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Viglione V, Berveglieri L, Filardo G, Buda R, Giannini S, Faldini C, Vannini F. Autologous chondrocyte implantation for the treatment of osteochondral lesions of the talus: What happens after 20 years? Foot Ankle Surg 2024; 30:546-551. [PMID: 38653636 DOI: 10.1016/j.fas.2024.04.007] [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: 02/09/2024] [Revised: 04/01/2024] [Accepted: 04/13/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND The purpose of this study was to assess the long-term clinical efficacy of first-generation autologous chondrocyte implantation (ACI) technique for osteochondral lesions of the ankle joint. METHODS Eleven patients with symptomatic OLTs underwent ACI from December 1997 to October 2002. A total of 9 patients (5 men, 4 women, age 25.2 ± 6.3) were evaluated at baseline and at 1, 3, 10 years, and at final follow-up of minimum 20 years with AOFAS ankle-hindfoot score, NRS for pain, and with the Tegner score. RESULTS The AOFAS score improved significantly from the baseline value of 40.4 ± 19.8 to 82.7 ± 12.9 at the final follow-up (p < 0.0005). The NRS for pain improved significantly from 7.8 ± 0.7 at baseline to 4.8 ± 2.1 at the final follow-up (p < 0.0005). Moreover, the Tegner score underwent a modification from the pre-operative median value of 1 (range: 1-3) and from a pre-injury value of 5 (range: 3-7) to 3 (range: 2-4) at the final follow-up (p < 0.0005). CONCLUSIONS ACI has proven to be an effective treatment option for patients suffering from OLTs, leading to a long-lasting clinical improvement even beyond 20 years of follow-up. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Valentina Viglione
- Clinica Ortopedica e Traumatologica 1; IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Luca Berveglieri
- Clinica Ortopedica e Traumatologica 1; IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Giuseppe Filardo
- Applied and Translational Research (ATR) Center; IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Roberto Buda
- Clinica Ortopedica di Chieti, Ospedale Clinicizzato SS Annunziata di Chieti, Chieti, Italy
| | | | - Cesare Faldini
- Clinica Ortopedica e Traumatologica 1; IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Francesca Vannini
- Clinica Ortopedica e Traumatologica 1; IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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2
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Anastasio AT, Lau B, Adams S. Ankle Osteoarthritis. J Am Acad Orthop Surg 2024; 32:738-746. [PMID: 38810230 DOI: 10.5435/jaaos-d-23-00743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 04/23/2024] [Indexed: 05/31/2024] Open
Abstract
Ankle osteoarthritis (OA) is less common than knee and hip OA, and 75% to 80% of all presentations are posttraumatic in nature, resulting from either ligamentous or bony injury to the ankle. While the ankle joint cartilage demonstrates capacity for self-restoration, the ankle joint is sensitive to aberrancies in biomechanics and the inflammatory milieu after an injury is thought to contribute to the onset of posttraumatic ankle OA. Conservative care for ankle OA is currently centered on pain reduction, and derivatives that may delay the progression of ankle OA are the subject of ongoing investigation. Surgical management for end-stage ankle OA currently focuses on ankle arthrodesis and total ankle arthroplasty. Specific indication for one procedure over the other is the topic of much debate. While total ankle arthroplasty has become more frequently used with the advent of newer generation systems, ankle arthrodesis may still be favored in younger patients with high-demand occupations.
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Affiliation(s)
- Albert T Anastasio
- From the Duke University Department of Orthopaedic Surgery, Division of Sports Medicine, Durham, North Carolina
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3
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Bogner B, Wenning M, Jungmann PM, Reisert M, Lange T, Tennstedt M, Klein L, Diallo TD, Bamberg F, Schmal H, Jung M. T1ρ relaxation mapping in osteochondral lesions of the talus: a non-invasive biomarker for altered biomechanical properties of hyaline cartilage? Eur Radiol Exp 2024; 8:83. [PMID: 39046607 PMCID: PMC11269556 DOI: 10.1186/s41747-024-00488-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 06/16/2024] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND To evaluate T1ρ relaxation mapping in patients with symptomatic talar osteochondral lesions (OLT) and healthy controls (HC) at rest, with axial loading and traction. METHODS Participants underwent 3-T ankle magnetic resonance imaging at rest and with 500 N loading and 120 N traction, without axial traction for a subcohort of 17/29 HC. We used a fast low-angle shot sequence with variable spin-lock intervals for monoexponential T1ρ fitting. Cartilage was manually segmented to extract T1ρ values. RESULTS We studied 29 OLT patients (age 31.7 ± 7.5 years, 15 females, body mass index [BMI] 25.0 ± 3.4 kg/m2) and 29 HC (age 25.2 ± 4.3 years, 17 females, BMI 22.5 ± 2.3 kg/m2. T1ρ values of OLT (50.4 ± 3.4 ms) were higher than those of intact cartilage regions of OLT patients (47.2 ± 3.4 ms; p = 0.003) and matched HC cartilage (48.1 ± 3.3 ms; p = 0.030). Axial loading and traction induced significant T1ρ changes in the intact cartilage regions of patients (loading, mean difference -1.1 ms; traction, mean difference 1.4 ms; p = 0.030 for both) and matched HC cartilage (-2.2 ms, p = 0.003; 2.3 ms, p = 0.030; respectively), but not in the OLT itself (-1.3 ms; p = 0.150; +1.9 ms; p = 0.150; respectively). CONCLUSION Increased T1ρ values may serve as a biomarker of cartilage degeneration in OLT. The absence of load- and traction-induced T1ρ changes in OLT compared to intact cartilage suggests that T1ρ may reflect altered biomechanical properties of hyaline cartilage. TRIAL REGISTRATION DRKS, DRKS00024010. Registered 11 January 2021, https://drks.de/search/de/trial/DRKS00024010 . RELEVANCE STATEMENT T1ρ mapping has the potential to evaluate compositional and biomechanical properties of the talar cartilage and may improve therapeutic decision-making in patients with osteochondral lesions. KEY POINTS T1ρ values in osteochondral lesions increased compared to intact cartilage. Significant load- and traction-induced T1ρ changes were observed in visually intact regions and in healthy controls but not in osteochondral lesions. T1ρ may serve as an imaging biomarker for biomechanical properties of cartilage.
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Affiliation(s)
- Balázs Bogner
- Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany.
- Berta-Ottenstein-Programme, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Markus Wenning
- Department of Orthopedics, BDH Klinik Waldkirch, 79283, Waldkirch, Germany
- Praxis Drescher-Eberbach-Wenning, Orthopedic Surgeons, 79100, Freiburg, Germany
| | - Pia M Jungmann
- Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany
| | - Marco Reisert
- Division of Medical Physics, Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany
- Department of Stereotactic and Functional Neurosurgery, University Medical Center Freiburg, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany
| | - Thomas Lange
- Division of Medical Physics, Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany
| | - Marcel Tennstedt
- Department of Orthopedic and Trauma Surgery, University Medical Center Freiburg, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany
| | - Lukas Klein
- Department of Orthopedic and Trauma Surgery, University Medical Center Freiburg, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany
| | - Thierno D Diallo
- Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany
| | - Hagen Schmal
- Department of Orthopedic and Trauma Surgery, University Medical Center Freiburg, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany
| | - Matthias Jung
- Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany
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Nguyen K, Cooperman S, Ng A. Osteochondral Injuries of the Talus. Clin Podiatr Med Surg 2024; 41:437-450. [PMID: 38789163 DOI: 10.1016/j.cpm.2024.01.004] [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: 05/26/2024]
Abstract
Osteochondral lesions of the talus are a common sequelae of trauma and are often associated with ankle sprains and ankle fractures. Because the surface of the talus is composed primarily of hyaline cartilage, the regenerative capacity of these injuries is limited. Therefore, several open and arthroscopic techniques have been described to treat osteochondral injuries of the talus and underlying bone marrow lesions. Throughout this review, these treatment options are discussed along with their indications and currently reported outcomes. A commentary on the authors' preferences among these techniques is also provided.
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Affiliation(s)
- Kevin Nguyen
- Advanced Orthopedic & Sports Medicine Specialists, Denver, CO, USA; Department of Podiatric Surgery, Orthopedic Centers of Colorado, Advanced Orthopedic & Sports Medicine Specialists, 8101 East Lowry Boulevard, Suite 230, Denver, CO 80230, USA.
| | - Steven Cooperman
- Department of Podiatric Surgery, Orthopedic Centers of Colorado, Advanced Orthopedic & Sports Medicine Specialists, 8101 East Lowry Boulevard, Suite 230, Denver, CO 80230, USA; HCA Presbyterian Saint Lukes, Denver, CO, USA
| | - Alan Ng
- Department of Podiatric Surgery, Orthopedic Centers of Colorado, Advanced Orthopedic & Sports Medicine Specialists, 8101 East Lowry Boulevard, Suite 230, Denver, CO 80230, USA
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Anastasio AT, Adams SB. Cartilage Injuries: Basic Science Update. Foot Ankle Clin 2024; 29:357-369. [PMID: 38679445 DOI: 10.1016/j.fcl.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
The last several decades have brought about substantial development in our understanding of the biomolecular pathways associated with chondral disease and progression to arthritis. Within domains relevant to foot and ankle, genetic modification of stem cells, augmentation of bone marrow stimulation techniques, and improvement on existing scaffolds for delivery of orthobiologic agents hold promise in improving treatment of chondral injuries. This review summarizes novel developments in the understanding of the molecular pathways underlying chondral damage and some of the recent advancements within related therapeutics.
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Affiliation(s)
- Albert T Anastasio
- Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, Duke University Health System, 311 Trent Drive, Durham, NC 27710, USA
| | - Samuel B Adams
- Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, Duke University Health System, 311 Trent Drive, Durham, NC 27710, USA.
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Vreeken JT, Dahmen J, Stornebrink T, Emanuel KS, Walinga AB, Stufkens SAS, Kerkhoffs GMMJ. Second-Look Arthroscopy Shows Inferior Cartilage after Bone Marrow Stimulation Compared with Other Operative Techniques for Osteochondral Lesions of the Talus: A Systematic Review and Meta-Analysis. Cartilage 2024:19476035241227332. [PMID: 38323533 DOI: 10.1177/19476035241227332] [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: 02/08/2024] Open
Abstract
OBJECTIVE To compare cartilage quality after different surgical interventions for osteochondral lesions of the talus (OLT), evaluated by second-look arthroscopy. Secondary aims were to report concomitant diagnoses, and to correlate cartilage quality with clinical and radiological outcomes. This review hypothesizes that the cartilage repair after bone marrow stimulation (BMS) is inferior to the other available treatment options. METHODS PROSPERO ID: CRD42022311489. Studies were retrieved through PubMed, EMBASE (Ovid), and Cochrane Library. Studies were included if they reported cartilage quality after second-look investigation after surgical treatment of OLT. The primary outcome measure was the cartilage quality success and failure rates (%) per surgical intervention group. Correlations between the cartilage quality and clinical or radiological outcomes were calculated. RESULTS Twenty-nine studies were included, comprising 586 ankles that had undergone second-look arthroscopy on average 16 months after initial surgery. The success rate for BMS was 57% (95% confidence interval [CI] = 48%-65%), for fixation (FIX) 86% (95% CI = 70%-94%), for osteo(chondral) transplantation (OCT) 91% (95% CI = 80%-96%), for cartilage implementation techniques (CITs) 80% (95% CI = 69%-88%), and for retrograde drilling 100% (95% CI = 66%-100%). The success rate of BMS was significantly lower than FIX, OCT, and CIT (P < 0.01). There were no significant differences between other treatment groups. A moderate positive significant correlation between the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score and the International Cartilage Repair Society score (ICRS) was found (ρ = 0.51, P < 0.001). CONCLUSIONS Successful restoration of cartilage quality was found in the majority of surgically treated OLTs. However, BMS yields inferior cartilage quality compared with FIX, OCT, and CIT. Study Design. Systematic review and meta-analysis. Level of evidence. Level IV, systematic review and meta-analysis.
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Affiliation(s)
- Jelmer T Vreeken
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health & Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - Jari Dahmen
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health & Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - Tobias Stornebrink
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health & Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - Kaj S Emanuel
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health & Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - Alex B Walinga
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health & Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - Sjoerd A S Stufkens
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health & Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - Gino M M J Kerkhoffs
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health & Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands
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Gupta A, Aratikatla A. Allogenic Umbilical Cord Tissue as a Scaffold for Ankle Osteoarthritis. Cureus 2023; 15:e46572. [PMID: 37933357 PMCID: PMC10625671 DOI: 10.7759/cureus.46572] [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] [Accepted: 10/06/2023] [Indexed: 11/08/2023] Open
Abstract
Osteoarthritis (OA) of ankle followed by injury to the talus is one of the most common disorders of ankle. Traditional treatment modalities have limitations and do not address the etiopathogenetic cause of OA. Perinatal tissue-derived biologics such as umbilical cords have shown potential for musculoskeletal regenerative medicine applications. This article qualitatively presents the in vitro, pre-clinical, clinical, and ongoing scientific literature exploring the application of umbilical cord tissue in the context of ankle OA. We identified only one clinical study wherein allogenic umbilical cord tissue was applied as a scaffold to the degenerated cartilage in the subtalar synovial joint. Administration of umbilical cord tissue is safe and potentially efficacious in patients with ankle OA. However, more in vitro, pre-clinical studies and high-powered, multi-center, non-randomized and randomized controlled trials are warranted to further establish the safety and efficacy of umbilical cord to justify its clinical use in ankle OA patients.
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Affiliation(s)
- Ashim Gupta
- Regenerative Medicine, Regenerative Orthopaedics, Noida, IND
- Regenerative Medicine, Future Biologics, Lawrenceville, USA
- Regenerative Medicine, BioIntegrate, Lawrenceville, USA
- Orthopaedics, South Texas Orthopaedic Research Institute, Laredo, USA
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Tewilliager T, Nguyen K, Ng A. Arthroscopic Cartilage Transplantation. Clin Podiatr Med Surg 2023; 40:483-494. [PMID: 37236685 DOI: 10.1016/j.cpm.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Arthroscopic cartilage repair has made several strides in recent years; however, no gold standard for cartilage restoration has been found. Simple treatment with bone marrow stimulation such as microfracture have shown good short-term results; however, concerns for long-term stability of cartilage repair as well as the subchondral bone health remain in question. Treatment of these lesions often comes down to surgeon preference, the aim of this study is to discuss some of the current options available on the market to further assist surgeons in their decision-making process.
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Affiliation(s)
- Tyler Tewilliager
- Advanced Orthopedics and Sports Medicine Specialists, 8101 East Lowry Boulevard Suite 230, Denver, CO 80230, USA.
| | - Kevin Nguyen
- Advanced Orthopedics and Sports Medicine Specialists, 8101 East Lowry Boulevard Suite 230, Denver, CO 80230, USA
| | - Alan Ng
- Advanced Orthopedics and Sports Medicine Specialists, 8101 East Lowry Boulevard Suite 230, Denver, CO 80230, USA
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9
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Peng J, Wang Q, Xu Y, He H. Platelet-rich plasma treatment for talar cartilage repair: a systematic review and meta-analysis. BMC Musculoskelet Disord 2023; 24:366. [PMID: 37161527 PMCID: PMC10169378 DOI: 10.1186/s12891-023-06466-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 04/26/2023] [Indexed: 05/11/2023] Open
Abstract
PURPOSE To systematically review the studies regarding to the safety, efficacy and application methods of PRP in promoting the talar cartilage repair. METHODS A systematic review was performed by searching PubMed, Web of Science, OVID and EMBASE to identify studies that compared the clinical efficacy of PRP for talar cartilage repair. Main outcome was the American Orthopedic Foot and Ankle Society (AOFAS) score for function and Visual Analog Scale (VAS) for pain was the second outcome. RESULTS A total of 10 studies were included in this systematic review, including 4 randomized controlled trials, 1 controlled trial, 3 case series and 2 cohort studies. Four RCTs were analyzed using meta-analysis. For all outcomes, statistical results favored PRP group (AOFAS: MD = 7.84; 95% CI= [-0.13, 15.80], I2 = 83%, P < 0.01; VAS: MD = 1.86; 95% CI= [0.68, 3.04], I2 = 85%, P < 0.01). There were almost no reports of adverse events related to PRP intervention. Subgroup analysis showed that whether PRP was used alone or combined with other treatments could result in high heterogeneity but no more specific factors were identified to contribute to this. CONCLUSION PRP is safe and effective for talar cartilage repair. In addition to the standardization of PRP preparation and application, it is necessary to distinguish the effects of PRP used alone or in combination with other treatments. In PRP studies, surgical treatment of talar cartilage repair remains the mainstream. The regulation of PRP in surgical applications are worth exploring. The most relative component is the mesenchymal stem cell because it is the only exposed chondrocyte precursor in the articular cavity whether it is microfracture or cell transplantation. TRIAL REGISTRATION The study was registered in the PROSPERO International prospective register of systematic reviews (CRD42022360183).
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Affiliation(s)
- Jialei Peng
- Department of Rehabilitation Medicine, Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, #37 Guoxue Street, Wuhou District, Chengdu, Sichuan, 610041, P. R. China
- School of Rehabilitation Sciences, West China School of Medicine, Sichuan University, Chengdu, 610041, P. R. China
- Rehabilitation Medicine Key Laboratory of Sichuan Province, Chengdu, 610041, P. R. China
| | - Qian Wang
- Department of Rehabilitation Medicine, Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, #37 Guoxue Street, Wuhou District, Chengdu, Sichuan, 610041, P. R. China
- School of Rehabilitation Sciences, West China School of Medicine, Sichuan University, Chengdu, 610041, P. R. China
- Rehabilitation Medicine Key Laboratory of Sichuan Province, Chengdu, 610041, P. R. China
| | - Yang Xu
- Department of Rehabilitation Medicine, Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, #37 Guoxue Street, Wuhou District, Chengdu, Sichuan, 610041, P. R. China
- School of Rehabilitation Sciences, West China School of Medicine, Sichuan University, Chengdu, 610041, P. R. China
- Rehabilitation Medicine Key Laboratory of Sichuan Province, Chengdu, 610041, P. R. China
| | - Hongchen He
- Department of Rehabilitation Medicine, Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, #37 Guoxue Street, Wuhou District, Chengdu, Sichuan, 610041, P. R. China.
- School of Rehabilitation Sciences, West China School of Medicine, Sichuan University, Chengdu, 610041, P. R. China.
- Rehabilitation Medicine Key Laboratory of Sichuan Province, Chengdu, 610041, P. R. China.
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Griffith JF, Ling SKK, Tischer T, Weber MA. Talar Dome Osteochondral Lesions: Pre- and Postoperative Imaging. Semin Musculoskelet Radiol 2022; 26:656-669. [PMID: 36791735 DOI: 10.1055/s-0042-1760217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
We suggest a similar approach to evaluating osteochondral lesions of the talar dome both pre- and postoperatively. This review addresses the etiology, natural history, and treatment of talar dome osteochondral lesions with an emphasis on imaging appearances. High-resolution magnetic resonance imaging, ideally combining a small field-of-view surface coil with ankle traction, optimizes visibility of most of the clinically relevant features both pre- and postoperatively.
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Affiliation(s)
- James Francis Griffith
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, China
| | - Samuel K K Ling
- Department of Orthopaedic and Traumatology, The Chinese University of Hong Kong, Hong Kong, China
| | - Thomas Tischer
- Department of Orthopaedic Surgery, University Medical Centre Rostock, Rostock, Germany
| | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center Rostock Germany
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11
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Knight R, Keene DJ, Dutton SJ, Handley R, Willett K. Radiological malunion after ankle fractures in older adults : definitions and new thresholds derived from clinical outcome data from the AIM trial. Bone Jt Open 2022; 3:841-849. [PMID: 36300624 PMCID: PMC9626854 DOI: 10.1302/2633-1462.310.bjo-2022-0035.r1] [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: 01/24/2023] Open
Abstract
AIMS The rationale for exacting restoration of skeletal anatomy after unstable ankle fracture is to improve outcomes by reducing complications from malunion; however, current definitions of malunion lack confirmatory clinical evidence. METHODS Radiological (absolute radiological measurements aided by computer software) and clinical (clinical interpretation of radiographs) definitions of malunion were compared within the Ankle Injury Management (AIM) trial cohort, including people aged ≥ 60 years with an unstable ankle fracture. Linear regressions were used to explore the relationship between radiological malunion (RM) at six months and changes in function at three years. Function was assessed with the Olerud-Molander Ankle Score (OMAS), with a minimal clinically important difference set as six points, as per the AIM trial. Piecewise linear models were used to investigate new radiological thresholds which better explain symptom impact on ankle function. RESULTS Previously described measures of RM and surgeon opinion of clinically significant malunion (CSM) were shown to be related but with important differences. CSM was more strongly related to outcome (-13.9 points on the OMAS; 95% confidence interval (CI) -21.9 to -5.4) than RM (-5.5 points; 95% CI -9.8 to -1.2). Existing malunion thresholds for talar tilt and tibiofibular clear space were shown to be slightly conservative; new thresholds which better explain function were identified (talar tilt > 2.4°; tibiofibular clear space > 6 mm). Based on this new definition the presence of RM had an impact on function, which was statistically significant, but the clinical significance was uncertain (-9.1 points; 95% CI -13.8 to -4.4). In subsequent analysis, RM of a posterior malleolar fracture was shown to have a statistically significant impact on OMAS change scores, but the clinical significance was uncertain (-11.6 points; 95% CI -21.9 to -0.6). CONCLUSION These results provide clinical evidence which supports the previously accepted definitions. Further research to investigate more conservative clinical thresholds for malunion is indicated.Cite this article: Bone Jt Open 2022;3(10):841-849.
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Affiliation(s)
- Ruth Knight
- Oxford Clinical Trials Research Unit, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK,Correspondence should be sent to Ruth Knight. E-mail:
| | - David J. Keene
- Kadoorie Centre for Critical Care Research and Education, John Radcliffe Hospital, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Susan J. Dutton
- Oxford Clinical Trials Research Unit, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Robert Handley
- Oxford Trauma Service, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Keith Willett
- Kadoorie Centre for Critical Care Research and Education, John Radcliffe Hospital, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Herrera-Pérez M, Valderrabano V, Godoy-Santos AL, de César Netto C, González-Martín D, Tejero S. Ankle osteoarthritis: comprehensive review and treatment algorithm proposal. EFORT Open Rev 2022; 7:448-459. [PMID: 35900210 PMCID: PMC9297055 DOI: 10.1530/eor-21-0117] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Ankle osteoarthritis (OA) is much less frequent than knee or hip OA, but it can be equally disabling, greatly affecting the quality of life of the patients. Approximately 80% of ankle OA is post-traumatic, mainly secondary to malleolar fractures, being another of the main causes untreated in chronic instability. The average age of the patient affected by ankle OA is around 50 years, being therefore active patients and in working age who seek to maintain mobility and remain active. The authors conducted a comprehensive review of the conservative, medical, and surgical treatment of ankle OA. Initial conservative treatment is effective and should be attempted in any stage of OA. From a pharmacological point of view, non-steroidal anti-inflammatory drugs (NSAIDs) and intra-articular infiltrations can produce temporary relief of symptoms. After the failure of conservative-medical treatment, two large groups of surgical treatment have been described: joint-preserving and joint-sacrificing procedures. In the early stages, only periarticular osteotomies have enough evidence to recommend in ankle OA with malalignment. Both ankle arthrodesis and ankle replacement can produce satisfactory functional results if correctly indicated in the final stages of the disease. Finally, the authors propose a global treatment algorithm that can aid in the decision-making process.
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Affiliation(s)
- Mario Herrera-Pérez
- Foot and Ankle Unit, Orthopaedic Department, Hospital Universitario de Canarias, Tenerife, Spain
- Department of Surgery, Universidad de La Laguna, Tenerife, Spain
| | - Victor Valderrabano
- Foot and Ankle Unit, Orthopaedic Department, Schmerzklinik, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | | | - César de César Netto
- Director of the UIOWA Orthopedic Functional Imaging Research Laboratory (OFIRL), Iowa, USA
- Department of Orthopedic and Rehabilitation, University of Iowa, Iowa, USA
| | - David González-Martín
- Foot and Ankle Unit, Orthopaedic Department, Hospital Universitario de Canarias, Tenerife, Spain
- Department of Surgery, Universidad de La Laguna, Tenerife, Spain
| | - Sergio Tejero
- Foot and Ankle Unit, Hospital Universitario Virgen del Rocío, Sevilla, Spain
- Department of Surgery, Universidad de Sevilla, Sevilla, Spain
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13
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Hinckley NB, Hassebrock JD, Karsen PJ, Deckey DG, Fernandez A, Kile TA, Drakos MC, Patel KA. Talus Visualization in Ankle Fractures: How Much Are We Really Seeing? Orthop J Sports Med 2022; 10:23259671211066856. [PMID: 35024369 PMCID: PMC8743951 DOI: 10.1177/23259671211066856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 09/27/2021] [Indexed: 11/29/2022] Open
Abstract
Background: Despite appropriate care, a subset of patients with ankle fractures has persistent pain. This condition may be associated with intra-articular pathology, which is present up to 65% of the time. Purpose: To quantify how much of the talus is visible through an open approach to a standard supination external rotation bimalleolar ankle fracture as a percentage of the entire weightbearing surface of the talus. Study Design: Descriptive laboratory study. Methods: Standard ankle approaches to lateral and medial malleolar fractures were performed in 4 cadaveric ankles from 2 cadavers. Osteotomies were made to simulate a supination external rotation bimalleolar ankle fracture based on the Lauge-Hansen classification. The visible segments of talar cartilage were removed. The tali were then exhumed, and the entire weightbearing superior portion of the talus was assessed and compared with the amount of cartilage removed by an open approach. The mean of the data points as well as the 95% confidence interval were calculated. Results: Four ankle specimens from 2 cadavers were used for these measurements. The mean surface area of the talus was 14.0 cm2 (95% CI, 13.3-14.7 cm2), while the mean area visible via an open approach was 2.1 cm2 (95% CI, 0.5-3.6 cm2). The mean proportion of the talus visualized via an open approach was 14.8% (95% CI, 3.6-26.1%). Conclusion: These findings indicate that the true area of weightbearing talar surface visible during an open exposure may be less than what many surgeons postulate. Clinical Relevance: Only a small fracture of the talus is visible via an open approach to the talus during fracture fixation. This could warrant arthroscopic evaluation of these injuries to evaluate and treat osteocondral lesions resulting from ankle fractures.
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Affiliation(s)
| | | | - Phillip J Karsen
- Department of Orthopaedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - David G Deckey
- Department of Orthopaedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Andrea Fernandez
- University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Todd A Kile
- Department of Orthopaedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Mark C Drakos
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Karan A Patel
- Department of Orthopaedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA
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14
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Danilkowicz RM, Allen NB, Grimm N, Nettles DL, Nunley JA, Easley ME, Adams SB. Histological and Inflammatory Cytokine Analysis of Osteochondral Lesions of the Talus After Failed Microfracture: Comparison With Fresh Allograft Controls. Orthop J Sports Med 2021; 9:23259671211040535. [PMID: 34734096 PMCID: PMC8558807 DOI: 10.1177/23259671211040535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 05/19/2021] [Indexed: 11/21/2022] Open
Abstract
Background: The most common first-line treatment of osteochondral lesions of the talus (OLTs) is microfracture. Although many patients do well with this procedure, a number fail and require reoperation. The mechanism of failure of microfracture is unknown, and to our knowledge there has been no research characterizing failed microfracture regarding histological and inflammatory makeup of these lesions that may contribute to failure. Purpose: To characterize the structural and biochemical makeup of failed microfracture lesions. Study Design: Case series; Level of evidence, 4. Methods: Specimens from 8 consecutive patients with symptomatic OLTs after microfracture who later underwent fresh osteochondral allograft transplantation were analyzed. For each patient, the failed microfracture specimen and a portion of the fresh allograft replacement tissue were collected. The allograft served as a control. Histology of the failed microfracture and the allograft replacement was scored using the Osteoarthritis Research Society International (OARSI) system. Surface roughness was also compared. In addition, tissue culture supernatants were analyzed for 16 secreted cytokines and matrix metalloproteinases (MMPs) responsible for inflammation, pain, cartilage damage, and chondrocyte death. Results: The OARSI grade, stage, and total score as well as surface smoothness were significantly worse in the failed microfracture sample, indicating better cartilage and bone morphology for the allografts compared with the failed microfracture lesions. Analyzed cytokines and MMPs were significantly elevated in the microfracture tissue culture supernatants when compared with fresh osteochondral tissue supernatants. Conclusion: These data demonstrate a significantly rougher cartilage surface, cartilage and subchondral bone histology that more closely resembles osteoarthritis, and elevated inflammatory cytokines and MMPs responsible for pain, inflammation, cartilage damage, and chondrocyte death when compared with fresh osteochondral allografts used as controls.
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Affiliation(s)
- Richard M Danilkowicz
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Nicholas B Allen
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Nate Grimm
- Idaho Sports Medicine Institute, Boise, Idaho, USA
| | - Dana L Nettles
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - James A Nunley
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Mark E Easley
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Samuel B Adams
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
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15
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Osteochondral lesions of the talar dome: an up-to-date approach to multimodality imaging and surgical techniques. Skeletal Radiol 2021; 50:2151-2168. [PMID: 34129065 DOI: 10.1007/s00256-021-03823-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 05/13/2021] [Accepted: 05/17/2021] [Indexed: 02/02/2023]
Abstract
Osteochondral lesions (OCLs) of the talar dome consist of a multifactorial pathology of the articular cartilage and subchondral bone and can result in persistent ankle pain and osteoarthritis (OA). Along with a physical examination and clinical history, an imaging evaluation plays a pivotal role in the diagnosis of these lesions and is fundamental for making treatment decisions and determining prognosis by providing information regarding the size, location, and cartilage and subchondral bone statuses as well as associated lesions and degenerative changes. Multiple surgical techniques for OCLs of the talar dome have been developed in recent decades, including cartilage repair, regeneration, and replacement strategies, and radiologists should be acquainted with their specific expected and abnormal postoperative imaging findings to better monitor the results and predict poor outcomes. The present article proposes a thorough review of the ankle joint anatomy and biomechanics, physiopathology, diagnosis, and treatment of OCLs of the talar dome, highlighting the radiological approach and imaging findings in both pre- and postoperative scenarios.
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16
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Herrera-Pérez M, González-Martín D, Vallejo-Márquez M, Godoy-Santos AL, Valderrabano V, Tejero S. Ankle Osteoarthritis Aetiology. J Clin Med 2021; 10:jcm10194489. [PMID: 34640504 PMCID: PMC8509242 DOI: 10.3390/jcm10194489] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 09/26/2021] [Accepted: 09/27/2021] [Indexed: 12/16/2022] Open
Abstract
Ankle osteoarthritis affects 1% of the population and, unlike gonarthrosis or coxarthrosis, is secondary to previous trauma in more than 75% of cases. Another peculiarity of this disease is that it affects a younger and active population, with socio-occupational implications. Mechanical factors, such as incongruity, instability, malalignment, and impacts, which increase stress on isolated areas of the ankle cartilage, have been clearly associated with the development of osteoarthritis. However, we cannot ignore the importance of pro-inflammatory mediators present from the moment of fracture as triggers of the cascade that eventually causes chondrocyte cell death, ultimately responsible for ankle osteoarthritis.
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Affiliation(s)
- Mario Herrera-Pérez
- Foot and Ankle Unit, Orthopedic Surgery and Traumatology Service, Hospital Universitario de Canarias, Carretera de la Cuesta s/n, 38320 Santa Cruz de Tenerife, Spain;
- School of Medicine (Health Sciences), Universidad de La Laguna, Campus de Ofra, s/n, 38071 San Cristóbal de La Laguna, Spain
- Correspondence:
| | - David González-Martín
- Foot and Ankle Unit, Orthopedic Surgery and Traumatology Service, Hospital Universitario de Canarias, Carretera de la Cuesta s/n, 38320 Santa Cruz de Tenerife, Spain;
- School of Medicine (Health Sciences), Universidad de La Laguna, Campus de Ofra, s/n, 38071 San Cristóbal de La Laguna, Spain
| | - Mercedes Vallejo-Márquez
- Musculoskeletal Radiology Unit, Hospital Universitario Virgen del Rocío, Av. Manuel Siurot, s/n, 41013 Sevilla, Spain;
| | | | - Victor Valderrabano
- Orthopaedic Department, Swiss Ortho Center, Schmerzklinik Basel, Hirschgässlein 15, 4051 Basel, Switzerland;
| | - Sergio Tejero
- Foot and Ankle Unit, Orthopedic Surgery and Traumatology Service, Hospital Universitario Virgen del Rocío, Av. Manuel Siurot, s/n, 41013 Sevilla, Spain;
- School of Medicine, Universidad de Sevilla, Av. Sánchez Pizjuán, s/n, 41009 Sevilla, Spain
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17
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Lan T, McCarthy HS, Hulme CH, Wright KT, Makwana N. The management of talar osteochondral lesions - Current concepts. JOURNAL OF ARTHROSCOPY AND JOINT SURGERY 2021; 8:231-237. [PMID: 34337329 PMCID: PMC8312263 DOI: 10.1016/j.jajs.2021.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 04/05/2021] [Indexed: 11/17/2022]
Abstract
Osteochondral lesions of the talus (OLTs) are a common complication following trauma, involving both the articular cartilage and the underlying subchondral bone, with variable aetiologies and often presenting with non-specific symptoms. Diagnosis of OLTs requires a combination of clinical assessment and imaging and despite many different treatment options, there is no generalised consensus regarding which option is the most effective. Left untreated, OLTs risk progressing to osteoarthritis. Acute non-displaced OLTs can be treated non-operatively. However, OLTs refractory to non-surgical care for three to six months may be suitable for surgical care. In these cases, conservative treatments are often unsuccessful, particularly for larger and more severe defects and so the majority require surgical intervention. Although bone marrow stimulation techniques remain the "gold standard" for lesions <150 mm2, there still requires a need for better long term clinical data and cost-benefit analyses compared with other treatment options. Biological attempts at either regenerating or replacing the articular cartilage are however demonstrating some promising results, but each with their own advantages and disadvantages. In this review, we summarise the clinical management of OLTs and present the current concepts of different treatment regimes.
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Affiliation(s)
- Tian Lan
- Spinal Studies & Cartilage Research Group, Robert Jones and Agnes Hunt Orthopaedic Hospital, NHS Trust, Oswestry, UK
- School of Pharmacy and Bioengineering, Keele University, UK
| | - Helen S. McCarthy
- Spinal Studies & Cartilage Research Group, Robert Jones and Agnes Hunt Orthopaedic Hospital, NHS Trust, Oswestry, UK
- School of Pharmacy and Bioengineering, Keele University, UK
| | - Charlotte H. Hulme
- Spinal Studies & Cartilage Research Group, Robert Jones and Agnes Hunt Orthopaedic Hospital, NHS Trust, Oswestry, UK
- School of Pharmacy and Bioengineering, Keele University, UK
| | - Karina T. Wright
- Spinal Studies & Cartilage Research Group, Robert Jones and Agnes Hunt Orthopaedic Hospital, NHS Trust, Oswestry, UK
- School of Pharmacy and Bioengineering, Keele University, UK
| | - Nilesh Makwana
- Robert Jones and Agnes Hunt Orthopaedic Hospital, NHS Trust, Oswestry, UK
- School of Pharmacy and Bioengineering, Keele University, UK
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18
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López-Alcorocho JM, Guillén-Vicente I, Rodríguez-Iñigo E, Navarro R, Caballero-Santos R, Guillén-Vicente M, Casqueiro M, Fernández-Jaén TF, Sanz F, Arauz S, Abelow S, Guillén-García P. High-Density Autologous Chondrocyte Implantation as Treatment for Ankle Osteochondral Defects. Cartilage 2021; 12:307-319. [PMID: 30880428 PMCID: PMC8236657 DOI: 10.1177/1947603519835898] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
PURPOSE Two-year follow-up to assess efficacy and safety of high-density autologous chondrocyte implantation (HD-ACI) in patients with cartilage lesions in the ankle. DESIGN Twenty-four consecutive patients with International Cartilage repair Society (ICRS) grade 3-4 cartilage lesions of the ankle were included. Five million chondrocytes per cm2 of lesion were implanted using a type I/III collagen membrane as a carrier and treatment effectiveness was assessed by evaluating pain with the visual analogue scale (VAS) and American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score at baseline, 12-month, and 24-month follow-up, together with dorsal and plantar flexion. Magnetic resonance observation for cartilage repair tissue (MOCART) score was used to evaluate cartilage healing. Histological study was possible in 5 cases. RESULTS Patients' median age was 31 years (range 18-55 years). Median VAS score was 8 (range 5-10) at baseline, 1.5 (range 0-8) at 12-month follow-up, and 2 (rang e0-5) at 24-month follow-up (P < 0.001). Median AOFAS score was 39.5 (range 29-48) at baseline, 90 (range 38-100) at 12-month follow-up, and 90 (range 40-100) at 24-month follow-up (P < 0.001). Complete dorsal flexion significantly increased at 12 months (16/24, 66.7%) and 24 months (17/24, 70.8%) with regard to baseline (13/24, 54.2%) (P = 0.002). MOCART at 12- and 24-month follow-ups were 73.71 ± 15.99 and 72.33 ± 16.21. Histological study confirmed that neosynthetized tissue was cartilage with hyaline extracellular matrix and numerous viable chondrocytes. CONCLUSION HD-ACI is a safe and effective technique to treat osteochondral lesions in the talus, providing good clinical and histological results at short- and mid-term follow-ups.
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Affiliation(s)
- Juan Manuel López-Alcorocho
- Department of Traumatology and Research
Unit, Clínica CEMTRO, Madrid, Spain,Juan Manuel López-Alcorocho, Research Unit,
Clínica CEMTRO, Avda. Ventisquero de la Condesa 42, 28035 Madrid, Spain.
| | | | | | - Ramón Navarro
- Department of Traumatology and Research
Unit, Clínica CEMTRO, Madrid, Spain
| | | | | | - Mercedes Casqueiro
- Department of Traumatology and Research
Unit, Clínica CEMTRO, Madrid, Spain
| | | | - Fernando Sanz
- Department of Traumatology and Research
Unit, Clínica CEMTRO, Madrid, Spain
| | - Santiago Arauz
- Department of Traumatology and Research
Unit, Clínica CEMTRO, Madrid, Spain
| | - Steve Abelow
- Department of Traumatology and Research
Unit, Clínica CEMTRO, Madrid, Spain
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19
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Hogan MV, Scott DM, Canton SP, LaBaze D, Yan AY, Wang JHC. Biologic therapies for foot and ankle injuries. Expert Opin Biol Ther 2020; 21:717-730. [PMID: 33382002 DOI: 10.1080/14712598.2021.1866534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: The use of orthobiologics as supplemental treatment for foot and ankle pathologies have increased in the past decades. They have been used to improve the healing of bone and soft tissue injuries. There have been several studies that examined the use of biologics for knee and hip pathologies but the foot and ankle construct has unique features that must be considered.Areas covered: The biologics for foot and ankle injuries that are covered in this review are platelet-rich plasma (PRP), stem cells, growth factors, hyaluronic acid, bone grafts, bone substitutes, and scaffolds. These modalities are used in the treatment of pathologies related to tendon and soft tissue as well as cartilage.Expert opinion: The utilization of biological adjuncts for improved repair and regeneration of ankle injuries represents a promising future in our efforts to address difficult clinical problems. The application of concentrated bone marrow and PRP each represents the most widely studied and commonly used injection therapies with early clinical studies demonstrating promising results, research is also being done using other potential therapies such as stem cells and growth factors; further investigation and outcome data are still needed.
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Affiliation(s)
- MaCalus V Hogan
- Departments of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.,Foot and Ankle Injury Research Center, University of Pittsburgh, Pittsburgh, PA, USA.,Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Devon M Scott
- Departments of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Stephen P Canton
- Departments of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Dukens LaBaze
- Departments of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Alan Y Yan
- Departments of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.,Foot and Ankle Injury Research Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - James H-C Wang
- Departments of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.,Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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20
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Evidence on ankle injections for osteochondral lesions and osteoarthritis: a systematic review and meta-analysis. INTERNATIONAL ORTHOPAEDICS 2020; 45:509-523. [PMID: 32647968 DOI: 10.1007/s00264-020-04689-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 06/26/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE To evaluate the evidence supporting safety and effectiveness of intra-articular injective treatments for ankle lesions ranging from osteochondral lesions of the talus (OLT) to osteoarthritis (OA). METHODS A systematic review and a meta-analysis were performed on PubMed, Embase, and Cochrane Library in March 2020. Safety was evaluated through the reported side effects and effectiveness through the scores used. The quality of the studies was assessed using the Cochrane Collaboration Risk of Bias 2.0 tool and the Downs and Black checklist. For each outcome, the quality of evidence was graded according to GRADE guidelines. RESULTS Twenty-four studies (21 for OA, 3 for OLT) were included on hyaluronic acid (HA), platelet-rich plasma (PRP), saline, methylprednisolone, botulinum toxin type A (BoNT-A), mesenchymal stem cells (MSCs), and prolotherapy. No severe adverse events were reported. For OLT, a comparison was possible between HA and PRP showing no significant difference. For ankle OA, a significant difference favouring HA versus saline was documented at six months (p < 0.001). The GRADE level of evidence was very low. CONCLUSION This meta-analysis supports the safety of intra-articular treatment for ankle OA and OLT, while only a very low evidence supports the efficacy of HA in terms of better results versus placebo for the treatment of ankle OA, and other conclusions are hindered by the scarcity of the available literature. This urges further and stronger trials to specifically investigate potential and limitations of these different injective approaches for the treatment of OLT and ankle OA.
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21
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Abstract
Malunion of ankle and pilon fractures has significant detrimental effect on function and development of post-trauma osteoarthritis. Unfortunately, the incidence of malunion has been reported to be increasing. It is important to assess the ankle for congruency, because this determines the level where correction will occur. A plethora of techniques are available, with low-level evidence supporting each, and therefore it is important that the treating surgeon is fully prepared and comfortable in the techniques they are to use. Supplementary procedures are common and should be expected. This article provides a review of current methods of treatment and their outcomes.
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22
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Zheng P, Hu X, Lou Y, Tang K. A Rabbit Model of Osteochondral Regeneration Using Three-Dimensional Printed Polycaprolactone-Hydroxyapatite Scaffolds Coated with Umbilical Cord Blood Mesenchymal Stem Cells and Chondrocytes. Med Sci Monit 2019; 25:7361-7369. [PMID: 31570688 PMCID: PMC6784681 DOI: 10.12659/msm.915441] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 06/01/2019] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND This study aimed to investigate a rabbit model of osteochondral regeneration using three-dimensional (3-D) printed polycaprolactone-hydroxyapatite (PCL-HA) scaffolds coated with umbilical cord blood mesenchymal stem cells (UCB-MSCs) and chondrocytes. MATERIAL AND METHODS Nine female New Zealand white rabbits were included in the study. The 3-D PCL-HA scaffolds were prepared using fused deposition modeling 3-D printing technology. Seeding cells were prepared by co-culture of rabbit UCB-MSCs and chondrocytes with a ratio of 3: 1. A total of 4×10⁶ cells were seeded on 3-D PCL-HA scaffolds and implanted into rabbits with femoral trochlear defects. After 8 weeks of in vivo implantation, 12 specimens were sampled and examined using histology and scanning electron microscopy (SEM). The International Cartilage Repair Society (ICRS) macroscopic scores and histological results were recorded and compared with those of the unseeded PCL-HA scaffolds. RESULTS Mean ICRS scores for the UCB-MSCs and chondrocyte-seeded PCL-HA scaffolds (group A) were significantly higher than the normal unseeded control (NC) PCL-HA scaffold group (group B) (P<0.05). Histology with safranin-O and fast-green staining showed that the UCB chondrocyte-seeded PCL-HA scaffolds significantly promoted bone and cartilage regeneration. CONCLUSIONS In a rabbit model of osteochondral regeneration using 3-D printed PCL-HA scaffolds, the UCB chondrocyte-seeded PCL-HA scaffold promoted articular cartilage repair when compared with the control or non-seeded PCL-HA scaffolds.
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23
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Ankle MRI and Arthroscopy Correlation With Cartilaginous Defects and Symptomatic Os Trigonum. Sports Med Arthrosc Rev 2017; 25:237-245. [DOI: 10.1097/jsa.0000000000000169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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24
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Liang D, Sun J, Wei F, Zhang J, Li P, Xu Y, Shang X, Deng J, Zhao T, Wei L. Establishment of rat ankle post-traumatic osteoarthritis model induced by malleolus fracture. BMC Musculoskelet Disord 2017; 18:464. [PMID: 29149841 PMCID: PMC5693506 DOI: 10.1186/s12891-017-1821-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 11/08/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malleolar fracture, which is present in 37-53% of human ankle osteoarthritis (OA), is the most common type of fracture in the ankle joint. In spite of this, no rat animal model has been developed for this type of injury to date. Here, we established a rat ankle post-traumatic OA (PTOA) model induced by malleolar fracture; this model will be useful in ankle OA research. METHODS Two-month-old male Sprague Dawley (SD) rats were randomized into 2 groups (n = 19 per group): 1) malleolus articular fracture, dislocation, and immediate reduction on the right joints and 2) malleolus articular fracture on the right ankle. The contralateral ankle joints were used as controls. The fracture and healing processes were confirmed and monitored by radiography. Changes in inflammation were monitored in vivo by fluorescence molecular tomography (FMT). Cartilage damage and changes in expression of OA-related genes were analyzed by histology, immunohistochemistry, Real-time quantitative PCR (qPCR) and enzyme-linked immunosorbent assay (ELISA) at 8 weeks post-surgery. RESULTS X-rays showed that all fractures were healed at 8 weeks post-surgery. A reproducible, mild to moderate degree of OA cartilage damage with reduced aggrecan was detected by histology in all animals in both groups but there was no significant difference between the two groups. Decreased Col-II and increased Col-X and MMP-13 levels were detected by qPCR, immunohistochemistry, ELISA and FMT from both groups cartilage. CONCLUSIONS Malleolus articular fracture alone induces ankle OA with lesions on the central weight bearing area of the tibiotalar joint in rats. This model will provide a reproducible and useful tool for researchers to study ankle OA.
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Affiliation(s)
- Dawei Liang
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Jian Sun
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Fangyuan Wei
- Foot and Ankle Orthopaedic Surgery Center, Beijing Tongren Hospital, Beijing, China
| | - Jianzhong Zhang
- Foot and Ankle Orthopaedic Surgery Center, Beijing Tongren Hospital, Beijing, China
| | - Pengcui Li
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Yingke Xu
- School of Community Health Science, Nevada Institute of Personalized Medicine, University of Nevada, Las Vegas, Nevada USA
| | - Xianwen Shang
- Department of Orthopaedics, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Jin Deng
- Department of Orthopaedics, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Ting Zhao
- Department of Orthopaedics, Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI USA
| | - Lei Wei
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, Taiyuan, China
- Department of Orthopaedics, Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI USA
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Abstract
Repair of osteochondral lesions of the talus can be difficult. Smaller lesions respond well to simple arthroscopy and microfracture, whereas larger cystic lesions may require allograft talus replacement or ankle fusions. The lesions in between are more difficult to treat. Autologous chondrocyte implantation and matrix-associated autologous chondrocyte implantation have shown promising results. Future research may include new techniques, pharmacologic intervention, and cell-based therapies, and may be better served with prospective observational studies instead of costly randomized controlled studies. A representative example of arthroscopic implantation is given.
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Affiliation(s)
- Alan Ng
- PMSR/RRA, Highlands/Presbyterian St. Luke's Podiatric Surgical Residency Program, 1719 East 19th Avenue, Denver, CO 80218, USA; Private Practice, Advanced Orthopedic and Sports Medicine Specialists, 8101 East Lowry Boulevard #230, Denver, CO 80230, USA.
| | - Andrew Bernhard
- PMSR/RRA, Highlands/Presbyterian St. Luke's Podiatric Surgical Residency Program, 1719 East 19th Avenue, Denver, CO 80218, USA; Private Practice, Eagle-Summit Foot & Ankle, 50 Buck Creek Road #205, Avon, CO 81620, USA
| | - Kaitlyn Bernhard
- PMSR/RRA, Highlands/Presbyterian St. Luke's Podiatric Surgical Residency Program, 1719 East 19th Avenue, Denver, CO 80218, USA
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