The anterior approach for the treatment of posterior osteochondral lesions of the talus: comparison of different surgical techniques

Introduction: Proficiency in the direct anterior approach (DAA) as with many surgical techniques is considered to be challenging. Added to this is the controversy of the benefits of DAA compared to other total hip arthroplasty (THA) approaches. Our study aims to assess the influence of experience on learning curve and clinical results when transitioning from THA via posterior approach in a lateral position to DAA in a supine position. Methods: A consecutive retrospective series of 525 total hip arthroplasty of one senior and six junior surgeons was retrospectively analysed from May 2013 to December 2017. Clinical results were analysed and compared between the two groups and represented as a learning curve. Mean follow up was 36.2 months ± 11.8. Results: This study found a significant difference in complications between the senior and junior surgeons for operating time, infection rate, and lateral femoral cutaneous nerve (LFCN) neuropraxia. A trainee’s learning curve was an average of 10 DAA procedures before matching the senior surgeon. Of note, the early complications correlated with intraoperative fractures increased with experience in both groups. Operating time for the senior equalised after 70 cases. Dislocation rate and limb length discrepancy were excellent and did not show a learning curve between the two groups. Conclusion: DAA is a safe approach to implant a THA. There is a learning curve and initial supervision is recommended for both seniors and trainees. Level of evidence: Retrospective, consecutive case series; level IV.

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Fresh Osteochondral Allograft Transplants in the Knee: Bipolar and Beyond

The Journal of Knee Surgery ◽

10.1055/s-0040-1714366 ◽

2020 ◽

Vol 33 (12) ◽

pp. 1172-1179

Author(s):

James P. Stannard ◽

James T. Stannard ◽

Anna J. Schreiner

Keyword(s):

Surgical Techniques ◽

Treatment Strategies ◽

Treatment Method ◽

Joint Disease ◽

Osteochondral Allograft ◽

Patient Specific ◽

Osteochondral Lesions ◽

Fresh Osteochondral Allograft ◽

Total Knee ◽

Spectrum Of Patients

AbstractKnee patients who have sustained chondral and osteochondral lesions suffer from debilitating pain, which can ultimately lead to posttraumatic osteoarthritis and whole-joint disease. Older, nonactive patients are traditionally steered toward total knee arthroplasty (TKA), but younger, active patients are not good candidates for TKA based on implant longevity, complications, morbidity, and risk for revision, such that treatment strategies at restoring missing hyaline cartilage and bone are highly desired for this patient population. Over the past four decades, fresh osteochondral allograft (OCA) transplantation has been developed as a treatment method for large (> 2.5 cm2) focal full-thickness articular cartilage lesions. This article documents our own institutional OCA journey since 2016 through enhanced graft preservation techniques (the Missouri Osteochondral Preservation System, or MOPS), technical improvements in surgical techniques, use of bone marrow aspirate concentrate, bioabsorbable pins and nails, and prescribed and monitored patient-specific rehabilitation protocols. Further follow-up with documentation of long-term outcomes will provide insight for continued optimization for future applications for OCA transplantation, potentially including a broader spectrum of patients appropriate for this treatment. Ongoing translational research is necessary to blaze the trail in further optimizing this treatment option for patients.

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Surgical Techniques and Exposures for Osteochondral Lesions of the Talus

Operative Techniques in Sports Medicine ◽

10.1053/j.otsm.2008.12.001 ◽

2008 ◽

Vol 16 (4) ◽

pp. 207-211

Author(s):

Nicola Corbett ◽

Raoul P. Rodriguez ◽

G. James Sammarco

Keyword(s):

Surgical Techniques ◽

Osteochondral Lesions

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Cement Casting to Optimize Reconstruction of Chronic Osteochondral Lesions of the Talus

Foot & Ankle Specialist ◽

10.1177/1938640017692414 ◽

2017 ◽

Vol 10 (4) ◽

pp. 333-336

Author(s):

Jorge Pulgar ◽

Mario Escudero ◽

Giovanni Carcuro ◽

Adam Schiff ◽

Manuel Pellegrini

Keyword(s):

Bone Cement ◽

Ankle Joint ◽

Surgical Techniques ◽

Osteochondral Lesions ◽

Limited Evidence ◽

Levels Of Evidence ◽

Novel Technique ◽

Evidence Level

Few surgical techniques have been described for reconstruction in massive osteochondral lesions of the talus, and there is limited evidence of techniques for accurately reproducing native talar anatomy with bone auto/allograft techniques. In this article, we present a novel technique, which is highly reproducible, using bone cement to restore the congruence and anatomy of the ankle joint. Levels of Evidence: Level V: Technical tip

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Pain in Osteochondral Lesions of the Ankle – an Investigation Based on Data from the German Cartilage Registry (KnorpelRegister DGOU)

Zeitschrift für Orthopädie und Unfallchirurgie ◽

10.1055/s-0043-124597 ◽

2018 ◽

Vol 156 (02) ◽

pp. 160-167

Author(s):

Daniel Körner ◽

Philipp Kohler ◽

Steffen Schröter ◽

Aline Naumann ◽

Markus Walther ◽

...

Keyword(s):

Pain Intensity ◽

Rating Scale ◽

Surgical Techniques ◽

Numeric Rating Scale ◽

The Other ◽

Osteochondral Lesions ◽

Preoperative Pain ◽

Female Patients ◽

The One ◽

Cartilage Therapy

Abstract Background The aim of the study was to investigate parameters influencing the preoperative pain intensity in patients with osteochondral lesions of the ankle. The evaluation covered patient-related parameters such as age, sex, body mass index (BMI), as well as defect-related parameters, such as localisation, size and stage (according to the classification of the International Cartilage Repair Society [ICRS] and the Berndt-Harty-Loomer classification). We also examined the correlation between the different surgical techniques and additional factors, such as debridement of an impingement or stabilisation of the ankle on the one hand, and the preoperative pain intensity on the other. Material and Methods 259 patients with osteochondral lesions of the ankle were operated in 32 clinical centres between October 2014 and December 2016 and enrolled consecutively in the German Cartilage Registry (KnorpelRegister DGOU). 151 patients were available for analysis. The preoperative pain intensity was assessed at the time of surgery with online questionnaires, using the Numeric Rating Scale for pain (NRS). Results The median preoperative pain intensity in the complete study population (n = 151) was 3 (range 0 – 10). There was no correlation between the age and the preoperative pain intensity (ρ = − 0.06). Further, there was not detected a difference between the two genders according to the preoperative pain intensity (p = 0.31). In female patients a higher BMI correlated with a higher preoperative pain intensity (ρ = 0.16). Within the group of patients with a solitary treated talus lesion there was no difference according to the preoperative pain intensity between the different localizations of the defect (medial vs. lateral talus) (p = 0.82). Within the group of patients with a solitary treated talus or tibia lesion there was no correlation between the defective area or the lesion stage according to the ICRS classification on the one hand, and the preoperative pain intensity on the other (ρ = 0.09, and ρ = 0.04, respectively). According to the Berndt-Harty-Loomer classification a higher lesion stage (stage four and five) was associated with a higher preoperative pain intensity (ρ = 0.13). There was no difference according to the preoperative pain intensity between the group of patients that received a debridement of a bony or soft tissue impingement in addition to the cartilage therapy and the group of patients without this kind of additional therapy (p = 0.10). Further, there was no difference according to the preoperative pain intensity between the group of patients that received a stabilisation of the ankle joint in addition to the cartilage therapy and the group of patients without a stabilisation procedure (p = 0.83). Conclusion Osteochondral lesions of the ankle can be associated with a moderate and in some cases high pain intensity. In female patients a higher BMI is associated with a higher pain intensity. Further, a higher lesion stage according to the Berndt-Harty-Loomer classification is associated with a higher pain intensity, which highlights the clinical relevance of this classification.

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Surgical Management of Osteochondral Lesions of the Talus

The Duke Orthopaedic Journal ◽

10.5005/jp-journals-10017-1054 ◽

2015 ◽

Vol 5 (1) ◽

pp. 35-47

Author(s):

Selene G Parekh ◽

Mark E Easley ◽

Samuel B Adams ◽

Christopher E Gross

Keyword(s):

United States ◽

Surgical Management ◽

Cartilage Repair ◽

Surgical Techniques ◽

Clinical Results ◽

The United States ◽

Osteochondral Lesions ◽

Scaffold Material ◽

Short Term ◽

Cell Source

ABSTRACT Osteochondral lesions of the talus (OLT) present a formidable treatment challenge to the orthopaedic surgeon. Historical cartilage repair strategies often result in the formation of fibro cartilage leading to suboptimal clinical results. With advances in regenerative medicine, modern surgical techniques are diverse and employ autograft, allograft and tissueengineered constructs for cartilage repair. Fresh and particulated juvenile allograft transplantation have become popular options in the United States. Worldwide, both cellular and acellular tissueengineered constructs are utilized. In all cases, there is still debate as to the optimal cell source and scaffold material and only short term clinical results are available. This article will review these current as well as experimental techniques for cartilage repair of osteochondral lesions of the talus. Adams Jr SB, Gross CE, Tainter DM, Easley ME, Parekh SG. Surgical Management of Osteochondral Lesions of the Talus. The Duke Orthop J 2015;5(1):3547.

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Surgical Techniques of Using Direct Anterior Approach and Bridging Plate Fixation of Periprosthetic Fracture of an Arthrodesed Hip: A Case Report

Journal of Orthopaedics Trauma and Rehabilitation ◽

10.1016/j.jotr.2017.05.004 ◽

2018 ◽

Vol 24 (1) ◽

pp. 39-43

Author(s):

Hing-Cheong Wong ◽

Siu-Bon Woo

Keyword(s):

Fracture Healing ◽

Blood Supply ◽

Periprosthetic Fracture ◽

Anterior Approach ◽

Surgical Techniques ◽

Direct Anterior Approach ◽

Invasive Technique ◽

Minimally Invasive Plate Osteosynthesis ◽

Stable Fixation ◽

Fracture Management

We present a case of a 65-year-old woman with traumatic periprosthetic fracture of left proximal femur with ipsilateral arthrodesed hip and cobra plate in-situ. It imposes challenges on achievement of stable fixation for fracture management and preservation of blood supply for fracture healing. Minimally invasive plate osteosynthesis through direct anterior approach was executed with intraoperative tem-plating. Anterior bridging plating using pre-bent reverse distal femoral locking compression plate (less invasive stabilisation system) was performed successfully. The patient had a fracture union in 10 months and returned to the previous mobility status. This technique can achieve stable fixation and preservation of blood supply for fracture healing through minimal invasive technique.

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Operative Treatment for Osteochondral Lesions of the Talus

Cartilage ◽

10.1177/1947603516644298 ◽

2016 ◽

Vol 8 (1) ◽

pp. 42-49 ◽

Cited By ~ 9

Author(s):

Youichi Yasui ◽

Adi Wollstein ◽

Christopher D. Murawski ◽

John G. Kennedy

Keyword(s):

Bone Marrow ◽

Clinical Outcomes ◽

Basic Science ◽

Clinical Evidence ◽

Surgical Techniques ◽

Biologic Agents ◽

Treatment Modalities ◽

Patient Specific ◽

Osteochondral Lesions ◽

Surgical Treatments

Objective Numerous basic science articles have published evidence supporting the use of biologic augmentation in the treatment of osteochondral lesions of the talus (OLT). However, a comprehensive evaluation of the clinical outcomes of those treatment modalities in OLT has yet to be published. The purpose of this review is to provide an evidence-based overview of clinical outcomes following biologic augmentation to surgical treatments for OLT. Design A comprehensive literature review was performed. Two commonly used surgical techniques for the treatment of OLT—bone marrow stimulation and osteochondral autograft transfer—are first introduced. The review describes the operative indications, step-by- step operative procedure, clinical outcomes, and concerns associated with each treatment. A review of the currently published basic science and clinical evidence on biologic augmentation in the surgical treatments for OLT, including platelet-rich plasma, concentrated bone marrow aspirate, and scaffold-based therapy follows. Results Biologic agents and scaffold-based therapies appear to be promising agents, capable of improving both clinical and radiological outcomes in OLT. Nevertheless, variable production methods of these biologic augmentations confound the interpretation of clinical outcomes of cases treated with these agents. Conclusions Current clinical evidence supports the use of biologic agents in OLT cases. Nonetheless, well-designed clinical trials with patient-specific, validated and objective outcome measurements are warranted to develop standardized clinical guidelines for the use of biologic augmentation for the treatment of OLT in clinical practice.

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Exposure of the Medial Talar Dome

Foot & Ankle Specialist ◽

10.1177/1938640012474035 ◽

2013 ◽

Vol 6 (1) ◽

pp. 12-14 ◽

Cited By ~ 5

Author(s):

Jaymes D. Granata ◽

William T. DeCarbo ◽

Christopher F. Hyer ◽

Angela M. Granata ◽

Gregory C. Berlet

Keyword(s):

Surgical Technique ◽

Complication Rate ◽

Surgical Techniques ◽

Osteochondral Lesions ◽

Medial Malleolus ◽

Talar Dome ◽

Medial Aspect ◽

Surgical Exposure ◽

Chevron Osteotomy ◽

Anterior Tibial

Open surgical exposure of the medial aspect of the talus is primarily indicated for osteochondral lesions of the talus and talar body fractures. Secondary to the difficulty of access, a variety of techniques have been described. The surgical techniques described in the literature include transmalleolar access windows, medial and anterior tibial osteotomies, and resection osteotomies (plafondoplasty). The purpose of this article is to describe the surgical technique for the bi-planar chevron osteotomy of the medial malleolus. This osteotomy can provide full exposure to the entire medial aspect of the talus. The orientation of the osteotomy allows for perpendicular placement of instrumentation on the medial half of the talus and is particularly useful for cartilage transplant procedures. The technique is reproducible and has a low complication rate when performed correctly.

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