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ter Laak Bolk CS, Rikken QG, Dahmen J, Shimozono Y, Takao M, Stufkens SA, Kerkhoffs GM. Back in Action: High Return to Pre-Injury Level of Sports after Arthroscopic Bone Marrow Stimulation for Osteochondral Lesions of the First Metatarsophalangeal (MTP-1) Joint. Cartilage 2024; 15:47-57. [PMID: 37735890 PMCID: PMC10985395 DOI: 10.1177/19476035231200332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 08/25/2023] [Indexed: 09/23/2023] Open
Abstract
OBJECTIVE The primary aim was to assess the return to sports outcomes of patients with symptomatic osteochondral lesions (OCLs) to the first metatarsophalangeal (MTP-1) joint treated by arthroscopic bone marrow stimulation (BMS). Secondary aims were to present patient-reported outcome measures (PROMs) on pain scores as well as surgery-related complications or reoperations to the MTP-1 joint. DESIGN All patients with MTP-1 OCLs treated by arthroscopic BMS with a minimum follow-up of 12 months were included. Outcomes included return to sports and work outcomes, satisfaction outcomes with the performed treatment, PROMs, as well as postoperative complications and reoperations. Medical records were screened by 2 independent reviewers and patients were contacted by phone to partake in an in-depth interview. Complications, reoperations, and revision surgeries were additionally assessed. RESULTS Nine patients (median age: 22 years with interquartile range (IQR) 20-29 years) were included with a median follow-up time of 47 (IQR: 23-92) months. Six (86%) out of 7 patients who participated in sports preoperatively returned to sports at any level at a median of 4 (IQR: 2.6-5.8) months. Five patients (71%) returned to pre-injury level of sport and eventually returned to performance at a median of 4 (IQR 2.8-7.5) and 8 (IQR: 4.0-10.5) months, respectively. The median Numeric Rating Scale for pain during walking was 1 (IQR 0-2.5) and all (100%) patients were able to return to work at a median of 4 (IQR: 2-17) weeks. Eighty-nine percent of the patients were very or fairly satisfied with the result of their treatment. No complications, reoperations, or revision surgeries were reported. CONCLUSIONS Arthroscopic BMS for patients with symptomatic OCLs to the MTP-1 joint can be considered safe and yields an 86% return to sport at any level and a 71% return to pre-injury and performance level, with good clinical, return to work, as well as satisfaction outcomes.
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Affiliation(s)
- Carlijn S. ter Laak Bolk
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Program Sports and Musculoskeletal Health, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Academic Center for Evidence-Based Sports Medicine, Amsterdam, The Netherlands
- Amsterdam Collaboration on Health & Safety in Sports, International Olympic Committee Research Centers, Amsterdam, The Netherlands
| | - Quinten G.H. Rikken
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Program Sports and Musculoskeletal Health, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Academic Center for Evidence-Based Sports Medicine, Amsterdam, The Netherlands
- Amsterdam Collaboration on Health & Safety in Sports, International Olympic Committee Research Centers, Amsterdam, The Netherlands
| | - Jari Dahmen
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Program Sports and Musculoskeletal Health, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Academic Center for Evidence-Based Sports Medicine, Amsterdam, The Netherlands
- Amsterdam Collaboration on Health & Safety in Sports, International Olympic Committee Research Centers, Amsterdam, The Netherlands
| | | | - Masato Takao
- Clinical and Research Institute for Foot and Ankle Surgery, Jujo Hospital, Kisarazu, Japan
| | - Sjoerd A.S. Stufkens
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Program Sports and Musculoskeletal Health, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Academic Center for Evidence-Based Sports Medicine, Amsterdam, The Netherlands
- Amsterdam Collaboration on Health & Safety in Sports, International Olympic Committee Research Centers, Amsterdam, The Netherlands
| | - Gino M.M.J. Kerkhoffs
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Program Sports and Musculoskeletal Health, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Academic Center for Evidence-Based Sports Medicine, Amsterdam, The Netherlands
- Amsterdam Collaboration on Health & Safety in Sports, International Olympic Committee Research Centers, Amsterdam, The Netherlands
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Walinga AB, Dahmen J, Stornebrink T, Kerkhoffs GM. Needle Arthroscopy for Osteochondral Lesions of the First Metatarsophalangeal Joint: A Standardized Approach. Arthrosc Tech 2023; 12:e1015-e1019. [PMID: 37533903 PMCID: PMC10390708 DOI: 10.1016/j.eats.2023.02.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 02/15/2023] [Indexed: 08/04/2023] Open
Abstract
Cartilage and osteochondral lesions of the first metatarsophalangeal (MTP-1) joint are characterized by pain during weight bearing and walking. The lesions often require surgical intervention(s). Arthroscopic bone marrow stimulation may be considered the preferred operative intervention for small lesions. Technological advances, patient preferences, and economic considerations combine to foster the development of minimally invasive needle arthroscopic procedures. This technical note presents and highlights our minimally invasive surgical technique for needle arthroscopic treatment through bone marrow stimulation for osteochondral lesions of the MTP-1 joint.
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Affiliation(s)
- Alex B. Walinga
- Amsterdam UMC location of the University of Amsterdam, Department of Orthopedic Surgery and Sports Medicine, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Sport, Amsterdam, The Netherlands
- Academic Center for Evidence-Based Sports Medicine, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health & Safety in Sports, International Olympic Committee Research Center, Amsterdam, The Netherlands
| | - Jari Dahmen
- Amsterdam UMC location of the University of Amsterdam, Department of Orthopedic Surgery and Sports Medicine, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Sport, Amsterdam, The Netherlands
- Academic Center for Evidence-Based Sports Medicine, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health & Safety in Sports, International Olympic Committee Research Center, Amsterdam, The Netherlands
| | - Tobias Stornebrink
- Amsterdam UMC location of the University of Amsterdam, Department of Orthopedic Surgery and Sports Medicine, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Sport, Amsterdam, The Netherlands
- Academic Center for Evidence-Based Sports Medicine, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health & Safety in Sports, International Olympic Committee Research Center, Amsterdam, The Netherlands
| | - Gino M.M.J. Kerkhoffs
- Amsterdam UMC location of the University of Amsterdam, Department of Orthopedic Surgery and Sports Medicine, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Sport, Amsterdam, The Netherlands
- Academic Center for Evidence-Based Sports Medicine, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health & Safety in Sports, International Olympic Committee Research Center, Amsterdam, The Netherlands
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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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Artioli E, Mazzotti A, Zielli SO, Arceri A, Langone L, Gerardi S, Faldini C. Surgical management of osteochondral lesions of the first metatarsal head: A systematic review. Foot Ankle Surg 2023:S1268-7731(23)00099-1. [PMID: 37301674 DOI: 10.1016/j.fas.2023.05.007] [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: 03/28/2023] [Revised: 05/05/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Treating osteochondral lesions of the first metatarsal head can help reducing pain and preventing end-stage arthritic cartilage degeneration and hallux rigidus. Several surgical techniques have been described, but no clear indications are reported. This systematic review aims to offer an overview of the current surgical treatments for focal osteochondral lesions of the first metatarsal head. METHODS The selected articles were examined to extract data about population, surgical technique, and clinical outcomes. RESULTS Eleven articles were included. Mean age at surgery was 38,2 years. Osteochondral autograft was the most used technique. After surgery, an improvement was achieved in AOFAS, VAS, and hallux dorsiflexion but not in plantarflexion. CONCLUSION There is limited evidence and knowledge regarding the surgical management of the first metatarsal head osteochondral lesions. Various surgical techniques have been proposed, drawn from other districts. Good clinical results have been reported. Further high-level comparative studies are necessary to design an evidence-based treatment algorithm.
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Affiliation(s)
- Elena Artioli
- IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy.
| | - Antonio Mazzotti
- IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, 40123 Bologna, Italy
| | - Simone Ottavio Zielli
- IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Alberto Arceri
- IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Laura Langone
- IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Simone Gerardi
- IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Cesare Faldini
- 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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5
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Khuc E, M Oloff L. First Metatarsophalangeal Joint Pathology in the Athlete. Clin Podiatr Med Surg 2023; 40:157-168. [PMID: 36368840 DOI: 10.1016/j.cpm.2022.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Movement of the first metatarsophalangeal joint is an essential function of many sports. Because of the high demand on this relatively small joint, it is prone to the development of several notable pathologic derangements that can prevent full and pain-free athletic performance. A complete understanding of the joint anatomy and a careful physical examination and history collection is crucial to identifying an accurate diagnosis. Treatment should be pathology specific and should keep in mind the career expectations of the athlete.
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Affiliation(s)
- Emily Khuc
- Saint Mary's Medical Center San Francisco, Graduate Medical Office, 450 Stanyan Street, San Francisco, CA 94117, USA
| | - Lawrence M Oloff
- Saint Mary's Medical Center San Francisco, Graduate Medical Office, 450 Stanyan Street, San Francisco, CA 94117, USA; Palo Alto Medical Foundation 1501 Trousdale Drive, Ste 115, Burlingame, CA 94010, USA.
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6
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Arthroscopic accessibility of the first metatarsophalangeal joint for osteochondral defects of the metatarsal head by two-portal technique - comparing joint distraction and plantarflexion. Foot Ankle Surg 2022; 28:1377-1383. [PMID: 35872116 DOI: 10.1016/j.fas.2022.07.008] [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: 03/26/2022] [Revised: 07/14/2022] [Accepted: 07/15/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Several techniques and approaches for first metatarsophalangeal (MTP1) joint arthroscopy have been reported, where joint accessibility plays a key role. This study aimed to evaluate differences in arthroscopic accessibility of the first metatarsal head (MTH1) comparing non-invasive distraction and maximum plantarflexion in a two-portal approach. METHODS Forty fresh-frozen lower leg specimens were included and divided into a distraction group (D-group) and a plantarflexion group (PF-group). A two-portal technique (1.9 mm-30°-scope) was used for arthroscopy, maximum reach at the MTH1 was marked. Following arthroscopy, specimens were dissected and examined for iatrogenic injuries. The reached area at the chondral surface was pinned and accessibility calculated. RESULTS Accessibility of the MTH1 was 58.03 % ± 13.64 (D-group) and 55.93 % ± 10.30 (PF-group, p = 0.51). The dorsomedial hallucal nerve was injured in one specimen (2.5 %). CONCLUSION Maximum plantarflexion showed no difference in arthroscopic MTP1 joint accessibility compared to non-invasive distraction in a two-portal approach. During dorsomedial portal placement, the dorsomedial hallucal nerve is at risk for iatrogenic injury.
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Casciato D, Zulauf E, Steginsky B. Use of Small Joint Arthroscopy for Diagnosis and Treatment of a First Metatarsal Head Osteochondral Defect: A Case Report. JBJS Case Connect 2022; 12:01709767-202212000-00009. [PMID: 36240292 DOI: 10.2106/jbjs.cc.22.00276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 08/12/2022] [Indexed: 02/24/2023]
Abstract
CASE A case of a painful first metatarsophalangeal joint in a 28-year-old woman is reported. Clinical examination and imaging were suspicious for osteochondral lesion of the first metatarsal head. A 1.9-mm arthroscope was used for diagnosis and treatment of an osteochondral defect with microfracture and dehydrated, micronized allogenic cartilage application with an excellent postoperative outcome. CONCLUSION From the 3-month through 1-year follow-up, the patient continued a pain-free return to normal function. This case suggests that arthroscopy is as a viable approach to resurfacing osteochondral lesions of the big toe joint.
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8
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Christensen BB, Olesen ML, Hede KTC, Bergholt NL, Foldager CB, Lind M. Particulated Cartilage for Chondral and Osteochondral Repair: A Review. Cartilage 2021; 13:1047S-1057S. [PMID: 32052642 PMCID: PMC8808866 DOI: 10.1177/1947603520904757] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Injuries to articular cartilage have a poor spontaneous repair potential and no gold standard treatment exist. Particulated cartilage, both auto- and allograft, is a promising new treatment method that circumvents the high cost of scaffold- and cell-based treatments. MATERIALS AND METHODS A comprehensive database search on particulated cartilage was performed. RESULTS Fourteen animal studies have found particulated cartilage to be an effective treatment for cartilage injuries. Many studies suggest that juvenile cartilage has increased regenerative potential compared to adult cartilage. Sixteen clinical studies on 4 different treatment methods have been published. (1) CAIS, particulated autologous cartilage in a scaffold, (2) Denovo NT, juvenile human allograft cartilage embedded in fibrin glue, (3) autologous cartilage chips-with and without concomitant bone grafting, and (4) augmented autologous cartilage chips. CONCLUSION Implantation of allogeneic and autologous particulated cartilage provides a low cost and effective treatment alternative to microfracture and autologous chondrocyte implantation. The methods are promising, but large randomized controlled studies are needed.
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Affiliation(s)
- Bjørn Borsøe Christensen
- Department of Orthopedic Surgery,
Horsens Regional Hospital, Denmark,Department of orthopedic surgery, Aarhus
University Hospital, Aarhus, Denmark,Bjørn Borsøe Christensen, Aarhus University
Hospital, Noerrebrogade 44, Building 1A, 1st Floor, Aarhus, 8000, Denmark.
| | | | | | - Natasja Leth Bergholt
- Orthopedic Research Laboratory, Aarhus
University Hospital, Denmark,Comparative medicine, Institute of
clinical medicine, Aarhus University Hospital, Denmark
| | | | - Martin Lind
- Department of orthopedic surgery, Aarhus
University Hospital, Aarhus, Denmark
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Lei Y, Peng J, Dai Z, Liao Y, Liu Q, Li J, Jiang Y. Articular Cartilage Fragmentation Improves Chondrocyte Migration by Upregulating Membrane Type 1 Matrix Metalloprotease. Cartilage 2021; 13:1054S-1063S. [PMID: 34654323 PMCID: PMC8804713 DOI: 10.1177/19476035211035435] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE This study was undertaken to elucidate the mechanism of improved chondrocyte migration after juvenile articular cartilage fragmentation. DESIGN In vitro organ culture with rabbit cartilage fragments and cell culture with rabbit chondrocytes were performed. In part A, minced juvenile cartilage fragments (~0.5 × 0.5 × 0.5 mm) from rabbits, planted in gelatin sponge and fibrin glue, were cultured for 2, 4, or 6 weeks in vitro and compared with the cartilage chunks (~4 × 4 × 1 mm) and membrane type 1 matrix metalloprotease (MT1-MMP) inhibitor groups. Chondrocyte outgrowth was evaluated on histology and confocal laser scanning microscopy. MT1-MMP expression was compared between the cartilage fragment group and the cartilage chunks group. In part B, articular chondrocytes were harvested from juvenile rabbits, MT1-MMP was transfected into the cells, and cell migration was evaluated using the Transwell and wound healing tests. RESULTS The histology and confocal microscopy results revealed that cell accumulation occurred at the edge of cartilage fragments, and outgrowth was better in the cartilage fragment group than those in the cartilage chunks group. Similar results were observed for MT1-MMP expression. After MT1-MMP inhibition, cells did not accumulate at the edge of the cartilage fragments, and chondrocyte outgrowth did not occur. Furthermore, overexpression of MT1-MMP enhanced the migration of articular chondrocytes. CONCLUSIONS Juvenile articular cartilage fragmentation improved chondrocyte migration by upregulating MT1-MMP.
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Affiliation(s)
- Yunliang Lei
- Department of Orthopaedics, the First
Affiliated Hospital of University of South China, Hengyang, Hunan, China
| | - Jiabin Peng
- Department of Orthopaedics, the First
Affiliated Hospital of University of South China, Hengyang, Hunan, China,Guangdong Hospital of Traditional
Chinese Medicine, Zhuhai, Guangdong, China
| | - Zhu Dai
- Department of Orthopaedics, the First
Affiliated Hospital of University of South China, Hengyang, Hunan, China,Zhu Dai, Department of Orthopedics, the
First Affiliated Hospital of University of South China, 69 Chuanshan Road,
Hengyang, Hunan 421001, China.
| | - Ying Liao
- Department of Orthopaedics, the First
Affiliated Hospital of University of South China, Hengyang, Hunan, China
| | - Quanhui Liu
- Department of Orthopaedics, the First
Affiliated Hospital of University of South China, Hengyang, Hunan, China
| | - Jian Li
- Department of Orthopaedics, the First
Affiliated Hospital of University of South China, Hengyang, Hunan, China
| | - Yonghui Jiang
- Department of Orthopaedics, the First
Affiliated Hospital of University of South China, Hengyang, Hunan, China
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Bruno MA, Marcos RF, Wagner FV, Wagner FV. Treatment of Osteochondral Lesion of the First Metatarsal Head: Osteochondral Graft Transplantation Combined With Moberg Osteotomy: Case Report. Foot Ankle Spec 2021; 14:515-520. [PMID: 33853417 DOI: 10.1177/19386400211001972] [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] [Indexed: 11/17/2022]
Abstract
Most osteochondral lesions of the first metatarsal head are likely traumatic in etiology. The treatment ranges from microfractures to mosaicplasty. In this case report, we describe a central osteochondral lesion of the first metatarsal head treated with osteochondral graft obtained from the head of the same metatarsal in combination with Moberg osteotomy. After surgical treatment, the patient's American Orthopedic Foot and Ankle Society Forefoot Scale score improved from 58 to 85, and the range of motion also improved. This technique may be an alternative treatment modality for osteochondral lesions of the first metatarsal.Level of Evidence: Level V.
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11
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Saxena A, Shou L. A Novel Technique to Treat Hallux Rigidus in Athletic Patients With Central Osteochondral Defects: Preliminary Report on 12 Cases. J Foot Ankle Surg 2021; 60:845-849. [PMID: 33573902 DOI: 10.1053/j.jfas.2019.11.011] [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: 11/29/2018] [Revised: 11/14/2019] [Accepted: 11/22/2019] [Indexed: 02/03/2023]
Abstract
Osteochondral defects, often caused by traumatic injuries, are focal areas of articular damage resulting in joint pain and stiffness ultimately leading to degenerative joint disease. This has not been well studied in the first metatarsal head, but is an often encountered problem in the active population in other joints. In this study, we prospectively evaluated the results of 12 patients who received autogenous bone grafting for repair of osteochondral defects of the first metatarsal head. Clinical outcomes were evaluated by the visual analog scale for pain and the Roles and Maudsley (RM) score. Between the years of 2009 and 2016, 12 patients received treatment for this particular surgical intervention and their outcomes were measured. The patients' average age was 43.5 ± 10.6 years and were followed from 52.3 ± 26.7 months postoperatively. Average return to activity was 4.7 ± 1.1 months. The average preoperative RM score was 4.0 ± 0.0 and postoperative RM score was 1.4 ± 0.7 (p = .0001). The encouraging outcomes of this study suggest that autogenous bone grafting for osteochondral defects of the first metatarsal head is an effective treatment to help restore the function of the first metatarsophalangeal joint.
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Affiliation(s)
- Amol Saxena
- Director, Department of Sports Medicine, Palo Alto Medical Foundation, Palo Alto, CA.
| | - Louie Shou
- Podiatric Physician and Surgeon, Reconstructive Orthopedics, Sewell, NJ
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12
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Hollawell S, Moen R, Coleman M, Carson M. Osteochondral Fresh Allograft Transfer to Address Osteochondral Defect of the First Metatarsal Head in Early Hallux Limitus. J Foot Ankle Surg 2021; 60:157-162. [PMID: 33160835 DOI: 10.1053/j.jfas.2020.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 11/05/2019] [Accepted: 04/01/2020] [Indexed: 02/03/2023]
Abstract
Osteochondral fresh allograft transfer of the first metatarsal can be an accepted surgical management option for early stages of hallux limitus. This study consisted of evaluating clinical outcomes with patients who underwent this procedure. Thirteen (N=13) patients were included in this study, 10 (76.9%) were female and 3 (23.1%) were male. The mean age was 52.2 (range, 27-61) years and the mean body mass index was 25.3 (range, 33.8-19.4) kg/m2. Intraoperative evaluation of osteochondral defects of the first metatarsal demonstrated a mean diameter size of 8.2 mm. Ten (76.9%) patients had a concomitant cheilectomy procedure performed. The mean follow-up was 41.0 (range, 3.5-89.1) months. American Orthopaedic Foot and Ankle Society (AOFAS) Hallux Metatarsophalangeal-Interphalangeal Scale questionnaire and patient satisfaction survey were completed. The mean AOFAS Hallux Metatarsophalangeal-Interphalangeal score, which was determined postoperatively, was 71.2 (range, 55-85) of 100. Four (30.8%) patients with overall scores below 60 (range, 55-59) reported moderate daily pain at the first metatarsophalangeal joint. Mean AOFAS pain score was 26.9 (range, 20-30) of 40. Mean AOFAS function score was 30.8 (range, 24-35) of 45. Mean AOFAS alignment score was 13.4 (range, 8-15) of 15. There was statistical significance in mean AOFAS total score when comparing hallux limitus grade 1 versus grade 2, as well as when comparing grade 1 versus grade 3, p < .05. There was no significance in mean AOFAS total score when comparing number of plugs used, body mass index, and size of defect. However, an overall improvement in preoperative symptoms and patient satisfaction was documented and therefore osteochondral fresh allograft transfer can be considered a reasonable option in treating defects found at the first metatarsal head.
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Affiliation(s)
- Shane Hollawell
- Fellowship Director, Orthopaedic Institute of Central Jersey, Manasquan, NJ
| | - Ruth Moen
- Past Fellow, Foot and Ankle Surgeon, Northwest Kaiser Permanente, Portland, OR
| | - Meagan Coleman
- Fellow, Orthopaedic Institute of Central Jersey, Manasquan, NJ.
| | - Michael Carson
- Vice Chair of Research/Outcomes, Department of Medicine, Jersey Shore Medical Center, Neptune, NJ
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13
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Zhang C, Ao Y, Cao J, Yang L, Duan X. Donor Cell Fate in Particulated Juvenile Allograft Cartilage for the Repair of Articular Cartilage Defects. Am J Sports Med 2020; 48:3224-3232. [PMID: 32966105 DOI: 10.1177/0363546520958700] [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 Particulated juvenile allograft cartilage (PJAC) has demonstrated good clinical efficacy in repairing articular cartilage defects, but the related repair mechanism after transplant and the biological characteristics of the transplanted cells are still unclear. PURPOSE To study the efficacy of PJAC in repairing full-thickness cartilage defects and the specific fate of donor cells to provide experimental evidence for its clinical application. STUDY DESIGN Controlled laboratory study. METHODS Twenty female Guizhou minipigs were randomly divided into an experimental group and a control group. An 8-mm cylindrical full-thickness cartilage defect was created in the femoral trochlea of 1 knee in all minipigs. The experimental group received transplant of PJAC from 5 male juvenile Guizhou minipigs (PJAC group; n = 10) and the control group received autologous cartilage chips (ACC group; n = 10). Follow-up assessments were conducted at 1 month and 3 months to track the transplanted cells by the male-specific sex-determining region Y-linked (SRY) gene; tissue sections were hybridized in situ, and O'Driscoll histological scoring was performed according to hematoxylin and eosin staining, safranin O and fast green staining, and toluidine blue O staining, as well as immunohistochemical evaluation of aggrecan and Sry-type HMG-box 9 (SOX9). RESULTS All 20 Guizhou minipigs were followed; no infection or incision healing disorder occurred after the operation. By SRY in situ hybridization, the SRY signal of the transplanted cells was positive in the repaired tissue of the defect, and the SRY positive signal could still be detected in repaired tissue at 3 months postoperatively. The average number of positive cells was 68.6 ± 11.91 at 1 month and 32.6 ± 3.03 at 3 months (confocal microscope: ×400), and the difference was statistically significant. The O'Driscoll histological scores were 14 ± 0.71 in the ACC group and 9.8 ± 0.84 in the PJAC group at 1 month, and 18 ± 1.20 in the ACC group and 17.4 ± 1.14 in the PJAC group at 3 months. The scores were statistically significant between the ACC group and PJAC group at 1 month. The positive rates of SOX9 in the PJAC and ACC groups at 1 month were 67.6% ± 3.78% and 63.4% ± 5.30%, respectively, and the difference was not statistically significant (P > .05). The positive rates of SOX9 in the PJAC and ACC groups at 3 months were 68.8% ± 2.69% and 17.1% ± 1.26%, respectively, and the difference was statistically significant (P < .05). The positive rates of aggrecan in the PJAC and ACC groups at 1 month were 40.5% ± 2.78% and 42.4% ± 0.54% respectively, and the difference was not statistically significant (P > .05). The positive rates of aggrecan in the PJAC and ACC groups at 3 months were 40.8% ± 1.50% and 30.1% ± 2.44%, respectively, and the difference was not statistically significant (P > .05). CONCLUSION An animal model was established with Guizhou minipigs, and the cartilage defect was repaired with PJAC from male minipigs. The SRY gene positive signal could be detected from the repaired tissue by in situ hybridization, indicating that the transplanted cells survived at least 3 months. The key genes of cartilage formation, SOX9 and aggrecan, were expressed at 1 month and 3 months, and SOX9 expression was stronger in the PJAC group than the ACC group at 3 months. CLINICAL RELEVANCE This study suggests that it is feasible to study the biological characteristics of transplanted cells in the cartilage region by the sex-determining gene.
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Affiliation(s)
- Changgui Zhang
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Yunong Ao
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Jin Cao
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Liu Yang
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Xiaojun Duan
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
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Gao Y, Gao J, Li H, Du D, Jin D, Zheng M, Zhang C. Autologous costal chondral transplantation and costa-derived chondrocyte implantation: emerging surgical techniques. Ther Adv Musculoskelet Dis 2019; 11:1759720X19877131. [PMID: 31579403 PMCID: PMC6759717 DOI: 10.1177/1759720x19877131] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 08/29/2019] [Indexed: 01/08/2023] Open
Abstract
It is a great challenge to cure symptomatic lesions and considerable defects of hyaline cartilage due to its complex structure and poor self-repair capacity. If left untreated, unmatured degeneration will cause significant complications. Surgical intervention to repair cartilage may prevent progressive joint degeneration. A series of surgical techniques, including biological augmentation, microfracture and bone marrow stimulation, autologous chondrocyte implantation (ACI), and allogenic and autogenic chondral/osteochondral transplantation, have been used for various indications. However, the limited repairing capacity and the potential pitfalls of these techniques cannot be ignored. Increasing evidence has shown promising outcomes from ACI and cartilage transplantation. Nevertheless, the morbidity of autologous donor sites and limited resource of allogeneic bone have considerably restricted the wide application of these surgical techniques. Costal cartilage, which preserves permanent chondrocytes and the natural osteochondral junction, is an ideal candidate for the restoration of cartilage defects. Several in vitro and in vivo studies have shown good performance of costal cartilage transplantation. Although costal cartilage is a classic donor in plastic and cosmetic surgery, it is rarely used in skeletal cartilage restoration. In this review, we introduce the fundamental properties of costal cartilage and summarize costa-derived chondrocyte implantation and costal chondral/osteochondral transplantation. We will also discuss the pitfalls and pearls of costal cartilage transplantation. Costal chondral/osteochondral transplantation and costa-based chondrocytotherapy might be up-and-coming surgical techniques for recalcitrant cartilage lesions.
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Affiliation(s)
| | - Junjie Gao
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
- Centre for Orthopaedic Translational Research, University of Western Australia, Nedlands, WA, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
| | - Hengyuan Li
- Department of Orthopaedics, Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang, China
- Centre for Orthopaedic Translational Research, Medical School, University of Western Australia, Nedlands, WA, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
| | - Dajiang Du
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Dongxu Jin
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Minghao Zheng
- Centre for Orthopaedic Translational Research, Medical School, University of Western Australia, Nedlands, WA, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
| | - Changqing Zhang
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai 200233, China
- Institute of Microsurgery on Extremities, Shanghai 200233, China
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Ao Y, Li Z, You Q, Zhang C, Yang L, Duan X. The Use of Particulated Juvenile Allograft Cartilage for the Repair of Porcine Articular Cartilage Defects. Am J Sports Med 2019; 47:2308-2315. [PMID: 31246493 DOI: 10.1177/0363546519856346] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The repair of porcine articular cartilage defects by using particulated juvenile allograft cartilage (PJAC) has demonstrated good short-term clinical efficacy, but the repair process and mechanism have not been fully elucidated. PURPOSE To study the efficacy of PJAC in repairing full-thickness cartilage defects and to provide an experimental basis for its clinical application. STUDY DESIGN Controlled laboratory study. METHODS Thirty Guizhou minipigs were randomly divided into an experimental group and control group. An 8-mm cylindrical full-thickness cartilage defect was created in the femoral trochlea of either knee in all minipigs. The experimental group received the PJAC transplantation (PJAC group; n = 15) and the control group received autologous cartilage chips (ACC group; n = 15). Five minipigs were euthanized at 1, 3, and 6 months in each group to obtain samples, which were evaluated by general view of the knee joint and histomorphometry of the chondral defect area (hematoxylin and eosin, safranin O). International Cartilage Repair Society (ICRS) II semiquantitative evaluation and collagen type II staining immunohistochemistry were also performed. RESULTS All 30 Guizhou minipigs were followed; there was no infection or incision healing disorder after the operation. At 1 month postoperatively, more hyaline cartilage was found in the ACC group (29.4%) compared with the PJAC group (20.1%) (P < .05); there was no statistical difference between the 2 groups at 3 and 6 months after operation. The fibrocartilage content in the ACC group was significantly more than that in the PJAC group at 1 and 3 months postoperatively (27.4% vs 18.2% and 49.9% vs 41.1%, respectively; P < .05); significant differences disappeared at 6 months postoperatively. The PJAC group produced more fibrous tissue than the ACC group at 1 and 3 months postoperatively (60.1% vs 40.6% and 38.8% vs 24.4%, respectively; P < .05) but showed no statistical difference at 6 months postoperatively. Regarding the ICRS II scores, those of the ACC group were significantly better than the scores of the PJAC group in some subclasses at 3 and 6 months postoperatively. The positive rates of immunohistochemical staining in the ACC group were higher at 1 and 3 months postoperatively than those in the PJAC group (54.2% vs 37.8% and 46.4% vs 34.4%, respectively; P < .05). The difference was not statistically significant between the 2 groups at 6 months postoperatively. CONCLUSION Both PJAC and ACC can produce a good repair effect on cartilage defects. At 1 and 3 months postoperatively, ACC resulted in better outcomes than PJAC, but there was no statistical difference in the repair effect between the 2 techniques at 6 months postoperatively. CLINICAL RELEVANCE Based on this animal experiment, further clinical studies are needed to investigate PJAC as a possible alternative first-line treatment for cartilage defects.
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Affiliation(s)
- Yunong Ao
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Department of Bone and Joint Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Zhong Li
- Department of Bone and Joint Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Qi You
- Department of Bone and Joint Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Chengchang Zhang
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Liu Yang
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Xiaojun Duan
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
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Diniz P, Pacheco J, Flora M, Quintero D, Stufkens S, Kerkhoffs G, Batista J, Karlsson J, Pereira H. Clinical applications of allografts in foot and ankle surgery. Knee Surg Sports Traumatol Arthrosc 2019; 27:1847-1872. [PMID: 30721345 DOI: 10.1007/s00167-019-05362-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 01/14/2019] [Indexed: 02/08/2023]
Abstract
PURPOSE The purpose of this review is to systematically analyse current literature on the use of allografts in the surgical treatment of foot and ankle disorders in adult patients. Based on this study, we propose evidence-based recommendations. METHODS The database for PubMed was searched for all published articles. No timeframe restrictions were applied. Clinical studies eligible for inclusion met the following criteria: performed on patients over 18 years old; subject to surgical treatment of foot and ankle disorders; with report on the outcome of the use of allografts; with a report and assessment of pain and function, or equivalent; minimum follow-up of 1 year was required. Two reviewers independently screened and selected studies for full-text analysis from title and abstract. 107 studies were included from 1113 records. Studies were grouped according to surgical indications into ten categories: musculoskeletal tumours (n = 16), chronic ankle instability (n = 15), ankle arthritis (n = 14), osteochondral lesions of the talus (n = 12), Achilles tendon defects (n = 11), other tendon defects (n = 9), fusions (n = 9), fractures (n = 8), hallux rigidus (n = 3) and other indications (n = 10). RESULTS Most studies displayed evidence level of IV (n = 57) and V (n = 39). There was one level I, one level II and nine level III studies. Most studies reported allografting as a good option (n = 99; 92.5%). Overall complication rate was 17% (n = 202). CONCLUSIONS Fair evidence (Grade B) was found in favour of the use of allografts in lateral ankle ligament reconstruction or treatment of intra-articular calcaneal fracture. Fair evidence (Grade B) was found against the use of allogeneic MSCs in tibiotalar fusions. LEVEL OF EVIDENCE V.
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Affiliation(s)
- Pedro Diniz
- Department of Orthopaedic Surgery, Hospital de Sant'Ana, Rua de Benguela, 501, 2775-028, Parede, Portugal. .,Institute for Bioengineering and Biosciences, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal. .,Fisiogaspar, Lisbon, Portugal.
| | - Jácome Pacheco
- Department of Orthopaedic Surgery, Hospital de Sant'Ana, Rua de Benguela, 501, 2775-028, Parede, Portugal
| | - Miguel Flora
- Department of Orthopaedic Surgery, Hospital de Sant'Ana, Rua de Benguela, 501, 2775-028, Parede, Portugal
| | - Diego Quintero
- Department of Applied Anatomy in Physiatry Orthopedics and Traumatology of the Chair of Normal Anatomy, Faculty of Medical Sciences, National University of Rosario, Rosario, Argentina
| | - Sjoerd Stufkens
- Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Gino Kerkhoffs
- Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Jorge Batista
- Clinical Department Club Atletico Boca Juniores, CAJB-Centro Artroscopico, Buenos Aires, Argentina
| | - Jon Karlsson
- Department of Orthopaedics, University of Gothenburg, Gothenburg, Sweden
| | - Hélder Pereira
- Orthopaedic Department, Centro Hospitalar Póvoa de Varzim, Vila do Conde, Portugal.,Ripoll y De Prado Sports Clinic: FIFA Medical Centre of Excellence, Murcia-Madrid, Spain.,University of Minho, ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
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Abstract
The body's ability to repair injured articular cartilage is poor due to the inherent physiology of cartilage. Joint arthritis, whether through injury or increasing age, is a prevalent condition. Treatment of an articular cartilage injury may include arthroplasty, fusion, or repair. A popular pathway of treatment in a salvageable joint is often to avoid donor site morbidity and place increased effort to reestablish native cartilage with the use of allografts. This article discusses current research on acellular and cellular allografts for articular cartilage restoration.
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Affiliation(s)
- Michael H Theodoulou
- Department of Surgery, Cambridge Health Alliance, Harvard Medical School, 1493 Cambridge Street, Cambridge, MA 02139, USA
| | - Laura Bohman
- Podiatry Associates of Cincinnati, 10615 Montgomery Road, Suite 100, Cincinnati, OH 45242, USA.
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