Treatment of Osteochondral Lesions of the Talus With Particulated Juvenile Cartilage (original) (raw)
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Osteochondral Lesions in the Ankle – a Review of Diagnostic and Treatment
2015
The purpose of this study is to present the problem of treatment the osteochondral lesions in the talus. Nowadays, the most popular methods are microfratures. The others are mosaicoplasty, osteochondral allograft transplantation, AMIC procedure (autologous matrix induced chodrogenesis), which is a microfrature combined with the use of collagen membrane. Retrograde drilling, fixation, osteotomies and metal implants should also be mentioned. Biological methods, such as platelet rich plasma, concentrated bone marrow, hialuronic acid injections (very often with the combination of the previously mentioned methods) become increasingly popular. There is no consensus about the treatment of OCL in the talus. This paper presents the OCL treatment algorithm of the talus.
Orthopaedic Journal of Sports Medicine
Background: Little is known about the long-term prognosis of osteochondral lesions of the talus (OLTs) after nonoperative treatment. Purpose: To evaluate the clinical and radiological long-term results of initially successfully treated OLTs after a minimum follow-up of 10 years. Study Design: Case series; Level of evidence, 4. Methods: Between 1998 and 2006, 48 patients (50 ankles) with OLTs were successfully treated nonoperatively. These patients were enrolled in a retrospective long-term follow-up, for which 24 patients could not be reached or were available only by telephone. A further 2 OLTs (6%) that had been treated surgically were excluded from the analysis and documented as failures of nonoperative treatment. The final study group of 22 patients (mean age at injury, 42 years; range, 10-69 years) with 24 OLTs (mean size, 1.4 cm2; range, 0.2-3.8 cm2) underwent clinical and radiological evaluation after a mean follow-up of 14 years (range, 11-20 years). Ankle pain was evaluated...
Foot and Ankle Surgery, 2020
Introduction/purpose: Osteochondral lesion of the talus (OCLT) is defined as a defect on the articular surface of the talus with/without subchondral bone involvement. Several surgical techniques are described in literature to treat OCLT. Particulated Juvenile Cartilage Allograft Transplantation (PJCAT) is a new emerging technique that has the potential of restoring the native cartilage. However, available data on PJCAT in treating OCLT is confined to a small number of studies with heterogeneous population. The aim of this study is to systematically review the literature on clinical and radiological outcomes of PJCAT in treating OCLT. Methods: A systematic search of Medline database was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Number of patients and demographic data included age, gender and body mass index (BMI) were extracted. The level of evidence of each included study was identified. When feasible, mechanism of injury, lesion size and average follow up were recorded. The American Orthopedic Foot and Ankle Society Score (AOFAS), and Foot and Ankle Outcome Score (FAOS) were obtained to assess the functional outcomes. Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score was selected to evaluate the radiological outcomes. Results: A total of 10 studies were eligible for this review involving 132 patients. Postoperative AOFAS scores were available for 44 patients who underwent PJCAT with an average of 86.14 at 25.5 months follow up. FAOS scores have been reported in 3 studies for 81 patients. The average preoperative score was 47.35 which has been improved to 62.88 at follow up of 23.6 months. MOCART was evaluated in 42 feet after the mean follow up of 18.2 months. The repair tissue was characterized by variable features; however, certain peculiarities were observed with higher frequency including infill hypertrophy, incomplete border zone integration, deep surface disruption, structure inhomogeneity, patches of hyperintense signals, damage of subchondral lamina and subchondral bone, adhesions and absence of effusion. Conclusion: PJCAT seems to be a promising modality of treatment for OLT in terms of functional outcomes. Fair attempts of defect filling can be confirmed with MRI. Nevertheless, heterogeneous picture of regenerate cartilaginous tissue and lack of repair in subchondral bone and subchondral lamina are not in favor with claims of full restoration of lost normal hyaline articular cartilage.
Techniques in Foot & Ankle Surgery, 2014
Osteochondral lesions of the talus are a common source of ankle pain, and often present in patients with a history of acute ankle trauma or chronic ankle instability. The management of these lesions can be divided between reparative and restorative techniques. Particulated juvenile cartilage allograft transplantation is a new technique, which utilizes fresh juvenile cartilage containing live cells in their native extracellular matrix, and implants these cells into the osteochondral defect with the use of a fibrin adhesive. The purpose of this article is to review the indications and describe the surgical technique for arthroscopic particulated juvenile cartilage allograft transplantation for the management of osteochondral lesions of the talus.
Current Concepts in the Diagnosis and Treatment of Osteochondral Lesions of the Ankle
The American Journal of Sports Medicine, 2010
Osteochondral lesions of the ankle are a more common source of ankle pain than previously recognized. Although the exact pathophysiology of the condition has not been clearly established, it is likely that a variety of etiological factors play a role, with trauma, typically from ankle sprains, being the most common. Technological advancements in ankle arthroscopy and radiologic imaging, most importantly magnetic resonance imaging, have improved diagnostic capabilities for detecting osteochondral lesions of the ankle. Moreover, these technologies have allowed for the development of more sophisticated classification systems that may, in due course, direct specific future treatment strategies. Nonoperative treatment yields best results when employed in select pediatric and adolescent patients with osteochondritis dissecans. However, operative treatment, which is dependent on the size and site of the lesion, as well as the presence or absence of cartilage damage, is frequently warranted in both children and adults with osteochondral lesions. Arthroscopic microdrilling, micropicking, and open procedures, such as osteochondral autograft transfer system and matrix-induced autologous chondrocyte implantation, are frequently employed. The purpose of this article is to review the history, etiology, and classification systems for osteochondral lesions of the ankle, as well as to describe current approaches to diagnosis and management.
The American journal of sports medicine, 2016
The critical lesion size treated with bone marrow stimulation (BMS) for osteochondral lesions of the talus (OLTs) has been 150 mm(2) in area or 15 mm in diameter. However, recent investigations have failed to detect a significant correlation between the lesion size and clinical outcomes after BMS for OLTs. To systematically review clinical studies reporting both the lesion size and clinical outcomes after BMS for OLTs. Systematic review. A systematic search of the MEDLINE and EMBASE databases was performed in March 2015 based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Included studies were evaluated with regard to the level of evidence (LOE), quality of evidence (QOE), lesion size, and clinical outcomes. Twenty-five studies with 1868 ankles were included; 88% were either LOE 3 or 4, and 96% did not have good QOE. The mean area was 103.8 ± 10.2 mm(2) in 20 studies, and the mean diameter was 10.0 ± 3.2 mm in 5 studies. The mean Ameri...
Natural History of Nonoperatively Treated Osteochondral Lesions of the Talus
Foot & Ankle International, 2014
Background: We hypothesized that patients undergoing nonoperative treatment for asymptomatic or minimally symptomatic osteochondral lesions of the talus (OLTs) would not deteriorate clinically or radiologically over time. Methods: Forty-eight patients (mean age = 48 years; range, 13-78 years) with an OLT confirmed by magnetic resonance imaging (MRI) who had not undergone ankle joint surgery were retrospectively reviewed. All patients were evaluated after a minimum follow-up of 2 years (mean = 52 months; range, 27-124 months). All patients filled out an individual questionnaire and underwent a physical and radiographic assessment (radiograph and hindfoot MRI). Results: At final follow-up, 43 ankles (86%) in 41 patients were pain-free (visual analogue scale [VAS] 0, n = 12) or less painful (VAS 1-3, n = 31). Radiographically, osteoarthritis was absent in 47%, and grade 1 and 2 osteoarthritis each were found in 27% (van Dijk classification). Magnetic resonance imaging revealed no subst...
Treatment of post-traumatic osteochondral lesions of the talus: a four-step approach
Knee Surgery, Sports Traumatology, Arthroscopy, 2013
Purpose The purpose of this retrospective study was to assess the treatment of post-traumatic osteochondral lesions (OCLs) of the ankle with a four-step protocol. Methods Thirty-eight patients with at least one MRIdocumented OCL of the ankle were treated from 2004 to 2010. Median age at surgery was 39 years (range: 18-52). Mean lesion size was 1.0 cm 2 (SD: 0.2). All patients underwent a four-step surgical procedure including synovectomy, debridement and microfractures of the OCL, capsular shrinkage, and bracing and non-weightbearing for 21 days. Clinical assessment included objective examination, the AOFAS ankle and hindfoot scoring system, Karlsson-Peterson score, Tegner activity level, and Sefton articular stability scale. MRI scans were taken 18 months after surgery in all patients. Results Follow-up examination at an average of 4 years (SD: 1.
Foot and Ankle Clinics, 2009
Chronic giving way and ankle dysfunction are common after ankle sprains ( . In a study involving young athletes in 1986, Smith and Reischl 1 reported in basketball players that 50% of the athletes have a dysfunction after sprain and 15% were affected in playing performance. In 1975, Staples 2 described 27% functional instability and 12% sport disability. According to the literature review 3 of more than 100 articles on treatment of ankle sprains, there is a variable (0%-78%) incidence of dysfunction regardless of treatment type: cast, surgery, or functional. In our approach to chronic ankle pain and giving way, one must consider the differential diagnosis before treatment can be directed appropriately.
Current management of talar osteochondral lesions
World journal of orthopedics, 2017
Osteochondral lesions of the talus (OLT) occur in up to 70% of acute ankle sprains and fractures. OLT have become increasingly recognized with the advancements in cartilage-sensitive diagnostic imaging modalities. Although OLT may be treated nonoperatively, a number of surgical techniques have been described for patients whom surgery is indicated. Traditionally, treatment of symptomatic OLT have included either reparative procedures, such as bone marrow stimulation (BMS), or replacement procedures, such as autologous osteochondral transplantation (AOT). Reparative procedures are generally indicated for OLT < 150 mm(2) in area. Replacement strategies are used for large lesions or after failed primary repair procedures. Although short- and medium-term results have been reported, long-term studies on OLT treatment strategies are lacking. Biological augmentation including platelet-rich plasma and concentrated bone marrow aspirate is becoming increasingly popular for the treatment of ...