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Anastasio AT, Wixted CM, McGroarty NK. Osteochondral Lesions of the Talus: Etiology, Clinical Presentation, Treatment Options, and Outcomes. Foot Ankle Clin 2024; 29:193-211. [PMID: 38679433 DOI: 10.1016/j.fcl.2023.11.002] [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
This article reviews the etiology, clinical presentation, classification schemes, and treatment options for osteochondral lesions of the talus. These lesions typically occur after a traumatic injury and are best diagnosed on MRI. Asymptomatic lesions and incidentally found lesions are best treated conservatively; however, acute displaced osteochondral fragments may require surgical treatment. Lesion characteristics may dictate surgical technique. Outcomes following surgical treatment may be impacted by patient age, BMI, and lesion characteristics.
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Affiliation(s)
- Albert T Anastasio
- Department of Orthopaedics, Duke University Hospital, 200 Trent Drive, Durham, NC 27710, USA
| | - Colleen M Wixted
- Duke University School of Medicine, 8 Searle Center Drive, Durham, NC 27710, USA.
| | - Neil K McGroarty
- Department of Orthopaedics, Duke University Hospital, 200 Trent Drive, Durham, NC 27710, USA
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Kemmeren LAM, van Bergen CJA, Reijman M, Piscaer TM. Physician preferences in diagnostics and treatment of juvenile osteochondritis dissecans are diverse across the knee, ankle and elbow: an ESSKA survey. Knee Surg Sports Traumatol Arthrosc 2023; 31:5228-5237. [PMID: 37787862 PMCID: PMC10598091 DOI: 10.1007/s00167-023-07563-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 08/30/2023] [Indexed: 10/04/2023]
Abstract
PURPOSE To investigate the current preferences regarding the work-up and treatment choices of juvenile osteochondritis dissecans (JOCD) of the knee, ankle and elbow among orthopaedic surgeons. METHODS An international survey was set up for all European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA) members, which assessed various questions on diagnosis and treatment of JOCD of different joints. Respondents answered questions for one or more joints, based on their expertise. Proportions of answers were calculated and compared between joints. Consensus was defined as more than 75% agreement on an item; disagreement was defined as less than 25% agreement. RESULTS Fifty physicians responded to the survey, of whom forty-two filled out the questions on the knee, fourteen on the ankle and nine on the elbow. Plain radiography and MRI were the most used imaging modalities for the assessment and follow-up of JOCD in the knee and ankle, but not for the elbow. MRI was also the preferred method to assess the stability of a lesion in the knee and ankle. There was universal agreement on activity and/or sports restriction as the non-operative treatment of choice for JOCD. Size, stability and physeal closure were the most important prognostic factors in determining the operative technique for the elbow. For the knee, these factors were size and stability and for the ankle, these were size and location. CONCLUSION Activity and/or sports restriction was the non-operative treatment of choice. Furthermore, plain radiography and MRI were the preferred imaging modalities for the knee and ankle, but not for the elbow. For determining the operative technique, physicians agreed that the size of the lesion is an important prognostic factor in all joints. These findings help us understand how juvenile osteochondritis dissecans is treated in current practice and may provide opportunities for improvement. LEVEL OF EVIDENCE Level V.
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Affiliation(s)
- Laura A M Kemmeren
- Department of Orthopaedic Surgery and Sports Medicine, Erasmus Medical Centre, Sophia Children's Hospital, Dr. Molewaterplein 40, 3015GD, Rotterdam, The Netherlands.
| | - Christiaan J A van Bergen
- Department of Orthopaedic Surgery and Sports Medicine, Erasmus Medical Centre, Sophia Children's Hospital, Dr. Molewaterplein 40, 3015GD, Rotterdam, The Netherlands
- Department of Orthopaedic Surgery, Amphia Hospital, Breda, The Netherlands
| | - Max Reijman
- Department of Orthopaedic Surgery and Sports Medicine, Erasmus Medical Centre, Sophia Children's Hospital, Dr. Molewaterplein 40, 3015GD, Rotterdam, The Netherlands
| | - Tom M Piscaer
- Department of Orthopaedic Surgery and Sports Medicine, Erasmus Medical Centre, Sophia Children's Hospital, Dr. Molewaterplein 40, 3015GD, Rotterdam, The Netherlands
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Chen Y, Li Y, Liu W, Wang Z, Li J, Chen C, Zeng G, Shen J, Song W. Comparison of surface microscopy coil and ankle joint special phased array coil magnetic resonance imaging in assessing preoperative osteochondral lesions of the talus. Quant Imaging Med Surg 2023; 13:4973-4983. [PMID: 37581067 PMCID: PMC10423370 DOI: 10.21037/qims-22-1202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 05/16/2023] [Indexed: 08/16/2023]
Abstract
Background Lesion size is a major determinant of treatment strategies and predictor of clinical outcomes for osteochondral lesions of the talus (OLTs). Although magnetic resonance imaging (MRI) has been commonly used in the preoperative evaluation of OLTs, MRI has low reliability and usually overestimates or underestimates lesion size compared with intraoperative assessment. This study aims to determine whether the surface microscopy coil (SMC) can improve the accuracy of assessment of preoperative OLTs compared with conventional coil MRI, ankle joint special phased array coil (ASC). Methods A total of 43 patients diagnosed with OLTs undertook preoperative MRI examination with both SMC and ASC were included in this prospective study from 2019 to 2022. The diameter of the lesion was measured in sagittal plane and coronal plane at its widest point and then the lesion area was calculated. Then MRI measurements were compared with arthroscopy or open-surgery measurements. Results The mean lesion area measured with ASC was significantly greater than that measured intraoperatively (95.07±44.60 vs. 52.74±29.86 mm2, P<0.001), while there was no significant difference between lesion area measured in SMC and intraoperatively (55.28±36.06 vs. 52.74±29.86 mm2, P=0.576). Diameter measured in ASC was significantly greater than that measured intraoperatively in both coronal plane (8.95±2.48 vs. 6.67±1.81, P<0.001) and sagittal plane (13.12±3.76 vs. 9.58±3.98, P<0.001). No significant difference between lesion diameter measured in SMC and intraoperatively in both coronal plane (6.44±2.59 vs. 6.67±1.81, P=0.608) or sagittal plane (10.23±3.69 vs. 9.58±3.98, P=0.194). Compared with surgical assessment, 39 of 43 cases were consistent with SMC assessment while only 26 of 43 cases were consistent with ASC assessment (39/43 vs. 26/43, P=0.002). Conclusions Diameter measured with SMC was much more accurate than ASC MRI. Compared with ASC MRI, the SMC had a much higher concordance rate between preoperative assessment and surgical assessment.
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Affiliation(s)
- Yanbo Chen
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yong Li
- Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wenzhou Liu
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhihui Wang
- Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jiajie Li
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Chen Chen
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Gang Zeng
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jun Shen
- Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Weidong Song
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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Haug LP, Sill AP, Shrestha R, Patel KA, Kile TA, Fox MG. Osteochondral Lesions of the Ankle and Foot. Semin Musculoskelet Radiol 2023; 27:269-282. [PMID: 37230127 DOI: 10.1055/s-0043-1766110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Osteochondral lesions (OCLs) in the ankle are more common than OCLs of the foot, but both share a similar imaging appearance. Knowledge of the various imaging modalities, as well as available surgical techniques, is important for radiologists. We discuss radiographs, ultrasonography, computed tomography, single-photon emission computed tomography/computed tomography, and magnetic resonance imaging to evaluate OCLs. In addition, various surgical techniques used to treat OCLs-debridement, retrograde drilling, microfracture, micronized cartilage-augmented microfracture, autografts, and allografts-are described with an emphasis on postoperative appearance following these techniques.
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Affiliation(s)
- Logan P Haug
- Department of Radiology, Mayo Clinic, Phoenix, Arizona
| | - Andrew P Sill
- Department of Radiology, Mayo Clinic, Phoenix, Arizona
| | | | - Karan A Patel
- Department of Orthopedics, Mayo Clinic, Phoenix, Arizona
| | - Todd A Kile
- Department of Orthopedics, Mayo Clinic, Phoenix, Arizona
| | - Michael G Fox
- Department of Radiology, Mayo Clinic, Phoenix, Arizona
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Arthroscopic accessibility of the first metatarsophalangeal joint for osteochondral defects of the metatarsal head by two-portal technique - comparing joint distraction and plantarflexion. Foot Ankle Surg 2022; 28:1377-1383. [PMID: 35872116 DOI: 10.1016/j.fas.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 07/14/2022] [Accepted: 07/15/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Several techniques and approaches for first metatarsophalangeal (MTP1) joint arthroscopy have been reported, where joint accessibility plays a key role. This study aimed to evaluate differences in arthroscopic accessibility of the first metatarsal head (MTH1) comparing non-invasive distraction and maximum plantarflexion in a two-portal approach. METHODS Forty fresh-frozen lower leg specimens were included and divided into a distraction group (D-group) and a plantarflexion group (PF-group). A two-portal technique (1.9 mm-30°-scope) was used for arthroscopy, maximum reach at the MTH1 was marked. Following arthroscopy, specimens were dissected and examined for iatrogenic injuries. The reached area at the chondral surface was pinned and accessibility calculated. RESULTS Accessibility of the MTH1 was 58.03 % ± 13.64 (D-group) and 55.93 % ± 10.30 (PF-group, p = 0.51). The dorsomedial hallucal nerve was injured in one specimen (2.5 %). CONCLUSION Maximum plantarflexion showed no difference in arthroscopic MTP1 joint accessibility compared to non-invasive distraction in a two-portal approach. During dorsomedial portal placement, the dorsomedial hallucal nerve is at risk for iatrogenic injury.
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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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Lockard CA, Stake IK, Brady AW, DeClercq MG, Tanghe KK, Douglass BW, Nott E, Ho CP, Clanton TO. Accuracy of MRI-Based Talar Cartilage Thickness Measurement and Talus Bone and Cartilage Modeling: Comparison with Ground-Truth Laser Scan Measurements. Cartilage 2021; 13:674S-684S. [PMID: 33269605 PMCID: PMC8808841 DOI: 10.1177/1947603520976774] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE The purpose of this work was to compare measurements of talar cartilage thickness and cartilage and bone surface geometry from clinically feasible magnetic resonance imaging (MRI) against high-accuracy laser scan models. Measurement of talar bone and cartilage geometry from MRI would provide useful information for evaluating cartilage changes, selecting osteochondral graft sources or creating patient-specific joint models. DESIGN Three-dimensional (3D) bone and cartilage models of 7 cadaver tali were created using (1) manual segmentation of high-resolution volumetric sequence 3T MR images and (2) laser scans. Talar cartilage thickness was compared between the laser scan- and MRI-based models for the dorsal, medial, and lateral surfaces. The laser scan- and MRI-based cartilage and bone surface models were compared using model-to-model distance. RESULTS Average cartilage thickness within the dorsal, medial, and lateral surfaces were 0.89 to 1.05 mm measured with laser scanning, and 1.10 to 1.22 mm measured with MRI. MRI-based thickness was 0.16 to 0.32 mm higher on average in each region. The average absolute surface-to-surface differences between laser scan- and MRI-based bone and cartilage models ranged from 0.16 to 0.22 mm for bone (MRI bone models smaller than laser scan models) and 0.35 to 0.38 mm for cartilage (MRI bone models larger than laser scan models). CONCLUSIONS This study demonstrated that cartilage and bone 3D modeling and measurement of average cartilage thickness on the dorsal, medial, and lateral talar surfaces using MRI were feasible and provided similar model geometry and thickness values to ground-truth laser scan-based measurements.
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Affiliation(s)
| | - Ingrid K. Stake
- Steadman Philippon Research Institute,
Vail, CO, USA
- Department of Orthopaedic Surgery,
Ostfold Hospital Trust, Grålum, Norway
| | - Alex W. Brady
- Steadman Philippon Research Institute,
Vail, CO, USA
| | | | | | | | | | - Charles P. Ho
- Steadman Philippon Research Institute,
Vail, CO, USA
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Schwartz AM, Niu S, Mirza FA, Thomas AR, Labib SA. Surgical Treatment of Talus OCL: Mid- to Long-Term Clinical Outcome With Detailed Analyses of Return to Sport. J Foot Ankle Surg 2021; 60:1188-1192. [PMID: 34130931 DOI: 10.1053/j.jfas.2021.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/28/2021] [Accepted: 05/05/2021] [Indexed: 02/03/2023]
Abstract
Talus osteochondral lesions are a commonly underdiagnosed problem in young athletes. Talus osteochondral lesions surgical algorithm remains controversial. Current metrics suggest that conventional treatment of osteochondral lesions of the talus is promising; yet return to sport is poorly studied. Fifty-seven patients following talus osteochondral lesion surgical intervention were included in this study. About 63.1% were female with mean age 37.1 years, mean lesion size 10 × 12.5 mm, and mean follow-up 79.9 months postoperatively. Patients were divided into 4 groups by surgery performed: antegrade arthroscopic bone marrow stimulation, retrograde arthroscopic drilling, osteochondral autograft transfer, and allograft cartilage implantation. Outcome metrics include Visual Analog Scale for pain and function, Short Form-12, Foot and Ankle Disability Scale, Tegner, Marx activity scores, Naal Sports inventory, and patient satisfaction. Over 77% of patients were satisfied with surgical intervention. Each intervention significantly decreased pain and increased function, except retrograde drilling. All interventions trended toward decreased Tegner score; only antegrade drilling showed significant decrease. Based on Naal's sports inventory, 85.7% of surgically treated patients reported participating in sport activities, on average 3 times/week and 50.6 minutes/session. Traditionally, talus osteochondral lesions present a difficult problem that is marred by unsatisfactory nonoperative outcomes in typically active patients. As our surgical understanding has evolved, we've continued to improve on outcomes. Our patients demonstrated 77.2% overall satisfaction rate, a statistically significant improvement in pain and function, at an average follow-up of 79.9 months postoperatively, and a high rate of return to sport with little difference between surgical interventions.
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Affiliation(s)
| | - Shuo Niu
- Emory University School of Medicine, Atlanta, GA
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Togher CJ, Sahli H, Butterfield J, Sebag J, Shane AM, Reeves CL. Incidence of Talar Osteochondral Lesions After Acute Ankle Fracture: A Retrospective Analysis. J Foot Ankle Surg 2021; 60:1184-1187. [PMID: 34092459 DOI: 10.1053/j.jfas.2021.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 03/16/2021] [Accepted: 05/04/2021] [Indexed: 02/03/2023]
Abstract
Recent literature suggests the majority of osteochondral lesions occur in the ankle joint. Previous studies have suggested that varying incidences of talar osteochondral lesions (OCLT) are associated with ankle fractures. The primary aim of our study was to investigate the incidence of osteochondral lesions associated with acute ankle fractures as observed on computed tomographic (CT) imaging. We also compared the rates of talar osteochondral lesions in patients who had ankle fractures with dislocation and closed manual reduction (CMR) prior to open reduction with internal fixation, to those who did not suffer from ankle joint dislocation. Additionally, a correlation between the location of talar dome lesions with type of ankle fracture as classified by Lauge-Hansen was investigated. Preoperative CT imaging was retrospectively reviewed in 108 patients with acute ankle fractures. A CT-modified version of Berndt Hardy's classification of osteochondral lesions, as previously described by Loomer et al, was used for diagnosis of lesions in our study. The incidence of lesions was calculated across all subjects, and retrospective comparison was performed in those who did and did not undergo closed manual reduction. Supplementary data on location of lesion and its association with ankle fracture type was also recorded. We found an overall incidence of 50.9% OCLT in patients with acute ankle fractures. This number did not significantly differ from those who underwent closed manual reduction (49%). Although a majority of lesions did occur posteriorly, we saw no statistically significant information was seen between either type of fractures or OCLT locations. Careful consideration and thorough evaluation of preoperative CT imaging should be assessed by the performing surgeon, as this could guide both diagnostic and therapeutic treatments for patients with possible osteochondral lesions of the talus undergoing surgical repair of a fractured ankle.
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Affiliation(s)
- Cody J Togher
- Resident, Advent Health East Orlando Podiatric Surgical Residency, Orlando, FL.
| | - Hannah Sahli
- Resident, Advent Health East Orlando Podiatric Surgical Residency, Orlando, FL
| | - Jordan Butterfield
- Resident, Advent Health East Orlando Podiatric Surgical Residency, Orlando, FL
| | - Josh Sebag
- Resident, Advent Health East Orlando Podiatric Surgical Residency, Orlando, FL
| | - Amber M Shane
- Chair of Department of Podiatric Surgery, AdventHealth System, Faculty, Advent Health East Orlando Podiatric Surgical Residency, Orlando, FL
| | - Christopher L Reeves
- Chair of Department of Podiatric Surgery, AdventHealth System, Faculty, Advent Health East Orlando Podiatric Surgical Residency, Orlando, FL
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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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High resolution flat-panel CT arthrography vs. MR arthrography of artificially created osteochondral defects in ex vivo upper ankle joints. PLoS One 2021; 16:e0255616. [PMID: 34375344 PMCID: PMC8354460 DOI: 10.1371/journal.pone.0255616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 07/20/2021] [Indexed: 11/19/2022] Open
Abstract
PURPOSE High resolution flat-panel computed tomography arthrography (FPCT-A) and magnetic resonance arthrography (MR-A) are well suited to evaluate osteochondral lesions. The current study compares the performance of FPCT-A versus MR-A in an experimental setting. METHODS Fourteen cadaveric ankles were prepared with artificial osteochondral defects of various sizes in four separate talar locations. After intra-articular contrast injection, FPCT-A and 3-T MR-A were acquired. Each defect was then filled with synthetic pallets. The resulting cast was used as reference. Two independent radiologists measured the dimensions of all defects with FPCT-A and MR-A. Intra-class correlation coefficients (ICC) were calculated. Data were compared using t-tests and Bland-Altman plots. RESULTS The correlation for FPCT-A and cast was higher compared to MR-A and cast (ICC 0.876 vs. 0.799 for surface [length x width]; ICC 0.887 vs. 0.866 for depth, p<0.001). Mean differences between FPCT-A and cast measurements were -1.1 mm for length (p<0.001), -0.7 mm for width (p<0.001) and -0.4 mm for depth (p = 0.023). By MR-A, there were no significant differences for length and width compared to cast (p>0.05). Depth measurements were significantly smaller by MR-A (mean difference -1.1 mm, p<0.001). There was no bias between the different modalities. CONCLUSIONS Ex vivo FPCT-A and MR-A both deliver high diagnostic accuracy for the evaluation of osteochondral defects. FPCT-A was slightly more accurate than MR-A, which was most significant when measuring lesion depth.
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Shimozono Y, Williamson ERC, Mercer NP, Hurley ET, Huang H, Deyer TW, Kennedy JG. Use of Extracellular Matrix Cartilage Allograft May Improve Infill of the Defects in Bone Marrow Stimulation for Osteochondral Lesions of the Talus. Arthroscopy 2021; 37:2262-2269. [PMID: 33771691 DOI: 10.1016/j.arthro.2021.03.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 03/09/2021] [Accepted: 03/14/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the effectiveness of extracellular matrix cartilage allograft (EMCA) as an adjuvant to bone marrow stimulation (BMS) compared with BMS alone in the treatment of osteochondral lesions of the talus. METHODS A retrospective cohort study comparing patients treated with BMS with EMCA (BMS-EMCA group) and BMS alone (BMS group) between 2013 and 2019 was undertaken. Clinical outcomes were evaluated with the Foot and Ankle Outcome Score (FAOS) preoperatively and postoperatively. Postoperative magnetic resonance imaging (MRI) scans were evaluated using the modified Magnetic Resonance Observation of Cartilage Repair Tissue score. Comparisons between groups were made with the Mann-Whitney U test for continuous variables and the Fisher exact test for categorical variables. RESULTS Twenty-four patients underwent BMS with EMCA (BMS-EMCA group), and 24 patients underwent BMS alone (BMS group). The mean age was 40.8 years (range, 19-60 years) in the BMS-EMCA group and 47.8 years (range, 24-60 years) in the BMS group (P = .060). The mean follow-up time was 20.0 months (range, 12-36 months) in the BMS-EMCA group and 26.9 months (range, 12-55 months) in the BMS group (P = .031). Both groups showed significant improvements in all FAOS subscales. No significant differences between groups were found in all postoperative FAOS values. The mean Magnetic Resonance Observation of Cartilage Repair Tissue score in the BMS-EMCA group was higher (76.3 vs 66.3) but not statistically significant (P = .176). The MRI analysis showed that 87.5% of the BMS-EMCA patients had complete infill of the defect with repair tissue; however, fewer than half of the BMS patients (46.5%) had complete infill (P = .015). CONCLUSIONS BMS with EMCA is an effective treatment strategy for osteochondral lesions of the talus and provides better cartilage infill in the defect on MRI. However, this did not translate to improved functional outcomes compared with BMS alone in the short term. Additionally, according to analysis of the minimal clinically important difference, there was no significant difference in clinical function scoring between the 2 groups postoperatively. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
| | | | | | | | - Hao Huang
- East River Medical Imaging, New York, New York, U.S.A
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Körner D, Gonser CE, Döbele S, Konrads C, Springer F, Keller G. Matrix-associated autologous chondrocyte implantation with autologous bone grafting of osteochondral lesions of the talus in adolescents: patient-reported outcomes with a median follow-up of 6 years. J Orthop Surg Res 2021; 16:243. [PMID: 33832525 PMCID: PMC8028759 DOI: 10.1186/s13018-021-02384-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 03/24/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND This study presents patient-reported outcome measures after combined matrix-associated autologous chondrocyte implantation and autologous bone grafting in high-stage osteochondral lesions of the talus in adolescents. METHODS A total of 12 adolescent patients (13 ankles) received matrix-associated autologous chondrocyte implantation and autologous bone grafting for a solitary osteochondral lesion of the talus at a single centre. The Foot and Ankle Outcome Score and Foot and Ankle Ability Measure were defined as outcome measures (median follow-up 80 months [range 22-107 months]). Pre- and postoperative ankle radiographs were evaluated according to the van Dijk ankle osteoarthritis scale. RESULTS The study population consisted of four male and nine female cases (mean age at the time of surgery, 17.7 ± 2.1 years). Eight lesions were classified as traumatic and five as idiopathic. Twelve lesions were located medial vs one lateral in the coronal plane and all central in the sagittal plane. The median lesion size and depth were 1.3 cm2 (range 0.9-3.2 cm2) and 5 mm (range 5-9 mm), respectively. There were no perioperative complications in any of the cases. In 9 cases patient-reported outcome measures were available. The results of the Foot and Ankle Outcome Score subscales were symptoms, 70 ± 14; pain, 83 ± 10; activities of daily living, 89 ± 12; sports/recreational activities, 66 ± 26; and quality of life, 51 ± 17. The mean overall Foot and Ankle Outcome Score was 78 ± 13. The results of the Foot and Ankle Ability Measure subscales were activities of daily living, 81 ± 20; function/activities of daily living, 84 ± 13; sports, 65 ± 29; and function/sports, 73 ± 27. According to the function overall subscale of the Foot and Ankle Ability Measure, in two cases, the patients assessed the ankle function as normal, in three as nearly normal, and in three as abnormal (missing data, n = 1). Preoperative van Dijk scale: stage 0 in five cases and stage I in eight cases; postoperative van Dijk scale: stage 0 in four cases, stage I in 9 cases CONCLUSIONS: Patient-reported outcome measures following matrix-associated autologous chondrocyte implantation and autologous bone grafting for high-stage osteochondral lesions of the talus in adolescents show heterogeneous results. Long-term limitations mainly affect sports and recreational activities. Osteochondral lesions of the talus are associated with osteoarthritis, even preoperatively. However, we did not find significant osteoarthritis progression after matrix-associated autologous chondrocyte implantation and autologous bone grafting in the long term.
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Affiliation(s)
- Daniel Körner
- Department of Traumatology and Reconstructive Surgery, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Schnarrenbergstr. 95, 72076, Tübingen, Germany.
| | - Christoph E Gonser
- Department of Traumatology and Reconstructive Surgery, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Schnarrenbergstr. 95, 72076, Tübingen, Germany
| | - Stefan Döbele
- Department of Traumatology and Reconstructive Surgery, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Schnarrenbergstr. 95, 72076, Tübingen, Germany
| | - Christian Konrads
- Department of Traumatology and Reconstructive Surgery, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Schnarrenbergstr. 95, 72076, Tübingen, Germany
| | - Fabian Springer
- Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Eberhard Karls University Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
- Department of Radiology, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Schnarrenbergstr. 95, 72076, Tübingen, Germany
| | - Gabriel Keller
- Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Eberhard Karls University Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
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Hirtler L, Rath C, Kügler P, Reissig L, Willegger M. Maximum Ankle Plantarflexion and Dorsiflexion Allow for Optimal Arthroscopic Access to the Talar Dome: An Anatomic 3-Dimensional Radiography Study. Arthroscopy 2021; 37:1245-1257. [PMID: 33359819 DOI: 10.1016/j.arthro.2020.12.207] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 12/09/2020] [Accepted: 12/14/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE (1) to improve the comprehension of the topographical position of the talar dome beneath the inferior articular surface of the tibia and, (2) to illustrate the changes of possible access to the articular surface of the talar dome during arthroscopic treatment of talar osteochondral defects in an anatomical model. METHODS Twenty matched pairs (n = 40) of anatomical ankle specimen were used. All specimens were mounted in a standardized fashion, 3-dimensional radiography was performed in 4 defined positions (maximum dorsiflexion, neutral position, noninvasive distraction, and maximum plantarflexion). All radiographs were analyzed and statistically compared. RESULTS Anterior accessibility was highest in maximum plantarflexion (medial: 49.20 ± 9.86%, lateral: 48.19 ± 8.85%), followed by non-invasive distraction (medial: 33.60 ± 7.96%, lateral: 31.98 ± 8.30%). Neutral position (medial: 19.34 ± 6.90%, lateral: 17.54 ± 6.63%) and dorsiflexion (medial: 15.36 ± 5.03%, lateral: 13.88 ± 4.33%) were not able to significantly increase accessibility. Posterior accessibility was greatest in maximum dorsiflexion (medial: 56.69 ± 9.65%, lateral: 46.82 ± 8.36%), followed by neutral position of the ankle joint (medial: 40.95 ± 8.28%, lateral: 31.06 ± 6.92%). Noninvasive distraction (medial: 31.41 ± 8.18%, lateral: 22.99 ± 7.63%) was still significantly better than plantarflexion (medial: 14.54 ± 5.10%, lateral: 13.89 ± 3.14%) and slightly increased accessibility to the talar dome. Medially, a central area of 5.89 ± 9.76% was accessible by maximum plantarflexion and maximum dorsiflexion from anterior and posterior, respectively, laterally a central blind spot of 4.99 ± 8.61% was detected. CONCLUSIONS From an anatomical point of view, maximum joint positions of the ankle (i.e., plantarflexion and dorsiflexion) allow for better access to the talar dome in anterior and posterior ankle arthroscopy. Noninvasive distraction may increase accessibility in anterior approaches, but has no benefit from posterior. CLINICAL RELEVANCE This study provides insight into the morphology of the ankle joint in a standardized laboratory setup and illustrates the influence of different surgically relevant ankle joint positions. The presented data allow for better preoperative planning for the arthroscopic treatment of talar osteochondral defects.
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Affiliation(s)
- Lena Hirtler
- Division of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria.
| | - Claus Rath
- Division of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
| | - Paul Kügler
- Department of Plastic, Aesthetic and Reconstructive Surgery, Klagenfurt Clinic, Klagenfurt, Austria
| | - Lukas Reissig
- Division of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
| | - Madeleine Willegger
- Division of Orthopedics, Department of Orthopedics and Trauma-Surgery, Medical University of Vienna, Vienna, Austria
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Dahmen J, Kerkhoffs GMMJ, van Bergen CJA. Editorial Commentary: How Far Can the Arthroscope Reach in the Ankle Joint? Arthroscopy 2021; 37:1258-1260. [PMID: 33485942 DOI: 10.1016/j.arthro.2021.01.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 01/13/2021] [Indexed: 02/02/2023]
Abstract
Surgical access to pathology of the talar dome (e.g., osteochondral lesions of the talus) can be limited because of the ankle joint congruity. When considering arthroscopic treatment, anterior arthroscopy with the ankle in plantar flexion or posterior arthroscopy with the ankle in dorsiflexion is used. The surgeon should carefully assess different clinical and radiologic aspects to plan the optimal operative approach. Meticulous physical examination, including ankle range of motion and possible palpation of a talar lesion, in combination with exact lesion localization on computed tomography or magnetic resonance imaging usually provide sufficient preoperative information. Most lesions with the anterior border localized on or anterior to the midline of the talus are accessible by anterior arthroscopy. In the case of preoperative doubt concerning the intraoperative accessibility, a computed tomography scan of the ankle in full plantarflexion is used to mirror arthroscopic reachability. Intraoperative surgical tricks to increase accessibility to the lesion may consist of an adjunct soft-tissue distraction device, reduction of the distal tibial rim, and treating the lesion from anteriorly to posteriorly, thereby gaining further exposure to the lesion throughout the procedure.
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Rikken QGH, Kerkhoffs GMMJ. Osteochondral Lesions of the Talus: An Individualized Treatment Paradigm from the Amsterdam Perspective. Foot Ankle Clin 2021; 26:121-136. [PMID: 33487235 DOI: 10.1016/j.fcl.2020.10.002] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Osteochondral lesions of the talus (OLTs) are characterized by damage to the articular cartilage of the talus and its underlying subchondral bone. Up to 75% of OLTs are caused by trauma, such as an ankle sprain or fracture. Physical examination and imaging are crucial for diagnosis and characterization of an OLT. No superior treatment for OLTs exists. It is paramount that an evidence-based personalized treatment approach is applied to patients with OLTs because lesion and patient characteristics guide treatment. This current concepts review covers clinical and preclinical evidence on OLT etiology, presentation, diagnosis, and treatment, all based on the Amsterdam perspective.
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Affiliation(s)
- Quinten G H Rikken
- Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands; Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherland; Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands
| | - Gino M M J Kerkhoffs
- Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands; Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherland; Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands.
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Fresh osteochondral allograft transplantation (FOCAT) for definitive management of a 198 square millimeter osteochondral lesion of the talus (OLT): A case report. Foot (Edinb) 2021; 46:101639. [PMID: 33144035 DOI: 10.1016/j.foot.2019.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 09/17/2019] [Indexed: 02/04/2023]
Abstract
An osteochondral lesion of the talus (OLT) is an idiopathic acquired lesion of the subchondral bone that can lead to debilitating sequelae. The causes of OLT's are still debatable, however, most agree that the etiology is repetitive microtrauma associated with vascular impairment. OLTs are most commonly described in the medial portion of the talus, while lateral involvement is less frequent. If not properly recognized and treated, an OLT may lead to numerous secondary conditions including premature osteoarthritis and functional limitations of the ankle joint. Multiple surgical and non-surgical treatment modalities have been described with varying results. Treatments are usually guided by the patients age, onset of symptoms, severity, and the disease stage according to the Berndt and Harty classification. Recent literature recommends curettage, drilling, or microfracture techniques for lesions which are no larger than 15mm in diameter and no deeper than 7mm. On the other hand, for large lesions or lesions that failed from primary bone marrow stimulation, surgery should be considered for autologous chondrocyte implantation (ACI), osteochondral autograft transplantation (OATs or mosaicplasty), or osteochondral allograft transplantation [1]. This case study examines surgical treatment of an extensive OLT in a 53 year old man who suffered with continuous ankle pain for over 10 years, misdiagnosed as ankle joint arthritis. Level of clinical evidence: Level of evidence 4.
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Darwich A, Adam J, Dally FJ, Hetjens S, Jawhar A. Incidence of concomitant chondral/osteochondral lesions in acute ankle fractures and their effect on clinical outcome: a systematic review and meta-analysis. Arch Orthop Trauma Surg 2021; 141:63-74. [PMID: 33128607 PMCID: PMC8213566 DOI: 10.1007/s00402-020-03647-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 10/15/2020] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Despite successful osteosynthesis, some patients report residual symptoms after ankle fractures. One of the reasons behind the postoperative complaints might be traumatic concomitant chondral lesions (CL) and/or osteochondral lesions (OCL) within the ankle joint. The study aims to systematically review the incidence of CL and/or OCL in ankle fractures and to assess their effect on the clinical outcome. MATERIALS AND METHODS This work was conducted according to PRISMA checklists. A systematic literature search was performed using following keywords: "Ankle Fractures" OR "Trimalleolar Fracture" OR "Bimalleolar Fracture" OR "Maisonneuve fracture" OR "Malleolus Fracture" AND "Cartilage" OR "Cartilage Diseases" OR "Cartilage, Articular" OR "chondral" up to March 2020. The identified articles were analysed to determine the incidence of CL and/or OCL. Included studies in the meta-analysis assessed possible cartilage damage through arthroscopy or MRI immediately after traumatic ankle fractures and described the postoperative clinical outcome. RESULTS The search identified a total of 111 publications; 19 described the incidence of CL and/or OCL after ankle fractures; six met the criteria to be included in the meta-analysis: five (n = 293) diagnosed CL and/or OCL through arthroscopy during ORIF and one study (n = 153) used preoperative MRI. The clinical outcome was evaluated in four studies (n = 177) using AOFAS score and in two (n = 269) using FAOS score. The mean incidence of arthroscopically detected CL and/or OCL was 65 ± 21% [95% CI 53.9 to 76.72]. The cumulative meta-analysis sample size comprised a total of 400 Patients (170 with and 230 without CL and/or OCL) available for a mean follow-up of 23.9 ± 11.5 months [95% CI 11.79 to 36.07]. The average age was 44.3 ± 5.5 years [95% CI 38.57 to 50.13]. The meta-analysis revealed a mean AOFAS score of 91.2 ± 4.8 [95% CI 83.53 to 98.93] with versus 94.4 ± 4.7 [95% CI 86.81 to 102.07] without CL and/or OCL (p = 0.15) and a mean FAOS score of 73.2 ± 11.31 [95% CI - 28.44 to 174.85] with versus 79.0 ± 18.4 [95% CI - 86.77 to 244.87] without CL and/or OCL (p = 0.18). CONCLUSIONS CL and/or OCL appear very frequently after ankle fractures. A tendency towards a favourable short- to mid-term clinical outcome was noticed in ankle fractures without CL and/or OCL, however without reaching statistical significance. LEVEL OF EVIDENCE Level I.
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Affiliation(s)
- Ali Darwich
- grid.7700.00000 0001 2190 4373Department of Orthopaedics and Traumatology Surgery, University Medical Centre, Medical Faculty Mannheim of the University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Julia Adam
- grid.7700.00000 0001 2190 4373Department of Orthopaedics and Traumatology Surgery, University Medical Centre, Medical Faculty Mannheim of the University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Franz-Joseph Dally
- grid.7700.00000 0001 2190 4373Department of Orthopaedics and Traumatology Surgery, University Medical Centre, Medical Faculty Mannheim of the University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Svetlana Hetjens
- grid.7700.00000 0001 2190 4373Institute of Medical Statistics and Biomathematics, University Medical Centre, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | - Ahmed Jawhar
- grid.7700.00000 0001 2190 4373Department of Orthopaedics and Traumatology Surgery, University Medical Centre, Medical Faculty Mannheim of the University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany ,Department of Trauma, Hand and Reconstructive Surgery, Klinikum Worms, Academic Teaching Hospital of the University Mainz, Worms, Germany
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Martin KD, McBride TJ, Horan DP, Haleem A, Huh J, Groth A, Dawson LK. Validation of 9-Grid Scheme for Localizing Osteochondral Lesions of the Talus. FOOT & ANKLE ORTHOPAEDICS 2020; 5:2473011420944925. [PMID: 35097402 PMCID: PMC8697075 DOI: 10.1177/2473011420944925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND A 9-grid scheme has been integrated into the foot and ankle literature to help clinicians and researchers localize osteochondral lesions of the talus (OLTs). We hypothesized that fellowship-trained orthopedic foot and ankle surgeons would have a high rate of intra/inter-observer reliability when localizing OLTs, therefore validating the scheme. METHODS We queried our institution's foot and ankle radiographic database for magnetic resonance images with OLTs. Each MRI was reviewed by the senior author, and 2 key images (widest OLT diameter) from each tangential view were copied and combined onto one slide. Fifty consecutive deidentified images of ankles were then sent to 4 practicing fellowship-trained foot and ankle surgeons. Each was asked to identify which zone the OLT was localized within. A radiologist's report served as the control. Statistical analyses were performed using Cohen and Fleiss kappa tests. RESULTS The reviewers demonstrated majority consensus on 45/50 images with substantial agreement for zones 4 and 6. The interobserver reliability was moderate with a κ = 0.55. The mean intraobserver reliability was substantial, with a κ = 0.79. A musculoskeletal radiologist determined there were 3 lesions in zone 7, 18 lesions in zone 4, and 29 lesions in zone 6. CONCLUSION This study is the first to critically evaluate the 9-grid scheme and its reliability among orthopedic foot and ankle surgeons. Our study found that the 9-grid scheme is an accurate method of localization for OLTs with high intra- and moderate interobserver reliability between surgeons. LEVEL OF EVIDENCE Level IV, retrospective diagnostic study.
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Affiliation(s)
| | | | | | - Amgad Haleem
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | | | - Adam Groth
- The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Laura K. Dawson
- Colonel Florence A Blanchfield Army Community Hospital, Fort Campbell, KY, USA
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Serino J, Kunze KN, Jacobsen SK, Morash JG, Holmes GB, Lin J, Lee S, Hamid KS, Bohl DD. Nuclear Medicine for the Orthopedic Foot and Ankle Surgeon. Foot Ankle Int 2020; 41:612-623. [PMID: 32141327 DOI: 10.1177/1071100720910422] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Nuclear medicine has been widely applied as a diagnostic tool for orthopedic foot and ankle pathology. Although its indications have diminished with improvements in and the availability of magnetic resonance imaging, nuclear medicine still has a significant and valuable role. The present article offers a comprehensive and current review of the most common nuclear imaging modalities for the orthopedic foot and ankle surgeon. Methods discussed include bone scintigraphy, gallium citrate scintigraphy, labeled-leukocyte scintigraphy, and single-photon emission computed tomography (SPECT). We review the indications and utility of these techniques as they pertain to specific foot and ankle conditions, including osteomyelitis, stress fractures, talar osteochondral lesions, complex regional pain syndrome, oncology, plantar fasciitis, and the painful total ankle arthroplasty. We conclude with a discussion of our approach to nuclear medicine with illustrative cases. Level of Evidence: Level V, expert opinion.
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Affiliation(s)
- Joseph Serino
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Kyle N Kunze
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Stephen K Jacobsen
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Joel G Morash
- Department of Orthopaedic Surgery, Dalhouse University, Halifax, Nova Scotia, Canada
| | - George B Holmes
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Johnny Lin
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Simon Lee
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Kamran S Hamid
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Daniel D Bohl
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
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21
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Hirtler L, Schellander K, Schuh R. Accessibility to Talar Dome in Neutral Position, Dorsiflexion, or Noninvasive Distraction in Posterior Ankle Arthroscopy. Foot Ankle Int 2019; 40:978-986. [PMID: 31081369 PMCID: PMC6669825 DOI: 10.1177/1071100719847134] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Osteochondral lesions of the talus are frequent pathologies of the ankle joint. Especially through arthroscopy, the treatment is kept as minimally invasive as possible. However, there are some drawbacks as to the reachability because of the high congruency of the ankle joint. Here, either noninvasive distraction or maximal dorsiflexion may be an option for better access to the lesion. The purpose of this study was to evaluate maximal dorsiflexion compared to neutral position or noninvasive distraction of the ankle joint in the arthroscopic reachability of the talar dome. The hypothesis of this study was that maximal dorsiflexion would allow for greater accessibility of the talar dome compared to neutral position or noninvasive distraction of the joint. METHODS Twenty matched pairs (n=40) of anatomical ankle specimens were used. The effects of neutral position, maximal dorsiflexion, and noninvasive distraction of the ankle joint on arthroscopic accessibility of the ankle joint were tested. After disarticulation of the talus, reach was measured and compared between the 3 positions. RESULTS In neutral position, 13.7±1.2 mm of the talar dome was reached laterally and 14.0±1.0 mm medially. In maximal dorsiflexion, the distance was 19.0±1.1mm laterally and 19.8±1.4 mm medially, and in noninvasive distraction it was 16.1±1.5 mm laterally and 15.7±1.0 mm medially. The statistical comparison showed a significantly better reach in dorsiflexion laterally (P = .003) and medially (P = .026). CONCLUSION Accessibility of the talar dome in maximal dorsiflexion was superior to that in neutral position or noninvasive distraction. CLINICAL RELEVANCE Results of this study may allow for better planning in arthroscopic treatment of osteochondral lesions of the talus.
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Affiliation(s)
- Lena Hirtler
- Division of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria,Lena Hirtler, MA, MD, PhD, Medical University of Vienna, Center for Anatomy and Cell Biology, Division of Anatomy, Währinger Straße 13, Vienna, 1090, Austria.
| | - Katarina Schellander
- Division of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
| | - Reinhard Schuh
- Department of Pediatric Orthopedics and Foot Surgery, Orthopedic Hospital Vienna–Speising, Vienna, Austria
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Tümer N, Kok AC, Vos FM, Streekstra GJ, Askeland C, Tuijthof GJM, Zadpoor AA. Three-Dimensional Registration of Freehand-Tracked Ultrasound to CT Images of the Talocrural Joint. SENSORS (BASEL, SWITZERLAND) 2018; 18:E2375. [PMID: 30037099 PMCID: PMC6068753 DOI: 10.3390/s18072375] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 07/09/2018] [Accepted: 07/19/2018] [Indexed: 12/11/2022]
Abstract
A rigid surface⁻volume registration scheme is presented in this study to register computed tomography (CT) and free-hand tracked ultrasound (US) images of the talocrural joint. Prior to registration, bone surfaces expected to be visible in US are extracted from the CT volume and bone contours in 2D US data are enhanced based on monogenic signal representation of 2D US images. A 3D monogenic signal data is reconstructed from the 2D data using the position of the US probe recorded with an optical tracking system. When registering the surface extracted from the CT scan to the monogenic signal feature volume, six transformation parameters are estimated so as to optimize the sum of monogenic signal features over the transformed surface. The robustness of the registration algorithm was tested on a dataset collected from 12 cadaveric ankles. The proposed method was used in a clinical case study to investigate the potential of US imaging for pre-operative planning of arthroscopic access to talar (osteo)chondral defects (OCDs). The results suggest that registrations with a registration error of 2 mm and less is achievable, and US has the potential to be used in assessment of an OCD' arthroscopic accessibility, given the fact that 51% of the talar surface could be visualized.
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Affiliation(s)
- Nazlı Tümer
- Department of Biomechanical Engineering, Delft University of Technology (TU Delft), Mekelweg 2, 2628 CD Delft, The Netherlands.
| | - Aimee C Kok
- Orthopaedic Research Center Amsterdam, Academic Medical Centre (AMC), Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| | - Frans M Vos
- Department of Imaging Science and Technology, Quantitative Imaging Group, Delft University of Technology (TU Delft), Lorentzweg 1, 2628 CJ Delft, The Netherlands.
- Department of Radiology, Academic Medical Centre (AMC), Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| | - Geert J Streekstra
- Department of Radiology, Academic Medical Centre (AMC), Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| | | | - Gabrielle J M Tuijthof
- Orthopaedic Research Center Amsterdam, Academic Medical Centre (AMC), Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
- Zuyd University of Applied Sciences, Research Centre Smart Devices, Nieuw Eyckholt 300, 6419 DJ Heerlen, The Netherlands.
| | - Amir A Zadpoor
- Department of Biomechanical Engineering, Delft University of Technology (TU Delft), Mekelweg 2, 2628 CD Delft, The Netherlands.
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van Bergen CJA, Baur OL, Murawski CD, Spennacchio P, Carreira DS, Kearns SR, Mitchell AW, Pereira H, Pearce CJ, Calder JDF. Diagnosis: History, Physical Examination, Imaging, and Arthroscopy: Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle. Foot Ankle Int 2018; 39:3S-8S. [PMID: 30215306 DOI: 10.1177/1071100718779393] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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 "Diagnosis: History, Physical Examination, Imaging, and Arthroscopy" developed at the 2017 International Consensus Meeting on Cartilage Repair of the Ankle. METHODS Seventy-five international experts in cartilage repair of the ankle representing 25 countries and 1 territory were convened and participated in a process based on the Delphi method of achieving consensus. Questions and statements were drafted within 11 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 characterized as follows: consensus: 51 - 74%; strong consensus: 75 - 99%; unanimous: 100%. RESULTS A total of 12 statements on the diagnosis of cartilage injuries of the ankle reached consensus during the 2017 International Consensus Meeting on Cartilage Repair of the Ankle. Two achieved unanimous support and 10 reached strong consensus (greater than 75% agreement). All statements reached at least 86% agreement. CONCLUSIONS This international consensus derived from leaders in the field will assist clinicians in the diagnosis of cartilage injuries of the ankle.
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Affiliation(s)
| | - Onno L Baur
- 2 Department of Radiology and Nuclear Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - Christopher D Murawski
- 3 Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | | | - Stephen R Kearns
- 6 Department of Trauma and Orthopaedic Surgery, University College Hospital Galway, Galway, Ireland
| | | | - Helder Pereira
- 8 Orthopaedic Department, Centro Hospitalar Póvoa de Varzim, Vila do Conde, Portugal
| | - Christopher J Pearce
- 9 National University Heath System, Division of Foot and Ankle Surgery, Singapore
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Horeman T, Buiter EC, Pouran B, Stijntjes M, Dankelman J, Tuijthof GJM. In-Vitro Detection of Small Isolated Cartilage Defects: Intravascular Ultrasound Vs. Optical Coherence Tomography. Ann Biomed Eng 2018; 46:1745-1755. [PMID: 29946970 PMCID: PMC6208880 DOI: 10.1007/s10439-018-2073-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 06/08/2018] [Indexed: 12/20/2022]
Abstract
This experimental work focused on the sensor selection for the development of a needle-like instrument to treat small isolated cartilage defects with hydrogels. The aim was to identify the most accurate and sensitive imaging method to determine the location and size of defects compared to a gold standard (µCT). Only intravascular ultrasound imaging (IVUS) vs. optical coherent tomography (OCT) were looked at, as they fulfilled the criteria for integration in the needle design. An in-vitro study was conducted on six human cadaveric tali that were dissected and submerged in saline. To simulate the natural appearance of cartilage defects, three types of defects were created via a standardised protocol: osteochondral defects (OCD), chondral defects (CD) and cartilage surface fibrillation (CSF), all sized between 0.1 and 3 mm in diameter. The detection rate by two observers for all diameters of OCD were 80, 92 and 100% with IVUS, OCT and µCT, for CD these were 60, 83 and 97%, and for CSF 0, 29 and 24%. Both IVUS and OCT can detect the presence of OCD and CD accurately if they are larger than 2 mm in diameter, and OCT can detect fibrillated cartilage defects larger than 3 mm in diameter. A significant difference between OCT–µCT and IVUS–µCT was found for the diameter error (p = 0.004) and insertion depth error (p = 0.002), indicating that OCT gives values closer to reference µCT. The OCT imaging technique is more sensitive to various types and sizes of defects and has a smaller diameter, and is therefore preferred for the intended application.
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Affiliation(s)
- T Horeman
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands. .,Department of Orthopedic Surgery, Academic Centre for Evidence-based Sports Medicine (ACES), Academic Medical Centre, Amsterdam, The Netherlands.
| | - E C Buiter
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - B Pouran
- Department of Orthopaedics, UMC Utrecht Regenerative Medicine Centre, Utrecht, The Netherlands
| | - M Stijntjes
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - J Dankelman
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - G J M Tuijthof
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands.,Department of Orthopedic Surgery, Academic Centre for Evidence-based Sports Medicine (ACES), Academic Medical Centre, Amsterdam, The Netherlands.,Research Centre Smart Devices, Zuyd University of Applied Sciences, Heerlen, The Netherlands
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25
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D'Ambrosi R, Maccario C, Ursino C, Serra N, Usuelli FG. The role of bone marrow edema on osteochondral lesions of the talus. Foot Ankle Surg 2018; 24:229-235. [PMID: 29409254 DOI: 10.1016/j.fas.2017.02.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 01/13/2017] [Accepted: 02/07/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND To assess the functional and radiological outcomes after arthroscopic talus autologous matrix-induced chondrogenesis (AT-AMIC®) in 2 groups: patients with and without bone marrow edema (BME). METHODS Thirty-seven patients of which 24 without edema (GNE) and 13 with edema (GE) were evaluated. All patients were treated with AT-AMIC® repair for symptomatic osteochondral talar lesion. Clinical and radiological parameters were evaluated with VAS score for pain, AOFAS and SF-12 at T0 (preoperatively), T1 (6 months), T2 (12 months), T3 (24 months) and MRI and CT-scan at T0, T1, T2 and T3. RESULTS No patients were lost to the final follow-up. In both groups we found a significant difference for clinical and radiological parameters with ANOVA for repeated measures through four time points (p<0.001). In GNE, AOFAS improved significantly at each follow-up (p<0.05); while CT and MRI showed a significant reduction in lesion size between T1 and T2 and T2 and T3 (p<0.05). In GE, AOFAS improved significantly between T0 and T1 and T2 and T3 (p<0.05); lesion size, measured with CT, decreased between T1 and T2 (p<0.05), while with MRI the lesion showed a reduction at each follow-up (p<0.05). Lesion size was significantly higher both in MRI and CT in GE compared to GNE (p<0.05). In GNE no patients presented edema at T3, while in GE only 23.08% of the patients presented edema at T3. CONCLUSIONS: The study revealed that osteochondral lesions of the talus were characterized by bigger size both in MRI and CT in patients with edema. We conclude that AT-AMIC® can be considered a safe and reliable procedure that allows effective healing, regardless of edema and more than half of patients did not present edema six months after surgery.
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Affiliation(s)
- Riccardo D'Ambrosi
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy; Istituto Ortopedico Galeazzi, U.O. C.A.S.C.O. - Piede e Caviglia, Milan, Italy.
| | - Camilla Maccario
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy; Istituto Ortopedico Galeazzi, U.O. C.A.S.C.O. - Piede e Caviglia, Milan, Italy
| | | | - Nicola Serra
- Seconda Università degli Studi di Napoli, Naples, Italy
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26
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Macera A, Carulli C, Sirleo L, Innocenti M. Postoperative Complications and Reoperation Rates Following Open Reduction and Internal Fixation of Ankle Fracture. JOINTS 2018; 6:110-115. [PMID: 30051108 PMCID: PMC6059857 DOI: 10.1055/s-0038-1653949] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 04/08/2018] [Indexed: 12/11/2022]
Abstract
Purpose
The purpose of this study was to determinate the overall postoperative complication and reoperation rates related to open reduction and internal fixation (ORIF) of ankle fractures.
Methods
All patients who had undergone an ankle fracture operation at our institution from January 2005 through December 2013 were identified by querying the hospital surgical procedure database for diagnoses codes. Medical records, surgical procedure, and outpatient control reports were reviewed to collect pre-, intra-, and postoperative details. All data obtained were retrospectively analyzed by the authors to evaluate the postoperative complications and the type of further surgical treatment required to treat them.
Results
A total of 378 consecutive patients were included in the study. Overall complications rate was 36.0%. Minor complications (4.5%) were represented by superficial infection (1.3%) and impaired wound healing (3.2%). All these patients required advanced wound care and prolonged oral antibiotics. Major complications (31.5%) included: residual pain (17.2%), deep infection (3.4%), malunion (2.4%), posttraumatic ankle osteoarthritis (5.0%), implant breakage (0.3%), complex regional pain syndrome (1.3%), and arthrofibrosis (1.9%). Note that 21.7% of major complications required further surgical procedure. Reoperations included arthroscopic debridement (15.1%), hardware removal and debridement of all necrotic tissue (4.5%), and ankle fusion (2.1%). Surgery was necessary mainly for pain removal and function recovery.
Conclusion
Ankle fracture ORIF represents a satisfying surgical treatment. Nevertheless, postoperative complications are not uncommon. Minor complications can be easily managed with medications and repeated outpatient controls. Reoperation is occasionally required to treat major complications. Revision surgery is mandatory to ensure pain relief and function improvement.
Level of Evidence
Level II, retrospective cohort study.
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Affiliation(s)
| | | | - Luigi Sirleo
- Orthopaedic Clinic, University of Florence, Florence, Italy
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27
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Usuelli FG, D'Ambrosi R, Maccario C, Boga M, de Girolamo L. All-arthroscopic AMIC ® (AT-AMIC ®) technique with autologous bone graft for talar osteochondral defects: clinical and radiological results. Knee Surg Sports Traumatol Arthrosc 2018; 26:875-881. [PMID: 27620469 PMCID: PMC5847209 DOI: 10.1007/s00167-016-4318-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 09/02/2016] [Indexed: 12/13/2022]
Abstract
PURPOSE Autologous Matrix-Induced Chondrogenesis (AMIC®) is known to provide satisfactory clinical results for the treatment of knee, hip, and ankle cartilage lesions. The purpose of this study was to evaluate clinical and radiological outcomes of patients treated with a new all-arthroscopic AMIC® (AT-AMIC®) technique with autologous bone graft for talar osteochondral defects at a follow-up of 24 months. METHODS Twenty patients underwent the AT-AMIC® procedure and autologous bone graft for type III and IV talar osteochondral lesions. Patients were evaluated pre-operatively and at 6, 12, and 24 months post-operatively using the American Orthopedic Foot and Ankle Society (AOFAS) score, the visual analog scale, and the SF-12 (Short Form-12). Radiological assessment included computed tomography (CT), magnetic resonance imaging (MRI), and magnetic resonance observation of cartilage repair tissue (MOCART). RESULTS All scores significantly improved (p < 0.05) with respect to pre-operative values after 6 months. Further improvements were detected at 24 months (AOFAS, from 57.1 ± 14.9 before surgery to 86.6 ± 10.9 after 24 months; VAS, from 8.1 ± 1.4 to 2.5 ± 2.2; SF-12, from 29.9 ± 4.1 to 48.5 ± 6.9 and from 43.8 ± 2.9 to 53.1 ± 3.9, respectively, for Physical and Mental component score). Lesion area significantly reduced from 111.1 ± 43.2 mm2 pre-operatively to 76.9 ± 38.1 mm2 (p < 0.05) at final follow-up as assessed by CT, and from 154.1 ± 93.6 to 94.3 ± 61.3 mm2 (p < 0.05) as assessed by MRI. The mean MOCART score was 42.8 ± 23.5 points and 50.9 ± 24.9 points, respectively, at 12 and 24 months after surgery (p < 0.05). CONCLUSIONS AT-AMIC® with autologous bone grafting has proven to be a safe and effective minimal invasive technique, able to rapidly and significantly improve pain, function, and radiological healing of osteochondral talar lesions, with progressive further improvements up to 24 months. Orthopedic surgeons specialized in foot and ankle surgery should adopt the AT-AMIC® technique for the treatment of osteochondral talar lesions, which proved to be effective and minimally invasive, avoiding malleolar osteotomy with a low risk of complications. LEVEL OF EVIDENCE IV.
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Affiliation(s)
| | - Riccardo D'Ambrosi
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.,Università degli Studi di Milano, Milan, Italy
| | - Camilla Maccario
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.,Università degli Studi di Milano, Milan, Italy
| | - Michele Boga
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Laura de Girolamo
- Laboratorio di Biotecnologie Applicate all'Ortopedia, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
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Hirtler L, Schuh R. Accessibility of the Talar Dome-Anatomic Comparison of Plantarflexion Versus Noninvasive Distraction in Arthroscopy. Arthroscopy 2018; 34:573-580. [PMID: 29079263 DOI: 10.1016/j.arthro.2017.07.036] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 07/28/2017] [Accepted: 07/28/2017] [Indexed: 02/06/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the difference in accessibility of the talar dome during ankle arthroscopy between noninvasive distraction and maximum plantar flexion without distraction. METHODS For this study, 20 matched pairs (n = 40) of anatomic ankle specimens were used. Two groups (distraction or maximum plantar flexion) were defined. Through the use of chondral picks, the accessibility of each technique was tested arthroscopically. Afterward, the ankle joint was dissected and the reach achieved was measured and compared between the 2 groups. RESULTS Through noninvasive distraction, 13.1 ± 4.4 mm of the talar dome was reached laterally and 16.7 ± 3.7 mm medially. Through plantar flexion, 18.1 ± 3.4 mm of the talar dome was reached laterally and 18.1 ± 3.4 mm medially. Statistical comparison revealed a significantly better reach in plantar flexion on the lateral side of the talar dome (P = .007). There was no significant difference medially. CONCLUSIONS Plantar flexion significantly improves reachability of the dome on the lateral side and it is equal to noninvasive distraction medially. Results of this study may allow for better access to the lesion of the talus. CLINICAL RELEVANCE Results of this study allow for a better planning of interventions in OCD of the talus.
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Affiliation(s)
- Lena Hirtler
- Division of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria.
| | - Reinhard Schuh
- Department of Pediatric Orthopedics and Foot Surgery, Orthopedic Hospital Vienna-Speising, Vienna, Austria
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29
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D'Ambrosi R, Indino C, Maccario C, Manzi L, Usuelli FG. Autologous Microfractured and Purified Adipose Tissue for Arthroscopic Management of Osteochondral Lesions of the Talus. J Vis Exp 2018. [PMID: 29443020 DOI: 10.3791/56395] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
In recent years, regenerative techniques have been increasingly studied and used to treat osteochondral lesions of the talus. In particular, several studies have focused their attention on mesenchymal stem cells derived from adipose tissue. Adipose-derived stem cells (ADSCs) exhibit morphological characteristics and properties similar to other mesenchymal cells, and are able to differentiate into several cellular lines. Moreover, these cells are also widely available in the subcutaneous tissue, representing 10 - 30% of the normal body weight, with a concentration of 5,000 cells per gram of tissue. In the presented technique, the first step involves harvesting ADSCs from the abdomen and a process of microfracture and purification; next, the surgical procedure is performed entirely arthroscopically, with less soft tissue dissection, better joint visualization, and a faster recovery compared with standard open procedures. Arthroscopy is characterized by a first phase in which the lesion is identified, isolated, and prepared with microperforations; the second step, performed dry, involves injection of adipose tissue at the level of the lesion. Between January 2016 and September 2016, four patients underwent arthroscopic treatment of osteochondral lesion of the talus with microfractured and purified adipose tissue. All patients reported clinical improvement six months after surgery with no reported complications. Functional scores at the latest follow-up are encouraging and confirm that the technique provides reliable pain relief and improvements in patients with osteochondral lesion of the talus.
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Affiliation(s)
- Riccardo D'Ambrosi
- IRCCS Istituto Ortopedico Galeazzi - C.A.S.C.O. Piede e Caviglia; Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano;
| | - Cristian Indino
- IRCCS Istituto Ortopedico Galeazzi - C.A.S.C.O. Piede e Caviglia
| | - Camilla Maccario
- IRCCS Istituto Ortopedico Galeazzi - C.A.S.C.O. Piede e Caviglia
| | - Luigi Manzi
- IRCCS Istituto Ortopedico Galeazzi - C.A.S.C.O. Piede e Caviglia
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30
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D'Ambrosi R, Maccario C, Ursino C, Serra N, Usuelli FG. Combining Microfractures, Autologous Bone Graft, and Autologous Matrix-Induced Chondrogenesis for the Treatment of Juvenile Osteochondral Talar Lesions. Foot Ankle Int 2017; 38:485-495. [PMID: 28076977 DOI: 10.1177/1071100716687367] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the clinical and radiologic outcomes of patients younger than 20 years, treated with the arthroscopic-talus autologous matrix-induced chondrogenesis (AT-AMIC) technique and autologous bone graft for osteochondral lesion of the talus (OLT). METHODS Eleven patients under 20 years (range 13.3-20.0) underwent the AT-AMIC procedure and autologous bone graft for OLTs. Patients were evaluated preoperatively (T0) and at 6 (T1), 12 (T2), and 24 (T3) months postoperatively, using the American Orthopaedic Foot & Ankle Society Ankle and Hindfoot (AOFAS) score, the visual analog scale and the SF-12 respectively in its Mental and Physical Component Scores. Radiologic assessment included computed tomographic (CT) scan, magnetic resonance imaging (MRI) and intraoperative measurement of the lesion. A multivariate statistical analysis was performed. RESULTS Mean lesion size measured during surgery was 1.1 cm3 ± 0.5 cm3. We found a significant difference in clinical and radiologic parameters with analysis of variance for repeated measures ( P < .001). All clinical scores significantly improved ( P < .05) from T0 to T3. Lesion area significantly reduced from 119.1 ± 29.1 mm2 preoperatively to 77.9 ± 15.8 mm2 ( P < .05) at final follow-up as assessed by CT, and from 132.2 ± 31.3 mm2 to 85.3 ± 14.5 mm2 ( P < .05) as assessed by MRI. Moreover, we noted an important correlation between intraoperative size of the lesion and body mass index (BMI) ( P = .011). CONCLUSIONS The technique can be considered safe and effective with early good results in young patients. Moreover, we demonstrated a significant correlation between BMI and lesion size and a significant impact of OLTs on quality of life. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Riccardo D'Ambrosi
- 1 Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy.,2 IRCCS Istituto Ortopedico Galeazzi, U.O. C.A.S.C.O., Piede e Caviglia, Milan, Italy
| | - Camilla Maccario
- 1 Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy.,2 IRCCS Istituto Ortopedico Galeazzi, U.O. C.A.S.C.O., Piede e Caviglia, Milan, Italy
| | | | - Nicola Serra
- 4 Seconda Università di Napoli, Dipartimento di Radiologia, Naples, Italy
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31
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Darton Y, Gallien V, Henrion É, Dupuis M, Richard I. Osteochondral lesions and partial fractures of the talus in paleopathology. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2017; 16:31-39. [PMID: 28290308 DOI: 10.1016/j.ijpp.2016.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Revised: 12/18/2016] [Accepted: 12/27/2016] [Indexed: 06/06/2023]
Affiliation(s)
- Yves Darton
- CEPAM (UMR 7264, CNRS/UNS), Pôle universitaire Saint-Jean d'Angély, SJA3, 24 avenue des Diables Bleus, F-06357, Nice Cedex 4, France
| | - Véronique Gallien
- CEPAM (UMR 7264, CNRS/UNS), Pôle universitaire Saint-Jean d'Angély, SJA3, 24 avenue des Diables Bleus, F-06357, Nice Cedex 4, France; NRAP Grand Ouest, Centre Archéologique, 20 rue Hippolyte Foucault, F-72000, Le Mans, France
| | - Élise Henrion
- Service départemental d'archéologie, Conseil Général des Alpes-de-Haute-Provence, 13 rue du Docteur Romieu-B.P.216, F-04003, Digne-les-Bains Cedex, France
| | - Mathias Dupuis
- Service départemental d'archéologie, Conseil Général des Alpes-de-Haute-Provence, 13 rue du Docteur Romieu-B.P.216, F-04003, Digne-les-Bains Cedex, France
| | - Isabelle Richard
- INRAP Grand Est Nord, Centre Archéologique de Saint-Martin-sur-le-Pré, 38 rue des Dats, F-51520, Saint-Martin-sur-le-Pré, France
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32
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Kraeutler MJ, Chahla J, Dean CS, Mitchell JJ, Santini-Araujo MG, Pinney SJ, Pascual-Garrido C. Current Concepts Review Update. Foot Ankle Int 2017; 38:331-342. [PMID: 27821659 DOI: 10.1177/1071100716677746] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Matthew J Kraeutler
- 1 Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jorge Chahla
- 2 Steadman Philippon Research Institute, Vail, CO, USA
| | - Chase S Dean
- 2 Steadman Philippon Research Institute, Vail, CO, USA
| | - Justin J Mitchell
- 3 Gundersen Health System, Department of Sports Medicine, La Crosse, WI, USA
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33
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Canata GL, Casale V. Arthroscopic debridement and bone marrow stimulation for talar osteochondral lesions: current concepts. J ISAKOS 2017. [DOI: 10.1136/jisakos-2016-000099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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34
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Devgan A, Rohilla R, Tanwar M, Jain A, Siwach K, Devgan R. Comparative analysis of arthroscopic debridement in osseous versus soft tissue anterior ankle impingement. J Clin Orthop Trauma 2016; 7:200-6. [PMID: 27489417 PMCID: PMC4949408 DOI: 10.1016/j.jcot.2016.02.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Accepted: 02/18/2016] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Arthroscopic debridement has been a gold standard procedure for anterior ankle impingement, both in cases of osseous and soft tissue impingement. There is sparse literature on comparative outcome with respect to functional results between the two types of impingement post-arthroscopic debridement. METHODS Our study included 14 patients diagnosed as cases of anterior ankle impingement on the basis of clinical and radiological examination. They were segregated into two groups (on the basis of cause of impingement (osseous versus soft tissue)). Both groups were treated by arthroscopic debridement. Primary outcome was patient satisfaction, which was assessed by Likert scale and clinical outcomes were measured using AOFAS ankle-hind foot scale, VAS score, range of motion and time to return to pre-injury activity level in both groups. RESULTS Mean follow-up was of 15 months where eleven patients reported an excellent recovery, two patients had good recovery while one patient reported poor outcome. Mean AOFAS ankle hind foot scale improved from 50.5 preoperatively to 85.71 postoperatively (statistically significant; p value - 0.0001). Mean Likert scale value post-operative was 4.21. VAS score showed significant improvement in patients of both the groups. Range of motion was slightly better in soft tissue impingement type with a relatively shorter time to return to sports or preinjury activity level as compared to osseous impingement group. CONCLUSIONS The patients in both the groups had comparable outcomes with no statistically significant difference with regard to patient satisfaction and clinical outcome.
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Affiliation(s)
- Ashish Devgan
- Professor Orthopaedics, PGIMS, Rohtak, Haryana, India
- Corresponding author. Tel.: +91 9812200712.
| | | | - Milind Tanwar
- Resident Orthopaedics, PGIMS, Rohtak, Haryana, India
| | - Aditya Jain
- Resident Orthopaedics, PGIMS, Rohtak, Haryana, India
| | - Karan Siwach
- Resident Orthopaedics, Subharti Medical College, Meerut, India
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