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Rikken QGH, Kerkhoffs GMMJ. Fixation of Osteochondral Lesions of the Talus: Indications, Techniques, Outcomes, and Pearls from the Amsterdam Perspective. Foot Ankle Clin 2024; 29:265-279. [PMID: 38679438 DOI: 10.1016/j.fcl.2023.07.004] [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] [Indexed: 05/01/2024]
Abstract
The treatment of osteochondral lesions of the talus (OLT) remains a topic of debate as no superior treatment has yet been identified. The current consensus is that it is crucial to incorporate lesion and patient characteristics into the treatment algorithm. One such lesion type is the OLT with a fragment, which may benefit from in situ fixation. Fixation preserves the native hyaline cartilage and offers a direct stabilization of the fragment with high-quality subchondral bone repair. This current concepts review describes the evidence-based clinical work-up, indications, surgical techniques, outcomes, and clinical pearls for fixation techniques of OLT from the Amsterdam perspective.
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Affiliation(s)
- Quinten G H Rikken
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Meibergdreef 9, Amsterdam 1105 AZ, the Netherlands; Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, the Netherlands; Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, the Netherlands
| | - Gino M M J Kerkhoffs
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Meibergdreef 9, Amsterdam 1105 AZ, the Netherlands; Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, the Netherlands; Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, the Netherlands.
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Rikken QGH, Favier BJC, Dahmen J, Stufkens SAS, Kerkhoffs GMMJ. Open lift-drill-fill-fix for medial osteochondral lesions of the talus: surgical technique. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2024; 36:132-144. [PMID: 37828133 PMCID: PMC11014820 DOI: 10.1007/s00064-023-00833-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 05/30/2023] [Accepted: 06/06/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVE Osteochondral lesions of the talus (OLT) with a fragment on the talar dome that fail conservative treatment and need surgical treatment can benefit from in situ fixation of the OLT. Advantages of fixation include the preservation of native cartilage, a high quality subchondral bone repair, and the restoration of the joint congruency by immediate fragment stabilization. To improve the chance of successful stabilization, adequate lesion exposure is critical, especially in difficult to reach lesions located on the posteromedial talar dome. In this study we describe the open Lift, Drill, Fill, Fix (LDFF) technique for medial osteochondral lesions of the talus with an osteochondral fragment. As such, the lesion can be seen as an intra-articular non-union that requires debridement, bone-grafting, stabilization, and compression. The LDFF procedure combines these needs with access through a medial distal tibial osteotomy. INDICATIONS Symptomatic osteochondral lesion of the talus with a fragment (≥ 10 mm diameter and ≥ 3 mm thick as per computed tomography [CT] scan) situated on the medial talar dome which failed 3-6 months conservative treatment. CONTRAINDICATIONS Systemic disease, including active bacterial arthritis, hemophilic or other diffuse arthropathies, rheumatoid arthritis of the ankle joint, and malignancies. Neuropathic disease. End-stage ankle osteoarthritis or Kellgren and Lawrence score 3 or 4 [3]. Ipsilateral medial malleolus fracture less than 6 months prior. Relative contra-indication: posttraumatic stiffness with range of motion (ROM) < 5°. Children with open physis: do not perform an osteotomy as stabilization of the osteotomy may lead to early closure of the physis, potentially resulting in symptomatic varus angulation of the distal tibia. In these cases only arthrotomy can be considered. SURGICAL TECHNIQUE The OLT is approached through a medial distal tibial osteotomy, for which the screws are predrilled and the osteotomy is made with an oscillating saw and finished with a chisel in order to avoid thermal damage. Hereafter, the joint is inspected and the osteochondral fragment is identified. The cartilage is partially incised at the borders and the fragment is then lifted as a hood of a motor vehicle (lift). The subchondral bone is debrided and thereafter drilled to allow thorough bone marrow stimulation (drill) and filled with autologous cancellous bone graft from either the iliac crest or the distal tibia (fill). The fragment is then fixated (fix) in anatomical position, preferably with two screws to allow additional rotational stability. Finally, the osteotomy is reduced and fixated with two screws. POSTOPERATIVE MANAGEMENT Casting includes 5 weeks of short leg cast non-weightbearing and 5 weeks of short leg cast with weightbearing as tolerated. At 10-week follow-up, a CT scan is made to confirm fragment and osteotomy healing, and patients start personalized rehabilitation under the guidance of a physical therapist.
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Affiliation(s)
- Quinten G H Rikken
- Department of Orthopedic Surgery and Sports Medicine, University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands
| | - Barbara J C Favier
- Department of Orthopedic Surgery and Sports Medicine, University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands
| | - Jari Dahmen
- Department of Orthopedic Surgery and Sports Medicine, University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands
| | - Sjoerd A S Stufkens
- Department of Orthopedic Surgery and Sports Medicine, University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands
| | - Gino M M J Kerkhoffs
- Department of Orthopedic Surgery and Sports Medicine, University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands.
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Kirengo TO, Dossajee H, Onyango EM, Rachakonda RH, Schneider B, Sela DP, Hosseinzadeh Z, Nadeem Z, Obonyo NG. Catalysing global surgery: a meta-research study on factors affecting surgical research collaborations with Africa. Syst Rev 2024; 13:89. [PMID: 38500200 PMCID: PMC10946148 DOI: 10.1186/s13643-024-02474-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 01/28/2024] [Indexed: 03/20/2024] Open
Abstract
INTRODUCTION In December 2019, the COVID-19 pandemic highlighted the urgent need for rapid collaboration, research, and interventions. International research collaborations foster more significant responses to rapid global changes by enabling international, multicentre research, decreasing biases, and increasing study validity while reducing overall research time and costs. However, there has been low uptake of collaborative research by African institutions and individuals. AIM To systematically review facilitating factors and challenges to collaborative surgical research studies conducted in Africa. METHODOLOGY A meta-research review using PubMed®/MEDLINE and Embase on surgical collaboration in Africa from 1st of January 2011 to 31st of September 2021 in accordance to PRISMA guidelines. Surgical studies by collaborative groups involving African authors and sites were included (55 papers). Data on the study period, geographical regions, and research scope, facilitating factors, and challenges were extracted from the studies retrieved from the search. RESULTS Most of the collaborations in Africa occurred with European institutions (76%). Of the 54 African countries, 63% (34/54) participated in surgical collaborations. The highest collaboration frequency occurred in South Africa (11%) and Nigeria (8%). However, most publications originated from Eastern Africa (43%). Leveraging synergies between high- and low- to middle-income countries (LMICs), well-defined structures, and secure data platforms facilitated collaboration. However, the underrepresentation of collaborators from LMICs was a significant challenge. CONCLUSION Available literature provides critical insights into the facilitating factors and challenges of research collaboration with Africa. However, there is a need for a detailed prospective study to explore the themes highlighted further. SYSTEMATIC REVIEW REGISTRATION PROSPERO 2022 CRD42022352115 .
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Affiliation(s)
- Thomas O Kirengo
- Imara Hospital, Embu, Kenya.
- Kenya Medical Association, Nairobi, Kenya.
| | - Hussein Dossajee
- MP Shah Hospital, Nairobi, Kenya
- Kenya Medical Association, Nairobi, Kenya
| | - Evans M Onyango
- Ministry of Health, Kajiado County, Kenya
- Kenya Medical Association, Nairobi, Kenya
| | - Reema H Rachakonda
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Critical Care Research Group, Brisbane, Australia
| | - Bailey Schneider
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Critical Care Research Group, Brisbane, Australia
| | - Declan P Sela
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Critical Care Research Group, Brisbane, Australia
| | - Zahra Hosseinzadeh
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Critical Care Research Group, Brisbane, Australia
| | - Zohaib Nadeem
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Critical Care Research Group, Brisbane, Australia
| | - Nchafatso G Obonyo
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Critical Care Research Group, Brisbane, Australia
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Kenya Medical Association, Nairobi, Kenya
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van Diepen PR, Smithuis FF, Hollander JJ, Dahmen J, Emanuel KS, Stufkens SAS, Kerkhoffs GMMJ. Reporting of Morphology, Location, and Size in the Treatment of Osteochondral Lesions of the Talus in 11,785 Patients: A Systematic Review and Meta-Analysis. Cartilage 2024:19476035241229026. [PMID: 38366391 DOI: 10.1177/19476035241229026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2024] Open
Abstract
OBJECTIVE Uniformity of reporting is a requisite to be able to compare results of clinical studies on the treatment of osteochondral lesions of the talus (OLT). The primary aim of this study was to evaluate the frequency and quality of reporting of size, morphology, and location of OLTs. DESIGN A literature search was performed from 1996 to 2023 to identify clinical studies on surgical treatment of OLTs. Screening was performed by 2 reviewers, who subsequently graded the quality using the methodological index for non-randomized studies (MINORS). The primary outcome was the frequency and qualitative assessment of reporting of size, morphology, and location. RESULTS Of 3,074 articles, 262 articles were included. This comprised a total of 11,785 patients. Size was reported in 248 (95%) of the articles and was described with a measure for surface area in 83%, however, in 56%, definition of measurement is unknown. Intraclass coefficient (ICC) value for the reliability of size measurement was 0.94 for computed tomography (CT) scan and 0.87 for MRI scan. Morphology was reported in 172 (66%) of the articles and using a classification system in 23% of the studies. Location was reported in 220 (84%) of the studies. CONCLUSION No consensus was found on the reporting of morphology, with non-validated classification systems and different terminologies used. For location, reporting in 9 zones is underreported. Size was well reported and measurements are more reliable for CT compared with MRI. As these prognostic factors guide clinical decision-making, we advocate the development of a standardized and validated OLT classification to reach uniform reporting in literature. LEVEL OF EVIDENCE Level III, systematic review.
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Affiliation(s)
- Pascal R van Diepen
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
- Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee(IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Programs Sports and Musculoskeletal Health, Amsterdam, The Netherlands
| | - Frank F Smithuis
- Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee(IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Julian J Hollander
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
- Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee(IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Programs Sports and Musculoskeletal Health, Amsterdam, The Netherlands
| | - Jari Dahmen
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
- Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee(IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Programs Sports and Musculoskeletal Health, Amsterdam, The Netherlands
| | - Kaj S Emanuel
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
- Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee(IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Programs Sports and Musculoskeletal Health, Amsterdam, The Netherlands
| | - Sjoerd A S Stufkens
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
- Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee(IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Programs Sports and Musculoskeletal Health, Amsterdam, The Netherlands
| | - Gino M M J Kerkhoffs
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
- Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee(IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Programs Sports and Musculoskeletal Health, Amsterdam, The Netherlands
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Nakasa T, Ikuta Y, Sumii J, Nekomoto A, Kawabata S, Adachi N. Arthroscopic Fixation Using Bioabsorbable Pins With Bone Grafting via a Medial Malleolus Approach to Treat Osteochondral Lesion of the Talus. Foot Ankle Spec 2024; 17:68S-74S. [PMID: 36113034 DOI: 10.1177/19386400221122766] [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] [Indexed: 11/15/2022]
Abstract
Fixation of the osteochondral fragment has the advantage to restore the naturally congruent morphology of the talar dome with native hyaline cartilage in the treatment of the osteochondral lesion of the talus (OLT). Surgical treatment of medial talar osteochondral lesions is commonly done through a medial malleolar osteotomy. However, a medial malleolar osteotomy is an invasive procedure and gives negative impacts on clinical outcomes. Fixation for the posteromedial lesion of the OLT without the medial malleolar osteotomy may provide good clinical outcomes. We showed arthroscopic fixation for medial OLT without the medial malleolar osteotomy. Curettage and bone grafting between the fragment and its bed were performed, and then 2-mm bone tunnel in the medial malleolus was created. Bioabsorbable pins were inserted through the tunnel to fix the osteochondral fragment. Three cases (mean age 18.6 years) were treated using this technique for medial OLT and followed at 16 months (range, 12-24 months). The Japanese Society for Surgery of the Foot scale improved from 73.3 ± 1.2 points before surgery to 95.7 ± 7.5 points at the final follow-up. Bone union of the osteochondral fragment was confirmed on magnetic resonance imaging (MRI). Arthroscopic fixation for medial OLT is less invasive and yields good clinical outcomes.Levels of Evidence: Level V.
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Affiliation(s)
- Tomoyuki Nakasa
- The Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima City, Japan
- Medical Center for Translational and Clinical Research, Hiroshima University Hospital, Hiroshima City, Japan
| | - Yasunari Ikuta
- The Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima City, Japan
| | - Junichi Sumii
- The Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima City, Japan
| | - Akinori Nekomoto
- The Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima City, Japan
| | - Shingo Kawabata
- The Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima City, Japan
| | - Nobuo Adachi
- The Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima City, Japan
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Dahmen J, Rikken Q, Stufkens SAS, Kerkhoffs GMMJ. Talar OsteoPeriostic Grafting from the Iliac Crest (TOPIC): Two-Year Prospective Results of a Novel Press-Fit Surgical Technique for Large, Complex Osteochondral Lesions of the Medial Talus. J Bone Joint Surg Am 2023; 105:1318-1328. [PMID: 37363948 DOI: 10.2106/jbjs.22.01322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
BACKGROUND Press-fit Talar OsteoPeriostic grafting from the Iliac Crest (TOPIC) is a novel technique for the treatment of large osteochondral lesions of the talus. The purpose of the present study was to prospectively evaluate the 2-year clinical outcomes for patients with medial osteochondral lesions of the talus that were treated with the TOPIC procedure. METHODS Forty-three patients were prospectively assessed before and 24 months after the TOPIC procedure. All procedures were performed through a medial distal tibial osteotomy. Clinical assessment preoperatively and at 24 months of follow-up included determination of the Numeric Rating Scale (NRS) scores for pain during walking (primary outcome), at rest, during running, and during stair-climbing. The Foot and Ankle Outcome Score (FAOS) and the Mental Component Summary (MCS) score and Physical Component Summary (PCS) score of the Short Form-36 (SF-36) were also assessed. A computed tomography (CT) scan was performed 12 weeks postoperatively to assess union of the distal tibial osteotomy site and at 1 and 2 years postoperatively to assess consolidation of the graft as well as cyst development in the graft. RESULTS All enrolled patients were available for follow-up. The median NRS score for pain during walking improved from 7 points preoperatively to 2 points at 2 years postoperatively (p < 0.001). All other NRS scores for pain improved significantly. All FAOS subscale scores improved significantly, including those for pain (from 53 to 75), symptoms (from 50 to 61), activities of daily living (from 68 to 88), sports (from 30 to 55), and quality of life (from 19 to 38). The SF-36 PCS score improved from 43 to 48 (p < 0.001), and the MCS score changed from 28 to 26 (p > 0.05). There was a 100% rate of union of the osteotomy site at the distal tibia and 100% of the grafts showed consolidation at 1 and 2 years postoperatively. CONCLUSIONS The TOPIC procedure for large osteochondral lesions of the medial talar dome is an effective technique that resulted in significant improvement exceeding the minimal clinically important difference in pain scores (primary outcome) as well as in other outcomes, with 100% consolidation of the grafts. LEVEL OF EVIDENCE Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Jari Dahmen
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Programs Sports and Musculoskeletal Health, Amsterdam, The Netherlands
- Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, The Netherlands
- Amsterdam Collaboration on Health & Safety in Sports (ACHSS), IOC Research Center, Amsterdam, The Netherland
| | - Quinten Rikken
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Programs Sports and Musculoskeletal Health, Amsterdam, The Netherlands
- Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, The Netherlands
- Amsterdam Collaboration on Health & Safety in Sports (ACHSS), IOC Research Center, Amsterdam, The Netherland
| | - Sjoerd A S Stufkens
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Programs Sports and Musculoskeletal Health, Amsterdam, The Netherlands
- Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, The Netherlands
- Amsterdam Collaboration on Health & Safety in Sports (ACHSS), IOC Research Center, Amsterdam, The Netherland
| | - Gino M M J Kerkhoffs
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Programs Sports and Musculoskeletal Health, Amsterdam, The Netherlands
- Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, The Netherlands
- Amsterdam Collaboration on Health & Safety in Sports (ACHSS), IOC Research Center, Amsterdam, The Netherland
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Tsuyuguchi Y, Nakasa T, Ikuta Y, Sumii J, Nekomoto A, Kawabata S, Adachi N. The role of the oblique medial osteotomy angle during osteochondral fragment fixation in patients with a posteromedial osteochondral lesion of the talus. J Orthop Sci 2023; 28:1093-1098. [PMID: 35864028 DOI: 10.1016/j.jos.2022.06.016] [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: 03/10/2022] [Revised: 05/26/2022] [Accepted: 06/27/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Medial malleolar osteotomy has been widely performed for posteromedial osteochondral lesions of the talus (OLT) to expose the lesion. In osteochondral fragment fixation, bioabsorbable pins should be inserted as perpendicular as possible to obtain the rigid fixation. However, the exposure of the lesion may depend on the osteotomy angle, which affects the pin insertion angles. This study aimed to analyze the relationship between pin insertion and osteotomy angles in the medial malleolar osteotomy. METHODS Twenty-four ankles of 23 patients were included. The malleolar bisector angle which was calculated from radiographs and actual osteotomy angles were measured on radiographs, and the pin insertion and osteotomy angles were measured using MRI. The intersection angle was defined by the tangential line of the tibial plafond and medial malleolar articular facet, and the bisector of this angle was defined as the malleolar bisector angle. The relationship between pin insertion and osteotomy angles was analyzed. RESULTS There was no significant difference between the actual osteotomy (55.7° ± 6.6°) and malleolar bisector angles (57.4° ± 4.3°) on the radiograph. There was a significant correlation between pin insertion and osteotomy angles (rs = 0.601). The pin insertion angle (54.3° ± 5.9°) in the lower actual osteotomy angle than the malleolar bisector angle was smaller than those in the higher actual osteotomy angle (63.4° ± 8.2°). CONCLUSIONS This study showed the osteotomy angle affected pin insertion angle. The osteotomy angle should not be smaller than the malleolar bisector angle at medial malleolar osteotomy to insert pins as perpendicular as possible for fixation of posteromedial OLTs.
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Affiliation(s)
- Yusuke Tsuyuguchi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima City, Hiroshima, 734-8551, Japan
| | - Tomoyuki Nakasa
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima City, Hiroshima, 734-8551, Japan; Medical Center for Translational and Clinical Research, Hiroshima University Hospital, 1-2-3 Kasumi, Minamiku, Hiroshima City, Hiroshima, 734-8551, Japan.
| | - Yasunari Ikuta
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima City, Hiroshima, 734-8551, Japan
| | - Junichi Sumii
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima City, Hiroshima, 734-8551, Japan
| | - Akinori Nekomoto
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima City, Hiroshima, 734-8551, Japan
| | - Shingo Kawabata
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima City, Hiroshima, 734-8551, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima City, Hiroshima, 734-8551, Japan
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Walther M, Gottschalk O, Madry H, Müller PE, Steinwachs M, Niemeyer P, Niethammer TR, Tischer T, Petersen J, Feil R, Fickert S, Schewe B, Hörterer H, Ruhnau K, Becher C, Klos K, Plaass C, Rolauffs B, Behrens P, Spahn G, Welsch G, Angele P, Ahrend MD, Kasten P, Erggelet C, Ettinger S, Günther D, Körner D, Aurich M. Etiology, Classification, Diagnostics, and Conservative Management of Osteochondral Lesions of the Talus. 2023 Recommendations of the Working Group "Clinical Tissue Regeneration" of the German Society of Orthopedics and Traumatology. Cartilage 2023; 14:292-304. [PMID: 37082983 PMCID: PMC10601568 DOI: 10.1177/19476035231161806] [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: 11/05/2022] [Revised: 02/18/2023] [Accepted: 02/19/2023] [Indexed: 04/22/2023] Open
Abstract
METHODS Peer-reviewed literature was analyzed regarding different topics relevant to osteochondral lesions of the talus (OLTs) treatment. This process concluded with a statement for each topic reflecting the best scientific evidence available for a particular diagnostic or therapeutic concept, including the grade of recommendation. Besides the scientific evidence, all group members rated the statements to identify possible gaps between literature and current clinical practice. CONCLUSION In patients with minimal symptoms, OLT progression to ankle osteoarthritis is unlikely. Risk factors for progression are the depth of the lesion on MRI, subchondral cyst formation, and the extent of bone marrow edema. Conservative management is the adaptation of activities to the performance of the ankle joint. A follow-up imaging after 12 months helps not to miss any progression. It is impossible to estimate the probability of success of conservative management from initial symptoms and imaging. Cast immobilization is an option in OLTs in children, with a success rate of approximately 50%, although complete healing, estimated from imaging, is rare. In adults, improvement by conservative management ranges between 45% and 59%. Rest and restrictions for sports activities seem to be more successful than immobilization. Intra-articular injections of hyaluronic acid and platelet-rich plasma can improve pain and functional scores for more than 6 months. If 3 months of conservative management does not improve symptoms, surgery can be recommended.
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Affiliation(s)
- Markus Walther
- Schön Klinik München Harlaching, FIFA Medical Centre of Excellence, Munich, Germany
- Department of Orthopeadics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, Ludwig Maximilian University Munich, Munich, Germany
- König-Ludwig-Haus, Julius Maximilian University of Würzburg, Würzburg, Germany
- Paracelsus Medizinische Privatuniversität, Salzburg, Austria
| | - Oliver Gottschalk
- Schön Klinik München Harlaching, FIFA Medical Centre of Excellence, Munich, Germany
- Department of Orthopeadics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Henning Madry
- Institute of Experimental Orthopaedics and Department of Orthopaedic Surgery, Saarland University, Homburg, Germany
| | - Peter E. Müller
- Department of Orthopeadics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Matthias Steinwachs
- SportClinic Zürich, Klinik Hirslanden, Zürich, Switzerland
- ETH Zürich, Zürich, Switzerland
- Albert-Ludwigs-Universität Freiburg, Freiburg, Germany
| | - Philipp Niemeyer
- Albert-Ludwigs-Universität Freiburg, Freiburg, Germany
- OCM—Hospital for Orthopedic Surgery Munich, Munich, Germany
| | - Thomas R. Niethammer
- Department of Orthopeadics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Thomas Tischer
- Klinik für Orthopädie und Unfallchirurgie, Malteser Waldkrankenhaus St. Marien, Erlangen, Germany
| | | | - Roman Feil
- Klinik für Unfallchirurgie und Orthopädie, Kath. Marienkrankenhaus gGmbH, Hamburg, Germany
| | - Stefan Fickert
- Sporthopaedicum Straubing, Straubing, Germany
- Sporthopaedicum Regensburg, Regensburg, Germany
| | - Bernhard Schewe
- Orthopädisch Chirurgisches Centrum Tübingen, Tübingen, Germany
| | - Hubert Hörterer
- Schön Klinik München Harlaching, FIFA Medical Centre of Excellence, Munich, Germany
- Department of Orthopeadics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | | | - Christoph Becher
- Internationales Zentrum für Orthopädie, ATOS Klinik Heidelberg, Heidelberg, Germany
| | | | - Christian Plaass
- Orthopedic Clinic of Medical School Hannover, DIAKOVERE Annastift, Hannover, Germany
| | - Bernd Rolauffs
- Klinik für Orthopädie und Unfallchirurgie and G.E.R.N. Forschungszentrum, Universitätsklinikum Freiburg, Freiburg, Germany
| | | | - Gunter Spahn
- Center of Trauma and Orthopaedic Surgery Eisenach, Eisenach, Germany
| | | | - Peter Angele
- Sporthopaedicum Straubing, Straubing, Germany
- Sporthopaedicum Regensburg, Regensburg, Germany
- Department of Trauma and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Marc-Daniel Ahrend
- BG Unfallklinik Tübingen, Klinik für Unfall- und Wiederherstellungschirurgie, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - Philip Kasten
- Orthopädisch Chirurgisches Centrum Tübingen, Tübingen, Germany
| | - Christoph Erggelet
- Albert-Ludwigs-Universität Freiburg, Freiburg, Germany
- alphaclinic zürich, Zürich, Switzerland
| | - Sarah Ettinger
- Orthopedic Clinic of Medical School Hannover, DIAKOVERE Annastift, Hannover, Germany
| | - Daniel Günther
- Department of Orthopaedic Surgery, Trauma Surgery, and Sports Medicine, Cologne-Merheim Medical Center, Witten/Herdecke University, Cologne, Germany
| | - Daniel Körner
- BG Unfallklinik Tübingen, Klinik für Unfall- und Wiederherstellungschirurgie, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - Matthias Aurich
- BG Klinikum Bergmannstrost Halle, Halle (Saale), Germany
- Abteilung für Unfall- und Wiederherstellungschirurgie, Martin-Luther-University Halle-Wittenberg, Universitätsklinikum Halle (Saale), Halle, Germany
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9
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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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10
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Griffith JF, Ling SKK, Tischer T, Weber MA. Talar Dome Osteochondral Lesions: Pre- and Postoperative Imaging. Semin Musculoskelet Radiol 2022; 26:656-669. [PMID: 36791735 DOI: 10.1055/s-0042-1760217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
We suggest a similar approach to evaluating osteochondral lesions of the talar dome both pre- and postoperatively. This review addresses the etiology, natural history, and treatment of talar dome osteochondral lesions with an emphasis on imaging appearances. High-resolution magnetic resonance imaging, ideally combining a small field-of-view surface coil with ankle traction, optimizes visibility of most of the clinically relevant features both pre- and postoperatively.
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Affiliation(s)
- James Francis Griffith
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, China
| | - Samuel K K Ling
- Department of Orthopaedic and Traumatology, The Chinese University of Hong Kong, Hong Kong, China
| | - Thomas Tischer
- Department of Orthopaedic Surgery, University Medical Centre Rostock, Rostock, Germany
| | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center Rostock Germany
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11
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Hurley DJ, Davey MS, Hurley ET, Murawski CD, Calder JDF, D'Hooghe P, van Bergen CJA, Walls RJ, Ali Z, Altink JN, Batista J, Bayer S, Berlet GC, Buda R, Dahmen J, DiGiovanni CW, Ferkel RD, Gianakos AL, Giza E, Glazebrook M, Guillo S, Hangody L, Haverkamp D, Hintermann B, Hogan MV, Hua Y, Hunt K, Jamal MS, Karlsson J, Kearns S, Kerkhoffs GMMJ, Lambers K, Lee JW, McCollum G, Mercer NP, Mulvin C, Nunley JA, Paul J, Pearce C, Pereira H, Prado M, Raikin SM, Savage-Elliott I, Schon LC, Shimozono Y, Stone JW, Stufkens SAS, Sullivan M, Takao M, Thermann H, Thordarson D, Toale J, Valderrabano V, Vannini F, van Dijk CN, Walther M, Yasui Y, Younger AS, Kennedy JG. Paediatric ankle cartilage lesions: Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle. J ISAKOS 2022; 7:90-94. [PMID: 35774008 DOI: 10.1016/j.jisako.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 04/03/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND The evidence supporting best practice guidelines in the field of cartilage repair of the ankle are based on both low quality and low levels of evidence. Therefore, an international consensus group of experts was convened to collaboratively advance toward consensus opinions based on the best available evidence on key topics within cartilage repair of the ankle. The purpose of this article is to report the consensus statements on "Pediatric Ankle Cartilage Lesions" developed at the 2019 International Consensus Meeting on Cartilage Repair of the Ankle. METHODS Forty-three international experts in cartilage repair of the ankle representing 20 countries convened to participate in a process based on the Delphi method of achieving consensus. Questions and statements were drafted within four 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 characterised as follows: consensus: 51-74%; strong consensus: 75-99%; unanimous: 100%. RESULTS A total of 12 statements on paediatric ankle cartilage lesions reached consensus during the 2019 International Consensus Meeting on Cartilage Repair of the Ankle. Five achieved unanimous support, and seven reached strong consensus (>75% agreement). All statements reached at least 84% agreement. CONCLUSIONS This international consensus derived from leaders in the field will assist clinicians with the management of paediatric ankle cartilage lesions.
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Affiliation(s)
- Daire J Hurley
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Martin S Davey
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Eoghan T Hurley
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Christopher D Murawski
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
| | - James D F Calder
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Pieter D'Hooghe
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - Raymond J Walls
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Zakariya Ali
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - J Nienke Altink
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jorge Batista
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Steve Bayer
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Gregory C Berlet
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Roberto Buda
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jari Dahmen
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - Richard D Ferkel
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Arianna L Gianakos
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Eric Giza
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Mark Glazebrook
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Stéphane Guillo
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Laszlo Hangody
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Daniel Haverkamp
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Beat Hintermann
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - MaCalus V Hogan
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Yinghui Hua
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Kenneth Hunt
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - M Shazil Jamal
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jón Karlsson
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Stephen Kearns
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Gino M M J Kerkhoffs
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Kaj Lambers
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jin Woo Lee
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Graham McCollum
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Nathaniel P Mercer
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Conor Mulvin
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - James A Nunley
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jochen Paul
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Christopher Pearce
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Helder Pereira
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Marcelo Prado
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Steven M Raikin
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Ian Savage-Elliott
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Lew C Schon
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Yoshiharu Shimozono
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - James W Stone
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Sjoerd A S Stufkens
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Martin Sullivan
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Masato Takao
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Hajo Thermann
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - David Thordarson
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - James Toale
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Victor Valderrabano
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Francesca Vannini
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - C Niek van Dijk
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Markus Walther
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Youichi Yasui
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Alastair S Younger
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - John G Kennedy
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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12
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Choi YR, Kim BS, Kim YM, Park JY, Cho JH, Ahn JT, Kim HN. Second-look arthroscopic and magnetic resonance analysis after internal fixation of osteochondral lesions of the talus. Sci Rep 2022; 12:10833. [PMID: 35760944 PMCID: PMC9237059 DOI: 10.1038/s41598-022-14990-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 06/16/2022] [Indexed: 11/09/2022] Open
Abstract
The purpose of this study was to evaluate cartilage quality after internal fixation of osteochondral lesion of the talus (OLT) using second-look arthroscopies and MRIs. Thirty-four patients underwent internal fixation of OLTs involving large bone fragments. Twenty-one of these patients underwent second-look arthroscopies and 23 patients underwent MRIs postoperatively. The arthroscopic findings were assessed using the International Cartilage Repair Society (ICRS) grading system, and the MRI findings were evaluated using the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score. Five of the patients who underwent second-look arthroscopies showed normal cartilage, 12 showed nearly normal cartilage, 3 showed abnormal cartilage, and 1 showed severely abnormal cartilage, according to the overall ICRS repair grades. All the patients who achieved bone fragment union showed normal, or nearly normal cartilage upon second-look arthroscopy. The ICRS and MOCART scores were significantly higher for the patients with bone fragment union compared to those with nonunion (ICRS scores: 10.3 ± 1.5 vs. 6.0 ± 2.0, p < 0.001, MOCART score: 88.3 ± 10.0 vs. 39.0 ± 20.4, p < 0.001). Low signal intensities of the bone fragments on preoperative T1-weighted MRIs were not associated with nonunion (Fisher's exact test, p = 0.55), and the signal intensities increased postoperatively to levels similar to the underlying talus when bone union was achieved. Second-look arthroscopy and MRI showed normal, or nearly normal, cartilage after internal fixation of OLTs when bone union was achieved. The nonunion of bone fragments resulted in inferior cartilage quality.
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Affiliation(s)
- Young Rak Choi
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Bom Soo Kim
- Department of Orthopedic Surgery, Inha University Hospital, Incheon, Republic of Korea
| | - Yu Mi Kim
- Department of Orthopedic Surgery, Sanbon Hospital, Wonkwang University College of Medicine, Gunpo-si, Gyeonggi-do, Republic of Korea
| | - Jae Yong Park
- Department of Orthopedic Surgery, Hallym Sacred Heart Hospital, Hallym University College of Medicine, Anyang-si, Gyeonggi-do, Republic of Korea
| | - Jae Ho Cho
- Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon-si, Gangwon-do, Republic of Korea
| | - Joong Taek Ahn
- Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 1, Shingil-ro, Yeongdeungpo-gu, Seoul, 07441, Republic of Korea
| | - Hyong Nyun Kim
- Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 1, Shingil-ro, Yeongdeungpo-gu, Seoul, 07441, Republic of Korea.
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13
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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: 3] [Impact Index Per Article: 1.5] [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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14
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Murawski CD, Jamal MS, Hurley ET, Buda R, Hunt K, McCollum G, Paul J, Vannini F, Walther M, Yasui Y, Ali Z, Altink JN, Batista J, Bayer S, Berlet GC, Calder JD, Dahmen J, Davey MS, D’Hooghe P, DiGiovanni CW, Ferkel RD, Gianakos AL, Giza E, Glazebrook M, Hangody L, Haverkamp D, Hintermann B, Hua Y, Hurley DJ, Karlsson J, Kearns S, Kennedy JG, Kerkhoffs GM, Lambers K, Lee JW, Mercer NP, Mulvin C, Nunley JA, Pearce C, Pereira H, Prado M, Raikin SM, Savage-Elliott I, Schon LC, Shimozono Y, Stone JW, Stufkens SA, Sullivan M, Takao M, Thermann H, Thordarson D, Toale J, Valderrabano V, van Bergen CJ, Niek van Dijk C, Walls RJ, Younger AS, Hogan MV. Terminology for Osteochondral Lesions of the Ankle Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle. J ISAKOS 2022; 7:62-66. [DOI: 10.1016/j.jisako.2021.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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15
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Powers RT, Dowd TC, Giza E. Surgical Treatment for Osteochondral Lesions of the Talus. Arthroscopy 2021; 37:3393-3396. [PMID: 34863377 DOI: 10.1016/j.arthro.2021.10.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 08/10/2021] [Indexed: 02/02/2023]
Abstract
Osteochondral lesions of the talus (OLT) are often associated with ankle pain and dysfunction. They can occur after ankle trauma, such as sprains or fractures, but they usually present as a continued ankle pain after the initial injury has resolved. Chronic ankle ligament instability and subsequent microtrauma may lead to insidious development of an OLT. Medial-sided lesions are more common (67%) than lateral-sided lesions. For acute lesions that are nondisplaced, nonoperative management is initially performed, with a 4-6 week period of immobilization and protected weight bearing. Symptomatic improvement results in more than 50% of patients by 3 months. Acute osteochondral talus fractures, which have a bone fragment thickness greater than 3 mm with displacement will benefit from early surgical intervention. These injuries should undergo primary repair via internal fixation with bioabsorbable compression screws 3.0 mm or smaller using at least 2 points of fixation. Acute lesions that are too small for fixation can be treated with morselization and reimplantation of the cartilage fragments. If OLTs are persistently symptomatic following an appropriate course of nonoperative treatment, various reparative and restorative surgical options may be considered on the basis of diameter, surface area, depth, and location of the lesion. A small subset of symptomatic osteochondral lesions of the talus involve subchondral pathology with intact overlying articular cartilage; in these cases, retrograde drilling into the cystic lesion can be employed to induce underlying bony healing. Cancellous bone graft augmentation may be used for subchondral cysts with volume greater than 100 mm3 or with those with a depth of more than 10 mm. Debridement, curettage, and bone marrow stimulation is a reparative technique that may be considered in lesions demonstrating a diameter less than 10 mm, with surface area less than 100 mm2, and a depth less than 5 mm. This technique is commonly performed arthroscopically using curettes and an arthroscopic shaver to remove surrounding unstable cartilage. A microfracture awl of 1 mm or less is used to puncture the subchondral bone with 3-4 mm of spacing between to induce punctate bleeding. Initial (<5 year) results are good to excellent in 80% of cases, with some deterioration of improvement over time. Factors contributing to poor results include surface area greater than 1.5 cm2, overall osteochondral lesion depth over 7.8 mm, smoking history, age over 40, and uncontained lesions. Lesions greater than 1.29 cm2, cystic lesions, and lesions that have failed prior treatment are potential candidates for osteochondral autograft transplantation. The autograft is typically harvested from the lateral femoral condyle of the ipsilateral knee with an optimal plug depth and diameter of 12-15 mm. Transplantation often involves open technique and may even require malleolar osteotomy for perpendicular access to the defect, as well as visualization of a flush, congruent graft fit. Good to excellent outcomes have been reported in up 87.4% of cases with the most common complication being donor site morbidity in up to 15% of cases. Failure rates increased significantly in lesions larger than 225 mm2. Scaffold-based therapies, such as matrix-associated chondrocyte implantation, can be employed in primary or revision settings in lesions larger than 1 cm2, including uncontained shoulder lesions with or without cysts. Lesions with greater than 4 mm of bone loss following debridement may require bone grafting to augment with the scaffold. This technique requires an initial procedure for chondrocyte harvest and a secondary procedure for transplantation of the scaffold. Outcomes have been good to excellent in up to 93% of cases; however, this technique requires a two-stage procedure and can be cost-prohibitive. Particulated juvenile cartilage is a restorative technique that employs cartilage allograft from juvenile donors. The cartilage is placed into the defect and secured with fibrin glue in a single-stage procedure. Studies have shown favorable outcomes in 92% of cases, with lesions between 10 and 15 mm in diameter, but increased failure rates and poorer outcomes in lesions larger than 15 mm. This may be an alternative option for contained lesions between 10 and 15 mm in diameter. Osteochondral allograft plugs are an option for larger contained lesions (>1.5 cm in diameter) and in patients with knee osteoarthritis (OA) and concern for donor site morbidity. Furthermore, bulk osteochondral allograft from a size-matched talus can also be used for even larger, unstable/uncontained shoulder lesions. An anterior approach is often employed and fixation is achieved via placement of countersunk headless compression screws. Failure of the aforementioned options associated with persistent pain or progressive OA would then lend consideration to ankle arthroplasty versus ankle arthrodesis.
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Affiliation(s)
- Robert T Powers
- SAUSHEC Orthopaedic Surgery Residency Program, San Antonio Military Medical Center, Department of Orthopaedic Surgery, Fort Sam Houston, Texas, U.S.A
| | - Thomas C Dowd
- SAUSHEC Orthopaedic Surgery Residency Program, San Antonio Military Medical Center, Department of Orthopaedic Surgery, Fort Sam Houston, Texas, U.S.A..
| | - Eric Giza
- Department of Orthopaedics, University of California, Davis, Sacramento, California, U.S.A
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16
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Dahmen J, Hurley ET, Shimozono Y, Murawski CD, Stufkens SAS, Kerkhoffs GMMJ, Kennedy JG. Evidence-based Treatment of Failed Primary Osteochondral Lesions of the Talus: A Systematic Review on Clinical Outcomes of Bone Marrow Stimulation. Cartilage 2021; 13:1411S-1421S. [PMID: 33618537 PMCID: PMC8721623 DOI: 10.1177/1947603521996023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE The purpose of this study is to systematically review the literature and to evaluate the outcomes following bone marrow stimulation (BMS) for nonprimary osteochondral lesions of the talus (OLT). DESIGN A literature search was performed to identify studies published using PubMed (MEDLINE), EMBASE, CDSR, DARE, and CENTRAL. The review was performed according to the PRISMA guidelines. Two authors separately and independently screened the search results and conducted the quality assessment using the Methodological Index for Non-Randomized Studies (MINORS). Studies were pooled on clinical, sports, work, and imaging outcomes, as well as revision rates and complications. The primary outcome was clinical success rate. RESULTS Five studies with 70 patients were included in whom nonprimary OLTs were treated with secondary BMS. The pooled clinical success rate was 61% (95% confidence interval [CI], 50-72). The rate of return to any level of sport was 83% (95% CI, 70-91), while the return to pre-injury level of sport was 55% (95% CI, 34-74). The rate of return to work was 92% (95% CI, 78-97), and the complication rate was assessed to be 10% (95% CI, 4-22). Imaging outcomes were heterogeneous in outcome assessment, though a depressed subchondral bone plate was observed in 91% of the patients. The revision rate was 27% (95% CI, 18-40). CONCLUSIONS The overall success rate of arthroscopic BMS for nonprimary osteochondral lesions of the talus was 61%, including a revision rate of 27%. Return to sports, work, and complication outcomes yielded fair to good results.
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Affiliation(s)
- Jari Dahmen
- Amsterdam UMC, University of Amsterdam,
Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam, the
Netherlands,Academic Center for Evidence-based
Sports Medicine (ACES), Amsterdam, the Netherlands,Amsterdam Collaboration for Health and
Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center
Amsterdam UMC, Amsterdam, the Netherlands,Jari Dahmen, Amsterdam UMC, University of
Amsterdam, Department of Orthopaedic Surgery, Amsterdam Movement Sciences,
Meibergdreef 9, Amsterdam 1105 AZ, the Netherlands.
| | - Eoghan T. Hurley
- Department of Orthopaedic Surgery, NYU
Langone Health, New York, NY, USA,Department of Orthopaedic Surgery, Royal
College of Surgeons in Ireland, Dublin, Ireland
| | - Yoshiharu Shimozono
- Department of Orthopaedic Surgery, NYU
Langone Health, New York, NY, USA,Department of Orthopaedic Surgery, Kyoto
University Graduate School of Medicine, Kyoto, Japan
| | - Christopher D. Murawski
- Department of Orthopaedic Surgery,
University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Sjoerd A. S. Stufkens
- Amsterdam UMC, University of Amsterdam,
Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam, the
Netherlands,Academic Center for Evidence-based
Sports Medicine (ACES), Amsterdam, the Netherlands,Amsterdam Collaboration for Health and
Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center
Amsterdam UMC, Amsterdam, the Netherlands
| | - Gino M. M. J. Kerkhoffs
- Amsterdam UMC, University of Amsterdam,
Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam, the
Netherlands,Academic Center for Evidence-based
Sports Medicine (ACES), Amsterdam, the Netherlands,Amsterdam Collaboration for Health and
Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center
Amsterdam UMC, Amsterdam, the Netherlands
| | - John G. Kennedy
- Department of Orthopaedic Surgery, NYU
Langone Health, New York, NY, USA
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17
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Reconstruction of Large Osteochondral Lesions in the Knee: Focus on Fixation Techniques. Life (Basel) 2021; 11:life11060543. [PMID: 34200546 PMCID: PMC8226590 DOI: 10.3390/life11060543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/28/2021] [Accepted: 06/04/2021] [Indexed: 11/17/2022] Open
Abstract
Large (>3 cm2), focal osteochondral lesions (OCL) may result in poor functional outcomes and early secondary osteoarthritis of the knee. The surgical management of these OCL remains challenging. The treatment strategy must be tailored to various aspects, including lesion-specific (e.g., size, location, chronicity), joint-specific (e.g., instability, limb alignment, meniscal status), and patient-specific factors (e.g., age, activity level, comorbidities). Simple chondroplasty and bone marrow stimulation (BMS) techniques should be reserved for smaller lesions, as they only realize midterm clinical benefits, related to inferior wear characteristics of the induced fibrocartilage (type I collagen). Therefore, much attention has been focused on surgical restoration with hyaline cartilage (type II collagen), based on chondrocyte transplantation and matrix-assisted autologous chondrocyte implantation (MACI). Limited graft availability, staged procedures (MACI), and high treatment costs are limitations of these techniques. However, acute traumatic OCL of the femoral condyles and patellofemoral joint may also be suitable for preservation by surgical fixation. Early detection of the fragment facilitates primary repair with internal fixation. The surgical repair of the articular surface may offer promising clinical and cost-effective benefits as a first-line therapy but remains under-investigated and potentially under-utilized. As a unique characteristic, the fixation technique allows the anatomic restoration of the hyaline articular surface with native cartilage and the repair of the subchondral bone. In this manuscript, we present a case series of large OCL around the knee that were preserved by surgical fixation. Furthermore, various implants and techniques reported for this procedure are reviewed.
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Ikuta Y, Nakasa T, Sumii J, Nekomoto A, Adachi N. Histopathological and Radiographic Features of Osteolysis After Fixation of Osteochondral Fragments Using Poly-L-Lactic Acid Pins for Osteochondral Lesions of the Talus. Am J Sports Med 2021; 49:1589-1595. [PMID: 33780270 DOI: 10.1177/03635465211001758] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Fixation of osteochondral fragments is a potential option for treating an osteochondral lesion of the talus (OLT) involving large lesions in the remaining articular cartilage surface. Bioabsorbable devices, especially those made of poly-L-lactic acid (PLLA), can be used for the fixation of an OLT. Postoperative osteolysis surrounding the PLLA pins is occasionally observed; however, the significance of osteolysis remains unknown. PURPOSE To elucidate the association between osteolysis surrounding the PLLA pins, histopathological findings in subchondral bone, and preoperative Hounsfield unit (HU) values at the pin fixation site. STUDY DESIGN Case Series; Level of evidence, 4. METHODS This retrospective analysis included 20 patients with OLT (11 men and 9 women; mean age, 20.9 years; 1 bilateral case). Tissue from the osteochondral fragment was collected intraoperatively using a bone biopsy needle for histological evaluation. The fragment was fixed through the biopsy hole using a PLLA pin. Osteolysis surrounding the PLLA pin was assessed at 1 year postoperatively using magnetic resonance imaging (MRI). Histopathological scores were assigned based on trabecular bone loss, empty lacunae, inflammatory granulation tissue, cartilage-like tissue, and the presence of osteoclasts. The HU values around the pin insertion site, detected on the postoperative MRI scans, were measured using the region of interest based on the preoperative coronal and sagittal computed tomography (CT) images. RESULTS Osteolysis was observed postoperatively in 9 ankles (42.9%). Histopathological evaluation revealed that the osteolysis group had a significantly higher pathological score than the nonosteolysis group (10.2 vs 6.3; P < .001). Lower HU values were identified in the osteolysis group on preoperative coronal and sagittal CT images (P < .05). The histopathological score negatively correlated with preoperative HU values (Pearson r = -0.46; P = .037). CONCLUSION Intraoperative biopsy of the OLT allowed for histopathological evaluation of the same site as that of the PLLA pin fixation. Our findings suggest that preoperative subchondral trabecular deterioration is associated with the incidence of postoperative osteolysis surrounding the PLLA pin. Additionally, low preoperative HU values in subchondral bone under OLT may serve as a predictor of osteolysis surrounding the PLLA pin.
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Affiliation(s)
- Yasunari Ikuta
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
- Sports Medical Center, Hiroshima University Hospital, Hiroshima, Japan
| | - Tomoyuki Nakasa
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
- Medical Center for Translational and Clinical Research, Hiroshima University Hospital, Hiroshima, Japan
| | - Junichi Sumii
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Akinori Nekomoto
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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[Osteochondral lesions of the talus : Individualized approach based on established and innovative reconstruction techniques]. Unfallchirurg 2021; 124:319-332. [PMID: 33666680 DOI: 10.1007/s00113-021-00964-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2021] [Indexed: 10/22/2022]
Abstract
Osteochondral lesions (OCL) of the talus are defined as chondral damage with subchondral involvement. The traumatic etiology is important; in particular, sprains and fractures can lead to lesions of the articular surface and the subchondral plate. As a result, unstable lesions and subchondral cysts can trigger substantial persistent pain and functional impairments. A primary conservative treatment can be considered and is especially recommended in children and adolescents; however, return to previous sports activity and level is often not achieved. The principles of reconstructive surgical management include internal fixation of osteochondral fragments, bone marrow stimulation, autologous membrane-augmented chondrogenesis ± bone grafting, osteochondral transfer, retrograde techniques ± bone grafting, (matrix-associated) autologous chondrocyte implantation and autologous osteoperiosteal graft from the iliac crest. Additional surgical procedures for ankle stabilization and deformity correction should be considered if necessary.
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Rikken QGH, Kerkhoffs GMMJ. Osteochondral Lesions of the Talus: An Individualized Treatment Paradigm from the Amsterdam Perspective. Foot Ankle Clin 2021; 26:121-136. [PMID: 33487235 DOI: 10.1016/j.fcl.2020.10.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Osteochondral lesions of the talus (OLTs) are characterized by damage to the articular cartilage of the talus and its underlying subchondral bone. Up to 75% of OLTs are caused by trauma, such as an ankle sprain or fracture. Physical examination and imaging are crucial for diagnosis and characterization of an OLT. No superior treatment for OLTs exists. It is paramount that an evidence-based personalized treatment approach is applied to patients with OLTs because lesion and patient characteristics guide treatment. This current concepts review covers clinical and preclinical evidence on OLT etiology, presentation, diagnosis, and treatment, all based on the Amsterdam perspective.
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Affiliation(s)
- Quinten G H Rikken
- Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands; Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherland; Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands
| | - Gino M M J Kerkhoffs
- Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands; Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherland; Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands.
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21
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Rak Choi Y, Soo Kim B, Kim YM, Park JY, Cho JH, Cho YT, Nyun Kim H. Internal Fixation of Osteochondral Lesion of the Talus Involving a Large Bone Fragment. Am J Sports Med 2021; 49:1031-1039. [PMID: 33719608 DOI: 10.1177/0363546520988739] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Internal fixation of an osteochondral lesion of the talus (OLT) can restore the congruency of the talus and maintain the subchondral bone and innate hyaline cartilage. However, OLT that is indicated for fixation is rarely encountered; hence, not many studies report on the results after the procedure. PURPOSE To evaluate the clinical and radiological outcomes after internal fixation of chronic OLT involving a large bone fragment of at least 10 mm in diameter and 3 mm in depth on computed tomography (CT). STUDY DESIGN Case series; Level of evidence, 4. METHODS We retrospectively reviewed the data of 26 patients with OLT treated with internal fixation between August 2014 and April 2018. Of the patients, 15 were male and 11 were female, with a mean age of 16 years (range, 11-29 years). The primary radiological outcome measurement was bone union assessed on the 6-month postoperative CT scan. Clinical outcomes were assessed at a mean of 27.7 months postoperatively. RESULTS Twenty patients (77%) achieved bone union on postoperative CT scan. The mean 100-mm visual analog scale (VAS) improved from 30.5 ± 8.5 preoperatively to 13.4 ± 9.7 postoperatively (P < .001). The mean Foot Function Index (FFI) improved from 30.5 ± 6.7 preoperatively to 13.7 ± 9.8 postoperatively (P < .001). A malleolar osteotomy was not necessary to approach the lesion in 88% of patients. A bone fragment with an irregular margin and low density on the preoperative CT scan was significantly associated with nonunion (odds ratio: 7.67, 95% confidence interval: 2.67 to 22.02, P = .008). The difference in clinical outcomes between patients with skeletally immature ankles and those with skeletally mature ankles was not statistically significant. Patient age did not correlate with postoperative 100-mm VAS (Pearson correlation coefficient, r = -0.07, P = 0.72) or the postoperative FFI (Pearson correlation coefficient, r = -0.05, P = .80). CONCLUSION Internal fixation of an OLT involving a large bone fragment resulted in satisfactory clinical and radiologic outcomes. We found that patients with skeletally immature and mature ankles attained healing at comparable rates after the internal fixation of OLT.
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Affiliation(s)
- Young Rak Choi
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Bom Soo Kim
- Department of Orthopedic Surgery, Inha University Hospital, Incheon, Republic of Korea
| | - Yu Mi Kim
- Department of Orthopedic Surgery, Sanbon Hospital, Wonkwang University College of Medicine, Gunpo-si, Gyeonggi-do, Republic of Korea
| | - Jae Yong Park
- Department of Orthopedic Surgery, Hallym Sacred Heart Hospital, Hallym University College of Medicine, Anyang-si, Gyeonggi-do, Republic of Korea
| | - Jae Ho Cho
- Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon-si, Gangwon-do, Republic of Korea
| | - Young Tak Cho
- Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Hyong Nyun Kim
- Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
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22
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Weber CD, Hildebrand F, Lichte P. [Arthroscopically assisted transmalleolar internal fixation of a lateral osteochondral lesion of the talus]. Unfallchirurg 2021; 124:333-337. [PMID: 33599791 DOI: 10.1007/s00113-021-00958-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2021] [Indexed: 11/30/2022]
Abstract
Osteochondral lesions (OCL) of the talus can be caused by isolated or recurrent traumatic events. The established surgical treatment techniques are predominantly based on defect coverage by stimulation of fibrous cartilage or transplantation of osteochondral tissue or chondrocytes. An alternative is the preservation of an intact autochthonous hyaline cartilage surface with reconstruction of the subchondral lamella and the natural joint congruence. This anatomical technique can be used for selected acute and chronic OCL and can frequently be carried out arthroscopically. This article presents the indications, contraindications, advantages and targets as well as the planning and execution of arthroscopically assisted transmalleolar internal fixation of a lateral OCL of the talus.
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Affiliation(s)
- Christian David Weber
- Klinik für Unfall- und Wiederherstellungschirurgie, Universitätsklinikum der RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland.
| | - Frank Hildebrand
- Klinik für Unfall- und Wiederherstellungschirurgie, Universitätsklinikum der RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - Philipp Lichte
- Klinik für Unfall- und Wiederherstellungschirurgie, Universitätsklinikum der RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
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Lambers KTA, Dahmen J, Reilingh ML, van Bergen CJA, Stufkens SAS, Kerkhoffs GMMJ. Arthroscopic lift, drill, fill and fix (LDFF) is an effective treatment option for primary talar osteochondral defects. Knee Surg Sports Traumatol Arthrosc 2020; 28:141-147. [PMID: 31520147 PMCID: PMC6970961 DOI: 10.1007/s00167-019-05687-w] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 08/20/2019] [Indexed: 12/12/2022]
Abstract
PURPOSE The purpose of this study was to describe the mid-term clinical and radiological results of a novel arthroscopic fixation technique for primary osteochondral defects (OCD) of the talus, named the lift, drill, fill and fix (LDFF) technique. METHODS Twenty-seven ankles (25 patients) underwent an arthroscopic LDFF procedure for primary fixable talar OCDs. The mean follow-up was 27 months (SD 5). Pre- and post-operative clinical assessments were prospectively performed by measuring the Numeric Rating Scale (NRS) of pain in/at rest, walking and when running. Additionally, the Foot and Ankle Outcome Score (FAOS) and the Short Form-36 (SF-36) were used to assess clinical outcome. The patients were radiologically assessed by means of computed tomography (CT) scans pre-operatively and 1 year post-operatively. RESULTS The mean NRS during running significantly improved from 7.8 pre-operatively to 2.9 post-operatively (p = 0.006), the NRS during walking from 5.7 to 2.0 (p < 0.001) and the NRS in rest from 2.3 to 1.2 (p = 0.015). The median FAOS at final follow-up was 86 for pain, 63 for other symptoms, 95 for activities of daily living, 70 for sport and 53 for quality of life. A pre- and post-operative score comparison was available for 16 patients, and improved significantly in most subscores. The SF-36 physical component scale significantly improved from 42.9 to 50.1. Of the CT scans at 1 year after surgery, 81% showed a flush subchondral bone plate and 92% of OCDs showed union. CONCLUSION Arthroscopic LDFF of a fixable primary talar OCD results in excellent improvement of clinical outcomes. The radiological follow-up confirms that fusion of the fragment is feasible in 92%. This technique could be regarded as the new gold standard for the orthopedic surgeon comfortable with arthroscopic procedures. LEVEL OF EVIDENCE Prospective case series, therapeutic level IV.
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Affiliation(s)
- Kaj T A Lambers
- Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands
- Department of Orthopedic Surgery, Amphia Hospital, Breda, The Netherlands
| | - Jari Dahmen
- Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands
| | - Mikel L Reilingh
- Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands
- Department of Orthopedic Surgery, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Christiaan J A van Bergen
- Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands
- Department of Orthopedic Surgery, Amphia Hospital, Breda, The Netherlands
| | - Sjoerd A S Stufkens
- Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands
| | - Gino M M J Kerkhoffs
- Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
- Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherlands.
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands.
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24
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Haraguchi N, Shiratsuchi T, Ota K, Ozeki T, Gibu M, Niki H. Fixation of the osteochondral talar fragment yields good results regardless of lesion size or chronicity. Knee Surg Sports Traumatol Arthrosc 2020; 28:291-297. [PMID: 31542817 DOI: 10.1007/s00167-019-05716-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 09/11/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE Osteochondral talar lesions, regardless of their size and/or chronicity, are, at our hospital, now treated by fixation of the fragment if the talar dome cartilage is judged to be healthy. The retrospective study described herein was conducted to assess clinical outcomes of this treatment strategy. METHODS The study group comprised 44 patients (18 men and 26 women) with 45 such talar lesions. In all cases, the osteochondral fragment was reduced and fixed with bone harvested from the osteotomy site and shaped into peg(s) (one to four pegs per lesion). Median follow-up was 2.1 years (1-9 years). The lesion area was measured on computed tomography arthrographs, and the Japanese Society for Surgery of the Foot (JSSF) ankle/hindfoot scale was used to evaluate postoperative outcomes. Clinical failure was defined as a JSSF score < 80 points. RESULTS The mean JSSF score improved significantly from 63.5 points preoperatively to 93.0 postoperatively (p < 0.001). Treatment failure occurred in only one ankle (0.02%). The mean lesion area was 51.2 mm2 (range 5-147 mm2). Correlation between lesion areas and the postoperative JSSF scores was weak (r = - 0.133). Correlation between the time of the trauma to the time of fixation surgery and the postoperative JSSF scores was also weak (r = 0.042). Radiographic outcomes were good for 28 ankles, fair for 10, and poor for 7. CONCLUSION Fixation of the lesion fragment, regardless of size and/or chronicity, appears to be appropriate in cases of an osteochondral talar lesion. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Naoki Haraguchi
- Department of Orthopaedic Surgery, St. Marianna University Yokohama Seibu Hospital, 1197-1 Yasashicho, Asahi-ku, Yokohama, Kanagawa, 241-0811, Japan.
| | - Takaki Shiratsuchi
- Department of Orthopaedic Surgery, St. Marianna University Yokohama Seibu Hospital, 1197-1 Yasashicho, Asahi-ku, Yokohama, Kanagawa, 241-0811, Japan
| | - Koki Ota
- Department of Orthopaedic Surgery, Tokyo Metropolitan Police Hospital, 4-22-1 Nakano, Nakano-ku, Tokyo, 164-8541, Japan
| | - Takuma Ozeki
- Department of Orthopaedic Surgery, Tokyo Metropolitan Police Hospital, 4-22-1 Nakano, Nakano-ku, Tokyo, 164-8541, Japan
| | - Masaki Gibu
- Department of Orthopaedic Surgery, Tokyo Metropolitan Police Hospital, 4-22-1 Nakano, Nakano-ku, Tokyo, 164-8541, Japan
| | - Hisateru Niki
- Department of Orthopaedic Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
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Nakasa T, Ikuta Y, Ota Y, Kanemitsu M, Adachi N. Clinical Results of Bioabsorbable Pin Fixation Relative to the Bone Condition for Osteochondral Lesion of the Talus. Foot Ankle Int 2019; 40:1388-1396. [PMID: 31423819 DOI: 10.1177/1071100719868726] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Fixation of an osteochondral lesion of the talus (OLT) can restore the natural congruency of the joint surface with hyaline cartilage. In this procedure, the bone condition of the osteochondral fragment is important for stabilizing the lesion, and it may affect clinical outcomes. The aim of this study was to explore the influence of the fragment's bone condition on clinical outcomes. METHODS Eighteen ankles in 17 patients with a mean age of 20.1 years, which had undergone fixation of an OLT using bioabsorbable pins, were included. Based on the fragment's bone condition on preoperative computed tomography scans, ankles were divided into 3 groups: normal, segmentation, and absorption. The American Orthopaedic Foot & Ankle Society (AOFAS) scale and magnetic resonance imaging (MRI) findings were evaluated both pre- and postoperatively. Second-look arthroscopic findings were evaluated in 15 ankles and were compared with biopsy specimens from the initial surgery. RESULTS The AOFAS scale significantly improved at the final follow-up in all groups with no significant differences among the 3 groups. MRI at 1 year showed good bone incorporation and a congruent cartilage surface in all groups, but the bone marrow lesion in the absorption group was significantly larger than that in the other groups. In second-look arthroscopy, all ankles showed stable and near-normal cartilage. There was no significant correlation between arthroscopic and histological findings. CONCLUSION We found that fixation can be considered when there is a good cartilage surface on a large OLT, even if bone absorption in the fragment exists. LEVEL OF EVIDENCE Level III, comparative study.
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Affiliation(s)
- Tomoyuki Nakasa
- Department of Orthopaedic Surgery, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima City, Hiroshima, Japan
- Medical Center for Translational and Clinical Research, Hiroshima University Hospital, Hiroshima City, Hiroshima, Japan
| | - Yasunari Ikuta
- Department of Orthopaedic Surgery, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima City, Hiroshima, Japan
| | - Yuki Ota
- Department of Orthopaedic Surgery, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima City, Hiroshima, Japan
| | - Munekazu Kanemitsu
- Department of Orthopaedic Surgery, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima City, Hiroshima, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima City, Hiroshima, Japan
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Steman JA, Dahmen J, Lambers KT, Kerkhoffs GM. Return to Sports After Surgical Treatment of Osteochondral Defects of the Talus: A Systematic Review of 2347 Cases. Orthop J Sports Med 2019; 7:2325967119876238. [PMID: 31673563 PMCID: PMC6806124 DOI: 10.1177/2325967119876238] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Osteochondral defects (OCDs) of the talus are found subsequent to ankle sprains and ankle fractures. With many surgical treatment strategies available, there is no clear evidence on return-to-sport (RTS) times and rates. PURPOSE To summarize RTS times and rates for talar OCDs treated by different surgical techniques. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS The literature from January 1996 to November 2018 was screened, and identified studies were divided into 7 different surgical treatment groups. The RTS rate, with and without associated levels of activity, and the mean time to RTS were calculated per study. When methodologically possible, a simplified pooling method was used to combine studies within 1 treatment group. Study bias was assessed using the MINORS (Methodological Index for Non-Randomized Studies) scoring system. RESULTS A total of 61 studies including 2347 talar OCDs were included. The methodological quality of the studies was poor. There were 10 retrospective case series (RCSs) that investigated bone marrow stimulation in 339 patients, with a pooled mean rate of RTS at any level of 88% (95% CI, 84%-91%); 2 RCSs investigating internal fixation in 47 patients found a pooled RTS rate of 97% (95% CI, 85%-99%), 5 RCSs in which autograft transplantation was performed in 194 patients found a pooled RTS rate of 90% (95% CI, 86%-94%), and 3 prospective case series on autologous chondrocyte implantation in 39 patients found a pooled RTS rate of 87% (95% CI, 73%-94%). The rate of return to preinjury level of sports was 79% (95% CI, 70%-85%) for 120 patients after bone marrow stimulation, 72% (95% CI, 60%-83%) for 67 patients after autograft transplantation, and 69% (95% CI, 54%-81%) for 39 patients after autologous chondrocyte implantation. The mean time to RTS ranged from 13 to 26 weeks, although no pooling was possible for this outcome measure. CONCLUSION Different surgical treatment options for talar OCDs allow for adequate RTS times and rates. RTS rates decreased when considering patients' return to preinjury levels versus return at any level.
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Affiliation(s)
- Jason A.H. Steman
- Department of Orthopaedic Surgery, Academic Medical Center,
University of Amsterdam, Amsterdam, the Netherlands
- Academic Center for Evidence-Based Sports Medicine, Amsterdam, the
Netherlands
- Amsterdam Collaboration on Health and Safety in Sports, Academic
Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Jari Dahmen
- Department of Orthopaedic Surgery, Academic Medical Center,
University of Amsterdam, Amsterdam, the Netherlands
- Academic Center for Evidence-Based Sports Medicine, Amsterdam, the
Netherlands
- Amsterdam Collaboration on Health and Safety in Sports, Academic
Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Kaj T.A. Lambers
- Department of Orthopaedic Surgery, Academic Medical Center,
University of Amsterdam, Amsterdam, the Netherlands
- Academic Center for Evidence-Based Sports Medicine, Amsterdam, the
Netherlands
- Amsterdam Collaboration on Health and Safety in Sports, Academic
Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- Department of Orthopedic Surgery, Amphia Hospital, Breda, the
Netherlands
| | - Gino M.M.J. Kerkhoffs
- Department of Orthopaedic Surgery, Academic Medical Center,
University of Amsterdam, Amsterdam, the Netherlands
- Academic Center for Evidence-Based Sports Medicine, Amsterdam, the
Netherlands
- Amsterdam Collaboration on Health and Safety in Sports, Academic
Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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Shimozono Y, Vannini F, Ferkel RD, Nakamura N, Kennedy JG. Restorative procedures for articular cartilage in the ankle: state-of-the-art review. J ISAKOS 2019. [DOI: 10.1136/jisakos-2017-000163] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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