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Faldini C, Mazzotti A, Artioli E, Ruffilli A, Barile F, Zielli SO, Geraci G. A novel retrograde technique for ankle osteochodral lesions: the sub-endo-chondral regenerative treatment (secret). Musculoskelet Surg 2023; 107:337-343. [PMID: 36376751 DOI: 10.1007/s12306-022-00767-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 10/21/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE To describe a new surgical technique for osteochondral lesions of the ankle, using bone marrow concentrate on a scaffold and homologous bone graft positioned through a retrograde approach. Many surgical options for ankle osteochondral lesions have been described, and the ideal treatment is still debated. Bone marrow stimulating techniques are recommended for cystic lesions, with some concerns regarding the healing potential of the subchondral bone. In case of wide osteochondral defects, regenerative solutions are preferred but a massive chondral debridement is usually required. To overcome these problems, a novel technique is proposed. METHODS The proposed technique was performed on patients affected by osteochondral lesions of the talus, either cysts with intact cartilage or wide osteochondral defects. A preoperative magnetic resonance imaging was obtained to localize the lesion. A 6-mm tarsal tunnel was retrogradely created toward the lesion, to allow a complete sub-endo-chondral debridement preserving the healthy cartilage. A hyaluronan scaffold soaked with a previously prepared bone marrow concentrate was retrogradely positioned under the cartilage surface and the tunnel was filled with homologous bone graft. Preoperative clinical scores and postoperative x-rays were registered. RESULTS Four patients were treated using this technique. No intraoperative and postoperative complications occurred. Good bone remodeling was observed at 12-week postoperative x-rays. CONCLUSIONS This technique combines the mini-invasiveness of retrograde drilling with the regenerative properties of biological scaffold soaked with bone marrow concentrate. Despite further research being needed, it seems a new viable solution to treat both subchondral cysts and large osteochondral defects of the ankle, whose management is still controversial.
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Affiliation(s)
- C Faldini
- 1St Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy.
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40123, Bologna, Italy.
| | - A Mazzotti
- 1St Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40123, Bologna, Italy
| | - E Artioli
- 1St Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - A Ruffilli
- 1St Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40123, Bologna, Italy
| | - F Barile
- 1St Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40123, Bologna, Italy
| | - S O Zielli
- 1St Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - G Geraci
- 1St Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40123, Bologna, Italy
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2
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Artioli E, Mazzotti A, Gerardi S, Arceri A, Barile F, Manzetti M, Viroli G, Ruffilli A, Faldini C. Retrograde drilling for ankle joint osteochondral lesions: a systematic review. J Orthop Traumatol 2023; 24:37. [PMID: 37495835 PMCID: PMC10371961 DOI: 10.1186/s10195-023-00716-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 07/01/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Extensive literature exists about the treatment of ankle osteochondral lesions, but there is no specific review of retrograde drilling, despite its common application. Indications for retrograde drilling are still few and are far from clear, and some evolutions of the technique have recently occurred. The aim of this review is to provide an update on actual applications and techniques of retrograde drilling for ankle osteochondral lesions. METHODS A systematic review was carried out according to the 2020 PRISMA guidelines. The PubMed and Embase databases were searched in June 2023. The search string focused on studies related to retrograde drilling in the treatment of ankle osteochondral lesions. RESULTS Twenty-one articles for a total of 271 ankles were included in this review. The mean length of the treated lesions was 11.4 mm. Different navigation systems were used, with fluoroscopy the most commonly used. Various adjuvants were employed after drilling, with bone graft the most commonly applied. In most cases, postoperative patient satisfaction and symptom relief were reported, and no complications occurred. Retrograde drilling was found to be suitable for the treatment of subchondral cysts with intact cartilage or small lesions. Some modifications to the original technique may allow surgical indications to be extended to more complex cases. CONCLUSIONS Middle-term results of retrograde drilling showed postoperative satisfaction and symptom relief with both original and modified techniques. Additional research is required to investigate the long-term results. LEVEL OF EVIDENCE IV. TRIAL REGISTRATION This systematic review was registered on PROSPERO (id number: CRD42022371128).
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Affiliation(s)
- Elena Artioli
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic-University of Bologna, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Antonio Mazzotti
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic-University of Bologna, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy.
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40123, Bologna, Italy.
| | - Simone Gerardi
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic-University of Bologna, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Alberto Arceri
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic-University of Bologna, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Francesca Barile
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40123, Bologna, Italy
| | - Marco Manzetti
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic-University of Bologna, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Giovanni Viroli
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic-University of Bologna, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Alberto Ruffilli
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic-University of Bologna, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40123, Bologna, Italy
| | - Cesare Faldini
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic-University of Bologna, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40123, Bologna, Italy
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3
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Haug LP, Sill AP, Shrestha R, Patel KA, Kile TA, Fox MG. Osteochondral Lesions of the Ankle and Foot. Semin Musculoskelet Radiol 2023; 27:269-282. [PMID: 37230127 DOI: 10.1055/s-0043-1766110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Osteochondral lesions (OCLs) in the ankle are more common than OCLs of the foot, but both share a similar imaging appearance. Knowledge of the various imaging modalities, as well as available surgical techniques, is important for radiologists. We discuss radiographs, ultrasonography, computed tomography, single-photon emission computed tomography/computed tomography, and magnetic resonance imaging to evaluate OCLs. In addition, various surgical techniques used to treat OCLs-debridement, retrograde drilling, microfracture, micronized cartilage-augmented microfracture, autografts, and allografts-are described with an emphasis on postoperative appearance following these techniques.
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Affiliation(s)
- Logan P Haug
- Department of Radiology, Mayo Clinic, Phoenix, Arizona
| | - Andrew P Sill
- Department of Radiology, Mayo Clinic, Phoenix, Arizona
| | | | - Karan A Patel
- Department of Orthopedics, Mayo Clinic, Phoenix, Arizona
| | - Todd A Kile
- Department of Orthopedics, Mayo Clinic, Phoenix, Arizona
| | - Michael G Fox
- Department of Radiology, Mayo Clinic, Phoenix, Arizona
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4
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Ferkel RD. Which Way Should We Treat an Osteochondral Lesion: Up or Down? Foot Ankle Int 2023; 44:497-498. [PMID: 37208915 DOI: 10.1177/10711007231170869] [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: 05/21/2023]
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5
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Cilengir AH, Bayraktar ES, Dursun S, Ozdemir M, Altay S, Elmali F, Tosun O. A retrospective magnetic resonance imaging analysis of bone and soft tissue changes associated with the spectrum of tarsal coalitions. Clin Anat 2023; 36:336-343. [PMID: 35384073 DOI: 10.1002/ca.23866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/27/2022] [Accepted: 03/28/2022] [Indexed: 11/10/2022]
Abstract
We aimed to investigate the bone and soft tissue changes accompanying tarsal coalition (TC) and aimed to evaluate their association with the location and type of coalition. Ankle magnetic resonance imagings of 65 patients with TC were included. The relationship between the location and type of coalition and bone marrow edema, subchondral cysts, sinus tarsi syndrome, tarsal tunnel syndrome, posterior impingement syndrome, accessory bone, tibiotalar effusion, talar osteochondritis dissecans, ganglion cysts, and calcaneal spur were evaluated. Twenty-nine patients without coalition were selected as the control group, and the distribution of these variables between the two groups was analyzed. There were 33 females and 32 males in the coalition group (mean age: 42.0 ± 15.63 years), and 22 females and seven males in the control group (mean age: 44.79 ± 12.33 years). Coalition was most common in the talocalcaneal joint (n = 33, 50.8%), and the most common coalition type was non-osseous (n = 57, 87.6%). We find no significant difference between the pathologies defined in terms of coalition location and type. Sinus tarsi syndrome, tarsal tunnel syndrome, subchondral cysts, and tibiotalar effusion were found to be more common in the coalition group (p = 0.028, p = 0.010, p = 0.023, and p = 0.006, respectively). The presence of coalition increased the probability of developing tarsal tunnel syndrome 9.91 times (95% CI: [1.25-78.59]; p = 0.029), and sinus tarsi syndrome 3.66 times (95% CI: [1.14-11.78]; p = 0.029). Tarsal coalition may predispose bone and soft tissue changes. In this study, sinus tarsi syndrome, tarsal tunnel syndrome, subchondral cysts and tibiotalar effusion were found to be more common in the coalition group.
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Affiliation(s)
| | - Ezgi Suat Bayraktar
- Department of Radiology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Suat Dursun
- Department of Radiology, Hatay Training and Research Hospital, Hatay, Turkey
| | - Mehmet Ozdemir
- Department of Orthopedics, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Sedat Altay
- Department of Radiology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Ferhan Elmali
- Faculty of Medicine, Department of Biostatistics, Izmir Katip Celebi University, Izmir, Turkey
| | - Ozgur Tosun
- Department of Radiology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
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6
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Shrestha R, Sill AP, Haug LP, Patel KA, Kile TA, Fox MG. Postoperative Ankle Imaging, 2022. Semin Musculoskelet Radiol 2022; 26:203-215. [PMID: 35654090 DOI: 10.1055/s-0042-1750841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Postoperative ankle imaging requires knowledge of the underlying surgical techniques, the usefulness of various imaging modalities, as well as an appreciation for the desired clinical outcomes. Surgical procedures discussed in this article are tibiotalar fracture fixation, tibiotalar, subtalar, and tibiotalocalcaneal arthrodesis, total ankle arthroplasty, talar osteochondral lesion repair and grafting, lateral ligamentous repair and reconstruction, and peroneal and Achilles tendon repair and reconstruction. Imaging can play a vital role in determining if the expected outcome has been achieved and identifying complications, with particular emphasis placed on the use of radiographs, computed tomography (including weight-bearing), magnetic resonance imaging, and ultrasonography.
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Affiliation(s)
- Roman Shrestha
- Department of Radiology, Mayo Clinic Arizona, Phoenix, Arizona
| | - Andrew P Sill
- Department of Radiology, Mayo Clinic Arizona, Phoenix, Arizona
| | - Logan P Haug
- Department of Radiology, Mayo Clinic Arizona, Phoenix, Arizona
| | - Karan A Patel
- Department of Orthopedics, Mayo Clinic Arizona, Phoenix, Arizona
| | - Todd A Kile
- Department of Orthopedics, Mayo Clinic Arizona, Phoenix, Arizona
| | - Michael G Fox
- Department of Radiology, Mayo Clinic Arizona, Phoenix, Arizona
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7
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Cheng KY, Fuangfa P, Shirazian H, Resnick D, Smitaman E. Osteochondritis dissecans of the talar dome in patients with tarsal coalition. Skeletal Radiol 2022; 51:191-200. [PMID: 34160680 DOI: 10.1007/s00256-021-03800-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 04/20/2021] [Accepted: 04/25/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Tarsal coalition is known to cause abnormal talocrural stress, hindfoot malalignment, and ankle sprains. These can all be associated with osteochondritis dissecans (OCD) of the talar dome. We present the first detailed description of a series of talar OCDs occurring in patients with tarsal coalition, with the goal of determining whether there is an increased prevalence of OCDs among patients with tarsal coalition. MATERIALS AND METHODS We studied ankle MRIs in 57 patients with tarsal coalitions, excluding those with a reported inciting traumatic event. The MRIs were performed on magnetic field strengths ranging from 0.3 to 1.5 T and included axial, coronal, and sagittal T1 and T2 or PD fat-suppressed sequences. We evaluated the morphology and location of classically described OCDs in these patients, type and location of concomitant tarsal coalition, and, when available, the presence of pes planus and hindfoot valgus on weight-bearing radiographs. Chi-squared analysis was used to compare categorical variables and a Student's t test was used for parametric continuous variables. Additionally, logistic regression was used to compute the odds ratio of talar OCD associated with patient age, gender, laterality, pes planus status, hindfoot valgus status, and coalition type. RESULTS Eighty-nine percent of tarsal coalitions were non-osseous coalitions and the calcaneonavicular space was the most common site of abnormal tarsal connection (54.4%). In the 29 patients with tarsal coalitions and talar OCDs, OCDs commonly occurred medially (75.9%). In the sagittal plane, talar OCDs occurred centrally, with only one case sparing the central talar dome. The mean surface area of the 29 OCDs was 89.7 mm2. Both osseous coalition and hindfoot valgus were associated with smaller talar OCD mean surface area (p = 0.015 and p = 0.0001, respectively). There was no association between depth and surface area of talar OCD with either coalition location or presence of pes planus (coalition location: p = 0.455 for depth and p = 0.295 for surface area; presence of pes planus: p = 0.593 for depth and p = 0.367 for surface area). CONCLUSION Talar OCD prevalence is higher in patients with tarsal coalition than that reported for the general population. This occurrence may relate to altered biomechanics and repetitive talocrural stress owing to altered subtalar motion, particularly given the findings of increased odds of talar OCD in older patients, as well as weak associations between OCD surface area and both non-osseous coalition and hindfoot alignment. However, we did not find any specific OCD morphologic features attributable to the precise location of the tarsal coalition.
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Affiliation(s)
- Karen Y Cheng
- Department of Radiology, UC San Diego Health, 200 W. Arbor Drive, #8226, San Diego, CA, 92103, USA
| | - Praman Fuangfa
- Department of Diagnostic and Therapeutic Radiology, Ramathibodi Hospital,, Mahidol University, Bangkok, Thailand
| | | | - Donald Resnick
- Department of Radiology, UC San Diego Health, 200 W. Arbor Drive, #8226, San Diego, CA, 92103, USA
| | - Edward Smitaman
- Department of Radiology, UC San Diego Health, 200 W. Arbor Drive, #8226, San Diego, CA, 92103, USA.
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8
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Marín Fermín T, Hovsepian JM, D'Hooghe P, Papakostas ET. Arthroscopic debridement of osteochondral lesions of the talus: A systematic review. Foot (Edinb) 2021; 49:101852. [PMID: 34536818 DOI: 10.1016/j.foot.2021.101852] [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: 12/12/2020] [Revised: 07/07/2021] [Accepted: 07/08/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Arthroscopic debridement (AD) for the osteochondral lesions of the talar dome (OLT) was widely documented in the nineties with satisfactory results. However, in modern treatment algorithms, its role is not described. The present systematic review aims to evaluate the current evidence on the clinical outcomes of AD in the management of OLT. METHODS Two independent reviewers searched PubMed, EMBASE, Scopus, and Virtual Health Library databases evaluating the clinical outcomes of AD of OLT with a minimum 6-month follow-up. The following terms "talus", "chondral", "cartilage", "injury", "lesion", "delamination", "damage", "excision", "curettage", "debridement", "chondrectomy", "chondroplasty", were used alone and in combination with Boolean operators AND and OR. Studies in which surgical technique was not described, an additional procedure was performed after debridement, and/or outcomes were not reported separately when more than one technique was implemented were excluded. The modified Coleman methodology score (mCMS) was used to evaluate the methodological quality of the included studies. A narrative analysis was conducted. Publication bias was assessed using the ROBIS tool. RESULTS AD showed satisfactory short and medium-term outcomes for the primary treatment of OLT irrespectively of size and depth. However, the heterogeneity of the included studies and the level of available evidence hinders its recommendation. CONCLUSIONS There is a paucity of evidence evaluating AD alone for OLT treatment in the last two decades. Bone-marrow stimulation techniques remain the first-line surgical strategy for OLT treatment without proven superiority. Adopting AD for OLT treatment instead of MF could represent a paradigm breakthrough in clinical practice given its many potential advantages while preserving the subchondral plate.
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Affiliation(s)
- Theodorakys Marín Fermín
- Department of Traumatology, Hospital Universitario Periférico de Coche "Dr. Leopoldo Manrique Terrero", Caracas, Venezuela.
| | - Jean M Hovsepian
- Department of Sports Orthopaedics, Hessing Klinik, Augsburg, Germany
| | - Pieter D'Hooghe
- Aspetar Orthopedic and Sports Medicine Hospital, Doha, Qatar
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Sheu C, Ferkel RD. Athletic Performance in the National Basketball Association After Arthroscopic Debridement of Osteochondral Lesions of the Talus. Orthop J Sports Med 2021; 9:2325967120970205. [PMID: 33457433 PMCID: PMC7802091 DOI: 10.1177/2325967120970205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 07/01/2020] [Indexed: 11/15/2022] Open
Abstract
Background: Use of marrow-stimulating techniques to treat osteochondral lesions of the
talus (OLTs) in National Basketball Association (NBA) players is
controversial. Hypothesis: NBA players will be able to return to preinjury playing status after
treatment of OLTs by arthroscopic debridement alone without
marrow-stimulating techniques. Study Design: Cohort study; Level of evidence, 3. Methods: Between the 2000 and 2015 seasons, 10 NBA players were treated with
arthroscopic debridement of an OLT. The following performance outcomes were
compared pre- and postoperatively: seasons played, games played, games
started, minutes per game, points per game, field goals, 3-point shots,
rebounds, assists, double doubles, triple doubles, steals, blocks,
turnovers, personal fouls, assists per turnovers, steals per turnovers, NBA
rating, scoring efficiency, and shooting efficiency. In addition, the
players were compared with a matched control group using mixed effects
regression and Fisher least significant difference modeling. Results: All 10 players returned to play in the NBA after arthroscopic debridement
without microfracture or drilling of an OLT. When compared with preoperative
performance, postoperative mean points scored, assists made, and steals made
increased by 2.86 (P = .042), 0.61 (P =
.049), and 0.15 (P = .027), respectively. Only field goal
percentage decreased postoperatively when compared with matched controls;
however, this normalized by the end of the second season after surgery.
There was no statistically significant change in any of the other
performance factors when compared with matched controls. All patients
returned to basketball during the same season (n = 1) or the following
season (n = 9) if the operation was performed off-season. The mean length of
career after surgery was 4.1 years, with 5 players still playing in the
league at the time of this study. Conclusion: After arthroscopic debridement of an OLT without drilling or microfracture,
there was a high rate of return to the NBA, with improved points scored,
assists, and steals made after surgery when compared with preoperative
performance. There was no statistically significant change in any
performance factors when compared with uninjured matched controls. Lesion
size did not affect player career length. These data should be used to
manage patients’ and teams’ expectations regarding players’ ability to
return to elite levels of athletic performance after surgery of an OLT.
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Affiliation(s)
| | - Richard D Ferkel
- Southern California Orthopedic Institute, Van Nuys, California, USA
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10
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McWilliams GD, Yao L, Simonet LB, Haysbert CW, Giza E, Kreulen CD, Boutin RD. Subchondroplasty of the Ankle and Hindfoot for Treatment of Osteochondral Lesions and Stress Fractures: Initial Imaging Experience. Foot Ankle Spec 2020; 13:306-314. [PMID: 31315447 DOI: 10.1177/1938640019863252] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective:To describe the imaging findings of patients treated with subchondroplasty (SCP) of the ankle and hindfoot. Materials and Methods: Eighteen patients (10 men, 8 women; age mean 43.1 years [range 20.1-67.7 years]) underwent ankle and hindfoot SCP at a single center over a 14-month period. Imaging data were reviewed retrospectively by 2 radiologists by consensus interpretation, including preoperative radiography (18), computed tomography (CT) (11), and magnetic resonance imaging (MRI) (13) and postoperative radiography (10), CT (4), and MRI (6). Follow-up imaging was acquired 1 month to 1.6 years following SCP. Results: Indications for SCP included symptomatic bone marrow lesions (BMLs) secondary to an osteochondral lesion (OCL) (16/18) or stress fracture (2/18). While focal radiodensity related to the SCP procedure was retrospectively identifiable on postoperative radiography in all except 1 case (10/11), postprocedural findings were not described by the interpreting radiologist in 6/11 cases. On CT, the average injected synthetic calcium phosphate (CaP) volume was 1.15 cm3 (SD = 0.33 cm3); mean CT attenuation of the injectate was 1220 HU (range 1058-1465 HU). In all patients who had pre- and postoperative MRI (5/18), BML size decreased on follow-up MRI. Extra-osseous extrusion of CaP was not seen on postoperative radiography, CT, or MRI. Conclusion: Physicians should be aware of the expanding preoperative indications and postoperative imaging findings of SCP, which is being performed with increasing frequency in the ankle and hindfoot.Levels of Evidence: Diagnostic, Level III: Retrospective cohort study.
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Affiliation(s)
- Geoffrey D McWilliams
- Department of Radiology, University of California Davis School of Medicine, Sacramento, California (GDM, LBS, RDB).,Radiology and Imaging Sciences, CC-NIH, Bethesda, Maryland (LY).,University of California Davis School of Medicine, Sacramento, California (CWH).,Foot and Ankle Service, Department of Orthopaedic Surgery University of California Davis, Sacramento, California (EG, CDK)
| | - Lawrence Yao
- Department of Radiology, University of California Davis School of Medicine, Sacramento, California (GDM, LBS, RDB).,Radiology and Imaging Sciences, CC-NIH, Bethesda, Maryland (LY).,University of California Davis School of Medicine, Sacramento, California (CWH).,Foot and Ankle Service, Department of Orthopaedic Surgery University of California Davis, Sacramento, California (EG, CDK)
| | - Luke B Simonet
- Department of Radiology, University of California Davis School of Medicine, Sacramento, California (GDM, LBS, RDB).,Radiology and Imaging Sciences, CC-NIH, Bethesda, Maryland (LY).,University of California Davis School of Medicine, Sacramento, California (CWH).,Foot and Ankle Service, Department of Orthopaedic Surgery University of California Davis, Sacramento, California (EG, CDK)
| | - Connor W Haysbert
- Department of Radiology, University of California Davis School of Medicine, Sacramento, California (GDM, LBS, RDB).,Radiology and Imaging Sciences, CC-NIH, Bethesda, Maryland (LY).,University of California Davis School of Medicine, Sacramento, California (CWH).,Foot and Ankle Service, Department of Orthopaedic Surgery University of California Davis, Sacramento, California (EG, CDK)
| | - Eric Giza
- Department of Radiology, University of California Davis School of Medicine, Sacramento, California (GDM, LBS, RDB).,Radiology and Imaging Sciences, CC-NIH, Bethesda, Maryland (LY).,University of California Davis School of Medicine, Sacramento, California (CWH).,Foot and Ankle Service, Department of Orthopaedic Surgery University of California Davis, Sacramento, California (EG, CDK)
| | - Christopher D Kreulen
- Department of Radiology, University of California Davis School of Medicine, Sacramento, California (GDM, LBS, RDB).,Radiology and Imaging Sciences, CC-NIH, Bethesda, Maryland (LY).,University of California Davis School of Medicine, Sacramento, California (CWH).,Foot and Ankle Service, Department of Orthopaedic Surgery University of California Davis, Sacramento, California (EG, CDK)
| | - Robert D Boutin
- Department of Radiology, University of California Davis School of Medicine, Sacramento, California (GDM, LBS, RDB).,Radiology and Imaging Sciences, CC-NIH, Bethesda, Maryland (LY).,University of California Davis School of Medicine, Sacramento, California (CWH).,Foot and Ankle Service, Department of Orthopaedic Surgery University of California Davis, Sacramento, California (EG, CDK)
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11
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Carlson MJ, Antkowiak TT, Larsen NJ, Applegate GR, Ferkel RD. Arthroscopic Treatment of Osteochondral Lesions of the Talus in a Pediatric Population: A Minimum 2-Year Follow-up. Am J Sports Med 2020; 48:1989-1998. [PMID: 32510966 DOI: 10.1177/0363546520924800] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Treatment of osteochondral lesions of the talus (OLTs) in children presents a difficult clinical challenge, with few large series reported. PURPOSE To evaluate functional and radiographic outcomes for children and adolescents undergoing arthroscopic treatment of symptomatic OLT with a minimum follow-up of 2 years. STUDY DESIGN Case series; Level of evidence, 4. METHODS Patients were identified who had symptomatic OLT treated arthroscopically with marrow stimulation techniques. Inclusion criteria were age ≤18 years, symptomatic chronic OLT as the surgical indication, failure of nonoperative treatment, and minimum follow-up of 24 months. Outcome measures included Foot Function Index, American Orthopaedic Foot and Ankle Society Hindfoot Score, Tegner Activity Scale, 36-Item Short Form Health Survey (Short Form-36, v 2), visual analog scale, ankle range of motion, and patient satisfaction survey. Weightbearing radiographs were compared with preoperative radiographs via an ankle arthritis classification system. Magnetic resonance imaging (MRI) was used to evaluate postoperative lesion characteristics per the MOCART scale (magnetic resonance observation of cartilage repair tissue). The size, location, lesion stability, traumatic etiology, skeletal maturity, and length of follow-up were recorded and analyzed through univariate logistic regression. RESULTS The study group consisted of 22 patients (11 male, 11 female) with a mean age of 14.4 years (range, 8-18 years) and a mean follow-up of 8.3 years (range, 2-27 years). Of 22 patients, 20 were satisfied with the results from surgery and would recommend it to others. Mean follow-up visual analog scale for pain was reported as 2.2 on a 10-point scale, and mean American Orthopaedic Foot and Ankle Society score at follow-up was 86.6. Mean postoperative Foot Function Index scores for the study group were as follows: pain, 17.1; disability, 16.5; activity, 4.7; and overall, 38.7. Mean Short Form-36 physical component score was 50.7. Postoperative radiographs indicated a van Dijk osteoarthritis grade of 0 in 56%, I in 38%, II in 6%, and III in 0%. Postoperative MRI MOCART scores showed complete filling of the cartilage in 27% of cases, complete graft integration in 22%, and intact repair surface in 22%, with a mean MOCART score of 48.0. No correlation was found between radiographic and MRI findings and clinical outcomes. None of the prognostic factors were significantly associated with patient satisfaction, progression of arthritis, or MOCART scores. CONCLUSION Arthroscopic treatment of symptomatic OLT in adolescent patients (≤18 years) demonstrated high functional outcomes, high clinical satisfaction rates, and minimal radiographic osteoarthritic progression despite low MOCART scores.
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Affiliation(s)
| | | | | | | | - Richard D Ferkel
- Southern California Orthopedic Institute, Van Nuys, California, USA
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Wang D, Shen Z, Fang X, Jiao C, Guo Q, Hu Y, Yu J, Jiang D, Zhang W. Vascular Compromising Effect of Drilling for Osteochondral Lesions of the Talus: A Three-Dimensional Micro-Computed Tomography Study. Arthroscopy 2019; 35:2930-2937. [PMID: 31439459 DOI: 10.1016/j.arthro.2019.05.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 05/03/2019] [Accepted: 05/09/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To explore an optimal drilling depth and direction for osteochondral lesions of the talus based on a 3-dimensional vascular microarchitecture model constructed with micro-computed tomography (microCT). METHODS Twelve tali were perfused with the contrast agent and then scanned with microCT. The talar dome was divided into 9 zones, and the vessel densities were measured at the subchondral depths of 0 to 5 mm, 5 to 10 mm and 10 to 15 mm in each zone. The anterolateral (AL) and posterolateral (PL) approaches of retrograde drilling were simulated and the vascular compromising effect was evaluated. RESULTS The vessel density of the 0- to 5-mm depth was lower than that of the 5- to 10-mm (P = .001) and 10- to 15-mm (P = .007) depths, but no significant difference was found between the 5- to 10-mm and 10- to 15-mm depths (P > .9999). The vessel density in the 5- to 10-mm depth of medial talar dome was similar to that of the adjacent zones (P = .05). Vessel density in the 5- to 10-mm depth around the lateral talar dome was higher in the anterior and medial side. The anterolateral approach disturbed the main intraosseous vessels from the tarsal canal-tarsal sinus, causing extensive vascular compromise in the talus neck and body, whereas the posterolateral approach disturbed only the vessels near the tunnel. CONCLUSIONS The vessel density changed greatly from the subchondral 0- to 5-mm to the 5- to 10-mm depth. The vessel densities of the 5- to 10-mm depth around the medial talar dome were similar, whereas the anterior and medial side of the lateral talar dome was better vascularized. The posterolateral approach caused less vascular damage than the anterolateral approach. CLINICAL RELEVANCE The anterograde drilling depth was preferable to the subchondral 5- to 10-mm depth. There was no preferred drilling direction for the osteochondral lesion in the medial talar dome, whereas it is preferable to drill anteriorly or medially in the lateral dome. The posterolateral approach might be a safer alternative for retrograde drilling.
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Affiliation(s)
- Dingyu Wang
- Department of Human Anatomy and Histology and Embryology, Peking University, Beijing, P. R. China; Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, P. R. China
| | - Zhongcheng Shen
- Department of Human Anatomy and Histology and Embryology, Peking University, Beijing, P. R. China; Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, P. R. China
| | - Xuan Fang
- Department of Human Anatomy and Histology and Embryology, Peking University, Beijing, P. R. China
| | - Chen Jiao
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, P. R. China
| | - Qinwei Guo
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, P. R. China
| | - Yuelin Hu
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, P. R. China
| | - Jiakuo Yu
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, P. R. China
| | - Dong Jiang
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, P. R. China.
| | - Weiguang Zhang
- Department of Human Anatomy and Histology and Embryology, Peking University, Beijing, P. R. China.
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Özer M, Yıldırım A. Evaluation of the Prevalence of Os Trigonum and Talus Osteochondral Lesions in Ankle Magnetic Resonance Imaging of Patients With Ankle Impingement Syndrome. J Foot Ankle Surg 2019; 58:273-277. [PMID: 30612863 DOI: 10.1053/j.jfas.2018.08.043] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Indexed: 02/03/2023]
Abstract
The prevalence of os trigonum and osteochondral lesions of talus (OCLT) have been presented in different prevalences among different groups in the literature for the patients with ankle impingement syndrome. Our main objective in the study was to determine the possible relationship between the impingement syndrome and the prevalence of os trigonum and OCLT in specific groups. The presence of anterior ankle impingement syndrome (AAIS), posterior ankle impingement syndrome (PAIS), os trigonum, OCLT, and the location of OCLT were evaluated in a blinded manner on magnetic resonance imaging from patients clinically considered to be diagnosed with ankle impingement syndrome from January 2014 to July 2017. The patients were separated into specific groups according to the confirmation of their clinical diagnosis of ankle impingement syndrome on magnetic resonance imaging . A total of 333 patients were included. The prevalence of os trigonum was found to be 1.3% in patients with PAIS(-) AAIS(+), 7.7% in patients with PAIS(-) AAIS(-), 63.3% in patients with PAIS(+) AAIS(-), and 81.1% in patients with PAIS(+) AAIS(+) (p < .001). The prevalence of OCLT was found to be 41.3% in patients with PAIS(-) AAIS(+), 23.1% in patients with PAIS(-) AAIS(-), 18.3% in patients with PAIS(+) AAIS(-), and 27% in patients with PAIS(+) AAIS(+) (p= .005). Our study showed that, for patients with isolated PAIS and AAIS combined with PAIS, the prevalence of os trigonum was 63.3% and 81.1%, respectively, which is more common than previously reported. For patients with isolated AAIS and PAIS, the prevalence of OCLT was 41.3% and 18.3%, respectively. Of the OCLTs combined with ankle impingement syndromes, 87.1% were medially located.
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Affiliation(s)
- Mustafa Özer
- Assistant Professor, Department of Orthopaedics & Traumatology, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey.
| | - Ahmet Yıldırım
- Assistant Professor, Department of Orthopaedics & Traumatology, Selçuk University School of Medicine, Konya, Turkey
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Ryan PM, Turner RC, Anderson CD, Groth AT. Comparative Outcomes for the Treatment of Articular Cartilage Lesions in the Ankle With a DeNovo NT Natural Tissue Graft: Open Versus Arthroscopic Treatment. Orthop J Sports Med 2018; 6:2325967118812710. [PMID: 30574515 PMCID: PMC6295701 DOI: 10.1177/2325967118812710] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The treatment of osteochondral lesions of the talus (OLTs) with a juvenile cartilage allograft is a relatively new procedure. Although other treatment options exist for large OLTs, the potential advantage of a particulated juvenile allograft is the ability to perform the procedure arthroscopically or through a minimal approach. No previous studies have looked at the results of an arthroscopic approach, nor have any compared an arthroscopic technique with an open approach. PURPOSE To compare the outcomes of an arthroscopic transfer technique with the previously published open technique. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 34 patients (mean age, 33 years) underwent treatment of talar cartilage lesions with a DeNovo NT Natural Tissue Graft. Of these treatments, 20 were performed arthroscopically and 14 were performed with open arthrotomy. There was no statistically significant difference between the groups with respect to age, lesion width, lesion depth, lesion length, or operative time. The mean lesion area was 107 mm2. The scores from 6 different validated outcome measures were recorded for patients in each group preoperatively and subsequently at 6 months, 1 year, 18 months, and 2 years. RESULTS Comparing outcome scores at each time point to baseline, there were no statistically significant postoperative differences found between open and arthroscopic approaches with regard to the visual analog scale (VAS) for pain (P = .09), American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale (P = .17), Foot and Ankle Ability Measure (FAAM)-sports subscale (P = .73), Short Form-12 (SF-12) physical health summary (P = .85), SF-12 mental health summary (P = .91), or FAAM-activities of daily living subscale (P = .76). CONCLUSION The treatment of talar articular cartilage lesions with a DeNovo NT Natural Tissue Graft demonstrated no significant differences in outcome at 2 years regardless of whether the graft was inserted with an arthroscopic or open technique. CLINICAL RELEVANCE Our analysis demonstrated no significant difference between an arthroscopic versus open approach at any time point for the first 2 years after implantation of a juvenile particulated cartilage allograft for large OLTs. With that said, both groups demonstrated improvement from baseline. These findings indicate that surgeons with different levels of comfort utilizing arthroscopic techniques can offer this treatment modality to their patients without altering their planned surgical approach. In addition, this will be particularly helpful in counseling patients for surgery when the extent of the defect will be evaluated intraoperatively. Patients can be counseled that they will likely have the same incisions regardless of whether they require debridement, microfracture, or implantation of a particulated allograft.
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Affiliation(s)
- Paul M. Ryan
- Tripler Army Medical Center, Honolulu, Hawaii, USA
| | | | | | - Adam T. Groth
- The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Walley KC, Gonzalez TA, Callahan R, Fairfull A, Roush E, Saloky KL, Juliano PJ, Lewis GS, Aynardi MC. The Role of 3D Reconstruction True-Volume Analysis in Osteochondral Lesions of the Talus: A Case Series. Foot Ankle Int 2018; 39:1113-1119. [PMID: 29701070 DOI: 10.1177/1071100718771834] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Evaluation and management of osteochondral lesions of the talus (OLTs) often warrant advanced imaging studies, especially in revision or cases with cystic defects. It is possible that orthopedic surgeons may overestimate the size and misinterpret the morphology of OLT from conventional computed tomography (CT), thereby influencing treatment strategies. The purpose of this study was to determine the utility of a novel means to estimate the true-volume of OLTs using 3D reconstructed images and volume analysis. METHODS With Institutional Review Board approval, an institutional radiology database was queried for patients with cystic OLTs that failed previous microfracture, having compatible CT scans and magnetic resonance imaging (MRI) between 2011 and 2016. Fourteen patients met inclusion criteria. Of these, 5 cases were randomly selected for 3D CT reconstruction modeling. Ten orthopedic surgeons independently estimated the volume of these 5 OLTs via standard CT. Then 3D reconstructions were made and morphometric true-volume (MTV) analysis measurements of each OLT were generated. The percent change in volumes from CT were compared to MTVs determined from 3D reconstructive analysis. RESULTS On average, the volume calculated by conventional CT scanner grossly overestimated the actual size of the OLTs. The volume calculated on conventional CT scanner overestimated the size of OLTs compared to the 3D MTV reconstructed analysis by 285% to 864%. CONCLUSIONS Our results showed that conventional measurements of OLTS with CT grossly overestimated the size of the lesion. The 3D MTV analysis of cystic osteochondral lesions may help clinicians with preoperative planning for graft selection and appropriate volume while avoiding unnecessary costs incurred with overestimation. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Kempland C Walley
- 1 Department of Orthopaedic Surgery, Penn State Hershey Bone and Joint Institute, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Tyler A Gonzalez
- 2 Department of Orthopedic Surgery, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Ryan Callahan
- 1 Department of Orthopaedic Surgery, Penn State Hershey Bone and Joint Institute, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Aubree Fairfull
- 1 Department of Orthopaedic Surgery, Penn State Hershey Bone and Joint Institute, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Evan Roush
- 1 Department of Orthopaedic Surgery, Penn State Hershey Bone and Joint Institute, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Kaitlin L Saloky
- 1 Department of Orthopaedic Surgery, Penn State Hershey Bone and Joint Institute, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Paul J Juliano
- 1 Department of Orthopaedic Surgery, Penn State Hershey Bone and Joint Institute, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Gregory S Lewis
- 1 Department of Orthopaedic Surgery, Penn State Hershey Bone and Joint Institute, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Michael C Aynardi
- 1 Department of Orthopaedic Surgery, Penn State Hershey Bone and Joint Institute, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
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Reilingh ML, Murawski CD, DiGiovanni CW, Dahmen J, Ferrao PNF, Lambers KTA, Ling JS, Tanaka Y, Kerkhoffs GMMJ. Fixation Techniques: Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle. Foot Ankle Int 2018; 39:23S-27S. [PMID: 30215310 DOI: 10.1177/1071100718781096] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The evidence supporting best practice guidelines in the field of cartilage repair of the ankle is based on both low quality and low levels of evidence. Therefore, an international consensus group of experts was convened to collaboratively advance toward consensus opinions based on the best available evidence on key topics within cartilage repair of the ankle. The purpose of this article is to report the consensus statements on "Fixation Techniques" developed at the 2017 International Consensus Meeting on Cartilage Repair of the Ankle. METHODS Seventy-five international experts in cartilage repair of the ankle representing 25 countries and 1 territory were convened and participated in a process based on the Delphi method of achieving consensus. Questions and statements were drafted within 11 working groups focusing on specific topics within cartilage repair of the ankle, after which a comprehensive literature review was performed and the available evidence for each statement was graded. Discussion and debate occurred in cases where statements were not agreed upon in unanimous fashion within the working groups. A final vote was then held, and the strength of consensus was characterized as follows: consensus, 51% to 74%; strong consensus, 75% to 99%; and unanimous, 100%. RESULTS A total of 15 statements on fixation techniques reached consensus during the 2017 International Consensus Meeting on Cartilage Repair of the Ankle. All 15 statements achieved strong consensus, with at least 82% agreement. CONCLUSIONS This international consensus derived from leaders in the field will assist clinicians with using fixation techniques in the treatment of osteochondral lesions of the talus.
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Affiliation(s)
- Mikel L Reilingh
- 1 Department of Orthopaedic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Christopher D Murawski
- 2 Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Jari Dahmen
- 1 Department of Orthopaedic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Paulo N F Ferrao
- 4 Orthopaedic Department, University of the Witwatersrand, Johannesburg, South Africa
| | - Kaj T A Lambers
- 1 Department of Orthopaedic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Jeffrey S Ling
- 5 Prince of Wales Hospital Clinical School, The University of New South Wales, Sydney, New South Wales, Australia
| | - Yasuhito Tanaka
- 6 Department of Orthopedic Surgery, Nara Medical University, Nara, Japan
| | - Gino M M J Kerkhoffs
- 1 Department of Orthopaedic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Teixeira J, Carvalho M, Torres A, Tavares N. Arthroscopic reduction and fixation of a lateral inverted osteochondral fracture of the talus ('LIFT'). BMJ Case Rep 2018; 2018:bcr-2017-223441. [PMID: 29643135 DOI: 10.1136/bcr-2017-223441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Some ankle sprains hide important lesions beyond the classic lateral ligament complex injuries. The lateral inverted osteochondral fracture of the talus (LIFT) represents a rare osteochondral lesion, whose diagnosis relies on a high clinical suspicion followed by correct image study interpretation. We present a successful arthroscopic fixation of a LIFT lesion in a 45-year-old active man. At 8 months follow-up, the patient was pain free and able to return to his daily activities without limitation. The imagiological study showed osteochondral fragment consolidation with no signs of hardware failure. This midterm results reassemble the need for early diagnosis and correct treatment to achieve a good outcome in these complex and rare osteochondral lesions.
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Affiliation(s)
- Joao Teixeira
- Centro Hospitalar de Entre o Douro e Vouga, E P E, Santa Maria da Feira, Aveiro, Portugal
| | - Manuel Carvalho
- Centro Hospitalar de Entre o Douro e Vouga, E P E, Santa Maria da Feira, Aveiro, Portugal
| | - António Torres
- Centro Hospitalar de Entre o Douro e Vouga, E P E, Santa Maria da Feira, Aveiro, Portugal
| | - Nuno Tavares
- Centro Hospitalar de Entre o Douro e Vouga, E P E, Santa Maria da Feira, Aveiro, Portugal
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18
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Editorial Commentary: Osteochondral Lesions of the Talus-Are We Going the Wrong Way? Arthroscopy 2017; 33:2246-2247. [PMID: 29198359 DOI: 10.1016/j.arthro.2017.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 09/07/2017] [Accepted: 09/12/2017] [Indexed: 02/02/2023]
Abstract
Recalcitrant osteochondral lesions of the talus present a difficult problem to the treating surgeon. Anterior and posterior approaches have been studied to facilitate treatment access. Current research highlights the accessibility of an osteochondral lesion to treatment from an anterior or posterior approach and shows the importance of foot position and noninvasive distraction to facilitate treatment. Moreover, it is important to consider that using both anterior and posterior portals, most osteochondral lesions can be well treated with a patient in the supine position. Most of all, ankle arthroscopy surgeons must be sure to visualize the central and posterior ankle so as not to miss essential pathology.
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Ankle MRI and Arthroscopy Correlation With Cartilaginous Defects and Symptomatic Os Trigonum. Sports Med Arthrosc Rev 2017; 25:237-245. [DOI: 10.1097/jsa.0000000000000169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Shimozono Y, Yasui Y, Ross AW, Miyamoto W, Kennedy JG. Scaffolds based therapy for osteochondral lesions of the talus: A systematic review. World J Orthop 2017; 8:798-808. [PMID: 29094011 PMCID: PMC5656496 DOI: 10.5312/wjo.v8.i10.798] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 07/19/2017] [Accepted: 08/02/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To clarify the effectiveness of scaffold-based therapy for osteochondral lesions of the talus (OLT).
METHODS A systematic search of MEDLINE and EMBASE databases was performed during August 2016 and updated in January 2017. Included studies were evaluated with regard to the level of evidence (LOE) and quality of evidence (QOE) using the Modified Coleman Methodology Score. Variable reporting outcome data, clinical outcomes, and the percentage of patients who returned to sport at previous level were also evaluated.
RESULTS Twenty-eight studies for a total of 897 ankles were included; 96% were either LOE III or IV. Studies were designated as either of poor or fair quality. There were 30 treatment groups reporting six different scaffold repair techniques: 13 matrix-induced autologous chondrocyte transplantation (MACT), nine bone marrow derived cell transplantation (BMDCT), four autologous matrix-induced chondrogeneis (AMIC), and four studies of other techniques. The categories of general demographics (93%) and patient-reported outcome data (85%) were well reported. Study design (73%), imaging data (73%), clinical variables (49%), and patient history (30%) were also included. The weighted mean American Orthopaedic Foot and Ankle Society (AOFAS) score at final follow-up was: 86.7 in MACT, 88.2 in BMDCT, and 82.3 in AMIC. Eight studies reported that a weighted mean of 68.3% of patients returned to a previous level of sport activity.
CONCLUSION Scaffold-based therapy for OLT may produce favorable clinical outcomes, but low LOE, poor QOE, and variability of the data have confounded the effectiveness of this treatment.
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Affiliation(s)
- Yoshiharu Shimozono
- Hospital for Special Surgery, New York, NY 10021, United States
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo 173-8605, Japan
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | - Youichi Yasui
- Hospital for Special Surgery, New York, NY 10021, United States
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo 173-8605, Japan
| | - Andrew W Ross
- Hospital for Special Surgery, New York, NY 10021, United States
| | - Wataru Miyamoto
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo 173-8605, Japan
| | - John G Kennedy
- Hospital for Special Surgery, New York, NY 10021, United States
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Chao J, Pao A. Restorative Tissue Transplantation Options for Osteochondral Lesions of the Talus: A Review. Orthop Clin North Am 2017; 48:371-383. [PMID: 28577786 DOI: 10.1016/j.ocl.2017.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Symptomatic osteochondral lesions of the talus remain a challenging problem due to inability for cartilage lesions to heal. Numerous treatment options exist, including nonoperative management, marrow stimulating techniques, and autograft-allograft. Arthroscopic marrow stimulation forms fibrocartilage that has been shown to be biomechanically weaker than hyaline cartilage. Restorative tissue transplantation options are being used more for larger and cystic lesions. Newer biologics and particulated juvenile cartilage are currently under investigation for possible clinical efficacy. This article provides an evidenced-based summary of available literature on the use of biologics for treatment of osteochondral lesions of the talus.
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Affiliation(s)
- John Chao
- Peachtree Orthopaedic Clinic, 5505 Peachtree Dunwoody Road, Suite 600, Atlanta, GA 30342, USA.
| | - Andrew Pao
- Atlanta Medical Center, 303 Parkway Drive, Northeast, Atlanta, GA 30312-1212, USA
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