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Hollander JJ, Dahmen J, Buck TMF, Rikken QGH, Stufkens SAS, Kerkhoffs GMMJ. No difference between 5 and 6 weeks of non-weight bearing after osteochondral grafts for medial osteochondral defects of the talus with medial malleolar osteotomy. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38881368 DOI: 10.1002/ksa.12315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/29/2024] [Accepted: 06/03/2024] [Indexed: 06/18/2024]
Abstract
PURPOSE The present study aimed to compare the clinical outcomes and safety at a 1-year follow-up after 5 or 6 weeks of non-weight bearing after a Talar OsteoPeriostic grafting from the Iliac Crest (TOPIC) for a medial osteochondral lesion of the talus (OLT). METHODS A retrospective comparative case-control analysis of prospectively followed patients who underwent a TOPIC procedure with medial malleolus osteotomy was performed. Patients were matched in two groups with either 5 or 6 weeks of non-weight bearing. Clinical outcomes were evaluated using the Numeric Rating Scale (NRS) during walking, rest, running, and stairclimbing. Additionally, the Foot and Ankle Outcome Score (FAOS) and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score were assessed. Moreover, radiology and complications were assessed. RESULTS Eleven patients were included in the 5-week non-weight bearing group and 22 in the 6-week non-weight bearing group. No significant differences were found in any of the baseline variables. The NRS during walking in the 5-week group improved by 3.5 points and 4 points for the 6-week group (p = 0.58 at 1-year post-operatively). In addition, all other NRS scores, FAOS subscales and the AOFAS scores improved (all n.s. at 1 year follow-up). No significant differences in radiological (osteotomy union and cyst presence in the graft) were found. Moreover, no significant differences were found in terms of complications and reoperations. CONCLUSION No statistical significant differences were found in terms of clinical, radiological and safety outcomes between 5 or 6 weeks of non-weight bearing following a TOPIC for a medial OLT. LEVEL OF EVIDENCE Level III, Therapeutic.
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Affiliation(s)
- Julian J Hollander
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam UMC, Location AMC, 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 UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - Jari Dahmen
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam UMC, Location AMC, 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 UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - Tristan M F Buck
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam UMC, Location AMC, 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 UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - Quinten G H Rikken
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam UMC, Location AMC, 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 UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - Sjoerd A S Stufkens
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam UMC, Location AMC, 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 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 Orthopaedic Surgery and Sports Medicine, Amsterdam UMC, Location AMC, 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 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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Tomonaga S, Yoshimura I, Hagio T, Ishimatsu T, Sugino Y, Fukagawa R, Taniguchi Y, Yamamoto T. Return to Sports Activity After Microfracture for Osteochondral Lesion of the Talus in Skeletally Immature Children. Foot Ankle Int 2024:10711007241241067. [PMID: 38571306 DOI: 10.1177/10711007241241067] [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: 04/05/2024]
Abstract
BACKGROUND Osteochondral lesions of the talus (OLTs) are among the common sports-related injuries. However, there are few reports on the return to sports after OLT surgery in skeletally immature children. This study was performed to evaluate the return to sports after microfracture for OLTs in skeletally immature children. METHODS This study involved 17 ankles of 16 patients (mean age, 13.2 years; range, 10-16 years) with open tibial epiphyses on magnetic resonance imaging (MRI) who underwent microfracture for OLTs <10 mm in diameter and confirmation of lesion instability under arthroscopy. Nine of 17 ankles had additional lateral ankle ligament stabilization. All patients were participating in some form of sports. The Japanese Society for Surgery of the Foot (JSSF) score, Ankle Activity Score (AAS), return to sports rate, lesion size, grade of subchondral bone marrow edema, and Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score on MRI were evaluated after microfracture. The mean postoperative follow-up period was 53.5 months. RESULTS The mean JSSF score significantly improved from 76.1 points preoperatively to 94.9 points at the final follow-up (P < .01). The mean AAS showed no change from preoperative state to final follow-up. The return to sports rate was 100%. The lesion size significantly decreased from 76.3 to 56.7 mm2 in area (P = .02) and from 283.2 to 185.6 mm3 in volume (P = .05). The bone marrow edema grade decreased in 8 of 17 ankles. The total MOCART score showed a significant improvement from 6 months to 1 year postoperatively (P = .05). CONCLUSION All skeletally immature children who underwent microfracture for OLTs in this study were able to return to sports activity and showed improvements in clinical scores and MRI parameters. Microfracture may be considered an effective first-line treatment for OLTs <10 mm in diameter in skeletally immature athletes. LEVEL OF EVIDENCE Level IV, retrospective case-control study.
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Affiliation(s)
- Seiya Tomonaga
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, Jonan-ku, Fukuoka, Japan
| | - Ichiro Yoshimura
- Faculty of Sports and Health Science, Fukuoka University, Jonan-ku, Fukuoka, Japan
| | - Tomonobu Hagio
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, Jonan-ku, Fukuoka, Japan
| | - Tetsuro Ishimatsu
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, Jonan-ku, Fukuoka, Japan
| | - Yuki Sugino
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, Jonan-ku, Fukuoka, Japan
| | - Ryo Fukagawa
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, Jonan-ku, Fukuoka, Japan
| | - Yoshimasa Taniguchi
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, Jonan-ku, Fukuoka, Japan
| | - Takuaki Yamamoto
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, Jonan-ku, Fukuoka, Japan
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Yasui Y, Miyamoto W, Shimozono Y, Tsukada K, Kawano H, Takao M. Evidence-Based Update on the Surgical Technique and Clinical Outcomes of Retrograde Drilling: A Systematic Review. Cartilage 2024:19476035241239303. [PMID: 38506486 DOI: 10.1177/19476035241239303] [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: 03/21/2024] Open
Abstract
BACKGROUND Retrograde drilling is an established surgical technique to treat osteochondral lesions of the talus (OLT). It involves non-trans-articular drilling to induce subchondral bone revascularization and bone formation without damaging the overlying articular cartilage. The present study aimed to elucidate the heterogeneity of clinical studies on retrograde drilling for OLT. DESIGN A systematic search of the MEDLINE, Web of Science, EMBASE, and Cochrane Library databases for studies published between January 1996 and August 27, 2022, was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines by two independent reviewers. The included studies were evaluated for their level of evidence (LoE) and quality of evidence (QoE) using the Modified Coleman Methodology Score. Variables reporting surgical and clinical outcomes and complications were evaluated. RESULTS Eleven studies with 207 ankles were included (mean follow-up period = 31.1 months). The mean LoE was 3.8 (LoE 3: two studies, LoE 4: nine studies), and the mean QoE was 50.8 (fair: three studies, poor: eight studies). Ten studies used the American Orthopedic Foot and Ankle Society (AOFAS) score, which improved from 57.9 preoperatively to 86.1 postoperatively. The period and protocol of conservative treatment, lesion character, surgical technique, and postoperative protocol were inconsistent or underreported. CONCLUSIONS This systematic review revealed that low LoE and poor QoE, coupled with heterogeneity among the included studies, impede definitive conclusions regarding the effectiveness of this technique. Consequently, well-designed clinical trials are essential to develop standardized clinical guidelines for using retrograde drilling in OLT.
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Affiliation(s)
- Youichi Yasui
- Department of Orthopaedic Surgery, School of Medicine, Teikyo University, Tokyo, Japan
| | - Wataru Miyamoto
- Department of Orthopaedic Surgery, School of Medicine, Teikyo University, Tokyo, Japan
| | | | - Keisuke Tsukada
- Department of Orthopaedic Surgery, School of Medicine, Teikyo University, Tokyo, Japan
| | - Hirotaka Kawano
- Department of Orthopaedic Surgery, School of Medicine, Teikyo University, Tokyo, Japan
| | - Masato Takao
- Clinical and Research Institute for Foot and Ankle Surgery, Jujo Hospital, Kisarazu, Japan
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Buck TM, Butler JJ, Azam MT, ter Laak Bolk C, Rikken QG, Weiss MB, Dahmen J, Stufkens SA, Kennedy JG, Kerkhoffs GM. Osteochondral Lesions of the Subtalar Joint: Clinical Outcomes in 11 Patients. Cartilage 2024; 15:16-25. [PMID: 37798912 PMCID: PMC10985396 DOI: 10.1177/19476035231200339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 08/25/2023] [Indexed: 10/07/2023] Open
Abstract
OBJECTIVE The purpose of this retrospective case series was to evaluate clinical outcomes following both conservative treatment and arthroscopic bone marrow stimulation (BMS) for the management of symptomatic subtalar osteochondral lesions (OCLs). DESIGN All symptomatic subtalar OCLs with a minimum of 12 months follow-up having undergone either a conservative management or arthroscopic procedure were included. Patient-reported outcomes were collected via questionnaires consisting of the Foot and Ankle Outcome Score (FAOS), Numeric Rating Scale (NRS) of pain in rest, during walking, during stair climbing, and during running. In addition, return to sports data, return to work data, reoperations, and complications were collected and assessed. In total, 11 patients across 2 academic institutions were included (3 males, 8 females). The median age was 43 years (interquartile range [IQR]: 32-53). RESULTS All patients underwent conservative treatment first; in addition, 9 patients underwent subtalar arthroscopic debridement with or without BMS. The median follow-up time was 15 months (IQR: 14-100). In the surgically treated group, the median NRS scores were 2 (IQR: 1-3) during rest, 3 (IQR: 2-4) during walking, 4 (IQR: 4-5) during stair climbing, 5 (IQR: 4-5) during running and the median FAOS score at final follow-up was 74 (IQR: 65-83). In the conservatively treated patients, the median NRS scores were all 0 (IQR: 0-0) and the median FAOS scores were 90 (IQR: 85-94). In the group of surgical treated patients, 4 were able to return to the same level of sports, 2 returned to a lower level of sports. Both conservatively treated patients returned to the sport and the same level of prior participation. All patients except one in the surgical group returned to work. CONCLUSIONS This retrospective case series demonstrated that a high number of patients converted to surgery after initial conservative treatment. In addition, debridement and BMS show good clinical outcomes for the management of symptomatic subtalar OCLs at short-term follow-up. No complications nor secondary surgical procedures were noted in the surgically treated group. The high rate of failure of conservative treatment suggests that surgical intervention for symptomatic subtalar OCLs can be the primary treatment strategy; however, further research is warranted in light of the small number of patients.
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Affiliation(s)
- Tristan M.F. Buck
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands
- Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration on Health & Safety in Sports (ACHSS), IOC Research Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - James J. Butler
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Mohammad T. Azam
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Carlijn ter Laak Bolk
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands
- Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration on Health & Safety in Sports (ACHSS), IOC Research Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - Quinten G.H. Rikken
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands
- Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration on Health & Safety in Sports (ACHSS), IOC Research Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - Matthew B. Weiss
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Jari Dahmen
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands
- Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration on Health & Safety in Sports (ACHSS), IOC Research Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - Sjoerd A.S. Stufkens
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands
- Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration on Health & Safety in Sports (ACHSS), IOC Research Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - John G. Kennedy
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Gino M.M.J. Kerkhoffs
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands
- Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration on Health & Safety in Sports (ACHSS), IOC Research Center, Amsterdam UMC, Amsterdam, The Netherlands
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Buck TMF, Dahmen J, Tak IJR, Rikken QGH, Otten R, Stufkens SAS, Kerkhoffs GMMJ. Large variation in postoperative rehabilitation protocols following operative treatment of osteochondral lesions of the talus: A systematic review and meta-analysis on >200 studies. Knee Surg Sports Traumatol Arthrosc 2024; 32:334-343. [PMID: 38294080 DOI: 10.1002/ksa.12038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 12/08/2023] [Accepted: 12/11/2023] [Indexed: 02/01/2024]
Abstract
PURPOSE A treatment-specific rehabilitation protocol and well-defined return-to-play criteria guide clinical decision-making on return to normal function, activity, sports and performance after surgical treatment for osteochondral lesion of the talus (OLT). The optimal rehabilitation protocols in the current literature remain unclear. The purpose of this study was to explore the existing literature on rehabilitation protocols from the early postoperative phase to return to sport onwards after different types of surgical treatment of OLTs. METHODS PubMed, Embase, CDSR, DARE and Central were searched systematically from inception to February 2023 according to the PRISMA 2020 guidelines. All clinical studies with a description of postoperative rehabilitation criteria after surgical treatment of OLTs were included. The primary outcome of this study is the extent of reportage for each rehabilitation parameter expressed in percentage. The secondary outcome is the reported median time for each parameter in rehabilitation protocols for all different treatment modalities (type of surgery). The median time, expressed as number of weeks, for each parameter was compared between different types of surgery. RESULTS A total of 227 articles were included reporting on 255 different rehabilitation protocols from seven different types of surgery. Weight-bearing instructions were reported in 84%-100% and the use of a cast or walker was prescribed in 27%-100%. Range of motion exercises were described in 54%-100% whereas physical therapy was advised in 21%-67% of the protocols. Any advice on return to sport was described in 0%-67% protocols. A nonparametric analysis of variance showed significant differences between the different surgical treatment modalities for the following parameters between the treatment groups: time to full weight-bearing (p < 0.0003) and return to high impact level of sports (p < 0.0003). Subjective or objective criteria for progression during rehabilitation were reported in only 24% of the studies. CONCLUSION An in-depth exploration of the current literature showed substantial variation in postoperative rehabilitation guidelines with an associated underreporting of the most important rehabilitation parameters in postoperative protocols after surgical treatment of OLTs. Furthermore, nearly all rehabilitation protocols were constructed according to a time-based approach. Only one out of four reported either objective or subjective criteria. LEVEL OF EVIDENCE Level IV, systematic review.
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Affiliation(s)
- Tristan M F Buck
- 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 and Safety in Sports (ACHSS), IOC Research Centre, Amsterdam UMC, Amsterdam, The Netherlands
| | - Jari Dahmen
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- 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 and Safety in Sports (ACHSS), IOC Research Centre, Amsterdam UMC, Amsterdam, The Netherlands
| | - Igor J R Tak
- 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 and Safety in Sports (ACHSS), IOC Research Centre, Amsterdam UMC, Amsterdam, The Netherlands
- Physiotherapy Utrecht Oost - Sports Rehabilitation and Manual Therapy, Utrecht, The Netherlands
| | - Quinten G H 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 and Safety in Sports (ACHSS), IOC Research Centre, Amsterdam UMC, Amsterdam, The Netherlands
| | - Roald Otten
- Fitaal Heerenveen - Physiotherapy and Rehabilitation, Heerenveen, The Netherlands
| | - 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 and Safety in Sports (ACHSS), IOC Research Centre, Amsterdam UMC, Amsterdam, The Netherlands
| | - Gino M M J Kerkhoffs
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- 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 and Safety in Sports (ACHSS), IOC Research Centre, Amsterdam UMC, Amsterdam, The Netherlands
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Matthias A, Becher C, Ettinger S, Gottschalk O, Guenther D, Klos K, Ahrend MD, Körner D, Plaass C, Walther M. Postoperative Management of Osteochondral Lesions of the Ankle: A Survey Among German-Speaking Foot and Ankle Surgeons. Cartilage 2023:19476035231213184. [PMID: 38044500 DOI: 10.1177/19476035231213184] [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: 12/05/2023] Open
Abstract
OBJECTIVE To assess the current treatment of osteochondral lesions of the ankle (OCLA) by German-speaking foot and ankle surgeons, focusing on the management of postoperative care and rehabilitation. DESIGN A questionnaire was created by a panel of 4 experienced foot and ankle surgeons on behalf of the "Clinical Tissue Regeneration" (CTR) working group of the German Society of Orthopaedics and Trauma Surgery (DGOU), and distributed electronically to members of the CTR, participants of the German Cartilage Registry (Knorpelregister DGOU©), and members of 6 German-speaking orthopedics or sports medicine societies. Results were classified depending on the consensus within the answers (agreement ≥75% "strong tendency," 50%-74% "tendency," 25%-49% "weak tendency," <25% "no tendency"). RESULTS A total of 60 participants returned the questionnaire. The main results are as follows: regarding the frequency of surgical procedures for OCLA, refixation of the fragment, retrograde drilling, and bone marrow stimulation with or without using a matrix were performed by at least 75% of the surgeons and was considered a strong tendency. There was a strong tendency to stabilize the ankle (76.7%) and perform corrective osteotomies (51.7%). In total, 75.5% and 75% of the surgeons performed bone marrow stimulation with and without using a matrix, respectively. Corrective osteotomy and ankle stabilization were performed in 64.5% and 65.2% cases, respectively. Most participants included published recommendations on postoperative rehabilitation and the return to sports activities in their postoperative management. The main surgical procedures were considered the most critical factor in influencing the postoperative management by 81% of the participants (strong tendency). Adjunct surgical procedures such as corrective osteotomy and stabilization of the ankle were considered important by 67.8% of the respondents (tendency). CONCLUSIONS The management of OCLA varies among German-speaking foot and ankle surgeons. Therefore, guidelines remain essential to standardize the management of OCLA, to achieve improved and stable results. This survey will assist clinicians and patients with rehabilitation to return to sports after treating the ankle's cartilage injury.
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Affiliation(s)
- Aurich Matthias
- DOUW, Section of Trauma- and Reconstructive Surgery, University Hospital Halle (Saale), Halle, Germany
- BG Trauma Center Bergmannstrost Halle, Department of Trauma- and Reconstructive Surgery, Halle, Germany
| | - Christoph Becher
- Department of Orthopaedic Surgery, Hannover Medical School, Diakovere Annastift, Hannover, Germany
| | - Sarah Ettinger
- University Hospital for Orthopedic Surgery, Pius Hospital Oldenburg, Oldenburg, Germany
| | - Oliver Gottschalk
- Hospital München Harlaching, Department of Foot and Ankle Surgery, München, Germany
- Department of Orthopaedics and Trauma Surgery, Muskuloskelettal University Center Munich (MUM), Hospital of the University Munich, LMU Munich, Germany
| | - Daniel Guenther
- Department of Orthopaedic Surgery, Trauma Surgery, and Sports Medicine, Cologne Merheim Medical Center, Cologne, Germany
| | - Kajetan Klos
- Joint Center Rhein-Main, Hochheim am Main, Germany
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Jena, Jena, Germany
| | - Marc-Daniel Ahrend
- BG Trauma Center Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany
| | - Daniel Körner
- BG Trauma Center Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany
| | | | - Markus Walther
- Schön Hospital München Harlaching-FIFA Medical Centre of Excellence, Munich, Germany
- Ludwig Maximilian University Munich, Department of Orthopaedics and Trauma Surgery, Muskuloskelletal University Center Munich (MUM), Munich, Germany
- Justus Maximilian University Wuerzburg, König-Ludwig-Haus, Würzburg, Germany
- Paracelsus Medical Private Universität, Salzburg, Austria
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Lopes R, Amouyel T, Benoist J, De L'Escalopier N, Cordier G, Freychet B, Baudrier N, Dubois Ferrière V, Leiber Wackenheim F, Mainard D, Padiolleau G, Barbier O. Return to sport after surgery for osteochondral lesions of the talar dome. Results of a multicenter prospective study on 58 patients. Orthop Traumatol Surg Res 2023; 109:103675. [PMID: 37683912 DOI: 10.1016/j.otsr.2023.103675] [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: 07/03/2022] [Revised: 07/28/2023] [Accepted: 08/21/2023] [Indexed: 09/10/2023]
Abstract
INTRODUCTION Osteochondral lesions of the talar dome (OLTD) are most often found in patients for whom the return to sports activities is the main issue. Two types of surgery have been distinguished at present, bone marrow stimulation techniques and mosaicplasty techniques. The size of the lesion indicating the need for bone marrow stimulation as the required surgical procedure has recently been decreased (<1cm). The main objective of this study was therefore to evaluate the return to sport after OLTD surgery. Our hypothesis is that surgery of osteochondral lesions of the talar dome allows the resumption of sports activities in the majority of cases. MATERIAL AND METHODS This multicenter prospective study was conducted across 10 French centers specializing in foot and ankle surgery. All patients aged 18 to 65 with symptomatic OLTD resistant to thorough medical treatment for at least 6 months, justifying surgery, were included from June 2018 to September 2019. In addition to the usual demographic data, the practice of sport and level (professional, competitive, leisure) were systematically investigated preoperatively. A common protocol for surgical management and postoperative follow-up had previously been established according to the arthrographic stage of the lesion. The most recent recommendations based on size, but also depth, were taken into account. The primary endpoint was return to sport. RESULTS A final functional evaluation with the AOFAS (American Orthopedic Foot & Ankle Society) score was performed at a minimum of 12 months. Of 58 sports patients, 70.6% returned to sport (41/58) with an average delay of 4.3 months. A high AOFAS functional score (p=0.02) and a stage 1 lesion (p=0.006) were the only preoperative criteria significantly associated with a return to sport. No other factor was predictive of a return to sport. CONCLUSION Our prospective study shows that 70.6% of sports patients returned to sport after OLTD surgery according to a surgical protocol and standardized follow-up. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Ronny Lopes
- Centre orthopédique Santy, 24, avenue Paul-Santy, 69000 Lyon, France.
| | - Thomas Amouyel
- Service de chirurgie orthopédique, CHRU Lille, hôpital Salengro, 2, avenue Oscar-Lambret, 59000 Lille, France
| | - Jonathan Benoist
- CHP Saint-Grégoire, 7, boulevard de la Boutière, 35760 Saint-Grégoire, France
| | - Nicolas De L'Escalopier
- Service de chirurgie orthopédique, traumatologique et réparatrice des membres, HIA Percy, 101, avenue Henri-Barbusse, 92140 Clamart, France
| | - Guillaume Cordier
- Centre de chirurgie orthopédique et sportive, 2, rue Georges-Negrevergne, 33700 Mérignac, France
| | - Benjamin Freychet
- Service de chirurgie orthopédique, hôpital Ambroise-Paré, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France
| | - Nicolas Baudrier
- Centre ASSAL de médecine et de chirurgie du pied, avenue de Beau-Séjour, 6, 1206 Genève, Suisse
| | | | | | - Didier Mainard
- Santé Atlantique, avenue Claude-Bernard, 44800 Saint-Herblain, France
| | - Giovanny Padiolleau
- Service de chirurgie orthopédique, HIA Sainte-Anne, 2, boulevard Sainte-Anne, 83000 Toulon, France
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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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Zhang M, Chen D, Wang Q, Li Y, Huang S, Zhan P, Lai J, Jiang J, Chen D. Comparison of arthroscopic debridement and microfracture in the treatment of osteochondral lesion of talus. Front Surg 2023; 9:1072586. [PMID: 36713661 PMCID: PMC9880473 DOI: 10.3389/fsurg.2022.1072586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 12/19/2022] [Indexed: 01/15/2023] Open
Abstract
Objective This study was performed to compare the clinical effect of arthroscopic debridement vs. arthroscopic microfracture in the treatment of osteochondral lesions of the talus. Methods We retrospectively reviewed patients with osteochondral lesion of talus who were admitted to our hospital from April 2020 to April 2021. The patients were divided into Group A (arthroscopic debridement group, n = 39) and Group B (arthroscopic microfracture group, n = 42), and the intraoperative details in the two groups were analyzed. The American Orthopaedic Foot and Ankle Society (AOFAS) score and visual analogue scale (VAS) score were compared between the two groups before surgery and at the last follow-up. Results The postoperative AOFAS score (Group A, 40.9-82.26; Group B, 38.12-87.38), VAS score (Group A, 6.44-3.92; Group B, 6.38-2.05) significantly improved in both groups, but the improvement was significantly greater in Group B than in Group A (P < 0.05). Among all patients, the AOFAS and VAS scores of men aged ≤30 years and patients with a low body mass index (BMI) improved more significantly (P < 0.05). Conclusion The arthroscopic microfracture for the treatment of osteochondral lesion of talus is superior to joint debridement in terms of improving ankle function, especially in relatively young men with a relatively low BMI.
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10
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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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11
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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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12
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Marín Fermín T, Hovsepian JM, D'Hooghe P, Papakostas ET. Arthroscopic debridement of osteochondral lesions of the talus: A systematic review. Foot (Edinb) 2021; 49:101852. [PMID: 34536818 DOI: 10.1016/j.foot.2021.101852] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 07/07/2021] [Accepted: 07/08/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Arthroscopic debridement (AD) for the osteochondral lesions of the talar dome (OLT) was widely documented in the nineties with satisfactory results. However, in modern treatment algorithms, its role is not described. The present systematic review aims to evaluate the current evidence on the clinical outcomes of AD in the management of OLT. METHODS Two independent reviewers searched PubMed, EMBASE, Scopus, and Virtual Health Library databases evaluating the clinical outcomes of AD of OLT with a minimum 6-month follow-up. The following terms "talus", "chondral", "cartilage", "injury", "lesion", "delamination", "damage", "excision", "curettage", "debridement", "chondrectomy", "chondroplasty", were used alone and in combination with Boolean operators AND and OR. Studies in which surgical technique was not described, an additional procedure was performed after debridement, and/or outcomes were not reported separately when more than one technique was implemented were excluded. The modified Coleman methodology score (mCMS) was used to evaluate the methodological quality of the included studies. A narrative analysis was conducted. Publication bias was assessed using the ROBIS tool. RESULTS AD showed satisfactory short and medium-term outcomes for the primary treatment of OLT irrespectively of size and depth. However, the heterogeneity of the included studies and the level of available evidence hinders its recommendation. CONCLUSIONS There is a paucity of evidence evaluating AD alone for OLT treatment in the last two decades. Bone-marrow stimulation techniques remain the first-line surgical strategy for OLT treatment without proven superiority. Adopting AD for OLT treatment instead of MF could represent a paradigm breakthrough in clinical practice given its many potential advantages while preserving the subchondral plate.
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Affiliation(s)
- Theodorakys Marín Fermín
- Department of Traumatology, Hospital Universitario Periférico de Coche "Dr. Leopoldo Manrique Terrero", Caracas, Venezuela.
| | - Jean M Hovsepian
- Department of Sports Orthopaedics, Hessing Klinik, Augsburg, Germany
| | - Pieter D'Hooghe
- Aspetar Orthopedic and Sports Medicine Hospital, Doha, Qatar
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13
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Hansen OB, Drakos MC. The Athlete's Foot and Ankle: Osteochondral Lesion of the Talus. OPER TECHN SPORT MED 2021. [DOI: 10.1016/j.otsm.2021.150849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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14
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Roth KE, Ossendorff R, Klos K, Simons P, Drees P, Salzmann GM. Arthroscopic Minced Cartilage Implantation for Chondral Lesions at the Talus: A Technical Note. Arthrosc Tech 2021; 10:e1149-e1154. [PMID: 33981564 PMCID: PMC8085507 DOI: 10.1016/j.eats.2021.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 01/10/2021] [Indexed: 02/03/2023] Open
Abstract
In the past few years, autologous chondrocyte implantation has been shown to be the most suitable cartilage reconstructive technique with the best tissue quality. Although this method is part of the standard surgical repertoire in the knee joint, it has so far not been an established method in the ankle because there are no prospective randomized controlled studies to prove a significant advantage over alternative methods of cartilage repair. The methods most frequently used in this context (e.g., marrow stimulation techniques) can, however, at most generate hyaline-like and thus biomechanically inferior regenerates. Minced cartilage implantation, on the other hand, is a relatively simple and cost-effective 1-step procedure with promising biological potential and-at least in the knee joint-satisfactory clinical results. We present an arthroscopic surgical technique by which the surgeon can apply autologous chondrocytes in a 1-step procedure (AutoCart; Arthrex, Munich, Germany) to treat articular cartilage defects in the ankle joint.
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Affiliation(s)
| | - Robert Ossendorff
- Department for Orthopaedics and Trauma, University Hospital Bonn, Bonn, Germany
| | | | | | - Philipp Drees
- Department for Orthopaedics and Trauma, University Hospital Mainz, Mainz, Germany
| | - Gian M. Salzmann
- Gelenkzentrum Rhein-Main, Hochheim, Germany
- Schulthess Clinic, Zurich, Switzerland
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15
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Görtz S, Tabbaa SM, Jones DG, Polousky JD, Crawford DC, Bugbee WD, Cole BJ, Farr J, Fleischli JE, Getgood A, Gomoll AH, Gross AE, Krych AJ, Lattermann C, Mandelbaum BR, Mandt PR, Mirzayan R, Mologne TS, Provencher MT, Rodeo SA, Safir O, Strauss ED, Wahl CJ, Williams RJ, Yanke AB. Metrics of OsteoChondral Allografts (MOCA) Group Consensus Statements on the Use of Viable Osteochondral Allograft. Orthop J Sports Med 2021; 9:2325967120983604. [PMID: 34250153 PMCID: PMC8237219 DOI: 10.1177/2325967120983604] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 07/31/2020] [Indexed: 11/15/2022] Open
Abstract
Background: Osteochondral allograft (OCA) transplantation has evolved into a first-line
treatment for large chondral and osteochondral defects, aided by
advancements in storage protocols and a growing body of clinical evidence
supporting successful clinical outcomes and long-term survivorship. Despite
the body of literature supporting OCAs, there still remains controversy and
debate in the surgical application of OCA, especially where high-level
evidence is lacking. Purpose: To develop consensus among an expert group with extensive clinical and
scientific experience in OCA, addressing controversies in the treatment of
chondral and osteochondral defects with OCA transplantation. Study Design: Consensus statement. Methods: A focus group of clinical experts on OCA cartilage restoration participated
in a 3-round modified Delphi process to generate a list of statements and
establish consensus. Questions and statements were initially developed on
specific topics that lack scientific evidence and lead to debate and
controversy in the clinical community. In-person discussion occurred where
statements were not agreed on after 2 rounds of voting. After final voting,
the percentage of agreement and level of consensus were characterized. A
systematic literature review was performed, and the level of evidence and
grade were established for each statement. Results: Seventeen statements spanning surgical technique, graft matching,
indications, and rehabilitation reached consensus after the final round of
voting. Of the 17 statements that reached consensus, 11 received unanimous
(100%) agreement, and 6 received strong (80%-99%) agreement. Conclusion: The outcomes of this study led to the establishment of consensus statements
that provide guidance on surgical and perioperative management of OCAs. The
findings also provided insights on topics requiring more research or
high-quality studies to further establish consensus and provide stronger
evidence.
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Affiliation(s)
- Simon Görtz
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Suzanne M Tabbaa
- University of California-San Francisco, San Francisco, California, USA
| | - Deryk G Jones
- Ochsner Sports Medicine Institute, Jefferson, Louisiana, USA
| | - John D Polousky
- Children's Health Andrews Institute for Orthopedics and Sports Medicine, Plano, Texas, USA
| | | | | | - William D Bugbee
- Brigham and Women's Hospital, Boston, Massachusetts, USA.,University of California-San Francisco, San Francisco, California, USA.,Ochsner Sports Medicine Institute, Jefferson, Louisiana, USA.,Children's Health Andrews Institute for Orthopedics and Sports Medicine, Plano, Texas, USA.,Oregon Health and Science University, Portland, Oregon, USA.,Investigation performed at Metrics of Osteochondral Allografts (MOCA), JRF Ortho, Centennial, Colorado, USA
| | - Brian J Cole
- Brigham and Women's Hospital, Boston, Massachusetts, USA.,University of California-San Francisco, San Francisco, California, USA.,Ochsner Sports Medicine Institute, Jefferson, Louisiana, USA.,Children's Health Andrews Institute for Orthopedics and Sports Medicine, Plano, Texas, USA.,Oregon Health and Science University, Portland, Oregon, USA.,Investigation performed at Metrics of Osteochondral Allografts (MOCA), JRF Ortho, Centennial, Colorado, USA
| | - Jack Farr
- Brigham and Women's Hospital, Boston, Massachusetts, USA.,University of California-San Francisco, San Francisco, California, USA.,Ochsner Sports Medicine Institute, Jefferson, Louisiana, USA.,Children's Health Andrews Institute for Orthopedics and Sports Medicine, Plano, Texas, USA.,Oregon Health and Science University, Portland, Oregon, USA.,Investigation performed at Metrics of Osteochondral Allografts (MOCA), JRF Ortho, Centennial, Colorado, USA
| | - James E Fleischli
- Brigham and Women's Hospital, Boston, Massachusetts, USA.,University of California-San Francisco, San Francisco, California, USA.,Ochsner Sports Medicine Institute, Jefferson, Louisiana, USA.,Children's Health Andrews Institute for Orthopedics and Sports Medicine, Plano, Texas, USA.,Oregon Health and Science University, Portland, Oregon, USA.,Investigation performed at Metrics of Osteochondral Allografts (MOCA), JRF Ortho, Centennial, Colorado, USA
| | - Alan Getgood
- Brigham and Women's Hospital, Boston, Massachusetts, USA.,University of California-San Francisco, San Francisco, California, USA.,Ochsner Sports Medicine Institute, Jefferson, Louisiana, USA.,Children's Health Andrews Institute for Orthopedics and Sports Medicine, Plano, Texas, USA.,Oregon Health and Science University, Portland, Oregon, USA.,Investigation performed at Metrics of Osteochondral Allografts (MOCA), JRF Ortho, Centennial, Colorado, USA
| | - Andreas H Gomoll
- Brigham and Women's Hospital, Boston, Massachusetts, USA.,University of California-San Francisco, San Francisco, California, USA.,Ochsner Sports Medicine Institute, Jefferson, Louisiana, USA.,Children's Health Andrews Institute for Orthopedics and Sports Medicine, Plano, Texas, USA.,Oregon Health and Science University, Portland, Oregon, USA.,Investigation performed at Metrics of Osteochondral Allografts (MOCA), JRF Ortho, Centennial, Colorado, USA
| | - Allan E Gross
- Brigham and Women's Hospital, Boston, Massachusetts, USA.,University of California-San Francisco, San Francisco, California, USA.,Ochsner Sports Medicine Institute, Jefferson, Louisiana, USA.,Children's Health Andrews Institute for Orthopedics and Sports Medicine, Plano, Texas, USA.,Oregon Health and Science University, Portland, Oregon, USA.,Investigation performed at Metrics of Osteochondral Allografts (MOCA), JRF Ortho, Centennial, Colorado, USA
| | - Aaron J Krych
- Brigham and Women's Hospital, Boston, Massachusetts, USA.,University of California-San Francisco, San Francisco, California, USA.,Ochsner Sports Medicine Institute, Jefferson, Louisiana, USA.,Children's Health Andrews Institute for Orthopedics and Sports Medicine, Plano, Texas, USA.,Oregon Health and Science University, Portland, Oregon, USA.,Investigation performed at Metrics of Osteochondral Allografts (MOCA), JRF Ortho, Centennial, Colorado, USA
| | - Christian Lattermann
- Brigham and Women's Hospital, Boston, Massachusetts, USA.,University of California-San Francisco, San Francisco, California, USA.,Ochsner Sports Medicine Institute, Jefferson, Louisiana, USA.,Children's Health Andrews Institute for Orthopedics and Sports Medicine, Plano, Texas, USA.,Oregon Health and Science University, Portland, Oregon, USA.,Investigation performed at Metrics of Osteochondral Allografts (MOCA), JRF Ortho, Centennial, Colorado, USA
| | - Bert R Mandelbaum
- Brigham and Women's Hospital, Boston, Massachusetts, USA.,University of California-San Francisco, San Francisco, California, USA.,Ochsner Sports Medicine Institute, Jefferson, Louisiana, USA.,Children's Health Andrews Institute for Orthopedics and Sports Medicine, Plano, Texas, USA.,Oregon Health and Science University, Portland, Oregon, USA.,Investigation performed at Metrics of Osteochondral Allografts (MOCA), JRF Ortho, Centennial, Colorado, USA
| | - Peter R Mandt
- Brigham and Women's Hospital, Boston, Massachusetts, USA.,University of California-San Francisco, San Francisco, California, USA.,Ochsner Sports Medicine Institute, Jefferson, Louisiana, USA.,Children's Health Andrews Institute for Orthopedics and Sports Medicine, Plano, Texas, USA.,Oregon Health and Science University, Portland, Oregon, USA.,Investigation performed at Metrics of Osteochondral Allografts (MOCA), JRF Ortho, Centennial, Colorado, USA
| | - Raffy Mirzayan
- Brigham and Women's Hospital, Boston, Massachusetts, USA.,University of California-San Francisco, San Francisco, California, USA.,Ochsner Sports Medicine Institute, Jefferson, Louisiana, USA.,Children's Health Andrews Institute for Orthopedics and Sports Medicine, Plano, Texas, USA.,Oregon Health and Science University, Portland, Oregon, USA.,Investigation performed at Metrics of Osteochondral Allografts (MOCA), JRF Ortho, Centennial, Colorado, USA
| | - Timothy S Mologne
- Brigham and Women's Hospital, Boston, Massachusetts, USA.,University of California-San Francisco, San Francisco, California, USA.,Ochsner Sports Medicine Institute, Jefferson, Louisiana, USA.,Children's Health Andrews Institute for Orthopedics and Sports Medicine, Plano, Texas, USA.,Oregon Health and Science University, Portland, Oregon, USA.,Investigation performed at Metrics of Osteochondral Allografts (MOCA), JRF Ortho, Centennial, Colorado, USA
| | - Matthew T Provencher
- Brigham and Women's Hospital, Boston, Massachusetts, USA.,University of California-San Francisco, San Francisco, California, USA.,Ochsner Sports Medicine Institute, Jefferson, Louisiana, USA.,Children's Health Andrews Institute for Orthopedics and Sports Medicine, Plano, Texas, USA.,Oregon Health and Science University, Portland, Oregon, USA.,Investigation performed at Metrics of Osteochondral Allografts (MOCA), JRF Ortho, Centennial, Colorado, USA
| | - Scott A Rodeo
- Brigham and Women's Hospital, Boston, Massachusetts, USA.,University of California-San Francisco, San Francisco, California, USA.,Ochsner Sports Medicine Institute, Jefferson, Louisiana, USA.,Children's Health Andrews Institute for Orthopedics and Sports Medicine, Plano, Texas, USA.,Oregon Health and Science University, Portland, Oregon, USA.,Investigation performed at Metrics of Osteochondral Allografts (MOCA), JRF Ortho, Centennial, Colorado, USA
| | - Oleg Safir
- Brigham and Women's Hospital, Boston, Massachusetts, USA.,University of California-San Francisco, San Francisco, California, USA.,Ochsner Sports Medicine Institute, Jefferson, Louisiana, USA.,Children's Health Andrews Institute for Orthopedics and Sports Medicine, Plano, Texas, USA.,Oregon Health and Science University, Portland, Oregon, USA.,Investigation performed at Metrics of Osteochondral Allografts (MOCA), JRF Ortho, Centennial, Colorado, USA
| | - Eric D Strauss
- Brigham and Women's Hospital, Boston, Massachusetts, USA.,University of California-San Francisco, San Francisco, California, USA.,Ochsner Sports Medicine Institute, Jefferson, Louisiana, USA.,Children's Health Andrews Institute for Orthopedics and Sports Medicine, Plano, Texas, USA.,Oregon Health and Science University, Portland, Oregon, USA.,Investigation performed at Metrics of Osteochondral Allografts (MOCA), JRF Ortho, Centennial, Colorado, USA
| | - Christopher J Wahl
- Brigham and Women's Hospital, Boston, Massachusetts, USA.,University of California-San Francisco, San Francisco, California, USA.,Ochsner Sports Medicine Institute, Jefferson, Louisiana, USA.,Children's Health Andrews Institute for Orthopedics and Sports Medicine, Plano, Texas, USA.,Oregon Health and Science University, Portland, Oregon, USA.,Investigation performed at Metrics of Osteochondral Allografts (MOCA), JRF Ortho, Centennial, Colorado, USA
| | - Riley J Williams
- Brigham and Women's Hospital, Boston, Massachusetts, USA.,University of California-San Francisco, San Francisco, California, USA.,Ochsner Sports Medicine Institute, Jefferson, Louisiana, USA.,Children's Health Andrews Institute for Orthopedics and Sports Medicine, Plano, Texas, USA.,Oregon Health and Science University, Portland, Oregon, USA.,Investigation performed at Metrics of Osteochondral Allografts (MOCA), JRF Ortho, Centennial, Colorado, USA
| | - Adam B Yanke
- Brigham and Women's Hospital, Boston, Massachusetts, USA.,University of California-San Francisco, San Francisco, California, USA.,Ochsner Sports Medicine Institute, Jefferson, Louisiana, USA.,Children's Health Andrews Institute for Orthopedics and Sports Medicine, Plano, Texas, USA.,Oregon Health and Science University, Portland, Oregon, USA.,Investigation performed at Metrics of Osteochondral Allografts (MOCA), JRF Ortho, Centennial, Colorado, USA
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16
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Fehske K, Lukas C. [Ligamentous ankle injury: an underestimated trauma?]. SPORTVERLETZUNG-SPORTSCHADEN 2020; 34:147-152. [PMID: 32823343 DOI: 10.1055/a-1201-6162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Ligamentous injuries of the ankle joint are among the most common injuries in sports, with landing on the opponent's foot or direct contact counting among the most common injury mechanisms. Initial measures most notably include a clinical examination, supplemented by X-rays, sonography or MRI as required. In most cases, conservative treatment is the treatment of choice. At the beginning, pain and swelling have to be reduced. Then function must be regained before patients may return to sports after a return-to-play test. Some injury patterns are more complex with concomitant injuries, and despite all the success of conservative treatment, certain cases remain the preserve of surgery. Not only the downtime of athletes, the severity of long-term damage and chronic functional limitations, but also the associated costs for treatment suggest the recommendation that ankle joint injuries should not be underestimated and adequate treatment should be selected.
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Affiliation(s)
- Kai Fehske
- Universitätsklinikum Würzburg Zentrum Operative Medizin/Zentrum Innere Medizin, Würzburg
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17
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Xu C, Li M, Wang C, Liu H. A comparison between arthroscopic and open surgery for treatment outcomes of chronic lateral ankle instability accompanied by osteochondral lesions of the talus. J Orthop Surg Res 2020; 15:113. [PMID: 32197661 PMCID: PMC7083050 DOI: 10.1186/s13018-020-01628-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 03/10/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND This study aimed to examine the efficacy and safety of the arthroscopic treatment of osteochondral lesion of talus (OLT) and lateral ankle instability. It was hypothesized that the outcome of all-arthroscopic surgery was no worse than that of the combined open and arthroscopic surgery for treating chronic lateral ankle instability accompanied by OLT. METHODS The patients diagnosed of chronic lateral ankle instability accompanied by OLT, who were surgically treated between May 2015 and May2017, were targeted for inclusion. Specifically, patients who received the arthroscopic treatment of OLT and lateral ankle instability were enrolled in the all-arthroscopic group, while patients who received the arthroscopic treatment of OLT and open lateral ankle stabilization were enrolled in the combined open and arthroscopic group. All the patients were followed up in terms of the Karlsson Ankle Functional Score, visual analog scale (VAS) score, Tegner activity score, and American Orthopaedic Foot & Ankle Society (AOFAS) score. Meanwhile, the satisfaction and complication rates were evaluated and compared. RESULTS This retrospective study included a total of 67 patients, including 32 patients in the all-arthroscopic group and 35 patients in the combined group. At a minimum of 24-month follow-up, the functional outcomes were significantly improved in both groups in relation to the preoperative condition. However, the two groups did not differ significantly from each other in terms of the Karlsson score (83.1 ± 8.2 vs 81.7 ± 9.1; P = 0.89), the VAS score (1.8 ± 1.6 vs 2.1 ± 1.7; P = 0.73), the Tegner score (5.5 ± 2.3 vs 5.0 ± 2.1; P = 0.72), and the AOFAS score (87.7 ± 7.6 vs 86.9 ± 7.3; P = 0.77). In addition, the satisfaction and complication rates exhibited no significant differences between the two groups. CONCLUSION In comparison with the open lateral ankle stabilization and arthroscopic treatment of OLT, the all-arthroscopic procedure showed no difference in clinical outcomes at a minimum of 24-month follow-up. Despite the benefits of minimally invasive arthroscopic procedure combined with a relatively aggressive postoperative rehabilitation protocol, the clinical outcomes for patients with chronic lateral ankle instability accompanied by OLT did not yield significant improvement. TRIAL REGISTRATION The present study was carried out with the approval issued by the Institutional Review Board of Xiangya Hospital (no. 202002010).
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Affiliation(s)
- Can Xu
- Department of Orthopaedics, Xiangya Hospital, Central South University, No. 87, Xiangya Road, Changsha, 410008 China
| | - Mingqing Li
- Department of Orthopaedics, Xiangya Hospital, Central South University, No. 87, Xiangya Road, Changsha, 410008 China
| | - Chenggong Wang
- Department of Orthopaedics, Xiangya Hospital, Central South University, No. 87, Xiangya Road, Changsha, 410008 China
| | - Hua Liu
- Department of Orthopaedics, Xiangya Hospital, Central South University, No. 87, Xiangya Road, Changsha, 410008 China
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18
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Choi SW, Lee GW, Lee KB. Arthroscopic Microfracture for Osteochondral Lesions of the Talus: Functional Outcomes at a Mean of 6.7 Years in 165 Consecutive Ankles. Am J Sports Med 2020; 48:153-158. [PMID: 31877099 DOI: 10.1177/0363546519887957] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Arthroscopic microfracture for osteochondral lesions of the talus (OLT) has shown good functional outcomes. However, some studies have reported that functional outcomes deteriorate over time after surgery. PURPOSE To use various functional scoring systems to evaluate functional outcomes in a large sample of patients with OLT treated by arthroscopic microfracture. STUDY DESIGN Case series; Level of evidence, 4. METHODS The study cohort consisted of 165 ankles (156 patients) that underwent arthroscopic microfracture for small to mid-sized OLT. The mean lesion size was 73 mm2 (range, 17-146 mm2), and the mean follow-up period was 6.7 years (range, 2.0-13.6 years). The Foot and Ankle Outcome Score (FAOS), American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale, visual analog scale (VAS) for pain, and 36-Item Short Form Health Survey (SF-36) were used to compare the functional outcomes between the preoperative and final follow-up assessments. RESULTS The mean FAOS significantly improved in regard to all subscores (P < .001). The AOFAS ankle-hindfoot scale showed an improvement from 71.0 points (range, 47.0-84.0) preoperatively to 89.5 points (range, 63.0-100) at the final follow-up (P < .001). The VAS score showed an improvement from 6.2 points (range, 4.0-9.0) preoperatively to 1.7 points (range, 0-6.0) at the final follow-up (P < .001). The mean SF-36 score improved from 62.4 points (range, 27.4-76.6) preoperatively to 76.2 points (range, 42.1-98.0) at the final follow-up (P < .001). Among 165 ankles, 22 ankles (13.3%) underwent repeat arthroscopic surgery for evaluation of repaired cartilage status. CONCLUSION Arthroscopic microfracture showed good functional outcomes and improved quality of life with maintenance of satisfactory outcomes at a mean follow-up of 6.7 years. Therefore, arthroscopic microfracture seems to be reliable as a first-line treatment for OLT at an intermediate-term follow-up.
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Affiliation(s)
- Seung-Won Choi
- Department of Orthopedic Surgery, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
| | - Gun-Woo Lee
- Department of Orthopedic Surgery, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
| | - Keun-Bae Lee
- Department of Orthopedic Surgery, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
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19
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Steman JA, Dahmen J, Lambers KT, Kerkhoffs GM. Return to Sports After Surgical Treatment of Osteochondral Defects of the Talus: A Systematic Review of 2347 Cases. Orthop J Sports Med 2019; 7:2325967119876238. [PMID: 31673563 PMCID: PMC6806124 DOI: 10.1177/2325967119876238] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Osteochondral defects (OCDs) of the talus are found subsequent to ankle sprains and ankle fractures. With many surgical treatment strategies available, there is no clear evidence on return-to-sport (RTS) times and rates. PURPOSE To summarize RTS times and rates for talar OCDs treated by different surgical techniques. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS The literature from January 1996 to November 2018 was screened, and identified studies were divided into 7 different surgical treatment groups. The RTS rate, with and without associated levels of activity, and the mean time to RTS were calculated per study. When methodologically possible, a simplified pooling method was used to combine studies within 1 treatment group. Study bias was assessed using the MINORS (Methodological Index for Non-Randomized Studies) scoring system. RESULTS A total of 61 studies including 2347 talar OCDs were included. The methodological quality of the studies was poor. There were 10 retrospective case series (RCSs) that investigated bone marrow stimulation in 339 patients, with a pooled mean rate of RTS at any level of 88% (95% CI, 84%-91%); 2 RCSs investigating internal fixation in 47 patients found a pooled RTS rate of 97% (95% CI, 85%-99%), 5 RCSs in which autograft transplantation was performed in 194 patients found a pooled RTS rate of 90% (95% CI, 86%-94%), and 3 prospective case series on autologous chondrocyte implantation in 39 patients found a pooled RTS rate of 87% (95% CI, 73%-94%). The rate of return to preinjury level of sports was 79% (95% CI, 70%-85%) for 120 patients after bone marrow stimulation, 72% (95% CI, 60%-83%) for 67 patients after autograft transplantation, and 69% (95% CI, 54%-81%) for 39 patients after autologous chondrocyte implantation. The mean time to RTS ranged from 13 to 26 weeks, although no pooling was possible for this outcome measure. CONCLUSION Different surgical treatment options for talar OCDs allow for adequate RTS times and rates. RTS rates decreased when considering patients' return to preinjury levels versus return at any level.
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Affiliation(s)
- Jason A.H. Steman
- Department of Orthopaedic Surgery, Academic Medical Center,
University of Amsterdam, Amsterdam, the Netherlands
- Academic Center for Evidence-Based Sports Medicine, Amsterdam, the
Netherlands
- Amsterdam Collaboration on Health and Safety in Sports, Academic
Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Jari Dahmen
- Department of Orthopaedic Surgery, Academic Medical Center,
University of Amsterdam, Amsterdam, the Netherlands
- Academic Center for Evidence-Based Sports Medicine, Amsterdam, the
Netherlands
- Amsterdam Collaboration on Health and Safety in Sports, Academic
Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Kaj T.A. Lambers
- Department of Orthopaedic Surgery, Academic Medical Center,
University of Amsterdam, Amsterdam, the Netherlands
- Academic Center for Evidence-Based Sports Medicine, Amsterdam, the
Netherlands
- Amsterdam Collaboration on Health and Safety in Sports, Academic
Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- Department of Orthopedic Surgery, Amphia Hospital, Breda, the
Netherlands
| | - Gino M.M.J. Kerkhoffs
- Department of Orthopaedic Surgery, Academic Medical Center,
University of Amsterdam, Amsterdam, the Netherlands
- Academic Center for Evidence-Based Sports Medicine, Amsterdam, the
Netherlands
- Amsterdam Collaboration on Health and Safety in Sports, Academic
Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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20
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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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