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Rikken QGH, Aalders MB, Dahmen J, Sierevelt IN, Stufkens SAS, Kerkhoffs GMMJ. Ten-Year Survival Rate of 82% in 262 Cases of Arthroscopic Bone Marrow Stimulation for Osteochondral Lesions of the Talus. J Bone Joint Surg Am 2024:00004623-990000000-01097. [PMID: 38728384 DOI: 10.2106/jbjs.23.01186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
BACKGROUND The long-term sustainability of arthroscopic bone marrow stimulation (BMS) for osteochondral lesions of the talus (OLT) remains a matter of debate. The primary aim of the present study was to assess the 10-year survival free from revision in ankles that had undergone arthroscopic BMS for an OLT. The secondary aim was to evaluate the influence of baseline patient and lesion characteristics on survival. METHODS Patients who underwent arthroscopic BMS for a symptomatic OLT and had a minimum follow-up of 10 years were included to assess procedure survival. The primary outcome, the 10-year cumulative survival rate, was analyzed by the Kaplan-Meier survival method. Secondary outcomes were the median time to revision and the effects of baseline factors (lesion size, primary or non-primary lesion type, preoperative cysts, and obesity as defined by a body mass index [BMI] of ≥30 kg/m2) on survival, analyzed with a Cox regression model and reported using hazard ratios (HRs). RESULTS The 262 included patients had a mean follow-up of 15.3 ± 4.8 years. The 10-year cumulative survival rate of the arthroscopic BMS procedures was 82% (95% confidence interval [CI]: 77% to 87%). At 15 years of follow-up, the cumulative survival rate was 82% (95% CI: 76% to 86%). The median time to revision was 2.4 years (interquartile range: 1.3 to 5.1 years). Of the baseline factors, obesity (HR: 3.0 [95% CI: 1.44 to 6.43], p < 0.01) was associated with decreased survival. Lesion size (HR: 0.9 [95% CI: 0.5 to 1.8], p = 0.8), non-primary lesion type (HR: 1.8 [95% CI: 0.9 to 3.4], p = 0.1), and the presence of preoperative cysts (HR: 1.0 [95% CI: 0.6 to 1.9], p = 0.9) were not significantly associated with survival. CONCLUSIONS At a minimum follow-up of 10 years, the survival rate of arthroscopic BMS for OLT was 82%. At 15 and 20 years of follow-up, survival appeared to remain stable. Obesity (BMI ≥ 30 kg/m2) was associated with a higher likelihood of revision surgery. This risk factor should be incorporated into the treatment algorithm for OLT when counseling patients regarding surgery. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Quinten G H Rikken
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Sports and Musculoskeletal Health Programs, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Centre, Amsterdam UMC, Amsterdam, The Netherlands
| | - Margot B Aalders
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Sports and Musculoskeletal Health Programs, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Centre, Amsterdam UMC, Amsterdam, The Netherlands
| | - Jari Dahmen
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Sports and Musculoskeletal Health Programs, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Centre, Amsterdam UMC, Amsterdam, The Netherlands
| | - Inger N Sierevelt
- Orthopedic Department, Spaarne Gasthuis Academy, Hoofddorp, The Netherlands
| | - Sjoerd A S Stufkens
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Sports and Musculoskeletal Health Programs, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Centre, Amsterdam UMC, Amsterdam, The Netherlands
| | - Gino M M J Kerkhoffs
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Sports and Musculoskeletal Health Programs, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Centre, Amsterdam UMC, Amsterdam, The Netherlands
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Rikken QGH, Dahmen J, Stufkens SAS, Kerkhoffs GMMJ. Bone Marrow Stimulation for Osteochondral Lesions of the Tibial Plafond Yields Good Patient-Reported Outcomes in Daily Living but Moderate Outcomes in Sports Activities at 2- to 22-Years Follow-Up. Arthroscopy 2024; 40:910-918.e2. [PMID: 37543147 DOI: 10.1016/j.arthro.2023.07.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/08/2023] [Accepted: 07/27/2023] [Indexed: 08/07/2023]
Abstract
PURPOSE To assess the patient-reported outcomes, as well as the revision and complication rates, of patients who underwent arthroscopic bone marrow stimulation (BMS) for an osteochondral lesion of the tibial plafond (OLTP). METHODS Patients with an OLTP treated with arthroscopic BMS at a minimum follow-up of 2-years were cross-sectionally included from a historical database. The primary outcome was the Numeric Rating Scale (NRS) during walking. Secondary outcomes included the NRS in rest and during running, and the Foot and Ankle Outcome Score. Additionally, the association of baseline patient and lesion demographics with follow-up patient-reported outcome measures (PROMs) was assessed with the Spearman rank correlation test. A subanalysis was performed for PROMs in patients with or without a coexisting talar (i.e., bipolar) lesion. Finally, the revision surgery (i.e., repeat surgery for the OLTP) and complication rates were assessed. RESULTS Fifty-one patients were included at a mean 8.8 (standard deviation [SD] = 5.7, range, 2-22) years follow-up. Seventy-three percent of patients had a solitary OLTP, and 27% had a coexisting talar (bipolar) lesion. Males had a significantly higher rate of bipolar lesions compared to females (P ≤ .01), and patients with a bipolar lesion had a significantly larger OLTP lesion diameter (P = .02) and volume (P = .04). At final follow-up, the mean NRS during walking was 1.9 (SD = 2.3) out of 10. Anterior-posterior OLTP size (r = 0.36; P ≤ .01) was significantly associated with a higher NRS pain score during walking, although the presence of bipolar lesions did not result in inferior clinical outcomes. At final follow-up, 6% of patients underwent revision surgery. Minor complications were observed in 12% of patients. CONCLUSIONS Arthroscopic BMS for OLTP results in favorable patient-reported outcomes at mid- to long-term follow-up, although moderate outcomes were observed in sports activities. Lesion size was associated with increased pain scores, although bipolar lesions did not result in inferior patient-reported outcomes. Six percent of patients required revision surgery, and 12% of patients had minor complications after surgery. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Quinten G H Rikken
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands; Academic Center for Evidence based Sports medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands; Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - Jari Dahmen
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands; Academic Center for Evidence based Sports medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands; Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - Sjoerd A S Stufkens
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands; Academic Center for Evidence based Sports medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands; Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - Gino M M J Kerkhoffs
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands; Academic Center for Evidence based Sports medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands; Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands.
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Park S, Park R, Westwood D, Moayedi M, Khan JS. Effect of Peripheral Magnetic Stimulation on Acute and Chronic Pain After Surgery: A Systematic Review and Meta-Analysis. THE JOURNAL OF PAIN 2023; 24:1151-1162. [PMID: 36878385 DOI: 10.1016/j.jpain.2023.02.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 02/16/2023] [Accepted: 02/28/2023] [Indexed: 03/07/2023]
Abstract
Peripheral magnetic stimulation (PMS) is a potentially promising modality to help manage postoperative pain. We systematically reviewed the effect of PMS on acute and chronic postoperative pain. MEDLINE, Cochrane CENTRAL, EMBASE, ProQuest Dissertations, and clinical trials.gov were searched from inception until May 2021. We included studies of any study design that included patients ≥18 years of age undergoing any type of surgery that administered PMS within the perioperative period and evaluated postoperative pain. Seventeen randomized controlled trials and 1 nonrandomized clinical trial were included into the review. Thirteen out of the 18 studies found a positive effect with PMS on postoperative pain scores. In our meta-analysis, peripheral magnetic stimulation was more efficacious than sham or no intervention within the first 7 postoperative days (mean difference [MD] -1.64 on a 0 to 10 numerical rating score, 95% confidence interval [CI] -2.08 to -1.20, I2 = 77%, 6 studies, 231 patients). This was also true at 1 and 2 months after surgery (MD -1.82, 95% CI -2.48 to -1.17, I2 = 0%, 3 studies, 104 patients; and MD -1.96, 95% CI -3.67 to -.26, I2 = 84%, 3 studies, 104 patients, respectively). A difference was not seen with persistent pain at 6 and 12-months after surgery, acute postoperative opioid consumption, or adverse events between groups. Results are limited by heterogeneity and generally low-quality studies, as well as low or very low quality of evidence. High-quality and adequately blinded trials are needed to definitively confirm the benefits of peripheral magnetic stimulation administered in the perioperative period. PERSPECTIVE: This review evaluates the efficacy and safety of PMS on postoperative pain. The results help elucidate PMS' role in postoperative pain management and identify gaps where more research is required.
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Affiliation(s)
- Stephanie Park
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rex Park
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Duncan Westwood
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada; Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Massieh Moayedi
- Centre for Multimodal Sensorimotor and Pain Research, University of Toronto, Ontario, Canada; University of Toronto Centre for the Study of Pain, University of Toronto, Toronto, Ontario, Canada; Department of Dentistry, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - James S Khan
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada; Mount Sinai Hospital, Toronto, Ontario, Canada.
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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.
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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
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Guevel B, Mathew ST, Coene RP, Maguire KJ, Williams KA, Micheli LJ, Milewski MD. Low-Intensity Pulsed Ultrasonography Plus Arthroscopic Drilling Does Not Improve Bone Healing More Than Arthroscopic Drilling Alone in Pediatric Patients With Stable Osteochondritis Dissecans of the Knee. Arthrosc Sports Med Rehabil 2023; 5:e225-e232. [PMID: 36866308 PMCID: PMC9971866 DOI: 10.1016/j.asmr.2022.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 11/09/2022] [Indexed: 01/12/2023] Open
Abstract
Purpose To determine whether adjuvant use of bone stimulation would improve the rate of healing in the operative management of stable osteochondritis dissecans (OCD) of the knee in pediatric patients. Methods This retrospective matched case-control study was performed at a single tertiary care pediatric hospital between January 2015 and September 2018. Patients who underwent antegrade drilling for stable femoral condyle OCD with greater than 2 years' follow-up were included. Preference was for all to receive postoperative bone stimulation; however, some were denied because of insurance coverage. This enabled us to create 2 matched groups of those who received postoperative bone stimulation and those who did not. Patients were matched on skeletal maturity, lesion location, sex, and age at surgery. The primary outcome measure was the rate of healing of the lesions determined by postoperative magnetic resonance imaging measurements at 3 months. Results Fifty-five patients were identified who met the inclusion and exclusion criteria. Twenty patients from the bone stimulator group (BSTIM) were matched to 20 patients from the no bone stimulator group (NBSTIM). Mean age for BSTIM at surgery was 13.2 years ± 2.0 (range, 10.9-16.7) and for NBSTIM at surgery 12.9 years ± 2.0 (range, 9.3-17.3). At 2 years, 36 patients (90%) in both groups went on to clinical healing without further interventions. In BSTIM, there was a mean decrease of 0.9 (±1.8) mm in lesion on coronal width and 12 patients (63%) had overall improved healing; in NBSTIM there was a mean decrease of 0.8 (±3.6) mm in coronal width and 14 patients (78%) had improved healing. No statistical differences in the rate of healing were found between the 2 groups (P = .706). Conclusion In antegrade drilling of stable knee OCD lesions in pediatric and adolescent patients, adjuvant bone stimulator use did not appear to improve radiographic or clinical healing. Level of evidence Level III, retrospective case-control study.
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Affiliation(s)
- Borna Guevel
- Boston Children's Hospital, Division of Sports Medicine, Department of Orthopaedic Surgery, Boston, Massachusetts, U.S.A
| | - Stephen T. Mathew
- Boston Children's Hospital, Division of Sports Medicine, Department of Orthopaedic Surgery, Boston, Massachusetts, U.S.A
| | - Ryan P. Coene
- Boston Children's Hospital, Division of Sports Medicine, Department of Orthopaedic Surgery, Boston, Massachusetts, U.S.A
| | | | - Kathryn A. Williams
- Boston Children’s Hospital, Biostatistics and Research Design Center, ICCTR Boston, Massachusetts, U.S.A
| | - Lyle J. Micheli
- Boston Children's Hospital, Division of Sports Medicine, Department of Orthopaedic Surgery, Boston, Massachusetts, U.S.A.,Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Matthew D. Milewski
- Boston Children's Hospital, Division of Sports Medicine, Department of Orthopaedic Surgery, Boston, Massachusetts, U.S.A.,Harvard Medical School, Boston, Massachusetts, U.S.A.,Address correspondence to Matthew Milewski, M.D., Boston Children's Hospital, Division of Sports Medicine, Department of Orthopaedic Surgery, 300 Longwood Avenue, Boston, MA 02115, U.S.A.
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Arshad Z, Aslam A, Iqbal AM, Bhatia M. Should Arthroscopic Bone Marrow Stimulation Be Used in the Management of Secondary Osteochondral Lesions of the Talus? A Systematic Review. Clin Orthop Relat Res 2022; 480:1112-1125. [PMID: 35130190 PMCID: PMC9263474 DOI: 10.1097/corr.0000000000002134] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 01/19/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Osteochondral lesions of the talus are common, particularly after trauma. Arthroscopic bone marrow stimulation has emerged as the first-choice surgical treatment for small primary lesions less than 100 mm2. Individual studies on the topic are small and heterogeneous, and they have differed in their main findings; for this reason, systematically reviewing the available evidence seems important. QUESTIONS/PURPOSES In this systematic review, we asked: (1) What patient-reported outcomes and pain scores have been observed after arthroscopic bone marrow stimulation for secondary osteochondral lesions of the talus? (2) What complications were reported? (3) What demographic and clinical factors were reported to be associated with better patient-reported outcome scores? METHODS We performed a systematic review according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using Embase, EmCare, PubMed, CINAHL, and Scopus (databases last searched June 23, 2021). A two-stage title/abstract and full-text screening process was performed independently by two reviewers. Randomized control trials, cohort studies, and observational studies published in English that evaluated the outcome of arthroscopic bone marrow stimulation for secondary osteochondral lesions of the talus were included. Case reports, review articles, commentaries, abstracts, and letters to the editor were excluded. A total of 12 articles (10 case series and two retrospective comparative studies) involving 446 patients were included. Of these, 111 patients with a mean age of 33 years (range 20 to 49) received arthroscopic bone marrow stimulation for a secondary osteochondral lesion of the talus. The Methodological Index for Non-randomized Studies (MINORS) criteria were used to assess the methodologic quality of included studies. The MINORS is a numerical score ranging from 0 to 16 for studies with no comparison group and 0 to 24 for comparative studies, with higher quality studies receiving higher scores. Of the 10 noncomparative case series, the highest score was 10 of 16, with a median (range) score of 7.5 (4 to 10), while the two comparative studies scored 22 of 24 and 19 of 24, respectively. RESULTS Studies varied widely in terms of patient-reported outcome measures such as the American Orthopaedic Foot and Ankle Society score (AOFAS), with inconsistent reporting across studies regarding whether or how much patients improved; there was variation in some effect sizes with regard to improvement seeming close to or below the minimum clinically important difference (MCID). Although no perioperative complications were reported in any included studies, 34% (26 of 77, in seven studies that reported on this endpoint) of patients who underwent a revision procedure. One study found a negative association between lesion size and AOFAS and VAS score. No other studies reported on factors associated with patient-reported outcome scores, and most studies were far too small to explore relationships of this sort. CONCLUSION We found that arthroscopic bone marrow stimulation for secondary osteochondral lesions of the talus yielded inconsistent and often small improvements in patient-reported outcomes, with approximately one in three patients undergoing a revision procedure. Reported outcomes likely represent a best-case scenario, inflated by low-level study designs and major sources of bias that are known to make treatment effects seem larger than they are. Therefore, the use of arthroscopic bone marrow stimulation in such patients cannot be recommended, unless we are able to refine selection criteria to effectively identify patients who show a substantial clinical benefit. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Affiliation(s)
- Zaki Arshad
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Aiman Aslam
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Adil M. Iqbal
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Maneesh Bhatia
- Department of Trauma and Orthopaedic Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK
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Saxena A, Maffulli N, Jin A, Isa E, Jaswal J, Allen R. Outcomes of Talar Osteochondral and Transchondral Lesions Using an Algorithmic Approach Based on Size, Location, and Subchondral Plate Integrity: A 10-Year Study on 204 Lesions. J Foot Ankle Surg 2022; 61:442-447. [PMID: 35249808 DOI: 10.1053/j.jfas.2021.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 04/02/2021] [Accepted: 06/08/2021] [Indexed: 02/03/2023]
Abstract
The management of transchondral and osteochondral talar lesions has evolved, with microfracturing originally considered the best initial treatment. Despite talar lesions being a tri-dimensional defect, most studies use 2-dimensional parameters to grade them. We propose in this study that tri-dimensional sizing may be more appropriate in evaluation for treatment. The present study evaluated the outcomes of treatment of talar lesions performed by a single surgeon, creating and using an algorithm based on volume, location, and integrity of the subchondral plate. The lesions were classified as "small" (up to 125 mm3), "medium" (125 mm3-1500 mm3), and "large" (>1500 mm3) based upon evaluation of the preoperative magnetic resonance imagining. Location of the lesion was also noted on a 9-region grid pattern of the talar dome. These 3 parameters dictated whether a lesion required microfracturing or retrograde drilling, autogenous or allogenous bone graft, and whether an open versus an arthroscopic approach was required. Over a 10-year period, surgery was performed on 204 lesions. Overall, the average time to return to activity was 7.93 ± 5.00 (range 2-36) months. The average preoperative American Orthopaedic Foot and Ankle score was 76.44 ± 10.98 (range 52-86), and the average postoperative American Orthopaedic Foot and Ankle score was 96.12 ± 3.46 (range 81-100), p = .0001. By using the proposed algorithm, the outcome and return to activity for most patients can be better predicted, regardless of the size or location of the osteochondral lesion. The treatment algorithm implemented in the present investigation yielded overall acceptable results, with only 7 of the 204 lesions needing additional surgery.
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Affiliation(s)
- Amol Saxena
- Department of Sports Medicine, Sutter-PAMF, Palo Alto, CA.
| | - Nicola Maffulli
- Department of Musculoskeletal Disorder, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy; Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, London, United Kingdom; School of Pharmacy and Bioengineering, Keele University School of Medicine, Stoke on Trent, United Kingdom
| | - Anqi Jin
- Former PAMFRI Researcher, Palo Alto, CA
| | - Eghosa Isa
- Fellow, Kaiser Permanente South Sacramento, Valley Foot & Ankle Care, Fresno, CA
| | - Jessica Jaswal
- Student, Scholl College of Podiatric Medicine, Chicago, IL
| | - Ryan Allen
- Fellow, Department of Sports Medicine, Sutter-PAMF, Palo Alto, CA
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Zheng Y, Mei L, Li S, Ma T, Xia B, Hao Y, Gao X, Wei B, Wei Y, Jing D, Luo Z, Huang J. Pulsed Electromagnetic Field Alleviates Intervertebral Disc Degeneration by Activating Sirt1-Autophagy Signaling Network. Front Bioeng Biotechnol 2022; 10:853872. [PMID: 35387300 PMCID: PMC8978825 DOI: 10.3389/fbioe.2022.853872] [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: 01/13/2022] [Accepted: 03/07/2022] [Indexed: 11/13/2022] Open
Abstract
Intervertebral disc (IVD) degeneration is regarded as a major contributor to low back pain (LBP), causing serious economic burden on individuals and society. Unfortunately, there are limited effective treatment for IVD degeneration. Pulsed electromagnetic field (PEMF) is an economical and effective physical therapy method, with reduced side-effects. It offers certain protection to a number of degenerative diseases. Therefore, understanding the underlying mechanism of PEMF on IVD is important for improving the PEMF therapeutic efficiency. In this study, PEMF up-regulated extracellular matrix (ECM) related genes in degenerated nucleus pulposus (NP) cells. It also increased SIRT1 expression and promoted autophagy in degenerated NP cells. In contrast, the autophagy suppressor 3-methyladenine (3-MA) reversed the beneficial effect of PEMF on ECM production. Similarly, the SIRT1 enzyme activity suppressor EX 527 also inhibited the effect of PEMF on autophagy and ECM production in NP cells, thereby suggesting that PEMF regulated ECM related genes expression through SIRT1-autophagy signaling pathway. Lastly, PEMF significantly reduced IVD degeneration in a rat model of IVD degeneration in vivo. In summary, our study uncovers a critical role of SIRT1-dependent autophagy signaling pathway in ECM protection and thus in the establishment of therapeutic effect of PEMF on IVD degeneration.
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Affiliation(s)
- Yi Zheng
- Department of Orthopedics, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Liangwei Mei
- Department of Orthopedics, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Shengyou Li
- Department of Orthopedics, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Teng Ma
- Department of Orthopedics, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Bing Xia
- Department of Orthopedics, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Yiming Hao
- Department of Orthopedics, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Xue Gao
- Faculty of Life Sciences, Northwest University, Xi'an, China
| | - Bin Wei
- Department of Orthopedics, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Yitao Wei
- Department of Orthopedics, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Da Jing
- Department of Biomedical Engineering, Fourth Military Medical University, Xi'an, China
| | - Zhuojing Luo
- Department of Orthopedics, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Jinghui Huang
- Department of Orthopedics, Xijing Hospital, Fourth Military Medical University, Xi'an, China
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Dahmen J, Altink JN, Vuurberg G, Wijdicks CA, Stufkens SAS, Kerkhoffs GMMJ. Clinical efficacy of the Ankle Spacer for the treatment of multiple secondary osteochondral lesions of the talus. World J Orthop 2022; 13:178-192. [PMID: 35317406 PMCID: PMC8891659 DOI: 10.5312/wjo.v13.i2.178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 11/18/2021] [Accepted: 01/06/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The Ankle Spacer was developed as a joint-sparing alternative to invasive end-stage surgeries. Currently, there are no clinical studies on the Ankle Spacer.
AIM To describe the operative technique and the clinical efficacy of the Ankle Spacer for the treatment of multiple, cystic osteochondral lesions of the talus in patients with failed prior operative treatment.
METHODS This is a prospective study during which patients were assessed preoperatively, at 2- and 6 wk, and at 3, 6, 12 and 24 mo postoperatively. Patients with multiple, cystic or large (≥ 15 mm) osteochondral lesions of the talus after failed prior surgery were included. The primary outcome measure was the numeric rating scale (NRS) for pain during walking at 2 years postoperatively. Secondary outcome measures included the NRS in rest and during stair climbing, the American Orthopaedic Foot and Ankle Society Hindfoot Score, the Foot and Ankle Outcome Score, the Short- Form 36 physical and mental component scale, and the Range of Motion (ROM). Radiographic evaluations were conducted to evaluate prosthetic loosening and subsidence. Revision rates and complications were also assessed.
RESULTS Two patients underwent an Ankle Spacer implantation on the talus. The NRS during walking improved from 6 and 7 preoperatively to 2 and 2 points postoperatively at 2 years, in patient 1 and 2, respectively. The other patient-reported outcome measures also improved substantially. There were no re-operations nor complications. Radiological imaging showed no loosening of the implant and no change of implant position.
CONCLUSION The Ankle Spacer showed clinically relevant pain reduction during walking, improvement in clinical outcomes as assessed with PROMs, and no complications or re-operations. This treatment option may evolve as a joint-sparing alternative to invasive end-stage surgeries.
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Affiliation(s)
- Jari Dahmen
- Department of Orthopedic Surgery, Amsterdam UMC, Location AMC, Amsterdam 1105AZ, Netherlands
| | - J Nienke Altink
- Department of Orthopedic Surgery, Amsterdam UMC, Location AMC, Amsterdam 1105AZ, Netherlands
| | - Gwendolyn Vuurberg
- Department of Orthopedic Surgery, Amsterdam UMC, Location AMC, Amsterdam 1105AZ, Netherlands
| | - Coen A Wijdicks
- Department of Orthopedic Research, Arthrex, Naples, FL 34108, United States
| | - Sjoerd AS Stufkens
- Department of Orthopedic Surgery, Amsterdam UMC, Location AMC, Amsterdam 1105AZ, Netherlands
| | - Gino MMJ Kerkhoffs
- Department of Orthopedic Surgery, Amsterdam UMC, Location AMC, Amsterdam 1105AZ, Netherlands
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10
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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.
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11
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Rikken QGH, Dahmen J, Reilingh ML, van Bergen CJA, Stufkens SAS, Kerkhoffs GMMJ. Outcomes of Bone Marrow Stimulation for Secondary Osteochondral Lesions of the Talus Equal Outcomes for Primary Lesions. Cartilage 2021; 13:1429S-1437S. [PMID: 34167358 PMCID: PMC8739575 DOI: 10.1177/19476035211025816] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To compare clinical, sports, work, and radiological outcomes between primary and secondary osteochondral lesions of the talus (OLTs; <15 mm) treated with arthroscopic bone marrow stimulation (BMS). DESIGN Secondary OLTs were matched to primary OLTs in a 1:2 ratio to assess the primary outcome measure-the Numeric Rating Scale (NRS) during activities. Secondary outcomes included the pre- and 1-year postoperative NRS at rest, American Orthopaedic Foot and Ankle Society score, Foot and Ankle Outcome Score subscales, and the EQ-5D general health questionnaire. The rates and time to return to work and sports were collected. Radiological examinations were performed preoperatively and at final follow-up using computed tomography (CT). RESULTS After matching, 22 and 12 patients with small (<15 mm) OLTs were included in the primary and secondary groups, respectively. The NRS during activities was not different between primary cases (median: 2, interquartile range [IQR]: 1-4.5) and secondary cases (median: 3, IQR: 1-4), P = 0.5. Both groups showed a significant difference between all pre- and postoperative clinical outcome scores, but no significant difference between BMS groups postoperatively. The return to sport rate was 90% for primary cases and 83% for secondary cases (P = 0.6). All patients returned to work. Lesion filling on CT was complete (67% to 100%) in 59% of primary cases and 67% of secondary cases (P = 0.6). CONCLUSION No differences in outcomes were observed between arthroscopic bone marrow stimulation in primary and secondary OLTs at 1-year follow-up. Repeat BMS may therefore be a viable treatment option for failed OLTs in the short term.
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Affiliation(s)
- Quinten G. H. Rikken
- Department of Orthopaedic Surgery,
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,
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
| | - Mikel L. Reilingh
- Department of Orthopedic Surgery,
Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Christiaan J. A. van Bergen
- 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,
Amphia Hospital, Breda, The Netherlands
| | - Sjoerd A. S. Stufkens
- Department of Orthopaedic Surgery,
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
| | - Gino M. M. J. Kerkhoffs
- Department of Orthopaedic Surgery,
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,Gino M. M. J. Kerkhoffs, Department of
Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC—Location AMC,
University of Amsterdam, Amsterdam, The Netherlands.
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12
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Dahmen J, Hurley ET, Shimozono Y, Murawski CD, Stufkens SAS, Kerkhoffs GMMJ, Kennedy JG. Evidence-based Treatment of Failed Primary Osteochondral Lesions of the Talus: A Systematic Review on Clinical Outcomes of Bone Marrow Stimulation. Cartilage 2021; 13:1411S-1421S. [PMID: 33618537 PMCID: PMC8721623 DOI: 10.1177/1947603521996023] [Citation(s) in RCA: 8] [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] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE The purpose of this study is to systematically review the literature and to evaluate the outcomes following bone marrow stimulation (BMS) for nonprimary osteochondral lesions of the talus (OLT). DESIGN A literature search was performed to identify studies published using PubMed (MEDLINE), EMBASE, CDSR, DARE, and CENTRAL. The review was performed according to the PRISMA guidelines. Two authors separately and independently screened the search results and conducted the quality assessment using the Methodological Index for Non-Randomized Studies (MINORS). Studies were pooled on clinical, sports, work, and imaging outcomes, as well as revision rates and complications. The primary outcome was clinical success rate. RESULTS Five studies with 70 patients were included in whom nonprimary OLTs were treated with secondary BMS. The pooled clinical success rate was 61% (95% confidence interval [CI], 50-72). The rate of return to any level of sport was 83% (95% CI, 70-91), while the return to pre-injury level of sport was 55% (95% CI, 34-74). The rate of return to work was 92% (95% CI, 78-97), and the complication rate was assessed to be 10% (95% CI, 4-22). Imaging outcomes were heterogeneous in outcome assessment, though a depressed subchondral bone plate was observed in 91% of the patients. The revision rate was 27% (95% CI, 18-40). CONCLUSIONS The overall success rate of arthroscopic BMS for nonprimary osteochondral lesions of the talus was 61%, including a revision rate of 27%. Return to sports, work, and complication outcomes yielded fair to good results.
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Affiliation(s)
- Jari Dahmen
- Amsterdam UMC, University of Amsterdam,
Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam, the
Netherlands,Academic Center for Evidence-based
Sports Medicine (ACES), Amsterdam, the Netherlands,Amsterdam Collaboration for Health and
Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center
Amsterdam UMC, Amsterdam, the Netherlands,Jari Dahmen, Amsterdam UMC, University of
Amsterdam, Department of Orthopaedic Surgery, Amsterdam Movement Sciences,
Meibergdreef 9, Amsterdam 1105 AZ, the Netherlands.
| | - Eoghan T. Hurley
- Department of Orthopaedic Surgery, NYU
Langone Health, New York, NY, USA,Department of Orthopaedic Surgery, Royal
College of Surgeons in Ireland, Dublin, Ireland
| | - Yoshiharu Shimozono
- Department of Orthopaedic Surgery, NYU
Langone Health, New York, NY, USA,Department of Orthopaedic Surgery, Kyoto
University Graduate School of Medicine, Kyoto, Japan
| | - Christopher D. Murawski
- Department of Orthopaedic Surgery,
University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Sjoerd A. S. Stufkens
- Amsterdam UMC, University of Amsterdam,
Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam, the
Netherlands,Academic Center for Evidence-based
Sports Medicine (ACES), Amsterdam, the Netherlands,Amsterdam Collaboration for Health and
Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center
Amsterdam UMC, Amsterdam, the Netherlands
| | - Gino M. M. J. Kerkhoffs
- Amsterdam UMC, University of Amsterdam,
Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam, the
Netherlands,Academic Center for Evidence-based
Sports Medicine (ACES), Amsterdam, the Netherlands,Amsterdam Collaboration for Health and
Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center
Amsterdam UMC, Amsterdam, the Netherlands
| | - John G. Kennedy
- Department of Orthopaedic Surgery, NYU
Langone Health, New York, NY, USA
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13
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Schwartz AM, Niu S, Mirza FA, Thomas AR, Labib SA. Surgical Treatment of Talus OCL: Mid- to Long-Term Clinical Outcome With Detailed Analyses of Return to Sport. J Foot Ankle Surg 2021; 60:1188-1192. [PMID: 34130931 DOI: 10.1053/j.jfas.2021.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/28/2021] [Accepted: 05/05/2021] [Indexed: 02/03/2023]
Abstract
Talus osteochondral lesions are a commonly underdiagnosed problem in young athletes. Talus osteochondral lesions surgical algorithm remains controversial. Current metrics suggest that conventional treatment of osteochondral lesions of the talus is promising; yet return to sport is poorly studied. Fifty-seven patients following talus osteochondral lesion surgical intervention were included in this study. About 63.1% were female with mean age 37.1 years, mean lesion size 10 × 12.5 mm, and mean follow-up 79.9 months postoperatively. Patients were divided into 4 groups by surgery performed: antegrade arthroscopic bone marrow stimulation, retrograde arthroscopic drilling, osteochondral autograft transfer, and allograft cartilage implantation. Outcome metrics include Visual Analog Scale for pain and function, Short Form-12, Foot and Ankle Disability Scale, Tegner, Marx activity scores, Naal Sports inventory, and patient satisfaction. Over 77% of patients were satisfied with surgical intervention. Each intervention significantly decreased pain and increased function, except retrograde drilling. All interventions trended toward decreased Tegner score; only antegrade drilling showed significant decrease. Based on Naal's sports inventory, 85.7% of surgically treated patients reported participating in sport activities, on average 3 times/week and 50.6 minutes/session. Traditionally, talus osteochondral lesions present a difficult problem that is marred by unsatisfactory nonoperative outcomes in typically active patients. As our surgical understanding has evolved, we've continued to improve on outcomes. Our patients demonstrated 77.2% overall satisfaction rate, a statistically significant improvement in pain and function, at an average follow-up of 79.9 months postoperatively, and a high rate of return to sport with little difference between surgical interventions.
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Affiliation(s)
| | - Shuo Niu
- Emory University School of Medicine, Atlanta, GA
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14
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Qulaghassi M, Cho YS, Khwaja M, Dhinsa B. Treatment strategies for osteochondral lesions of the talus: A review of the recent evidence. Foot (Edinb) 2021; 47:101805. [PMID: 33946007 DOI: 10.1016/j.foot.2021.101805] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 03/08/2021] [Accepted: 04/11/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND There has been no consensus regarding the treatment of osteochondral lesions of the talus, there has been many attempts to formulate a treatment pathway, with multiple proposed modalities and adjuncts used. OBJECTIVES The aim of this paper was to investigate the evidence published in the recent history, identify the relevant papers, review and summarize the findings, to help clarify the available operative treatment options and their respective efficacies based on the level of evidence provided. STUDY DESIGN & METHODS A literature search through electronic databases MEDLINE and EMBASE was done, these databases were screened for publications and papers form June 2004 to June 2019. Key words were utilised in the search 'talus, talar, tibia, cartilage, osteochondral, ankle, osteochondritis dissecans, articular cartilage'. Studies on adults aged 18-60 years were included. Exclusion criteria were studies with less than 10 patients, or no clear outcome was recorded. Papers were reviewed by the authors and data extracted as per a pre-defined proforma. RESULTS Following screening, 28 published articles were included and reviewed. Of these publications 5 were level I, 7 level II, 4 level III and 12 level IV. The total number of patients was 1061 patients. Treatment modalities included arthroscopic microfracture, drilling, hyaluronic acid injection, platelet rich plasma, osteochondral autologous transplantation (OAT), vascularised free bone graft among others. The most common functional measures used to assess efficacy were the Visual analogue scale (VAS) and the American Orthopaedic Foot and Ankle (AOFAS) score. Follow up ranged from 26 weeks upto 4 years. CONCLUSIONS Despite the abundance of treatment options, high level evidence (level I) remains limited and does not conclude a definitive treatment modality as superior to others. Further research, in the form highly organised randomised clinical trials, is needed to help improve the efficacy and develop new treatment modalities in the future.
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Affiliation(s)
| | - Young Seok Cho
- East Kent Hospitals NHS University Foundation Trust, Ashford, United Kingdom
| | | | - Baljinder Dhinsa
- East Kent Hospitals NHS University Foundation Trust, Ashford, United Kingdom
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15
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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: 2] [Impact Index Per Article: 0.7] [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.
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16
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Lambers KTA, Dahmen J, Altink JN, Reilingh ML, van Bergen CJA, Kerkhoffs GMMJ. Bone marrow stimulation for talar osteochondral lesions at long-term follow-up shows a high sports participation though a decrease in clinical outcomes over time. Knee Surg Sports Traumatol Arthrosc 2021; 29:1562-1569. [PMID: 32918555 PMCID: PMC8038982 DOI: 10.1007/s00167-020-06250-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 08/21/2020] [Indexed: 01/13/2023]
Abstract
PURPOSE Although bone marrow stimulation (BMS) as a treatment for osteochondral lesions of the talus (OCLT) shows high rates of sport resumption at short-term follow-up, it is unclear whether the sports activity is still possible at longer follow-up. The purpose of this study was, therefore, to evaluate sports activity after arthroscopic BMS at long-term follow-up. METHODS Sixty patients included in a previously published randomized-controlled trial were analyzed in the present study. All patients had undergone arthroscopic debridement and BMS for OCLT. Return to sports, level, and type were assessed in the first year post-operative and at final follow-up. Secondary outcome measures were assessed by standardized questionnaires with use of numeric rating scales for pain and satisfaction and the Foot and Ankle Outcome Score (FAOS). RESULTS The mean follow-up was 6.4 years (SD ± 1.1 years). The mean level of activity measured with the AAS was 6.2 pre-injury and 3.4 post-injury. It increased to 5.2 at 1 year after surgery and was 5.8 at final follow-up. At final follow-up, 54 patients (90%) participated in 16 different sports. Thirty-three patients (53%) indicated they returned to play sport at their pre-injury level. Twenty patients (33%) were not able to obtain their pre-injury level of sport because of ankle problems and eight other patients (13%) because of other reasons. Mean NRS for pain during rest was 2.7 pre-operative, 1.1 at 1 year, and 1.0 at final follow-up. Mean NRS during activity changed from 7.9 to 3.7 to 4.4, respectively. The FAOS scores improved at 1 year follow-up, but all subscores significantly decreased at final follow-up. CONCLUSION At long-term follow-up (mean 6.4 years) after BMS for OCLT, 90% of patients still participate in sports activities, of whom 53% at pre-injury level. The AAS of the patients participating in sports remains similar pre-injury and post-operatively at final follow-up. A decrease over time in clinical outcomes was, however, seen when the follow-up scores at 1 year post-operatively were compared with the final follow-up. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Kaj T A Lambers
- Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ, 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 Orthopaedic Surgery, Academic Medical Center, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ, 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 Orthopaedic Surgery, Academic Medical Center, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ, 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
| | - Mikel L Reilingh
- 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
- Department of Orthopedic Surgery, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Christiaan J A van Bergen
- 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
- Department of Orthopedic Surgery, Amphia Hospital, Breda, The Netherlands
| | - Gino M M J Kerkhoffs
- Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ, 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.
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17
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Ehnert S, Schröter S, Aspera-Werz RH, Eisler W, Falldorf K, Ronniger M, Nussler AK. Translational Insights into Extremely Low Frequency Pulsed Electromagnetic Fields (ELF-PEMFs) for Bone Regeneration after Trauma and Orthopedic Surgery. J Clin Med 2019; 8:jcm8122028. [PMID: 31756999 PMCID: PMC6947624 DOI: 10.3390/jcm8122028] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 11/15/2019] [Accepted: 11/18/2019] [Indexed: 02/07/2023] Open
Abstract
The finding that alterations in electrical potential play an important role in the mechanical stimulation of the bone provoked hype that noninvasive extremely low frequency pulsed electromagnetic fields (ELF-PEMF) can be used to support healing of bone and osteochondral defects. This resulted in the development of many ELF-PEMF devices for clinical use. Due to the resulting diversity of the ELF-PEMF characteristics regarding treatment regimen, and reported results, exposure to ELF-PEMFs is generally not among the guidelines to treat bone and osteochondral defects. Notwithstanding, here we show that there is strong evidence for ELF-PEMF treatment. We give a short, confined overview of in vitro studies investigating effects of ELF-PEMF treatment on bone cells, highlighting likely mechanisms. Subsequently, we summarize prospective and blinded studies, investigating the effect of ELF-PEMF treatment on acute bone fractures and bone fracture non-unions, osteotomies, spinal fusion, osteoporosis, and osteoarthritis. Although these studies favor the use of ELF-PEMF treatment, they likewise demonstrate the need for more defined and better controlled/monitored treatment modalities. However, to establish indication-oriented treatment regimen, profound knowledge of the underlying mechanisms in the sense of cellular pathways/events triggered is required, highlighting the need for more systematic studies to unravel optimal treatment conditions.
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Affiliation(s)
- Sabrina Ehnert
- Siegfried Weller Institute for Trauma Research, Depterment of Trauma and Reconstructive Surgery, BG Unfallklinik Tübingen, Eberhard Karls Universität Tübingen, D-72076 Tübingen, Germany; (S.S.); (R.H.A.-W.); (W.E.); (A.K.N.)
- Correspondence: or ; Tel.: +49-7071-606-1067
| | - Steffen Schröter
- Siegfried Weller Institute for Trauma Research, Depterment of Trauma and Reconstructive Surgery, BG Unfallklinik Tübingen, Eberhard Karls Universität Tübingen, D-72076 Tübingen, Germany; (S.S.); (R.H.A.-W.); (W.E.); (A.K.N.)
| | - Romina H. Aspera-Werz
- Siegfried Weller Institute for Trauma Research, Depterment of Trauma and Reconstructive Surgery, BG Unfallklinik Tübingen, Eberhard Karls Universität Tübingen, D-72076 Tübingen, Germany; (S.S.); (R.H.A.-W.); (W.E.); (A.K.N.)
| | - Wiebke Eisler
- Siegfried Weller Institute for Trauma Research, Depterment of Trauma and Reconstructive Surgery, BG Unfallklinik Tübingen, Eberhard Karls Universität Tübingen, D-72076 Tübingen, Germany; (S.S.); (R.H.A.-W.); (W.E.); (A.K.N.)
| | - Karsten Falldorf
- Sachtleben GmbH, Hamburg, Haus Spectrum am UKE, Martinistraße 64, D-20251 Hamburg, Germany; (K.F.); (M.R.)
| | - Michael Ronniger
- Sachtleben GmbH, Hamburg, Haus Spectrum am UKE, Martinistraße 64, D-20251 Hamburg, Germany; (K.F.); (M.R.)
| | - Andreas K. Nussler
- Siegfried Weller Institute for Trauma Research, Depterment of Trauma and Reconstructive Surgery, BG Unfallklinik Tübingen, Eberhard Karls Universität Tübingen, D-72076 Tübingen, Germany; (S.S.); (R.H.A.-W.); (W.E.); (A.K.N.)
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Ziegler P, Nussler AK, Wilbrand B, Falldorf K, Springer F, Fentz AK, Eschenburg G, Ziegler A, Stöckle U, Maurer E, Ateschrang A, Schröter S, Ehnert S. Pulsed Electromagnetic Field Therapy Improves Osseous Consolidation after High Tibial Osteotomy in Elderly Patients-A Randomized, Placebo-Controlled, Double-Blind Trial. J Clin Med 2019; 8:jcm8112008. [PMID: 31744243 PMCID: PMC6912342 DOI: 10.3390/jcm8112008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 11/13/2019] [Accepted: 11/15/2019] [Indexed: 11/25/2022] Open
Abstract
Extremely low-frequency pulsed electromagnetic field (ELF-PEMF) therapy is proposed to support bone healing after injuries and surgical procedures, being of special interest for elderly patients. This study aimed at investigating the effect of a specific ELF-PEMF, recently identified to support osteoblast function in vitro, on bone healing after high tibial osteotomy (HTO). Patients who underwent HTO were randomized to ELF-PEMF or placebo treatment, both applied by optically identical external devices 7 min per day for 30 days following surgery. Osseous consolidation was evaluated by post-surgical X-rays (7 and 14 weeks). Serum markers were quantified by ELISA. Data were compared by a two-sided t-test (α = 0.05). Device readouts showed excellent therapy compliance. Baseline parameters, including age, sex, body mass index, wedge height and blood cell count, were comparable between both groups. X-rays revealed faster osseous consolidation for ELF-PEMF compared to placebo treatment, which was significant in patients ≥50 years (∆mean = 0.68%/week; p = 0.003). Findings are supported by post-surgically increased bone-specific alkaline phosphatase serum levels following ELF-PEMF, compared to placebo (∆mean = 2.2 µg/L; p = 0.029) treatment. Adverse device effects were not reported. ELF-PEMF treatment showed a tendency to accelerate osseous consolidation after HTO. This effect was stronger and more significant for patients ≥50 years. This ELF-PEMF treatment might represent a promising adjunct to conventional therapy supporting osseous consolidation in elderly patients. Level of Evidence: I.
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Affiliation(s)
- Patrick Ziegler
- Siegfried Weller Institute for Trauma Research, Department of Trauma and Reconstructive Surgery, BG Unfallklinik Tübingen, Eberhard Karls Universität Tübingen, Schnarrenbergstr. 95, D-72076 Tübingen, Germany; (P.Z.); (B.W.); (E.M.); (A.A.); (S.S.); (S.E.)
| | - Andreas K. Nussler
- Siegfried Weller Institute for Trauma Research, Department of Trauma and Reconstructive Surgery, BG Unfallklinik Tübingen, Eberhard Karls Universität Tübingen, Schnarrenbergstr. 95, D-72076 Tübingen, Germany; (P.Z.); (B.W.); (E.M.); (A.A.); (S.S.); (S.E.)
- Correspondence: ; Tel.: +49-7071-606-1065
| | - Benjamin Wilbrand
- Siegfried Weller Institute for Trauma Research, Department of Trauma and Reconstructive Surgery, BG Unfallklinik Tübingen, Eberhard Karls Universität Tübingen, Schnarrenbergstr. 95, D-72076 Tübingen, Germany; (P.Z.); (B.W.); (E.M.); (A.A.); (S.S.); (S.E.)
| | - Karsten Falldorf
- Sachtleben GmbH, Haus Spectrum am UKE, Martinistraße 64, D-20251 Hamburg, Germany; (K.F.); (A.-K.F.); (G.E.)
| | - Fabian Springer
- Department of Diagnostic and Interventional Radiology, University of Tübingen, Hoppe-Seyler-Str. 3, D-72076 Tübingen, Germany;
| | - Anne-Kristin Fentz
- Sachtleben GmbH, Haus Spectrum am UKE, Martinistraße 64, D-20251 Hamburg, Germany; (K.F.); (A.-K.F.); (G.E.)
| | - Georg Eschenburg
- Sachtleben GmbH, Haus Spectrum am UKE, Martinistraße 64, D-20251 Hamburg, Germany; (K.F.); (A.-K.F.); (G.E.)
| | - Andreas Ziegler
- StatSol Lübeck, Moenring 2, D-23560 Lübeck, Germany;
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Pietermaritzburg, Scottsville 3209, South Africa
| | - Ulrich Stöckle
- Center for Musculoskeletal Surgery, Charité—University Medicine Berlin, Augustenburger Platz 1, D-13353 Berlin, Germany;
| | - Elke Maurer
- Siegfried Weller Institute for Trauma Research, Department of Trauma and Reconstructive Surgery, BG Unfallklinik Tübingen, Eberhard Karls Universität Tübingen, Schnarrenbergstr. 95, D-72076 Tübingen, Germany; (P.Z.); (B.W.); (E.M.); (A.A.); (S.S.); (S.E.)
| | - Atesch Ateschrang
- Siegfried Weller Institute for Trauma Research, Department of Trauma and Reconstructive Surgery, BG Unfallklinik Tübingen, Eberhard Karls Universität Tübingen, Schnarrenbergstr. 95, D-72076 Tübingen, Germany; (P.Z.); (B.W.); (E.M.); (A.A.); (S.S.); (S.E.)
| | - Steffen Schröter
- Siegfried Weller Institute for Trauma Research, Department of Trauma and Reconstructive Surgery, BG Unfallklinik Tübingen, Eberhard Karls Universität Tübingen, Schnarrenbergstr. 95, D-72076 Tübingen, Germany; (P.Z.); (B.W.); (E.M.); (A.A.); (S.S.); (S.E.)
| | - Sabrina Ehnert
- Siegfried Weller Institute for Trauma Research, Department of Trauma and Reconstructive Surgery, BG Unfallklinik Tübingen, Eberhard Karls Universität Tübingen, Schnarrenbergstr. 95, D-72076 Tübingen, Germany; (P.Z.); (B.W.); (E.M.); (A.A.); (S.S.); (S.E.)
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Steman JA, Dahmen J, Lambers KT, Kerkhoffs GM. Return to Sports After Surgical Treatment of Osteochondral Defects of the Talus: A Systematic Review of 2347 Cases. Orthop J Sports Med 2019; 7:2325967119876238. [PMID: 31673563 PMCID: PMC6806124 DOI: 10.1177/2325967119876238] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Osteochondral defects (OCDs) of the talus are found subsequent to ankle sprains and ankle fractures. With many surgical treatment strategies available, there is no clear evidence on return-to-sport (RTS) times and rates. PURPOSE To summarize RTS times and rates for talar OCDs treated by different surgical techniques. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS The literature from January 1996 to November 2018 was screened, and identified studies were divided into 7 different surgical treatment groups. The RTS rate, with and without associated levels of activity, and the mean time to RTS were calculated per study. When methodologically possible, a simplified pooling method was used to combine studies within 1 treatment group. Study bias was assessed using the MINORS (Methodological Index for Non-Randomized Studies) scoring system. RESULTS A total of 61 studies including 2347 talar OCDs were included. The methodological quality of the studies was poor. There were 10 retrospective case series (RCSs) that investigated bone marrow stimulation in 339 patients, with a pooled mean rate of RTS at any level of 88% (95% CI, 84%-91%); 2 RCSs investigating internal fixation in 47 patients found a pooled RTS rate of 97% (95% CI, 85%-99%), 5 RCSs in which autograft transplantation was performed in 194 patients found a pooled RTS rate of 90% (95% CI, 86%-94%), and 3 prospective case series on autologous chondrocyte implantation in 39 patients found a pooled RTS rate of 87% (95% CI, 73%-94%). The rate of return to preinjury level of sports was 79% (95% CI, 70%-85%) for 120 patients after bone marrow stimulation, 72% (95% CI, 60%-83%) for 67 patients after autograft transplantation, and 69% (95% CI, 54%-81%) for 39 patients after autologous chondrocyte implantation. The mean time to RTS ranged from 13 to 26 weeks, although no pooling was possible for this outcome measure. CONCLUSION Different surgical treatment options for talar OCDs allow for adequate RTS times and rates. RTS rates decreased when considering patients' return to preinjury levels versus return at any level.
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Affiliation(s)
- Jason A.H. Steman
- Department of Orthopaedic Surgery, Academic Medical Center,
University of Amsterdam, Amsterdam, the Netherlands
- Academic Center for Evidence-Based Sports Medicine, Amsterdam, the
Netherlands
- Amsterdam Collaboration on Health and Safety in Sports, Academic
Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Jari Dahmen
- Department of Orthopaedic Surgery, Academic Medical Center,
University of Amsterdam, Amsterdam, the Netherlands
- Academic Center for Evidence-Based Sports Medicine, Amsterdam, the
Netherlands
- Amsterdam Collaboration on Health and Safety in Sports, Academic
Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Kaj T.A. Lambers
- Department of Orthopaedic Surgery, Academic Medical Center,
University of Amsterdam, Amsterdam, the Netherlands
- Academic Center for Evidence-Based Sports Medicine, Amsterdam, the
Netherlands
- Amsterdam Collaboration on Health and Safety in Sports, Academic
Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- Department of Orthopedic Surgery, Amphia Hospital, Breda, the
Netherlands
| | - Gino M.M.J. Kerkhoffs
- Department of Orthopaedic Surgery, Academic Medical Center,
University of Amsterdam, Amsterdam, the Netherlands
- Academic Center for Evidence-Based Sports Medicine, Amsterdam, the
Netherlands
- Amsterdam Collaboration on Health and Safety in Sports, Academic
Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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20
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Hurley ET, Shimozono Y, McGoldrick NP, Myerson CL, Yasui Y, Kennedy JG. High reported rate of return to play following bone marrow stimulation for osteochondral lesions of the talus. Knee Surg Sports Traumatol Arthrosc 2019; 27:2721-2730. [PMID: 29582098 DOI: 10.1007/s00167-018-4913-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 03/20/2018] [Indexed: 12/11/2022]
Abstract
PURPOSE The purpose of this study is to systematically review the literature and to evaluate the reported rehabilitation protocols, return to play guidelines and subsequent rates and timing of return to play following bone marrow stimulation (BMS) for osteochondral lesions of the talus (OLT). METHODS MEDLINE, EMBASE and the Cochrane Library were searched according to the PRISMA guidelines in September 2017. The rate and timing of return to play was assessed. The rehabilitation protocols were recorded, including time to start range of motion, partial weight-bearing and complete weight-bearing. RESULTS Fifty-seven studies with 3072 ankles were included, with a mean age of 36.9 years (range 23-56.8 years), and a mean follow-up of 46.0 months (range 1.5-141 months). The mean rate of return to play was 86.8% (range 60-100%), and the mean time to return to play was 4.5 months (range 3.5-5.9 months). There was large variability in the reported rehabilitation protocols. Range of motion exercises were most often allowed to begin in the first week (46.2%), and second week postoperatively (23.1%). The most commonly reported time to start partial weight-bearing was the first week (38.8%), and the most frequently reported time of commencing full weight-bearing was 6 weeks (28.8%). Surgeons most often allowed return to play at 4 months (37.5%). CONCLUSIONS There is a high rate of return following BMS for OLT with 86.8% and the mean time to return to play was 4.5 months. There is also a significant deficiency in reported rehabilitation protocols, and poor quality reporting in return to play criteria. Early weightbearing and early postoperative range of motion exercises appear to be advantageous in accelerated return to sports. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- 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
| | - 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
| | - Niall P McGoldrick
- Department of Trauma and Orthopaedic Surgery, St. Vincent's University Hospital, Elm Park, Dublin 4, 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
| | - Youichi Yasui
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - John G Kennedy
- Hospital for Special Surgery, 523 East 72nd Street, Suite 507, New York, NY, 10021, USA.
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21
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Electrical stimulation-based bone fracture treatment, if it works so well why do not more surgeons use it? Eur J Trauma Emerg Surg 2019; 46:245-264. [PMID: 30955053 DOI: 10.1007/s00068-019-01127-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 03/29/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Electrical stimulation (EStim) has been proven to promote bone healing in experimental settings and has been used clinically for many years and yet it has not become a mainstream clinical treatment. METHODS To better understand this discrepancy we reviewed 72 animal and 69 clinical studies published between 1978 and 2017, and separately asked 161 orthopedic surgeons worldwide about their awareness, experience, and acceptance of EStim for treating fracture patients. RESULTS Of the 72 animal studies, 77% reported positive outcomes, and the most common model, bone, fracture type, and method of administering EStim were dog, tibia, large bone defects, and DC, respectively. Of the 69 clinical studies, 73% reported positive outcomes, and the most common bone treated, fracture type, and method of administration were tibia, delayed/non-unions, and PEMF, respectively. Of the 161 survey respondents, most (73%) were aware of the positive outcomes reported in the literature, yet only 32% used EStim in their patients. The most common fracture they treated was delayed/non-unions, and the greatest problems with EStim were high costs and inconsistent results. CONCLUSION Despite their awareness of EStim's pro-fracture healing effects few orthopedic surgeons use it in their patients. Our review of the literature and survey indicate that this is due to confusion in the literature due to the great variation in methods reported, and the inconsistent results associated with this treatment approach. In spite of this surgeons seem to be open to using this treatment if advancements in the technology were able to provide an easy to use, cost-effective method to deliver EStim in their fracture patients.
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22
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Management of Conditions Associated With Aging and Older Adults Using Therapeutic Electromagnetic Energy. TOPICS IN GERIATRIC REHABILITATION 2018. [DOI: 10.1097/tgr.0000000000000210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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23
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Reilingh ML, Lambers KTA, Dahmen J, Opdam KTM, Kerkhoffs GMMJ. The subchondral bone healing after fixation of an osteochondral talar defect is superior in comparison with microfracture. Knee Surg Sports Traumatol Arthrosc 2018; 26:2177-2182. [PMID: 28752185 PMCID: PMC6061443 DOI: 10.1007/s00167-017-4654-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 07/19/2017] [Indexed: 12/15/2022]
Abstract
PURPOSE Arthroscopic bone marrow stimulation (BMS) has been considered the primary surgical treatment for osteochondral defects (OCDs) of the talus. However, fixation has been considered as a good alternative. Recently, a new arthroscopic fixation technique was described: the lift, drill, fill and fix procedure (LDFF). The purpose of this study was to evaluate the clinical and radiological results between arthroscopic LDFF and arthroscopic BMS in primary fixable talar OCDs at 1-year follow-up. METHODS In a prospective comparative study, 14 patients were treated with arthroscopic BMS and 14 patients with arthroscopic LDFF. Pre- and postoperative clinical assessment included the American Orthopaedic Foot and Ankle Society (AOFAS) score and the numeric rating scales (NRSs) of pain at rest and running. Additionally, the level of the subchondral plate (flush or depressed) was analysed on the 1 year postoperative computed tomography scans. RESULTS No significant differences in the AOFAS and NRS pain at rest and running were found between both groups at 1-year follow-up. After LDFF the level of the subchondral bone plate was flush in 10 patients and after BMS in three patients (p = 0.02). CONCLUSION No clinical differences were found between arthroscopic LDFF and arthroscopic BMS in the treatment of talar OCDs at 1-year follow-up. However, the subchondral bone plate restores significantly superior after arthroscopic LDFF compared to arthroscopic BMS. It may therefore give less progression of ankle osteoarthritis in the future with a thus potential better long-term outcome. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Mikel L. Reilingh
- Department of Orthopedic Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ,Academic Center for Evidence Based Sports Medicine (ACES), Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Kaj T. A. Lambers
- Department of Orthopedic Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ,Academic Center for Evidence Based Sports Medicine (ACES), Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Jari Dahmen
- Department of Orthopedic Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ,Academic Center for Evidence Based Sports Medicine (ACES), Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Kim T. M. Opdam
- Department of Orthopedic Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ,Academic Center for Evidence Based Sports Medicine (ACES), Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Gino M. M. J. Kerkhoffs
- Department of Orthopedic Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ,Academic Center for Evidence Based Sports Medicine (ACES), Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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24
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Dahmen J, Lambers KTA, Reilingh ML, van Bergen CJA, Stufkens SAS, Kerkhoffs GMMJ. No superior treatment for primary osteochondral defects of the talus. Knee Surg Sports Traumatol Arthrosc 2018; 26:2142-2157. [PMID: 28656457 PMCID: PMC6061466 DOI: 10.1007/s00167-017-4616-5] [Citation(s) in RCA: 104] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 06/19/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this systematic literature review is to detect the most effective treatment option for primary talar osteochondral defects in adults. METHODS A literature search was performed to identify studies published from January 1996 to February 2017 using PubMed (MEDLINE), EMBASE, CDSR, DARE, and CENTRAL. Two authors separately and independently screened the search results and conducted the quality assessment using the Newcastle-Ottawa Scale. Subsequently, success rates per separate study were calculated. Studies methodologically eligible for a simplified pooling method were combined. RESULTS Fifty-two studies with 1236 primary talar osteochondral defects were included of which forty-one studies were retrospective and eleven prospective. Two randomised controlled trials (RCTs) were identified. Heterogeneity concerning methodological nature was observed, and there was variety in reported success rates. A simplified pooling method performed for eleven retrospective case series including 317 ankles in the bone marrow stimulation group yielded a success rate of 82% [CI 78-86%]. For seven retrospective case series investigating an osteochondral autograft transfer system or an osteoperiosteal cylinder graft insertion with in total 78 included ankles the pooled success rate was calculated to be 77% [CI 66-85%]. CONCLUSIONS For primary talar osteochondral defects, none of the treatment options showed any superiority over others. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Jari Dahmen
- Department of Orthopedic Surgery, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ,Academic Center for Evidence based Sports medicine (ACES), Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Kaj T. A. Lambers
- Department of Orthopedic Surgery, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ,Academic Center for Evidence based Sports medicine (ACES), Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Mikel L. Reilingh
- Department of Orthopedic Surgery, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ,Academic Center for Evidence based Sports medicine (ACES), Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Christiaan J. A. van Bergen
- Department of Orthopedic Surgery, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ,Academic Center for Evidence based Sports medicine (ACES), Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ,Department of Orthopedic Surgery, Amphia Hospital, Breda, The Netherlands
| | - Sjoerd. A. S. Stufkens
- Department of Orthopedic Surgery, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ,Academic Center for Evidence based Sports medicine (ACES), Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Gino M. M. J. Kerkhoffs
- Department of Orthopedic Surgery, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ,Academic Center for Evidence based Sports medicine (ACES), Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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25
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Lambers KTA, Dahmen J, Reilingh ML, van Bergen CJA, Stufkens SAS, Kerkhoffs GMMJ. No superior surgical treatment for secondary osteochondral defects of the talus. Knee Surg Sports Traumatol Arthrosc 2018; 26:2158-2170. [PMID: 28687862 PMCID: PMC6061445 DOI: 10.1007/s00167-017-4629-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 06/26/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of this systematic review was to identify the most effective surgical treatment for talar osteochondral defects after failed primary surgery. METHODS A literature search was conducted to find studies published from January 1996 till July 2016 using PubMed (MEDLINE), EMBASE, CDSR, DARE and CENTRAL. Two authors screened the search results separately and conducted quality assessment independently using the Newcastle-Ottawa scale. Weighted success rates were calculated. Studies eligible for pooling were combined. RESULTS Twenty-one studies with a total of 299 patients with 301 talar OCDs that failed primary surgery were investigated. Eight studies were retrospective case series, twelve were prospective case series and there was one randomized controlled trial. Calculated success percentages varied widely and ranged from 17 to 100%. Because of the low level of evidence and the scarce number of patients, no methodologically proper meta-analysis could be performed. A simplified pooling method resulted in a calculated mean success rate of 90% [CI 82-95%] for the osteochondral autograft transfer procedure, 65% [CI 46-81%] for mosaicplasty and 55% [CI 40-70%] for the osteochondral allograft transfer procedure. There was no significant difference between classic autologous chondrocyte implantation (success rate of 59% [CI 39-77%]) and matrix-associated chondrocyte implantation (success rate of 73% [CI 56-85%]). CONCLUSIONS Multiple surgical treatments are used for talar OCDs after primary surgical failure. More invasive methods are administered in comparison with primary treatment. No methodologically proper meta-analysis could be performed because of the low level of evidence and the limited number of patients. It is therefore inappropriate to draw firm conclusions from the collected results. Besides an expected difference in outcome between the autograft transfer procedure and the more extensive procedures of mosaicplasty and the use of an allograft, neither a clear nor a significant difference between treatment options could be demonstrated. The need for sufficiently powered prospective investigations in a randomized comparative clinical setting remains high. This present systematic review can be used in order to inform patients about expected outcome of the different treatment methods used after failed primary surgery. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Kaj T. A. Lambers
- Department of Orthopedic Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ 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, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ 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
| | - Mikel L. Reilingh
- Department of Orthopedic Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ 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
| | - Christiaan J. A. van Bergen
- Department of Orthopedic Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ 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 ,Department of Orthopedic Surgery, Amphia Hospital, Breda, The Netherlands
| | - Sjoerd A. S. Stufkens
- Department of Orthopedic Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ 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, 1105 AZ 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
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26
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Dahmen J, Lambers KTA, Reilingh ML, van Bergen CJA, Stufkens SAS, Kerkhoffs GMMJ. Reply to the letter to the editor: comment on "No superior treatment for primary osteochondral defects of the talus". Knee Surg Sports Traumatol Arthrosc 2017; 25:3984-3986. [PMID: 28918432 DOI: 10.1007/s00167-017-4715-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Accepted: 09/11/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Jari Dahmen
- Department of Orthopedic Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.,Academic Center for Evidence-based Sports medicine (ACES), Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Kaj T A Lambers
- Department of Orthopedic Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.,Academic Center for Evidence-based Sports medicine (ACES), Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Mikel L Reilingh
- Department of Orthopedic Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.,Academic Center for Evidence-based Sports medicine (ACES), Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Christiaan J A van Bergen
- Department of Orthopedic Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.,Academic Center for Evidence-based Sports medicine (ACES), Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.,Department of Orthopedic Surgery, Amphia Hospital, Breda, The Netherlands
| | - Sjoerd A S Stufkens
- Department of Orthopedic Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.,Academic Center for Evidence-based Sports medicine (ACES), Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Gino M M J Kerkhoffs
- Department of Orthopedic Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. .,Academic Center for Evidence-based Sports medicine (ACES), Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. .,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
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Comment on "No superior treatment for primary osteochondral defects of the talus. Dahmen J, et al. KSSTA 2017 Jun 27 PMID:28656457". Knee Surg Sports Traumatol Arthrosc 2017; 25:3982-3983. [PMID: 28871367 DOI: 10.1007/s00167-017-4700-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 08/24/2017] [Indexed: 10/18/2022]
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Candela V, Longo UG, Ciuffreda M, Salvatore G, Berton A, Cimmino M, Denaro V. Talar osteochondral size influences outcome after bone marrow stimulation: a systematic review. J ISAKOS 2017. [DOI: 10.1136/jisakos-2016-000092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Ng JL, Kersh ME, Kilbreath S, Knothe Tate M. Establishing the Basis for Mechanobiology-Based Physical Therapy Protocols to Potentiate Cellular Healing and Tissue Regeneration. Front Physiol 2017; 8:303. [PMID: 28634452 PMCID: PMC5460618 DOI: 10.3389/fphys.2017.00303] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Accepted: 04/27/2017] [Indexed: 12/17/2022] Open
Abstract
Life is mechanobiological: mechanical stimuli play a pivotal role in the formation of structurally and functionally appropriate body templates through mechanobiologically-driven cellular and tissue re/modeling. The body responds to mechanical stimuli engendered through physical movement in an integrated fashion, internalizing and transferring forces from organ, through tissue and cellular length scales. In the context of rehabilitation and therapeutic outcomes, such mechanical stimuli are referred to as mechanotherapy. Physical therapists use mechanotherapy and mechanical interventions, e.g., exercise therapy and manual mobilizations, to restore function and treat disease and/or injury. While the effect of directed movement, such as in physical therapy, is well documented at the length scale of the body and its organs, a number of recent studies implicate its integral effect in modulating cellular behavior and subsequent tissue adaptation. Yet the link between movement biomechanics, physical therapy, and subsequent cellular and tissue mechanoadaptation is not well established in the literature. Here we review mechanoadaptation in the context of physical therapy, from organ to cell scale mechanotransduction and cell to organ scale extracellular matrix genesis and re/modeling. We suggest that physical therapy can be developed to harness the mechanosensitivity of cells and tissues, enabling prescriptive definition of physical and mechanical interventions to enhance tissue genesis, healing, and rehabilitation.
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Affiliation(s)
- Joanna L. Ng
- Graduate School of Biomedical Engineering, University of New South WalesSydney, NSW, Australia
| | - Mariana E. Kersh
- Department of Mechanical Science and Engineering, University of Illinois at Urbana-ChampaignChampaign, IL, United States
| | - Sharon Kilbreath
- Faculty of Health Sciences, University of SydneySydney, NSW, Australia
| | - M. Knothe Tate
- Graduate School of Biomedical Engineering, University of New South WalesSydney, NSW, Australia
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Canata GL, Casale V. Arthroscopic debridement and bone marrow stimulation for talar osteochondral lesions: current concepts. J ISAKOS 2017. [DOI: 10.1136/jisakos-2016-000099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Reilingh ML, van Bergen CJA, Gerards RM, van Eekeren IC, de Haan RJ, Sierevelt IN, Kerkhoffs GMMJ, Krips R, Meuffels DE, van Dijk CN, Blankevoort L. Effects of Pulsed Electromagnetic Fields After Debridement and Microfracture of Osteochondral Talar Defects: Response. Am J Sports Med 2016; 44:NP61-NP62. [PMID: 27836879 DOI: 10.1177/0363546516676454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Cadossi M, Sambri A, Sandro G, Massari L. Effects of Pulsed Electromagnetic Fields After Debridement and Microfracture of Osteochondral Talar Defects: Letter to the Editor. Am J Sports Med 2016; 44:NP60-NP61. [PMID: 27836878 DOI: 10.1177/0363546516676453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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van Eekeren ICM, van Bergen CJA, Sierevelt IN, Reilingh ML, van Dijk CN. Return to sports after arthroscopic debridement and bone marrow stimulation of osteochondral talar defects: a 5- to 24-year follow-up study. Knee Surg Sports Traumatol Arthrosc 2016; 24:1311-5. [PMID: 26846661 PMCID: PMC4823315 DOI: 10.1007/s00167-016-3992-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 01/12/2016] [Indexed: 11/05/2022]
Abstract
PURPOSE Osteochondral defects (OCD) often have a severe impact on the quality of life due to deep ankle pain during and after weight bearing, which prevents young patients from leading an active life. Arthroscopic debridement and bone marrow stimulation are currently the gold standard treatment. The purpose of this study was to evaluate the number of patients that resume and maintain sports to their pre-injury activity level after arthroscopic debridement and bone marrow stimulation. METHODS This retrospective study evaluated patients treated with arthroscopic debridement and bone marrow stimulation between 1989 and 2008. All patients who were participating in sports before injury were included. The Ankle Activity Scale (AAS) was used to determine activity levels during specific time points (before injury, before operation, after operation and at the time of final follow-up). RESULTS Ninety-three patients were included. Fifty-seven (76%) patients continued participating in sports at final follow-up. The median AAS before injury of 8 (range 3-10) significantly decreased to 4 (range 2-10) at final follow-up. CONCLUSION It is shown that 76% of the patients were able to return to sports at long-term follow-up after arthroscopic debridement and bone marrow stimulation of talar OCDs. The activity level decreased at long-term follow-up and never reached the level of that before injury. The data of our study can be of importance to inform future patients on expectations after debridement and bone marrow stimulation of a talar OCD. LEVEL OF EVIDENCE Retrospective case series, Level IV.
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Affiliation(s)
- I. C. M. van Eekeren
- Department of Orthopaedic Surgery, Academic Medical Centre, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands
| | - C. J. A. van Bergen
- Department of Orthopaedic Surgery, Academic Medical Centre, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands
| | - I. N. Sierevelt
- Department of Orthopaedic Surgery, Slotervaart Ziekenhuis, Amsterdam, The Netherlands
| | - M. L. Reilingh
- Department of Orthopaedic Surgery, Academic Medical Centre, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands
| | - C. N. van Dijk
- Department of Orthopaedic Surgery, Academic Medical Centre, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands
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Reilingh ML, van Bergen CJA, Blankevoort L, Gerards RM, van Eekeren ICM, Kerkhoffs GMMJ, van Dijk CN. Computed tomography analysis of osteochondral defects of the talus after arthroscopic debridement and microfracture. Knee Surg Sports Traumatol Arthrosc 2016; 24:1286-92. [PMID: 26713327 PMCID: PMC4823333 DOI: 10.1007/s00167-015-3928-6] [Citation(s) in RCA: 28] [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] [Received: 09/08/2015] [Accepted: 12/04/2015] [Indexed: 12/22/2022]
Abstract
PURPOSE The primary surgical treatment of osteochondral defects (OCD) of the talus is arthroscopic debridement and microfracture. Healing of the subchondral bone is important because it affects cartilage repair and thus plays a role in pathogenesis of osteoarthritis. The purpose of this study was to evaluate the dimensional changes and bony healing of talar OCDs after arthroscopic debridement and microfracture. METHODS Fifty-eight patients with a talar OCD were treated with arthroscopic debridement and microfracture. Computed tomography (CT) scans were obtained at baseline, 2 weeks postoperatively, and 1 year postoperatively. Three-dimensional changes and bony healing were analysed on CT scans. Additionally, clinical outcome was measured with the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and numeric rating scales (NRS) for pain. RESULTS Average OCD size increased significantly (p < 0.001) in all directions from 8.6 (SD 3.6) × 6.3 (SD 2.6) × 4.8 (SD 2.3) mm (anterior-posterior × medial-lateral × depth) preoperatively to 11.3 (SD 3.4) × 7.9 (SD 2.8) × 5.8 (SD 2.3) mm 2 weeks postoperatively. At 1-year follow-up, average defect size was 8.3 (SD 4.2) × 5.7 (SD 3.0) × 3.6 (SD 2.4) mm. Only average defect depth decreased significantly (p < 0.001) from preoperative to 1 year postoperative. Fourteen of the 58 OCDs were well healed. No significant differences in the AOFAS and NRS-pain were found between the well and poorly healed OCDs. CONCLUSION Arthroscopic debridement and microfracture of a talar OCD leads to an increased defect size on the direct postoperative CT scan but restores at 1-year follow-up. Only fourteen of the 58 OCDs were filled up completely, but no differences were found between the clinical outcomes and defect healing at 1-year follow-up. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- M. L. Reilingh
- Department of Orthopaedic Surgery, Orthopaedic Research Center Amsterdam, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands
| | - C. J. A. van Bergen
- Department of Orthopaedic Surgery, Orthopaedic Research Center Amsterdam, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands
| | - L. Blankevoort
- Department of Orthopaedic Surgery, Orthopaedic Research Center Amsterdam, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands
| | - R. M. Gerards
- Department of Orthopaedic Surgery, Orthopaedic Research Center Amsterdam, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands
| | - I. C. M. van Eekeren
- Department of Orthopaedic Surgery, Orthopaedic Research Center Amsterdam, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands
| | - G. M. M. J. Kerkhoffs
- Department of Orthopaedic Surgery, Orthopaedic Research Center Amsterdam, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands
| | - C. N. van Dijk
- Department of Orthopaedic Surgery, Orthopaedic Research Center Amsterdam, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands
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