osteochondral transplantation (AOT) procedures of the talus. After ATFL and deltoid sectioning, there was an increase in available graft donor cartilage available for AOT procedures. CONCLUSION The thickness of the medial and lateral talar cartilage surfaces is very similar to that of the talar dome cartilage surface, which provides evidence that the medial and lateral surfaces may serve as acceptable AOT donor cartilage. The surface area available for AOT donor site grafting was sufficient in the intact state; however, sectioning the ATFL and superficial anterior deltoid ligament increased the overall lateral talar surface area available for circular grafting for an AOT procedure that requires a larger graft. These results support the idea that lateral surfaces of the talus may be used as donor cartilage for an AOT procedure since donor and recipient sites are similar in cartilage thickness, and there is sufficient cartilage surface area available for common lesion sizes in the foot and ankle. CLINICAL RELEVANCE This anatomical study investigates the feasibility of talar osteochondral autografts from the medial or lateral talar surfaces exposed with standard approaches. It confirms the similar cartilage thickness of the talar dome and the ability to access up to an 8- to 10-mm donor graft from the lateral side of the talus after ligament release. This knowledge may allow better operative planning for use of these surfaces for osteochondral lesions within the foot and ankle, particularly in certain circumstances of a revision microfracture.
Collapse
Affiliation(s)
- Erik Nott
- The Steadman Clinic, Vail, CO, USA.,The Steadman Philippon Research Institute, Vail, CO, USA
| | | | | | - Carly Lockard
- The Steadman Philippon Research Institute, Vail, CO, USA
| | | | - Kira K Tanghe
- The Steadman Philippon Research Institute, Vail, CO, USA
| | - Nicholas Matta
- The Steadman Philippon Research Institute, Vail, CO, USA
| | - Alex W Brady
- The Steadman Philippon Research Institute, Vail, CO, USA
| |
Collapse
|
15
|
Lambert LA, Mangwani J, Davies MB, Molloy AP, Mason LW. The lateral transligamentous approach to the talar dome. Foot Ankle Surg 2021; 27:767-771. [PMID: 33153917 DOI: 10.1016/j.fas.2020.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 09/11/2020] [Accepted: 10/03/2020] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Anatomic reduction of talar body fractures is critical in restoring congruency to the talocrural joint. Previous studies have indicated 43% talar body access with a single incision and without malleolar osteotomy. The aim of this study was to investigate the percentage talar body exposure when using the lateral transligamentous approach. METHODS The lateral transligamentous approach to the talus was undertaken in 10 fresh frozen cadaveric specimens by surgeons inexperienced in the approach following demonstration of the technique. An incision was made on the anterolateral aspect of the ankle augmented by the removal of the anterior talofibular ligament (ATFL) and the calcaneofibular ligament (CFL) from their fibular insertions. A bone lever was then placed behind the lateral aspect of the talus and levered forward with the foot in equinus and inversion. A mark was made on the talar dome where an instrument could be placed 90 degrees to the talar surface. The talus was subsequently disarticulated and high-resolution images were taken of the talar dome surface. The images were overlain with a reproducible nine-grid division. Accessibility to each zone within the grid was documented using the mark made on the talar surface. ImageJ software was used to calculate the surface area exposed with each approach. RESULTS The mean percentage area of talar dome available through the transligamentous approach was 77.3% (95% confidence interval 73.3, 81.3). In all specimens the complete lateral talar process was accessible, along with the lateral and dorsomedial aspect of the talar neck. This approach gives complete access to Zones 1, 2, 3, 5 & 6 with partial access to Zones 4, 8 & 9. CONCLUSION The lateral transligamentous approach to the talus provides significantly greater access to the talar dome as compared to standard approaches. The residual surface area that is inaccessible with this approach is predominantly within Zones 4,7 and 8, the posteromedial corner. LEVEL OF CLINICAL EVIDENCE V.
Collapse
Affiliation(s)
- Laura-Ann Lambert
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom.
| | - Jitendra Mangwani
- Leicester Royal Infirmary, Leicester, United Kingdom; University of Leicester, Leicester, United Kingdom
| | - Mark B Davies
- Northern General Hospital, Sheffield, United Kingdom
| | - Andrew P Molloy
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom; University of Liverpool, Liverpool, United Kingdom
| | - Lyndon W Mason
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom; University of Liverpool, Liverpool, United Kingdom
| |
Collapse
|
16
|
Kılıçaslan ÖF, Levent A, Çelik HK, Tokgöz MA, Köse Ö, Rennie AEW. Effect of cartilage thickness mismatch in osteochondral grafting from knee to talus on articular contact pressures: A finite element analysis. Jt Dis Relat Surg 2021; 32:355-362. [PMID: 34145811 PMCID: PMC8343842 DOI: 10.52312/jdrs.2021.41] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 04/26/2021] [Indexed: 12/16/2022] Open
Abstract
Objectives
The aim of this study was to investigate the effect of cartilage thickness mismatch on tibiotalar articular contact pressure in osteochondral grafting from femoral condyles to medial talar dome using a finite element analysis (FEA). Materials and methods
Flush-implanted osteochondral grafting was performed on the talar centromedial aspect of the dome using osteochondral plugs with two different cartilage thicknesses. One of the plugs had an equal cartilage thickness with the recipient talar cartilage and the second plug had a thicker cartilage representing a plug harvested from the knee. The ankle joint was loaded during a single-leg stance phase of gait. Tibiotalar contact pressure, frictional stress, equivalent stress (von Mises values), and deformation were analyzed. Results
In both osteochondral grafting simulations, tibiotalar contact pressure, frictional stress, equivalent stress (von Mises values) on both tibial and talar cartilage surfaces were restored to near-normal values. Conclusion
Cartilage thickness mismatch does not significantly change the tibiotalar contact biomechanics, when the graft is inserted flush with the talar cartilage surface.
Collapse
Affiliation(s)
| | | | | | | | - Özkan Köse
- Sağlık Bilimleri Üniversitesi, Antalya Eğitim ve Araştırma Hastanesi Ortopedi ve Travmatoloji Kliniği, 07100 Muratpaşa, Antalya, Türkiye.
| | | |
Collapse
|
17
|
Lesion Size May Predict Return to Play in Young Elite Athletes Undergoing Microfracture for Osteochondral Lesions of the Talus. Arthroscopy 2021; 37:1612-1619. [PMID: 33359815 DOI: 10.1016/j.arthro.2020.12.206] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 12/08/2020] [Accepted: 12/14/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE To evaluate the clinical and sports-related outcomes of arthroscopic microfracture (MFx) for osteochondral lesion of the talus (OLT) in elite athletes. METHODS The athletes who underwent arthroscopic MFx for OLTs at our institution between January 2011 and September 2015 with minimum 2 years of follow-up were reviewed. The Foot and Ankle Outcome Score, American Orthopaedic Foot & Ankle Society, and visual analog scale pain score, time and rate of "return-to-competition" (RTC, return to an official match for at least 1 minute after treatment), and rate of "return-to-play" (RTP, participation in at least 2 entire seasons after treatment) were used to evaluate the outcomes. We compared athletes who were able to RTP with those who were not. RESULTS In total, 41 patients (mean age 19.34 ± 3.76 years) were included. The mean follow-up was 54.9 ± 13.72 months. In total, 36 patients had medial lesions, and 5 patients had lateral lesions. All subscales of preoperative Foot and Ankle Outcome Score were significantly improved at the final follow-up. The mean preoperative American Orthopaedic Foot & Ankle Society score of 74.46 ± 8.10 improved to 91.62 ± 2.99 (P < .001) at the final follow-up. The mean preoperative visual analog scale pain score of 5.44 ± 1.57 improved to 2.66 ± 1.04 (P < .001). All patients achieved RTC (100%) at mean time of 5.45 ± 3.18 months, and 74.4% of patients were able to RTP. The RTP-group showed significantly smaller lesions compared to the No-RTP group (71.52 ± 43.29 vs 107.00 ± 45.28 mm2, P = .009). The cut-off OLT size for predicting RTP was 84.0 mm2, with a sensitivity of 90.0% and specificity of 75.9%. CONCLUSIONS All athletes were able to RTC at average of 5.45 months after MFx for OLTs with minimal subchondral involvement, and 74.4% were able to RTP. The only prognostic variable for RTP was lesion size, and its predictive cut-off was 84.0 mm2. LEVEL OF EVIDENCE IV, Case series.
Collapse
|
18
|
Long-term results of osteochondral autograft transplantation of the talus with a novel groove malleolar osteotomy technique. Jt Dis Relat Surg 2021; 31:509-515. [PMID: 32962583 PMCID: PMC7607963 DOI: 10.5606/ehc.2020.75231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objectives
This study aims to evaluate the long-term results of osteochondral autograft transfer (OAT) of talar lesions performed using a modified osteotomy technique. Patients and methods
This retrospective study included 20 consecutive patients (11 males, 9 females; mean age 33.5±11 years; range, 15 to 56 years) (21 ankles) with osteochondral lesions of the talus (OLT) treated with the OAT system between August 2002 and October 2008. We performed a modified sulcus groove osteotomy, which provides better exposure of medial and central lesions. After a minimum duration of 10 years following surgery, patients’ clinical functions were evaluated according to the American Orthopaedic Foot and Ankle Society (AOFAS) ankle- hindfoot scale and visual analog scale (VAS). The Tegner-Lysholm scoring system was used to determine the levels of knee activity. Results
The mean follow-up period was 143.5 (range, 120 to 186) months. The mean AOFAS scores significantly improved from 60.4±7.4 (range, 48 to 70) preoperatively to 86.2±9.23 (range, 60 to 94) at the last follow-up (p≤0.05). The mean ankle VAS score significantly decreased from 6.3±0.4 (range, 5 to 7) preoperatively to 2.0±1.4 (range, 0 to 4). The mean Tegner-Lysholm score for this group was 89.7±11.7 (range, 68 to 100). Revision surgery was performed in only two patients because of impingement and arthritis. Recurrent knee pain at the donor site of the osteochondral autograft was observed in three patients (14%). Conclusion In the present study, good to excellent results were obtained in the treatment of OLT with OAT for a minimum follow-up duration of 10 years. This novel technique can also simplify the steep learning curve, which is challenging for surgeons.
Collapse
|
19
|
Sheu C, Ferkel RD. Athletic Performance in the National Basketball Association After Arthroscopic Debridement of Osteochondral Lesions of the Talus. Orthop J Sports Med 2021; 9:2325967120970205. [PMID: 33457433 PMCID: PMC7802091 DOI: 10.1177/2325967120970205] [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: 06/11/2020] [Accepted: 07/01/2020] [Indexed: 11/15/2022] Open
Abstract
Background: Use of marrow-stimulating techniques to treat osteochondral lesions of the
talus (OLTs) in National Basketball Association (NBA) players is
controversial. Hypothesis: NBA players will be able to return to preinjury playing status after
treatment of OLTs by arthroscopic debridement alone without
marrow-stimulating techniques. Study Design: Cohort study; Level of evidence, 3. Methods: Between the 2000 and 2015 seasons, 10 NBA players were treated with
arthroscopic debridement of an OLT. The following performance outcomes were
compared pre- and postoperatively: seasons played, games played, games
started, minutes per game, points per game, field goals, 3-point shots,
rebounds, assists, double doubles, triple doubles, steals, blocks,
turnovers, personal fouls, assists per turnovers, steals per turnovers, NBA
rating, scoring efficiency, and shooting efficiency. In addition, the
players were compared with a matched control group using mixed effects
regression and Fisher least significant difference modeling. Results: All 10 players returned to play in the NBA after arthroscopic debridement
without microfracture or drilling of an OLT. When compared with preoperative
performance, postoperative mean points scored, assists made, and steals made
increased by 2.86 (P = .042), 0.61 (P =
.049), and 0.15 (P = .027), respectively. Only field goal
percentage decreased postoperatively when compared with matched controls;
however, this normalized by the end of the second season after surgery.
There was no statistically significant change in any of the other
performance factors when compared with matched controls. All patients
returned to basketball during the same season (n = 1) or the following
season (n = 9) if the operation was performed off-season. The mean length of
career after surgery was 4.1 years, with 5 players still playing in the
league at the time of this study. Conclusion: After arthroscopic debridement of an OLT without drilling or microfracture,
there was a high rate of return to the NBA, with improved points scored,
assists, and steals made after surgery when compared with preoperative
performance. There was no statistically significant change in any
performance factors when compared with uninjured matched controls. Lesion
size did not affect player career length. These data should be used to
manage patients’ and teams’ expectations regarding players’ ability to
return to elite levels of athletic performance after surgery of an OLT.
Collapse
Affiliation(s)
| | - Richard D Ferkel
- Southern California Orthopedic Institute, Van Nuys, California, USA
| |
Collapse
|
20
|
Wang CC, Yang KC, Chen IH. Current treatment concepts for osteochondral lesions of the talus. Tzu Chi Med J 2020; 33:243-249. [PMID: 34386361 PMCID: PMC8323653 DOI: 10.4103/tcmj.tcmj_106_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 05/29/2020] [Accepted: 06/13/2020] [Indexed: 11/22/2022] Open
Abstract
Osteochondral lesions of the talus (OLT) are a well-known cause of ankle joint pain and can sometimes lead to instability. These lesions are not only confined to articular hyaline cartilage, they can also affect the subchondral bone at the weight-bearing aspect of the talar dome. Nonoperative treatment is the preferred option for small lesions, however surgical intervention is recommended for large lesions or those for which conservative treatment has failed. Microfracture, abrasion arthroplasty and multiple drilling are all classified as bone marrow stimulation procedures; they are used to try to recruit precursor cells for cartilage regeneration and are especially suitable for small OLT lesions. For large lesions, osteochondral autografting and allografting are better options to reconstruct the articular defect, as they have better contours and mechanical strength. When there is limited subchondral bone involvement in large lesions, cell-based therapies such as autogenous chondrocyte implantation, potentially combined with a biomaterial matrix, are a promising option and acceptable functional outcomes have been reported. To provide evidence-based recommendations for clinicians, this article evaluates the currently available treatment strategies for OLT and their evolution over the past few decades.
Collapse
Affiliation(s)
- Chen-Chie Wang
- Department of Orthopedic Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan.,Department of Orthopedics, School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Kai-Chiang Yang
- School of Dental Technology, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ing-Ho Chen
- Department of Orthopedics, School of Medicine, Tzu Chi University, Hualien, Taiwan.,Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| |
Collapse
|
21
|
Yausep OE, Madhi I, Trigkilidas D. Platelet rich plasma for treatment of osteochondral lesions of the talus: A systematic review of clinical trials. J Orthop 2020; 18:218-225. [PMID: 32071508 PMCID: PMC7013135 DOI: 10.1016/j.jor.2020.01.046] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 01/26/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The ankle is the second most frequent site, following the knee, that requires cartilage repair. Osteochondral lesion of the talus (OLT) is common among athletes and is a result of talar cartilage detachment with or without subchondral bone fragmentation after a traumatic event. Treatment strategies for OLT can be classified as reparative or replacement interventions, with the former taking precedence. Recent studies show that the growth factors and bioactive components in platelet rich plasma (PRP) could improve cartilage regeneration. The prospect of using autologous blood to obtain a product that could enhance regeneration in damaged cartilage has been regarded as innovative, as it could circumvent the need for a replacement, and potentially join the ranks of first line reparative interventions against cartilage diseases. METHODS Literature searches were performed across seven search engines for randomized controlled trials using PRP to treat patients with OLT. Outcomes extracted included ankle function and pain measures. Level of evidence and methodological quality were evaluated using relevant guidelines. RESULTS Four studies met the eligibility criteria and were systematically appraised. Two studies scored Level 1 and 2 scored Level 2 based on the LOE assessment. MQOE evaluation revealed one study with excellent quality, and three with good quality. Overall results showed that PRP, as an adjunct to microfracture surgery, significantly improved function and reduced pain compared to microfracture surgery alone. Intra-articular PRP injection also demonstrated significantly enhanced recovery of function, and decreased pain scores compared to HA. CONCLUSION PRP improves joint function, and reduces pain in patients with OLT regardless of the method of implementation. In addition, inter-study comparison demonstrated that patients that received surgery along with PRP injections improved more than those that received PRP only. The studies that corroborate this conclusion have high levels of evidence with satisfactory methodological quality. LEVEL OF EVIDENCE Level 2, systematic review of Level 1 and 2 studies.
Collapse
Affiliation(s)
| | - Imad Madhi
- Orthopedic Division, South Tyneside District Hospital, South Shields, United Kingdom
| | - Dionysios Trigkilidas
- Orthopedic Division, South Tyneside District Hospital, South Shields, United Kingdom
| |
Collapse
|
22
|
Zhang H, Zhai L, Pan Z, Yu H, Zhu J, Tang K. [Effectiveness of Tang's arthroscopy approach for anterior and posterior ankle impingement syndrome]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:1340-1344. [PMID: 31650745 PMCID: PMC8337454 DOI: 10.7507/1002-1892.201904129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 09/17/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate the effectiveness of Tang's arthroscopy approach in treatment of anterior and posterior ankle impingement syndrome. METHODS Between August 2010 and September 2017, 92 patients with anterior and posterior ankle impingement syndrome were retrospectively analyzed. There were 58 patients were treated with Tang's arthroscopy approach under floating decubitus (group A) and 34 patients were treated with standard anterior and posterior approaches (group B). There was no significant difference in gender, age, body mass index, side, disease duration, preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score, and preoperative visual analogue scale (VAS) score between the two groups ( P>0.05).The operation time, AOFAS score, VAS score, and Roles-Maudsley score were recorded to evaluated the pain and function of the ankle, and patient subjective satisfaction. The X-ray film and MRI at 12 months were used to observe the ankle impingement. RESULTS Median operation time of group A was 50.5 minutes [95%CI (49.3, 54.6)], which was significantly shorter than that of group B [88.5 minutes, 95%CI (76.5, 92.8)] (Z=-4.685, P=0.000). All incisions in group A healed by first intention; while the incisions of 2 cases in group B delayed healed after debridement. The follow-up time of group A was (54.7±18.8) months, while that of group B was (55.4±17.9) months, and there was no significant difference between the two groups ( t=-0.178, P=0.859). The lateral X-ray films at 12 months showed that the talus process was removed incompletely in 2 cases (3.4%) of group A and 1 case (2.9%) of group B. There was no significant difference in the incidence between the two groups (χ 2=0.014, P=0.699). At last follow-up, the AOFAS scores were 83.1±6.6 in group A and 85.2±6.4 in group B; the VAS scores were 1.3±1.1 in group A and 1.6±1.0 in group B. The AOFAS and VAS scores at last follow-up were superior to preoperative ones ( P<0.05), but there was no significant difference between the two groups ( P>0.05). The median subjective satisfaction score of group A was 2.0 [95%(1.4, 1.7)], which was better than that of group B [2.0, 95%(1.6, 2.2)] ( Z=-2.480, P=0.013). CONCLUSION Arthroscopic treatment of anterior and posterior ankle impingement syndrome through Tang's approach can shorten the operation time, simplify the procedures, and obtain good effectiveness and patient satisfaction.
Collapse
Affiliation(s)
- Hongxin Zhang
- Department of Orthopedics Surgery, the 89th Hospital of Chinese PLA, Weifang Shangdong, 261021, P.R.China;Department of Orthopedics/Sports Medicine Center, the First Affiliated Hospital of Army Medical University (the Third Military Medical University), Chongqing, 400038, P.R.China
| | - Longdi Zhai
- Department of Orthopedics Surgery, the 89th Hospital of Chinese PLA, Weifang Shangdong, 261021, P.R.China
| | - Zhaoxun Pan
- Department of Orthopedics Surgery, the 89th Hospital of Chinese PLA, Weifang Shangdong, 261021, P.R.China
| | - Hongchang Yu
- Department of Orthopedics Surgery, the 89th Hospital of Chinese PLA, Weifang Shangdong, 261021, P.R.China
| | - Jinhang Zhu
- Department of Orthopedics Surgery, the 89th Hospital of Chinese PLA, Weifang Shangdong, 261021, P.R.China
| | - Kanglai Tang
- Department of Orthopedics/Sports Medicine Center, the First Affiliated Hospital of Army Medical University (the Third Military Medical University), Chongqing, 400038,
| |
Collapse
|
23
|
Shimozono Y, Vannini F, Ferkel RD, Nakamura N, Kennedy JG. Restorative procedures for articular cartilage in the ankle: state-of-the-art review. J ISAKOS 2019. [DOI: 10.1136/jisakos-2017-000163] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|
24
|
CORR Insights®: Knee-to-Talus Donor-Site Morbidity Following Autologous Osteochondral Transplantation: A Meta-analysis with Best-case and Worst-case Analysis. Clin Orthop Relat Res 2019; 477:1932-1933. [PMID: 31107329 PMCID: PMC7000028 DOI: 10.1097/corr.0000000000000775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
|
25
|
Anders S, Götz J, Grifka J, Baier C. [Ankle cartilage repair : Therapeutic options, results and technical aspects]. DER ORTHOPADE 2018; 46:938-946. [PMID: 28956086 DOI: 10.1007/s00132-017-3470-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Therapeutic strategies for cartilage repair of the talus are varied. With the use of biologic scaffolds and biologic agents new cell-based therapies have become the focus of attention. OBJECTIVES Ankle cartilage repair techniques are presented and assessed by current data. In addition, technical notes for each technique are given. MATERIAL AND METHODS Currently, the following established ankle cartilage repair procedures exist: microfracturing, AMIC (autologous matrix-induced chondrogenesis), OCT (osteochondral transplantation, mosaicplasty), allograft transplantation. DISCUSSION The success of each repair technique is dependent on the proper indication, addressing of co-morbidities like axis deviation or ligament instabilities, the experience of the surgeon and the appropriate rehabilitation. Mid- and long-term results are often good or excellent. Best results are seen in isolated cartilage defects without co-morbidities in patients younger than 40 years of age and non-smokers with normal BMI and early intervention. New cell-based therapies utilize scaffolds and biologic agents. They offer promising perspectives, although current data is inconsistent.
Collapse
Affiliation(s)
- S Anders
- Orthopädische Klinik für die Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Deutschland.
| | - J Götz
- Orthopädische Klinik für die Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - J Grifka
- Orthopädische Klinik für die Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - C Baier
- Orthopädische Klinik für die Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Deutschland
| |
Collapse
|
26
|
Shimozono Y, Hurley ET, Myerson CL, Kennedy JG. Good clinical and functional outcomes at mid-term following autologous osteochondral transplantation for osteochondral lesions of the talus. Knee Surg Sports Traumatol Arthrosc 2018; 26:3055-3062. [PMID: 29572556 DOI: 10.1007/s00167-018-4917-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 03/20/2018] [Indexed: 12/11/2022]
Abstract
PURPOSE Autologous osteochondral transplantation is an established treatment for large-sized osteochondral lesions of the talus (OLT) with excellent short term outcomes. However, few studies assess the outcomes of autologous osteochondral transplantation at mid-term follow-up. The purpose of the current systematic review was to evaluate the clinical outcomes of the autologous osteochondral transplantation procedure in the treatment of OLT at mid-term and long-term follow-up. METHODS A systematic search of the MEDLINE, EMBASE and Cochrane Library databases was performed in October 2017 based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Included studies were evaluated with regard to level of evidence (LOE) and quality of evidence (QOE) using the Coleman Methodology Score. Clinical outcomes, and complications were also evaluated. RESULTS Eleven studies, with 500 ankles were included at a mean 62.8 months follow-up. Seven studies used the American Orthopaedic Foot and Ankle Society (AOFAS) score. The weighted mean preoperative AOFAS score was 55.1 ± 6.1, and the postoperative score was 86.2 ± 4.5, with 87.4% of patients (132 of 151) being reported as excellent or good results. In total, 53 of the 500 patients (10.6%) had complications. The most common complication was donor site morbidity with 18 patients (3.6%) at final follow-up. Thirty-one patients (6.2%) underwent reoperations, and 5 ankles (1.0%) were regarded as failed autologous osteochondral transplantation. CONCLUSION The current systematic review demonstrated that good clinical and functional outcomes can be expected following autologous osteochondral transplantation for the treatment of OLT, with a low failure rate. The results from this study show patients can be reasonably counselled to expect good clinical outcomes in the mid-term. MRI and radiographs showed restoration of articular surface as well as a minimal presence of osteoarthritis at mid-term follow-up. However, as low level and quality of evidence and the variability of the data may confound the data, further well-designed studies are necessary to determine the effectiveness of autologous osteochondral transplantation in the treatment for OLT. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Yoshiharu Shimozono
- Hospital for Special Surgery, 523 East 72nd Street, Suite 507, New York, NY, 10021, USA
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Eoghan T Hurley
- Hospital for Special Surgery, 523 East 72nd Street, Suite 507, New York, NY, 10021, USA
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Charles L Myerson
- Hospital for Special Surgery, 523 East 72nd Street, Suite 507, New York, NY, 10021, USA
- Tulane University School of Medicine, New Orleans, LA, USA
| | - John G Kennedy
- Hospital for Special Surgery, 523 East 72nd Street, Suite 507, New York, NY, 10021, USA.
| |
Collapse
|
27
|
Sawa M, Nakasa T, Ikuta Y, Yoshikawa M, Tsuyuguchi Y, Kanemitsu M, Ota Y, Adachi N. Outcome of autologous bone grafting with preservation of articular cartilage to treat osteochondral lesions of the talus with large associated subchondral cysts. Bone Joint J 2018; 100-B:590-595. [PMID: 29701088 DOI: 10.1302/0301-620x.100b5.bjj-2017-1119.r1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Aims The aim of this study was to evaluate antegrade autologous bone grafting with the preservation of articular cartilage in the treatment of symptomatic osteochondral lesions of the talus with subchondral cysts. Patients and Methods The study involved seven men and five women; their mean age was 35.9 years (14 to 70). All lesions included full-thickness articular cartilage extending through subchondral bone and were associated with subchondral cysts. Medial lesions were exposed through an oblique medial malleolar osteotomy, and one lateral lesion was exposed by expanding an anterolateral arthroscopic portal. After refreshing the subchondral cyst, it was grafted with autologous cancellous bone from the distal tibial metaphysis. The fragments of cartilage were fixed with 5-0 nylon sutures to the surrounding cartilage. Function was assessed at a mean follow-up of 25.3 months (15 to 50), using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot outcome score. The radiological outcome was assessed using MRI and CT scans. Results The mean AOFAS score improved from 65.7 (47 to 81) preoperatively to 92 (90 to 100) at final follow-up, with 100% patient satisfaction. The radiolucent area of the cysts almost disappeared on plain radiographs in all patients immediately after surgery, and there were no recurrences at the most recent follow-up. The medial malleolar screws were removed in seven patients, although none had symptoms. At this time, further arthroscopy was undertaken, when it was found that the mean International Cartilage Repair Society (ICRS) arthroscopic score represented near-normal cartilage. Conclusion Autologous bone grafting with fixation of chondral fragments preserves the original cartilage in the short term, and could be considered in the treatment for adult patients with symptomatic osteochondral defect and subchondral cysts. Cite this article: Bone Joint J 2018;100-B:590-5.
Collapse
Affiliation(s)
- M Sawa
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - T Nakasa
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Y Ikuta
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - M Yoshikawa
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Y Tsuyuguchi
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - M Kanemitsu
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Y Ota
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - N Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| |
Collapse
|
28
|
Park KH, Hwang Y, Han SH, Park YJ, Shim DW, Choi WJ, Lee JW. Primary Versus Secondary Osteochondral Autograft Transplantation for the Treatment of Large Osteochondral Lesions of the Talus. Am J Sports Med 2018. [PMID: 29537877 DOI: 10.1177/0363546518758014] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Recent studies have reported promising clinical results after osteochondral autograft transplantation (OAT) for the treatment of large osteochondral lesions of the talus (OLT). However, no study has yet compared clinical outcomes between primary and secondary OAT for large OLT. PURPOSE To compare clinical outcomes among patients with large OLT who receive primary OAT versus those who receive secondary OAT after failure of marrow stimulation and to identify factors associated with clinical failure. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS From 2005 to 2014, 46 patients with large OLT (≥150 mm2) underwent OAT: 18 underwent OAT as initial surgical management (primary OAT group), and 28 patients underwent secondary OAT after failure of previous arthroscopic marrow stimulation (secondary OAT group). In both groups, OAT procedures included arthroscopic inspection and debridement of concomitant soft tissue injuries. Clinical outcomes were assessed using pain visual analog scale (VAS), the Roles and Maudsley score, Foot and Ankle Outcome Scores (FAOS), and revisional surgery rates. Factors associated with clinical failures were evaluated using bivariate and logistic regression analyses. Survival outcomes were compared using Kaplan-Meier analysis. RESULTS Mean follow-up time was 6 years (range, 2-10.8 years). Mean lesion size was 194.9 mm2 (range, 151.7-296.3 mm2). There were no significant differences between groups in patient demographics and preoperative findings. Postoperative pain VAS, Roles and Maudsley score, FAOS, and revisional surgery rates were not significantly different at last follow-up. Prior marrow stimulation was not significantly associated with clinical failure on bivariate analysis. Lesion size greater than 225 mm2 on preoperative magnetic resonance imaging was significantly associated with clinical failure. Survival probabilities from Kaplan-Meier plots were not significantly different between the primary and secondary OAT groups ( P = .947). CONCLUSION Clinical outcomes of patients with large OLT treated with secondary OAT after failed marrow stimulation were found to be comparable with those who were treated with primary OAT. These results may be helpful to orthopaedic surgeons deciding appropriate surgical options for patients with large OLT.
Collapse
Affiliation(s)
- Kwang Hwan Park
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yeokgu Hwang
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seung Hwan Han
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yoo Jung Park
- Department of Orthopaedic Surgery, Wonju College of Medicine, Yonsei University, Wonju, Republic of Korea
| | - Dong Woo Shim
- Department of Orthopaedic Surgery, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Republic of Korea
| | - Woo Jin Choi
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin Woo Lee
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
29
|
Rungprai C, Tennant JN, Gentry RD, Phisitkul P. Management of Osteochondral Lesions of the Talar Dome. Open Orthop J 2017; 11:743-761. [PMID: 28979588 PMCID: PMC5620407 DOI: 10.2174/1874325001711010743] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Revised: 07/21/2016] [Accepted: 07/23/2016] [Indexed: 12/24/2022] Open
Abstract
Osteochondral lesion of the talus (OLT) is a common condition associated with ankle injury that brings challenges in the diagnosis and treatment. Symptoms related to this condition are nonspecific including pain, swelling, stiffness, and mechanical symptoms of locking and catching. While the natural history of the OLTs is not well understood, surgical treatment is often required especially in chronic cases and acute cases with displaced articular fragments. Arthroscopic treatment of the OLTs aims to restore ankle joint function and pain relief by the removal of the chondral or osteochondral fragment, debridement and stabilization of cartilage rim and subchondral bone, and stimulate healing of the bone and damaged cartilage. In patients with a large lesion or after a failure of previous bone marrow stimulation, biologic restoration techniques including the use of particulate juvenile cartilage techniques, autogenous chondrocyte implantation, and osteochondral autograft or allograft transplantation may have role. This article summarizes the contemporary concepts in the clinical evaluation and treatment of OLTs with particular emphasis on surgical strategies.
Collapse
Affiliation(s)
| | | | - Ryan D Gentry
- Department of Orthopaedics, University of North Carolina School of Medicine, 3147 Bioinformatics Building, 130 Mason Farm Road, Chapel Hill, NC 27599-7055, USA
| | - Phinit Phisitkul
- Department of Orthopaedics and Rehabilitation, University of Iowa Hospital and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242
| |
Collapse
|
30
|
Chao J, Pao A. Restorative Tissue Transplantation Options for Osteochondral Lesions of the Talus: A Review. Orthop Clin North Am 2017; 48:371-383. [PMID: 28577786 DOI: 10.1016/j.ocl.2017.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Symptomatic osteochondral lesions of the talus remain a challenging problem due to inability for cartilage lesions to heal. Numerous treatment options exist, including nonoperative management, marrow stimulating techniques, and autograft-allograft. Arthroscopic marrow stimulation forms fibrocartilage that has been shown to be biomechanically weaker than hyaline cartilage. Restorative tissue transplantation options are being used more for larger and cystic lesions. Newer biologics and particulated juvenile cartilage are currently under investigation for possible clinical efficacy. This article provides an evidenced-based summary of available literature on the use of biologics for treatment of osteochondral lesions of the talus.
Collapse
Affiliation(s)
- John Chao
- Peachtree Orthopaedic Clinic, 5505 Peachtree Dunwoody Road, Suite 600, Atlanta, GA 30342, USA.
| | - Andrew Pao
- Atlanta Medical Center, 303 Parkway Drive, Northeast, Atlanta, GA 30312-1212, USA
| |
Collapse
|
31
|
Dekker TJ, Dekker PK, Tainter DM, Easley ME, Adams SB. Treatment of Osteochondral Lesions of the Talus. JBJS Rev 2017; 5:01874474-201703000-00004. [DOI: 10.2106/jbjs.rvw.16.00065] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
32
|
Repetto I, Biti B, Cerruti P, Trentini R, Felli L. Conservative Treatment of Ankle Osteoarthritis: Can Platelet-Rich Plasma Effectively Postpone Surgery? J Foot Ankle Surg 2017; 56:362-365. [PMID: 28231968 DOI: 10.1053/j.jfas.2016.11.015] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Indexed: 02/03/2023]
Abstract
Osteoarthritis is the most common and disabling of the orthopedic diseases. Currently, the conservative treatment of osteoarthritis is limited to symptomatic treatment, whose goal is to improve function and pain control. Ankle osteoarthritis is relatively uncommon, in contrast to osteoarthritis of the hip and knee, and the therapeutic options (both pharmacologic and surgical) are limited, with surgery providing poorer and less predictable results. The effectiveness of platelet-rich plasma injections for osteoarthritis is still controversial, especially so for ankle arthritis, owing to the lack of evidence in the present data. We retrospectively evaluated the mid- to long-term clinical results (mean follow-up of 17.7 months) for platelet-rich plasma injections in 20 patients (20 ankles) with ankle osteoarthritis. We evaluated the presence of pain using the visual analog scale, function using the Foot and Ankle Disability Index, and subjective satisfaction. The pre- and post-treatment scores, obtained from the clinical records and from telephone interviews during the follow-up period, were compared using the Student t test. We found a strong positive effect for 4 platelet-rich plasma injections (injected once a week) on pain (p = .0001) and function (p = .001), with 80% of patients very satisfied and satisfied, and only 2 patients (10%) required surgery because of early treatment failure. These results suggest that the use of platelet-rich plasma injection is a valid and safe alternative to postpone the need for surgery.
Collapse
Affiliation(s)
- Ilaria Repetto
- Orthopedist, Department of Surgical Sciences, Orthopaedic and Traumatologic Clinic, University of Genoa, IRCCS University Hospital San Martino IST, National Institute for Cancer Research, Genoa, Italy.
| | - Besmir Biti
- Orthopedist, Department of Surgical Sciences, Orthopaedic and Traumatologic Clinic, University of Genoa, IRCCS University Hospital San Martino IST, National Institute for Cancer Research, Genoa, Italy
| | - Paola Cerruti
- Orthopedist, Department of Surgical Sciences, Orthopaedic and Traumatologic Clinic, University of Genoa, IRCCS University Hospital San Martino IST, National Institute for Cancer Research, Genoa, Italy
| | - Roberto Trentini
- Orthopedist, Department of Surgical Sciences, Orthopaedic and Traumatologic Clinic, University of Genoa, IRCCS University Hospital San Martino IST, National Institute for Cancer Research, Genoa, Italy
| | - Lamberto Felli
- Professor, Department of Surgical Sciences, Orthopaedic and Traumatologic Clinic, University of Genoa, IRCCS University Hospital San Martino IST, National Institute for Cancer Research, Genoa, Italy
| |
Collapse
|
33
|
Yoo J, Yeo ED, Lee YK. Treatment of Osteochondral Lesions of the Talus in Athletes. ACTA ACUST UNITED AC 2017. [DOI: 10.5763/kjsm.2017.35.2.77] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Jungwoo Yoo
- Department of Orthopedics, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Eui Dong Yeo
- Department of Orthopedics, Veterans Health Service Medical Center, Seoul, Korea
| | - Young Koo Lee
- Department of Orthopedics, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| |
Collapse
|
34
|
Looze CA, Capo J, Ryan MK, Begly JP, Chapman C, Swanson D, Singh BC, Strauss EJ. Evaluation and Management of Osteochondral Lesions of the Talus. Cartilage 2017; 8:19-30. [PMID: 27994717 PMCID: PMC5154424 DOI: 10.1177/1947603516670708] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Osteochondral lesions of the talus are common injuries that affect a wide variety of active patients. The majority of these lesions are associated with ankle sprains and fractures though several nontraumatic etiologies have also been recognized. Patients normally present with a history of prior ankle injury and/or instability. In addition to standard ankle radiographs, magnetic resonance imaging and computed tomography are used to characterize the extent of the lesion and involvement of the subchondral bone. Symptomatic nondisplaced lesions can often be treated conservatively within the pediatric population though this treatment is less successful in adults. Bone marrow stimulation techniques such as microfracture have yielded favorable results for the treatment of small (<15 mm) lesions. Osteochondral autograft can be harvested most commonly from the ipsilateral knee and carries the benefit of repairing defects with native hyaline cartilage. Osteochondral allograft transplant is reserved for large cystic lesions that lack subchondral bone integrity. Cell-based repair techniques such as autologous chondrocyte implantation and matrix-associated chondrocyte implantation have been increasingly used in an attempt to repair the lesion with hyaline cartilage though these techniques require adequate subchondral bone. Biological agents such as platelet-rich plasma and bone marrow aspirate have been more recently studied as an adjunct to operative treatment but their use remains theoretical. The present article reviews the current concepts in the evaluation and management of osteochondral lesions of the talus, with a focus on the available surgical treatment options.
Collapse
Affiliation(s)
- Christopher A. Looze
- Division of Sports Medicine, Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, USA
| | - Jason Capo
- Division of Sports Medicine, Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, USA
| | - Michael K. Ryan
- Division of Sports Medicine, Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, USA
| | - John P. Begly
- Division of Sports Medicine, Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, USA
| | - Cary Chapman
- Division of Sports Medicine, Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, USA
| | - David Swanson
- Division of Sports Medicine, Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, USA
| | - Brian C. Singh
- Division of Sports Medicine, Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, USA
| | - Eric J. Strauss
- Division of Sports Medicine, Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, USA
| |
Collapse
|
35
|
Osteochondral transplantation of autologous graft for the treatment of osteochondral lesions of talus: 5- to 7-year follow-up. Knee Surg Sports Traumatol Arthrosc 2016; 24:3722-3729. [PMID: 25326766 DOI: 10.1007/s00167-014-3389-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 10/10/2014] [Indexed: 12/27/2022]
Abstract
PURPOSE Bone marrow stimulation procedures (microfractures/drilling) are considered the gold standard for the primary treatment of osteochondral talar lesions. In the literature, there is lack of evidence about the appropriate treatment in cases of failure of these procedures. A technique of osteochondral autologous transplantation of talar graft was used. It was hypothesized that this is a successful method with good results and low complication rates. Additionally, a technique of anterior ankle approach with temporary removal of a bone block from the distal tibia that gives adequate access to posterior talar dome lesions is demonstrated. METHODS Between 2004 and 2007, 46 patients (37 males, 9 females), with OLT for which arthroscopic treatment with curettage and drilling or microfracture had failed, underwent osteochondral transplantation with an osteochondral graft harvested from the ipsilateral talar articular facet. A medial malleolar osteotomy or a distal tibial wedge osteotomy was used to access the talar dome defect. RESULTS The median follow-up time was 5.5 years (range 52-75 m). Thirty-four lesions (70.8 %) were located in the central talar dome in the coronal plane, while 26 (54.1 %) and 19 (39.5 %) lesions were located in the lateral and medial aspect of talar dome in saggital plane, respectively. The overall improvement between the preoperative and post-operative AOFAS and VAS FA score was 35 points (p < 0.001) and 39 points (p < 0.001), respectively. Clinical results were considered as good in 43 patients (93.4 %) and fair in three patients (6.5 %). All the transplanted grafts were observed to incorporate fully into the recipient bed. No complications occurred at the site of the malleolus osteotomy or tibial osteotomy and the donor site at the talus. CONCLUSIONS The midterm results suggest that the technique of osteochondral transplantation of autologous talar graft for osteochondral lesions of talus after failure of primary treatment with bone marrow stimulation can be safely and successfully used. It demonstrates excellent post-operative scores including improvement of pain and function. This procedure is combined with removal of a tibial bone block and its subsequent replacement and does not yield complications experienced with other procedures. LEVEL OF EVIDENCE Retrospective case series, Level IV.
Collapse
|
36
|
Gül M, Çetinkaya E, Aykut ÜS, Özkul B, Saygılı MS, Akman YE, Kabukcuoglu YS. Effect of the Presence of Subchondral Cysts on Treatment Results of Autologous Osteochondral Graft Transfer in Osteochondral Lesions of the Talus. J Foot Ankle Surg 2016; 55:1003-6. [PMID: 27432027 DOI: 10.1053/j.jfas.2016.05.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Indexed: 02/03/2023]
Abstract
The aim of the present study was to clinically evaluate whether the presence of subchondral cysts had an effect on the treatment results of autologous osteochondral graft transfer in osteochondral lesions of the talus. Patients were enrolled in the present study according to the inclusion criteria. In the evaluation, we divided the patients into 2 groups according to presence (n = 13 patients) or absence (n = 15 patients) of a subchondral cyst. The mean age, body mass index, follow-up period, and lesion size in each group were measured and compared, and no statistically significant differences were found between the 2 groups (p > .05). The clinical assessment was performed using the American Orthopaedic Foot and Ankle Society Hindfoot scoring system, visual analog scale, and International Knee Society scoring system. No statistically significant difference was found between the pre- and postoperative scores of the 2 patient groups (p > .05). The successful results in both groups after a 2-year follow-up period have demonstrated that treatment of osteochondral lesions of the talus with osteochondral graft transfer is a safe method that can be performed independently of the presence of a subchondral cyst.
Collapse
Affiliation(s)
- Murat Gül
- Baltalimani Bone and Joint Diseases Education and Research Hospital, Istanbul, Turkey
| | - Engin Çetinkaya
- Baltalimani Bone and Joint Diseases Education and Research Hospital, Istanbul, Turkey.
| | - Ümit Selçuk Aykut
- Baltalimani Bone and Joint Diseases Education and Research Hospital, Istanbul, Turkey
| | - Barış Özkul
- Baltalimani Bone and Joint Diseases Education and Research Hospital, Istanbul, Turkey
| | - Mehmet Selçuk Saygılı
- Baltalimani Bone and Joint Diseases Education and Research Hospital, Istanbul, Turkey
| | - Yunus Emre Akman
- Baltalimani Bone and Joint Diseases Education and Research Hospital, Istanbul, Turkey
| | | |
Collapse
|
37
|
Ross AW, Murawski CD, Fraser EJ, Ross KA, Do HT, Deyer TW, Kennedy JG. Autologous Osteochondral Transplantation for Osteochondral Lesions of the Talus: Does Previous Bone Marrow Stimulation Negatively Affect Clinical Outcome? Arthroscopy 2016; 32:1377-83. [PMID: 27062010 DOI: 10.1016/j.arthro.2016.01.036] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 01/17/2016] [Accepted: 01/21/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine if functional outcomes and magnetic resonance imaging (MRI) outcomes were significantly different between patients receiving primary autologous osteochondral transplantation (AOT) and patients receiving secondary AOT surgery after failed microfracture. METHODS A group of 76 patients enrolled into the Foot and Ankle Service between 2006 and 2012 was retrospectively analyzed. Patient-reported outcomes were evaluated in 76 patients using the Foot and Ankle Outcome Score (FAOS). Superficial and deep tissues at the repaired defect site, as well as the adjacent normal cartilage, were analyzed using quantitative T2 mapping MRI. Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) allowed for morphological evaluation of the repair tissue. The mean clinical follow-up time was 51 ± 23 months (range, 12 to 97 months), and the mean MRI follow-up time was 26 months (range, 24 to 36 months). RESULTS Twenty-two patients received primary AOT and 54 received secondary AOT after failed microfracture. Patient characteristics between groups were similar with regard to age, gender, lesion size, and follow-up time. The mean postoperative FAOS was 10 points higher in the primary AOT group (83.2 ± 17.0) compared with the secondary AOT group (72.4 ± 19.4) (P = .01). Regression analysis showed that secondary AOT patients preoperative to postoperative change in FAOS was 9 points lower than in primary AOT patients after adjustment for age, preoperative FAOS, and lesion size (P = .045). The mean MOCART score, superficial T2 and deep T2 values, and the difference between normal and repair cartilage T2 values were not significantly different between groups. Lesion size was negatively correlated with MOCART scores (ρ = -0.2, P = .04), but positively correlated with difference in T2 values between repair and adjacent normal cartilage in the superficial layer (ρ = 0.3, P = .045). CONCLUSIONS Primary AOT shows better functional outcomes compared with secondary AOT after failed microfracture in patients with similar characteristics and lesion size. No significant differences in T2 mapping relaxation times and MOCART scores were identified. LEVEL OF EVIDENCE Level III, case control study.
Collapse
Affiliation(s)
- Andrew W Ross
- Department of Orthopedic Surgery, Foot and Ankle Service, Hospital for Special Surgery, New York, New York, U.S.A
| | - Christopher D Murawski
- Department of Orthopedic Surgery, Foot and Ankle Service, Hospital for Special Surgery, New York, New York, U.S.A
| | - Ethan J Fraser
- Department of Orthopedic Surgery, Foot and Ankle Service, Hospital for Special Surgery, New York, New York, U.S.A
| | - Keir A Ross
- Department of Orthopedic Surgery, Foot and Ankle Service, Hospital for Special Surgery, New York, New York, U.S.A
| | - Huong T Do
- Department of Orthopedic Surgery, Foot and Ankle Service, Hospital for Special Surgery, New York, New York, U.S.A
| | - Timothy W Deyer
- Department of Orthopedic Surgery, Foot and Ankle Service, Hospital for Special Surgery, New York, New York, U.S.A
| | - John G Kennedy
- Department of Orthopedic Surgery, Foot and Ankle Service, Hospital for Special Surgery, New York, New York, U.S.A..
| |
Collapse
|
38
|
Ferreira C, Vuurberg G, Oliveira JM, Espregueira-Mendes J, Pereira H, Reis RL, Ripoll PL. Good clinical outcome after osteochondral autologous transplantation surgery for osteochondral lesions of the talus but at the cost of a high rate of complications: a systematic review. J ISAKOS 2016. [DOI: 10.1136/jisakos-2015-000020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
|
39
|
Long-term results of microfracture in the treatment of talus osteochondral lesions. Knee Surg Sports Traumatol Arthrosc 2016; 24:1299-303. [PMID: 26831855 DOI: 10.1007/s00167-016-3990-8] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 01/12/2016] [Indexed: 12/20/2022]
Abstract
PURPOSE Osteochondral lesions of the talus are common injuries, and many clinicians consider arthroscopic debridement and microfracture as the first-stage treatment. This study assessed the long-term clinical and radiographic outcomes of arthroscopic debridement and microfracture for osteochondral lesions of the talus. METHODS A total of 82 patients (48 males, 34 females) who were treated with arthroscopic debridement and microfracture for osteochondral lesions of the talus between 1996 and 2009 with a minimum 5-year follow-up were included in our study group. Functional scores (AOFAS, VAS) and ankle range of motion were determined, and an arthrosis evaluation was performed. Subgroup evaluations based on age, lesion localization, and defect size were performed using functional outcome correlations. RESULTS The mean age of the patients was 35.9 ± 13.4 years (14-69 years), and the mean follow-up period was 121.3 months (61-217 months). The mean defect size was 1.7 ± 0.7 cm2 (0.25-5). The mean pre-operative AOFAS score was 58.7 ± 5.2 (49-75), and the mean post-operative AOFAS score was 85.5 ± 9.9 (56-100). At the last follow-up, 35 patients (42.6%) had no symptoms and 19 patients (23.1%) had pain after walking more than 2 h or after competitive sports activities. Radiological assessments of arthrosis revealed that no patient had grade 4 arthritis but that 27 patients (32.9%) had a one-stage increase in their arthrosis level. Subgroup analyses of the lesion location demonstrated that lateral lesions had significantly better functional results (p = 0.02). CONCLUSIONS Arthroscopic debridement and microfracture provide a good option for the treatment of osteochondral lesions of the talus over the long term in select patients. Functional outcomes do not correlate with defect size or patient age. Orthopaedic surgeons should adopt the microfracture technique, which is minimally invasive and effective for treating osteochondral lesions of the talus. LEVEL OF EVIDENCE IV.
Collapse
|
40
|
Autologous osteochondral transplantation for osteochondral lesions of the talus in an athletic population. Knee Surg Sports Traumatol Arthrosc 2016; 24:1272-9. [PMID: 25962962 DOI: 10.1007/s00167-015-3606-8] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 04/08/2015] [Indexed: 12/17/2022]
Abstract
PURPOSE To assess clinical outcomes and return to sport in an athletic population treated with autologous osteochondral transplantation (AOT) for osteochondral lesions of the talus. METHODS A total of 36 patients were included in this retrospective study including 21 professional athletes and 15 amateur athletes who participated in regular moderate- or high-impact athletic activity. All patients underwent autologous osteochondral transplantation of the talus under the care of a single surgeon. At a mean follow-up of 5.9 years, patients were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) scoring system. All patients also received pre-operative MRI with the follow-up MRI performed at 1 year and underwent assessment of return to athletic activity. RESULTS The overall AOFAS score improved from 65.5 (SD ± 11.1) to 89.4 (SD ± 14.4) (p = 0.01). At a final follow-up, 90% of professional athletes (19 of 21) were still competing in athletic activity or still able to participate in unrestricted activity. Of the recreational athletes, 87% (13 of 15) had full return to pre-injury activity levels, while two (13%) returned to activity with restrictions or reduced intensity. MRI showed cystic change in 33% of patients post-operatively; however, this did not appear to affect outcomes (n.s.). Donor site symptoms were seen in 11% of the cohort at final follow-up, despite high function at donor knee. CONCLUSION The results of our study indicate that AOT procedure is able to achieve good outcomes in an athletic population at a midterm follow-up. LEVEL OF EVIDENCE Retrospective case series, Level IV.
Collapse
|
41
|
Pinski JM, Boakye LA, Murawski CD, Hannon CP, Ross KA, Kennedy JG. Low Level of Evidence and Methodologic Quality of Clinical Outcome Studies on Cartilage Repair of the Ankle. Arthroscopy 2016; 32:214-22.e1. [PMID: 26372522 DOI: 10.1016/j.arthro.2015.06.050] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Revised: 06/16/2015] [Accepted: 06/30/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To examine the level of evidence and methodologic quality of studies reporting surgical treatments for osteochondral lesions of the ankle. METHODS A search was performed using the PubMed/Medline, Embase, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and Cochrane databases for all studies in which the primary objective was to report the outcome after surgical treatment of osteochondral lesions of the ankle. Studies reporting outcomes of microfracture, bone marrow stimulation, autologous osteochondral transplantation, osteochondral allograft transplantation, and autologous chondrocyte implantation were the focus of this analysis because they are most commonly reported in the literature. Two independent investigators scored each study from 0 to 100 based on 10 criteria from the modified Coleman Methodology Score (CMS) and assigned a level of evidence using the criteria established by the Journal of Bone and Joint Surgery. Data were collected on the study type, year of publication, number of surgical procedures, mean follow-up, preoperative and postoperative American Orthopaedic Foot & Ankle Society score, measures used to assess outcome, geography, institution type, and conflict of interest. RESULTS Eighty-three studies reporting the results of 2,382 patients who underwent 2,425 surgical procedures for osteochondral lesions of the ankle met the inclusion criteria. Ninety percent of studies were of Level IV evidence. The mean CMS for all scored studies was 53.6 of 100, and 5 areas were identified as methodologically weak: study size, type of study, description of postoperative rehabilitation, procedure for assessing outcome, and description of the selection process. There was no significant difference between the CMS and the type of surgical technique (P = .1411). A statistically significant patient-weighted correlation was found between the CMS and the level of evidence (r = -0.28, P = .0072). There was no statistically significant patient-weighted correlation found between the CMS and the institution type (r = 0.05, P = .6480) or financial conflict of interest (r = -0.16, P = .1256). CONCLUSIONS Most studies assessing the clinical outcomes of cartilage repair of the ankle are of a low level of evidence and of poor methodologic quality. LEVEL OF EVIDENCE Level IV, systematic review of Level I through IV studies.
Collapse
Affiliation(s)
- John M Pinski
- Hospital for Special Surgery, New York, New York, U.S.A
| | | | | | | | - Keir A Ross
- Hospital for Special Surgery, New York, New York, U.S.A
| | - John G Kennedy
- Hospital for Special Surgery, New York, New York, U.S.A..
| |
Collapse
|
42
|
Ahmad J, Jones K. Comparison of Osteochondral Autografts and Allografts for Treatment of Recurrent or Large Talar Osteochondral Lesions. Foot Ankle Int 2016; 37:40-50. [PMID: 26333683 DOI: 10.1177/1071100715603191] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [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 prospectively evaluate and compare the long-term clinical and radiographic outcomes of using osteochondral autograft and allograft to manage either recurrent or large osteochondral lesions of the talar dome (OLT) in a single surgeon's practice. METHODS Between January 2008 and January 2014, a total of 40 patients presented with either a recurrent OLT that failed initial arthroscopic treatment (ie, excision, curettage, debridement, and micro-fracture) or a primary OLT greater than 1.5 cm2 that had undergone no prior surgery. Before surgery, 20 patients were randomized to receive osteochondral autograft plugs (Arthrex, Naples, FL) from the ipsilateral superolateral distal femoral condyle whereas the remaining 20 were randomized to receive osteochondral allograft plugs from a fresh size-matched donor talus (Joint Restoration Foundation, Centennial, CO, and Arthrex, Naples, FL), but 4 of these were excluded that received a hemi-talus allograft with internal fixation. Preoperative and postoperative function and pain was graded using the Foot and Ankle Ability Measures (FAAM) scoring system and a Visual Analog Scale (VAS) of pain, respectively. Radiographs were assessed for osteochondral graft healing, joint congruency, and degenerative changes. Data regarding postoperative complications and revision surgeries were also recorded. RESULTS Of the 20 patients who received osteochondral autograft, the mean FAAM score increased from 54.4 preoperatively to 85.5 at the time of final follow-up. The mean VAS pain score decreased from 7.9 of 10 preoperatively to 2.2 of 10 at final follow-up. Two patients (10%) that received osteochondral autograft, 1 for a recurrent OLT of 1.3 cm2 and 1 for a primary OLT of 2.0 cm2, developed a symptomatic nonunion at the entire graft site. Both of these patients had their autograft converted to talar allograft plugs and achieved full osteochondral healing. At the time of final follow-up, no patients who received osteochondral autograft developed ankle degenerative changes or knee complications. The mean FAAM score of the 16 patients who received osteochondral allograft plugs increased from 55.2 preoperatively to 80.7 at the time of final follow-up. This postoperative score was lower than that of the osteochondral autograft group, but not to a statistically significant degree (P = .25). The mean VAS pain score decreased from 7.8 of 10 preoperatively to 2.7 of 10 at final follow-up. This postoperative score was higher than that of the osteochondral autograft group but not to a statistically significant degree (P = .15). Three patients (18.8%) that received osteochondral talar allograft, 2 for recurrent OLTs less than 1.5 cm2 and 1 for a primary OLT of 2.2 cm2, developed a symptomatic nonunion at the entire graft site. Two of these 3 patients had their allograft converted to osteochondral autograft plugs harvested from the ipsilateral superolateral distal femoral condyle and achieved full osteochondral healing. At the time of final follow-up, 1 of these 16 (6.3%) patients who received talar allograft as OLT treatment had developed asymptomatic anterior ankle arthritis upon radiographs. CONCLUSION Using fresh talar osteochondral allograft provided results that were comparable to the use of distal femoral osteochondral autograft for treating recurrent or large OLTs. Although the use of allograft avoided the risk of knee complications when harvesting autograft from the distal femur, fresh talar allograft may have lower healing rates than osteochondral autograft. LEVEL OF EVIDENCE Level II, comparative case series.
Collapse
Affiliation(s)
- Jamal Ahmad
- Orthopaedic Surgery, Rothman Institute Orthopaedics at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Kennis Jones
- Rothman Institute Orthopaedics at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| |
Collapse
|
43
|
Younger A, Wing K, Penner M, Cresswell M. A study to evaluate the safety of platelet-derived growth factor for treatment of osteochondral defects of the talus. Knee Surg Sports Traumatol Arthrosc 2016; 24:1250-8. [PMID: 25796584 PMCID: PMC4823349 DOI: 10.1007/s00167-015-3549-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 02/24/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE An arthroscopic procedure for the treatment of osteochondral defects using platelet-derived growth factor (PDGF) carried out in a matrix of tricalcium phosphate was developed. This prospective, case-series-based study was designed to evaluate the safety and clinical utility of this procedure. METHODS Patients with an isolated osteochondral defect larger than 5 mm long, 3 mm wide, and 5 mm deep and smaller than 30 mm long, 25 mm wide, or 20 mm deep were considered for enrolment. Only patients with chronic lesions were enroled. Arthroscopic debridement was followed by the placement of recombinant human PDGF in a matrix of tricalcium phosphate. The Ankle Osteoarthritis Scale (AOS), visual analogue scale (VAS) for pain, and SF-36 questionnaires were administered at 0, 2, 6, 12, and 24 weeks. Magnetic resonance imaging (MRI) and computed tomography (CT) scans were taken before and after surgery. RESULTS Five patients were ultimately enroled in this proof-of-concept trial. All outcome measures demonstrated marked improvement from baseline to final follow-up: The mean weight bearing VAS pain score improved by 49%, and the mean AOS functional score improved by 28%. Bone healing was seen on CT, and reduction in oedema signal was seen on MRI. CONCLUSION This new procedure may offer a promising alternative for the treatment of osteochondral defects. Further high-quality studies are needed to confirm these results and to analyse the long-term effects of the procedure. The clinical relevance of this study is that the procedure may provide a less invasive option with improved bone healing compared to standard techniques . LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Alastair Younger
- Department of Orthopedics, University of British Columbia, 560 – 1144 Burrard Street, Vancouver, BC V6Z 2A5 Canada
| | - Kevin Wing
- Department of Orthopaedics, University of British Columbia, 1000 – 1200 Burrard Street, Vancouver, BC V6Z 2C7 Canada
| | - Murray Penner
- Department of Orthopaedics, University of British Columbia, 1000 – 1200 Burrard Street, Vancouver, BC V6Z 2C7 Canada
| | - Mark Cresswell
- Department of Radiology, University of British Columbia, St. Paul’s Hospital - 1081 Burrard Street, Vancouver, BC V6Z 1Y6 Canada
| |
Collapse
|
44
|
Calder JDF, Ballal MS, Deol RS, Pearce CJ, Hamilton P, Lutz M. Histological evaluation of calcaneal tuberosity cartilage--A proposed donor site for osteochondral autologous transplant for talar dome osteochondral lesions. Foot Ankle Surg 2015; 21:193-7. [PMID: 26235859 DOI: 10.1016/j.fas.2014.11.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 11/24/2014] [Accepted: 11/28/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND Osteochondral Autologous Transplant (OATs) as a treatment option for Osteochondral lesions (OCLs) of the talar dome frequently uses the distal femur as the donor site which is associated with donor site morbidity in up to 50%. Some studies have described the presence of hyaline cartilage in the posterior superior calcaneal tuberosity. The aim of this study was to evaluate the posterior superior calcaneal tuberosity to determine if it can be a suitable donor site for OATs of the talus METHODS In this cadaveric study, we histologically evaluated 12 osteochondral plugs taken from the posterior superior calcaneal tuberosity and compared them to 12 osteochondral plugs taken from the talar dome. RESULTS In the talar dome group, all samples had evidence of hyaline cartilage with varying degrees of GAG staining. The average hyaline cartilage thickness in the samples was 1.33 mm. There was no evidence of fibrocartilage, fibrous tissue or fatty tissue in this group. In contrast, the Calcaneal tuberosity samples had no evidence of hyaline cartilage. Fibrocartilage was noted in 3 samples only. CONCLUSIONS We believe that the structural differences between the talus and calcanium grafts render the posterior superior clancaneal tuberosity an unsuitable donor site for OATs in the treatment of OCL of the talus.
Collapse
Affiliation(s)
- James D F Calder
- Chelsea & Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK; Fortius Clinics, 17 Fitzhardinge Street, London W1H6WQ, UK
| | - Moez S Ballal
- Chelsea & Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK; Fortius Clinics, 17 Fitzhardinge Street, London W1H6WQ, UK.
| | - Rupinderbir S Deol
- Chelsea & Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK; Fortius Clinics, 17 Fitzhardinge Street, London W1H6WQ, UK
| | - Christopher J Pearce
- Chelsea & Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK; Fortius Clinics, 17 Fitzhardinge Street, London W1H6WQ, UK
| | - Paul Hamilton
- Chelsea & Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK; Fortius Clinics, 17 Fitzhardinge Street, London W1H6WQ, UK
| | - Michael Lutz
- Chelsea & Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK; Fortius Clinics, 17 Fitzhardinge Street, London W1H6WQ, UK
| |
Collapse
|
45
|
Görmeli G, Karakaplan M, Görmeli CA, Sarıkaya B, Elmalı N, Ersoy Y. Clinical Effects of Platelet-Rich Plasma and Hyaluronic Acid as an Additional Therapy for Talar Osteochondral Lesions Treated with Microfracture Surgery: A Prospective Randomized Clinical Trial. Foot Ankle Int 2015; 36:891-900. [PMID: 25825393 DOI: 10.1177/1071100715578435] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Osteochondral ankle injuries commonly affect the dome of the talus, and these injuries are a common cause of athletic disability. Various treatment options are available for these injuries including intra-articular hyaluronic acid (HA) and platelet-rich plasma (PRP) injections. The purpose of this study was to compare the effects of HA and PRP as adjunct therapies after arthroscopic microfracture in osteochondral lesions (OCLs) of the talus. METHODS In this prospective, randomized blinded study, 40 patients with talar OCLs in their ankle joints were treated with arthroscopic debridement and a microfracture technique. Thirteen randomly selected patients received PRP, 14 patients received HA, and the remaining 13 patients received saline as a control group. The participants were assessed using the American Orthopaedic Foot & Ankle Society (AOFAS) and visual analog pain scale (VAS) scores after a 15.3-month (range, 11-25 months) follow-up. RESULTS Postoperatively, all the groups exhibited significantly increased AOFAS scores and decreased VAS scores compared with their preoperative results (P < .005). The AOFAS scores were significantly increased in the PRP group versus the HA and control groups (P < .005), although the increased AOFAS scores in the HA group versus the control group were also significant (P < .005). Similar to the AOFAS scores, the decrease in the VAS scores was significantly lower in the PRP group versus the HA and control groups (P < .005). In addition, the HA group had significantly lower VAS scores than the control group (P < .005). CONCLUSION Both PRP and HA injections improved the clinical outcomes of patients who underwent operation for talar OCLs in the midterm period and can be used as adjunct therapies for these patients. Because a single dose of PRP provided better results, we recommend PRP as the primary adjunct treatment option in the talar OCL postoperative period. LEVEL OF EVIDENCE Level I, prospective randomized study.
Collapse
Affiliation(s)
- Gökay Görmeli
- Inonu University, Turgut Ozal Medical Center, Department of Orthopedics and Traumatology, Malatya, Turkey
| | - Mustafa Karakaplan
- Inonu University, Turgut Ozal Medical Center, Department of Orthopedics and Traumatology, Malatya, Turkey
| | - Cemile Ayşe Görmeli
- Inonu University, Turgut Ozal Medical Center, Department of Radiology, Malatya, Turkey
| | - Baran Sarıkaya
- Baskent University, Department of Orthopedics and Traumatology, Adana, Turkey
| | - Nurzat Elmalı
- Vakıf Gureba University, Department of Orthopedics and Traumatology, İstanbul, Turkey
| | - Yüksel Ersoy
- Inonu University, Turgut Ozal Medical Center, Department of Physiotherapy and Rehabilitation, Malatya, Turkey
| |
Collapse
|
46
|
Repair of articular cartilage defects in the knee with autologous iliac crest cartilage in a rabbit model. Knee Surg Sports Traumatol Arthrosc 2015; 23:1119-27. [PMID: 24573237 DOI: 10.1007/s00167-014-2906-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 02/05/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE To demonstrate that iliac crest cartilage may be used to repair articular cartilage defects in the knees of rabbits. METHODS Full-thickness cartilage defects were created in the medial femoral condyle on both knees of 36 New Zealand white rabbits. The 72 defects were randomly assigned to be repaired with ipsilateral iliac crest cartilage (Group I), osteochondral tissues removed at defect creation (Group II), or no treatment (negative control, Group III). Animals were killed at 6, 12, and 24 weeks post-operatively. The repaired tissues were harvested for magnetic resonance imaging (MRI), histological studies (haematoxylin and eosin and immunohistochemical staining), and mechanical testing. RESULTS At 6 weeks, the iliac crest cartilage graft was not yet well integrated with the surrounding articular cartilage, but at 12 weeks, the graft deep zone had partial ossification. By 24 weeks, the hyaline cartilage-like tissue was completely integrated with the surrounding articular cartilage. Osteochondral autografts showed more rapid healing than Group I at 6 weeks and complete healing at 12 weeks. Untreated defects were concave or partly filled with fibrous tissue throughout the study. MRI showed that Group I had slower integration with surrounding normal cartilage compared with Group II. The mechanical properties of Group I were significantly lower than those of Group II at 12 weeks, but this difference was not significant at 24 weeks. CONCLUSION Iliac crest cartilage autografts were able to repair knee cartilage defects with hyaline cartilage and showed comparable results with osteochondral autografts in the rabbit model.
Collapse
|
47
|
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: 28] [Impact Index Per Article: 3.1] [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.
Collapse
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
| |
Collapse
|
48
|
Use of Cartilage Extracellular Matrix and Bone Marrow Aspirate Concentrate in Treatment of Osteochondral Lesions of the Talus. TECHNIQUES IN FOOT AND ANKLE SURGERY 2014. [DOI: 10.1097/btf.0000000000000054] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
|
49
|
Yoon HS, Park YJ, Lee M, Choi WJ, Lee JW. Osteochondral Autologous Transplantation Is Superior to Repeat Arthroscopy for the Treatment of Osteochondral Lesions of the Talus After Failed Primary Arthroscopic Treatment. Am J Sports Med 2014; 42:1896-903. [PMID: 24907287 DOI: 10.1177/0363546514535186] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Several studies have reported on the outcome of arthroscopic treatment or osteochondral autologous transplantation (OAT) for osteochondral lesions of the talus (OLT), with mixed results. None of these studies has compared the results of repeat arthroscopy and OAT after failed primary arthroscopic treatment. PURPOSE To compare the outcomes of OAT and repeat arthroscopy for the treatment of OLT after primary arthroscopy STUDY DESIGN Cohort study; Level of evidence, 3. METHODS This study included 22 patients who underwent OAT (group A) and 22 patients who underwent repeat arthroscopy (group B) after failed treatment of OLT among 399 patients who received primary arthroscopic marrow stimulation at single institution between 2001 and 2009. All patients were evaluated clinically using the visual analog scale (VAS) for pain and American Orthopaedic Foot and Ankle Society (AOFAS) Ankle Hindfoot Scale. The cumulative success rates were compared by use of Kaplan-Meier life table analysis. RESULTS The patients' demographic and clinical characteristics and indications for surgery were comparable between the groups. Both groups showed significantly improved (P < .001) VAS and AOFAS scores 6 months after surgery. However, group B showed significant deterioration over a mean follow-up period of 50 months. Overall, 18 of 22 (81.8%) patients in group A and 7 of 22 (31.8%) patients in group B achieved an excellent or good (≥80) AOFAS score (P < .001). No patient in group A and 14 of 22 (63.6%) in group B required further revisions. CONCLUSION Osteochondral autologous transplantation was significantly superior to repeat arthroscopic treatment of OLT after a mean follow-up period of 48 months. Therefore, repeat arthroscopy should be used judiciously for the treatment of OLT after failed arthroscopic treatment.
Collapse
Affiliation(s)
- Hang Seob Yoon
- Department of Orthopaedic Surgery, Wooridul Hospital, Seoul, Korea
| | - Yoo Jung Park
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Moses Lee
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Woo Jin Choi
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Woo Lee
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
50
|
Clanton TO, Johnson NS, Matheny LM. Outcomes Following Microfracture in Grade 3 and 4 Articular Cartilage Lesions of the Ankle. Foot Ankle Int 2014; 35:764-770. [PMID: 25015392 DOI: 10.1177/1071100714539656] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [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 document outcomes following microfracture of articular cartilage lesions of the ankle. Our hypothesis was that patients who underwent ankle microfracture would have good to excellent outcomes. METHODS This study was institutional review board approved. Patients older than 18 years who underwent ankle microfracture surgery for Outerbridge grade 3 or 4 articular cartilage lesions, by a single surgeon, were included. Detailed intraoperative findings were documented at surgery. Patients completed a questionnaire with Foot and Ankle Disability Index (FADI), Lysholm, Tegner, and patient satisfaction with outcome. All data were collected prospectively and stored in a data registry and retrospectively reviewed. Forty patients (21 males, 19 females, mean age = 42 years [range, 19-65 years]) were included in this study. Thirteen (33%) had previous ankle surgery. Follow-up was obtained for 94% of patients (n = 34). Mean follow-up time was 26 months (range, 12-48 months). RESULTS Mean talar defect size was 70 mm2 (range, 4-300 mm2). Mean tibia defect size was 31 mm2 (range, 8-54 mm2). Four patients (10.5%) required subsequent surgery following microfracture surgery. Mean time to second surgery was 17 months (range, 4-32 months). Mean Lysholm score was 74 (range, 31-96). Mean FADI Activities of Daily Living (ADL) was 81 (range, 33-99), FADI Sport was 62 (range, 13-100), and FADI total score was 77 (range, 28-98). Median Tegner was 4 (range, 0-10). Median patient satisfaction was 8 (range, 3-10). Patients who had previous ankle surgery had significantly lower outcome scores versus patients who did not have previous ankle surgery for FADI ADL (70 vs 81, P = .029) and FADI Total (51 vs 77, P = .028). Days from injury to surgery were correlated with age at surgery (r = .323, P = .042) and negatively correlated with FADI ADL (r = -.431, P = .014), FADI Sport (r = -.490, P = .004), FADI Total (r = -.429, P = .014), and Tegner (r = -.402, P = .023). CONCLUSION Patients who underwent microfracture for grade 3 or 4 ankle articular cartilage lesions had high patient satisfaction. Patients who had previous ankle surgery had lower postoperative ankle function; however, patient satisfaction remained high. This study supports microfracture for treatment of grade 3 and 4 ankle articular cartilage lesions. LEVEL OF EVIDENCE Level IV, case series.
Collapse
|