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Kim J, Rajan L, Gagne O, Kim JB, Lee WC. Realignment Surgery for Failed Osteochondral Autologous Transplantation in Osteochondral Lesions of the Talus Associated With Malalignment. Foot Ankle Spec 2024; 17:240-248. [PMID: 37021377 DOI: 10.1177/19386400231163030] [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: 04/07/2023]
Abstract
BACKGROUND While osteochondral autologous transplantation (OAT) offers favorable results in most patients with osteochondral lesions of the talus (OLT), some patients continue to experience persistent pain following the procedure. Information regarding the etiology of this pain and outcomes of revision surgery are limited. This study aimed to report results of revision surgery with realignment procedures in patients with failed OAT who demonstrated concomitant malalignment at the distal tibia or hindfoot. METHODS Eight patients (8 ankles), who had been experiencing persistent pain for more than 1 year following OAT, underwent realignment procedures during revision surgery. All patients underwent primary OAT for the treatment of medial OLTs. Patients were divided into 2 groups based on the main location of deformity: the supramalleolar realignment group (SRG, 5 ankles) and the hindfoot realignment group (HRG, 3 ankles). No direct procedure was performed on the osteochondral lesion at the time of revision surgery. Ankle and hindfoot alignment were evaluated using 6 parameters in weightbearing radiographs. Computed tomography (CT) was used to assess for medial gutter narrowing, spur formation, and cyst volume around transplanted osteochondral plug preoperatively and postoperatively. Clinical outcomes were assessed using Foot Function Index and Visual Analogue Scale. RESULTS All patients had medial gutter narrowing or spur formation, which are early signs of ankle arthritis. The SRG had varus distal tibial alignment with a median medial distal tibial angle of 85.7 degrees (interquartile range [IQR], 3.2). The HRG had valgus hindfoot alignment and a lower medial longitudinal arch with a median hindfoot moment arm of 8.4 mm (IQR, 6.1) and a median Meary's angle of 11.8 degrees (IQR, 1.4). Spontaneous restoration of the osteochondral lesion was observed after realignment surgery, with cyst volume decreasing from 0.2592 to 0.0873 cm3 (P < .05). Clinical scores improved in all patients. CONCLUSION The current study demonstrates the effectiveness of realignment surgery in a selected patient group who experienced persistent pain and showed radiographic evidence of malalignment after primary OAT. Our study provides evidence supporting the use of realignment procedures in these cases, with results indicating improved patient-reported outcomes and spontaneous restoration of osteochondral lesions. LEVELS OF EVIDENCE Level IV: Case series.
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Affiliation(s)
- Jaeyoung Kim
- Hospital for Special Surgery, New York, New York
| | - Lavan Rajan
- Hospital for Special Surgery, New York, New York
| | - Oliver Gagne
- University of British Columbia, Vancouver, BC, Canada
| | - Ji-Beom Kim
- Seoul Foot and Ankle Center, Dubalo Orthopaedic Clinic, Seoul, Republic of Korea
| | - Woo-Chun Lee
- Seoul Foot and Ankle Center, Dubalo Orthopaedic Clinic, Seoul, Republic of Korea
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Rikken QGH, Aalders MB, Dahmen J, Sierevelt IN, Stufkens SAS, Kerkhoffs GMMJ. Ten-Year Survival Rate of 82% in 262 Cases of Arthroscopic Bone Marrow Stimulation for Osteochondral Lesions of the Talus. J Bone Joint Surg Am 2024:00004623-990000000-01097. [PMID: 38728384 DOI: 10.2106/jbjs.23.01186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
BACKGROUND The long-term sustainability of arthroscopic bone marrow stimulation (BMS) for osteochondral lesions of the talus (OLT) remains a matter of debate. The primary aim of the present study was to assess the 10-year survival free from revision in ankles that had undergone arthroscopic BMS for an OLT. The secondary aim was to evaluate the influence of baseline patient and lesion characteristics on survival. METHODS Patients who underwent arthroscopic BMS for a symptomatic OLT and had a minimum follow-up of 10 years were included to assess procedure survival. The primary outcome, the 10-year cumulative survival rate, was analyzed by the Kaplan-Meier survival method. Secondary outcomes were the median time to revision and the effects of baseline factors (lesion size, primary or non-primary lesion type, preoperative cysts, and obesity as defined by a body mass index [BMI] of ≥30 kg/m2) on survival, analyzed with a Cox regression model and reported using hazard ratios (HRs). RESULTS The 262 included patients had a mean follow-up of 15.3 ± 4.8 years. The 10-year cumulative survival rate of the arthroscopic BMS procedures was 82% (95% confidence interval [CI]: 77% to 87%). At 15 years of follow-up, the cumulative survival rate was 82% (95% CI: 76% to 86%). The median time to revision was 2.4 years (interquartile range: 1.3 to 5.1 years). Of the baseline factors, obesity (HR: 3.0 [95% CI: 1.44 to 6.43], p < 0.01) was associated with decreased survival. Lesion size (HR: 0.9 [95% CI: 0.5 to 1.8], p = 0.8), non-primary lesion type (HR: 1.8 [95% CI: 0.9 to 3.4], p = 0.1), and the presence of preoperative cysts (HR: 1.0 [95% CI: 0.6 to 1.9], p = 0.9) were not significantly associated with survival. CONCLUSIONS At a minimum follow-up of 10 years, the survival rate of arthroscopic BMS for OLT was 82%. At 15 and 20 years of follow-up, survival appeared to remain stable. Obesity (BMI ≥ 30 kg/m2) was associated with a higher likelihood of revision surgery. This risk factor should be incorporated into the treatment algorithm for OLT when counseling patients regarding surgery. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Quinten G H Rikken
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Sports and Musculoskeletal Health Programs, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Centre, Amsterdam UMC, Amsterdam, The Netherlands
| | - Margot B Aalders
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Sports and Musculoskeletal Health Programs, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Centre, Amsterdam UMC, Amsterdam, The Netherlands
| | - Jari Dahmen
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Sports and Musculoskeletal Health Programs, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Centre, Amsterdam UMC, Amsterdam, The Netherlands
| | - Inger N Sierevelt
- Orthopedic Department, Spaarne Gasthuis Academy, Hoofddorp, The Netherlands
| | - Sjoerd A S Stufkens
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Sports and Musculoskeletal Health Programs, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Centre, Amsterdam UMC, Amsterdam, The Netherlands
| | - Gino M M J Kerkhoffs
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Sports and Musculoskeletal Health Programs, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Centre, Amsterdam UMC, Amsterdam, The Netherlands
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Cui Y, Chen B, Wang G, Wang J, Liu B, Zhu L, Xu Q. Partial talar replacement with a novel 3D printed prosthesis. Comput Assist Surg (Abingdon) 2023; 28:2198106. [PMID: 37070416 DOI: 10.1080/24699322.2023.2198106] [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] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND The treatment of talus avascular necrosis (AVN) is challenging owing to its unique anatomical features. Despite decades of studies, till date, there is no appropriate treatment for talus AVN. Therefore, surgeons need to develop newer surgical methods. In the present study we introduce a new surgical method, 3D printed partial talus replacement (PTR), to treat partial talus necrosis and collapse (TNC). METHODS A male patient with talus AVN underwent PTR in our hospital. The morphology of the talus was quantified using 3D computed tomography (CT) imaging. A novel 3D printed titanium prothesis was designed and manufactured according to the findings of the CT imaging. The prosthesis was applied during talus replantation surgery to reconstruct the anatomical structure of the ankle. The follow-up period for this patient was 24 months. The visual analog scale (VAS) scores before and after surgery, American Orthopedic Foot and Ankle Score (AOFAS), ankle range of motion, and postoperative complications were recorded to evaluate the prognosis. RESULTS The anatomical structure of the talus was reconstructed. The patient was satisfied with the effects of treatment, recovery, and function. The VAS score decreased from 5 to 1. The AOFAS improved from 70 to 93. The range of motion remained the same as that during the pre-operation. The patient returned to a normal life. CONCLUSION 3D printed PTR is a new surgical method for talus AVN that can provide satisfactory outcomes. In future, PTR might be an effective and preferential treatment for the treatment of partial talus AVN and collapse.
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Affiliation(s)
- Yidong Cui
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, P.R. China
| | - Bin Chen
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, P.R. China
| | - Gang Wang
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, P.R. China
| | - Juntao Wang
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, P.R. China
| | - Ben Liu
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, P.R. China
| | - Lei Zhu
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, P.R. China
| | - Qingjia Xu
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, P.R. China
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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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5
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Choi SM, Cho BK, Kang C, Min CH. Comparison of Intermediate-Term Clinical Outcomes Between Medial and Lateral Osteochondral Lesions of the Talus Treated With Autologous Osteochondral Transplantation. Foot Ankle Int 2023; 44:606-616. [PMID: 37232401 DOI: 10.1177/10711007231169946] [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: 05/27/2023]
Abstract
BACKGROUND The conventional operative method to treat an osteochondral lesion of the talus (OLT) is through bone marrow stimulation (BMS). Autologous osteochondral transplantation (AOT) is being used as an alternative option in cases with a large OLT, accompanying subchondral cyst, and/or failed BMS. We aimed to compare the intermediate-term clinical and radiologic results between medial and lateral OLTs after an AOT procedure. METHODS Among the patients who underwent AOT, 45 cases with at least 3 years' follow-up were included in this retrospective study. We had 15 cases of lateral lesions and selected 30 cases of medial lesions matched for age and gender. Lateral lesions were resurfaced without an osteotomy; medial lesion resurfacing was combined with a medial malleolar osteotomy. Clinical assessment was performed using the Foot and Ankle Outcome Score (FAOS) and Foot and Ankle Ability Measure (FAAM). Radiographic assessment included the irregularity of articular surface (subchondral plate), the progression of degenerative arthritis, and the change of the talar tilt. RESULTS The mean FAOS and FAAM scores significantly improved after surgery in both groups. Up to 1 year postoperatively, there was significant difference in FAAM scores between the both groups (mean 75.3 points in medial group and 87.2 points in lateral group, P < .001). Delayed union or malunion of the malleolar osteotomy was found in 4 cases (13%) in the medial group. In addition, the progression of joint degeneration was observed in 3 cases (10%) in the medial group. There were no significant differences in the irregularity of articular surface and the change of talar tilt between both groups. CONCLUSION A comparison between medial and lateral OLTs treated with AOT demonstrated comparable intermediate-term clinical outcomes. However, patients with medial OLT required a longer period to restore ability for daily and sport activities. In addition, we found more complications and higher rate of progression in the radiologic arthritis grade after medial malleolar osteotomy. LEVEL OF EVIDENCE Level IV, retrospective comparative study.
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Affiliation(s)
- Seung-Myung Choi
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Byung-Ki Cho
- Department of Orthopaedic Surgery, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Chan Kang
- Department of Orthopaedic Surgery, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Chan-Hong Min
- Department of Orthopaedic Surgery, College of Medicine, Chungbuk National University, Cheongju, Korea
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6
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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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Yontar NS, Aslan L, Öğüt T. Functional Outcomes of Autologous Matrix-Related Chondrogenesis to Treat Large Osteochondral Lesions of the Talus. Foot Ankle Int 2022; 43:783-789. [PMID: 35536146 DOI: 10.1177/10711007221078021] [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: 02/01/2023]
Abstract
BACKGROUND Osteochondral lesions of the talus (OLT) treatment is widely debated when the lesion size exceeds 150 mm2. The aim of this study was to assess functional outcome and satisfaction rates of the autologous matrix-related chondrogenesis (AMIC) technique and compare the outcomes for OLTs larger than 150 mm2 that were classified as primary, primary with local tumor-related OLT, or revision cases. METHODS A total of 77 patients who were operated by AMIC were included. The average age of the population was 39.6 years. The mean body mass index (BMI) was 27.2. Smoker rate was 28.5% of the population. Forty-two patients were primary cases, 14 patients had primary with local tumor-related OLT, and 18 patients were revision cases. Overall and subgroup functional outcomes were evaluated by visual analog scale (VAS) and Foot and Ankle Disability Index (FADI) scores. Satisfaction rates were queried, and failures were recorded. RESULTS After a median follow-up of 32 months, the score improvement for primary, primary with local tumor-related, and revision group were for VAS, 5.4 ± 0.4, 5.6 ± 0.7, and 3.6 ± 0.8, and for FADI, 46.5 ± 3.8, 45.3 ±6.5, and 26.6 ± 6.7, respectively (P < .001). Intergroup comparison showed greater improvement for the primary OLT group when compared to the revision group (P < .001). The failure rates for the primary, primary with local tumor-related, and revision group were 4.8%, 11.8%, and 38.9%, respectively. CONCLUSION AMIC procedure provides good functional outcome and satisfactory rates in patients with primary and primary with local tumor-related OLT larger than 150 mm2, but in revision cases, the AMIC success rate was not encouraging as all had advanced OLT operative interventions. LEVEL OF EVIDENCE Level III, therapeutic retrospective study.
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Affiliation(s)
- Necip Selçuk Yontar
- Nisantasi Ortopedi Merkezi ayak-ayak bileği cerrahisi kliniği, Istanbul, Turkey
| | - Lercan Aslan
- Orthopaedics and Traumatology Department, Koc University Hospital, Istanbul, Turkey
| | - Tahir Öğüt
- Nisantasi Ortopedi Merkezi ayak-ayak bileği cerrahisi kliniği, Istanbul, Turkey
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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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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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