Functional evaluation of patients treated with osteochondral allograft transplantation for post-traumatic ankle arthritis: One year follow-up

Background: When compared with fluid arthroscopy, carbon dioxide (CO2) insufflation offers an increased scope of view and a more natural-appearing joint cavity, and it eliminates floating debris that may obscure the surgeon’s view. Despite the advantages of CO2 insufflation during knee arthroscopy and no reported cases of air emboli, the technique is not widely used because of concerns of hematogenous gas leakage and a lack of case series demonstrating safety. Purpose/Hypothesis: To investigate the safety profile of CO2 insufflation during arthroscopic osteochondral allograft transplantation of the knee and report the midterm clinical outcomes using this technique. We hypothesized that patients undergoing CO2 insufflation of the knee joint would have minimal systemic complications, allowing arthroscopic cartilage work in a dry field. Study Design: Case series; level of evidence, 4. Methods: A retrospective chart review was performed of electronic medical records for patients who underwent arthroscopic osteochondral allograft transplantation of the knee with the use of CO2 insufflation. Included were patients aged 18 to 65 years who underwent knee arthroscopy with CO2 insufflation from January 1, 2015, to January 1, 2021, and who had a minimum follow-up of 24 months. All procedures were performed by a single, fellowship-trained and board-certified sports medicine surgeon. The patients’ electronic medical records were reviewed in their entirety for relevant demographic and clinical outcomes. Results: We evaluated 27 patients (14 women and 13 men) with a mean age of 38 and a mean follow-up of 39.2 months. CO2 insufflation was used in 100% of cases during the placement of the osteochondral allograft. None of the patients sustained any systemic complications, including signs or symptoms of gas embolism or persistent subcutaneous emphysema. Conclusion: The results of this case series suggest CO2 insufflation during knee arthroscopy can be performed safely with minimal systemic complications and provide an alternative environment for treating osteochondral defects requiring a dry field in the knee.

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Midterm Results of Fresh-Frozen Osteochondral Allografting for Osteochondral Lesions of the Talus

Foot & Ankle International ◽

10.1177/1071100720949861 ◽

2020 ◽

pp. 107110072094986

Author(s):

Chung-Hua Chu ◽

Ing-Ho Chen ◽

Kai-Chiang Yang ◽

Chen-Chie Wang

Keyword(s):

Short Form ◽

Case Series ◽

Osteochondral Allograft ◽

Osteochondral Lesions ◽

Midterm Results ◽

Level Of Evidence ◽

Allograft Transplantation ◽

Fresh Frozen ◽

The Mean

Background: Osteochondral lesions of the talus (OLT) are relatively common. Following the failure of conservative treatment, many operative options have yielded varied results. In this study, midterm outcomes after fresh-frozen osteochondral allograft transplantation for the treatment of OLT were evaluated. Methods: Twenty-five patients (12 women and 13 men) with a mean age 40.4 (range 18-70) years between 2009 and 2014 were enrolled. Of 25 ankles, 3, 13, 4, and 4 were involved with the talus at Raikin zone 3, 4, 6, and 7 as well as one coexisted with zone 4 and 6 lesion. The mean OLT area was 1.82 cm2 (range, 1.1-3.0). The mean follow-up period was 5.5 years (range, 4-9.3). Outcomes evaluation included the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, visual analog scale score, and 12-item Short Form Health Survey (SF-12). Result: AOFAS ankle-hindfoot score increased from 74 preoperatively to 94 at 2 years postoperatively ( P < .001) and the SF-12 physical health component scores increased from 32 to 46 points ( P < .001). Incorporation was inspected in all patients in the latest follow-up, and graft subsidence and radiolucency were observed in 2 and 7 cases, respectively, whereas graft collapse and revision OLT graft were not observed. Bone sclerosis was found in 6 of 25 patients. Conclusion: With respect to midterm results, fresh, frozen-stored allograft transplantation might be an option in the management of symptomatic OLT. Level of Evidence: Level IV, retrospective case series.

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A Systematic Review of Fresh Osteochondral Allograft Transplantation for Osteochondral Lesions of the Talus

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00382 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0038

Author(s):

Gregory F. Pereira ◽

John Steele ◽

Amanda N. Fletcher ◽

Samuel B. Adams ◽

Ryan B. Clement

Keyword(s):

Systematic Review ◽

Survival Rate ◽

Graft Survival ◽

Graft Survival Rate ◽

Osteochondral Allograft ◽

Osteochondral Lesions ◽

Cochrane Central Register ◽

Allograft Transplantation ◽

Fresh Osteochondral Allograft

Category: Ankle Introduction/Purpose: The term osteochondral lesion of the talus (OLT) refers to any pathology of the talar articular cartilage and corresponding subchondral bone. In general, OLTs can pose a formidable treatment challenge to the orthopaedic surgeon due to the poor intrinsic ability of cartilage to heal as well as the tenuous vascular supply to the talus. Although many treatment options exist, including microfracture, retrograde drilling, autologous chondrocyte implantation (ACI), and osteochondral autograft transfer system (OATS) these options may be inadequate to treat large cartilage lesions. Osteochondral allografts have demonstrated promise as the primary treatment for OLTs with substantial cartilage and bone involvement. To our knowledge, this is the first systematic review of outcomes after fresh osteochondral allograft transplantation for OLTs. Methods: PudMed, the Cochrane Central Register of Controlled Trials, EMBASE, and Medline were searched using PRISMA guidelines. Studies that evaluated outcomes in adult patients after fresh osteochondral allograft transplantation for chondral defects of the talus were included. Operative results, according to standardized scoring systems, such as the AOFAS Ankle/Hindfoot scale and the Visual Analog Scale were compared across various studies. The methodological quality of the included studies was assessed using the Coleman methodology score. Results: There were a total of 12 eligible studies reporting on 191 patients with OLTs with an average follow-up of 56.8 months (range 6-240). The mean age was 37.5 (range 17-74) years and the overall graft survival rate was 86.6%. The AOFAS Ankle/Hindfoot score was obtained pre- and postoperatively in 6 of the 12 studies and had significant improvements in each (P<0.05). Similarly, the VAS pain score was evaluated in 5 of the 12 studies and showed significant decreases (P<0.05) from pre- to postoperatively with an aggregate mean preoperative VAS score of 7.3 and an aggregate postoperative value of 2.6. The reported short-term complication rate was 0%. The overall failure rate was 13.4% and 21.6% percent of patients had subsequent procedures. Conclusion: The treatment of osteochondral lesions of the talus remains a challenge to orthopaedic surgeons. From this systematic review, one can conclude that osteochondral allograft transplantation for osteochondral lesions of the talus results in predictably favorable outcomes with an impressive graft survival rate and high satisfaction rates at intermediate follow-up. [Table: see text]

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Osteochondral Allograft Transplantation of the Knee in Patients with an Elevated Body Mass Index

Cartilage ◽

10.1177/1947603518754630 ◽

2018 ◽

Vol 10 (2) ◽

pp. 214-221 ◽

Cited By ~ 5

Author(s):

Dean Wang ◽

Brian J. Rebolledo ◽

David M. Dare ◽

Mollyann D. Pais ◽

Matthew R. Cohn ◽

...

Keyword(s):

Body Mass Index ◽

Body Mass ◽

Short Form ◽

International Knee Documentation Committee ◽

Osteochondral Allograft ◽

Cartilage Defects ◽

Elevated Body Mass Index ◽

Allograft Transplantation ◽

Patient Responses

Objective To characterize the graft survivorship and clinical outcomes of osteochondral allograft transplantation (OCA) of the knee in patients with an elevated body mass index (BMI). Design Prospective data on 38 consecutive patients with a BMI ≥30 kg/m2 treated with OCA from 2000 to 2015 were reviewed. Complications, reoperations, and patient responses to validated outcome measures were examined. Failures were defined by any removal/revision of the allograft or conversion to arthroplasty. Results Thirty-one knees in 31 patients (mean age, 35.4 years [range, 17-61 years]; 87% male) met the inclusion criteria. Mean BMI was 32.9 kg/m2 (range, 30-39 kg/m2). Mean chondral defect size was 6.4 cm2 (range, 1.0-15.3 cm2). Prior to OCA, 23 patients (74%) had undergone previous surgery to the ipsilateral knee. Mean duration of follow-up was 4.1 years (range, 2-11 years). After OCA, 5 knees (13%) underwent conversion to unicompartmental (1) or total (4) knee arthroplasty. Two- and 5-year graft survivorship were 87% and 83%, respectively. At final follow-up, clinically significant improvements were noted in the pain (49.3-72.6) and physical functioning (52.9-81.3) subscales of the Short Form–36 ( P ≤ 0.001), International Knee Documentation Committee subjective form (43.5-67.0; P = 0.002), Knee Outcome Survey–Activities of Daily Living (58.2-80.4; P = 0.002), and overall condition subscale of the Cincinnati Knee Rating System (4.7-6.9; P = 0.046). Conclusions OCA can be a successful midterm treatment option for focal cartilage defects of the knee in select patients with a BMI ≥30 kg/m2.

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Mid Term 5-Year Follow Up of a Novel Algorithm for Non-Operative Weber B Ankle Fractures

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00366 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0036

Author(s):

Edward M Rooney ◽

Fred T Finney ◽

Paul Talusan ◽

James R Holmes ◽

David Walton

Keyword(s):

Pain Score ◽

Visual Analog Scale ◽

Weight Bearing ◽

Ankle Fractures ◽

Ankle Arthritis ◽

Analog Scale ◽

Post Traumatic ◽

Grading Scale ◽

Novel Algorithm

Category: Ankle, Ankle Arthritis, Trauma Introduction/Purpose: It is important to understand which isolated fibular fractures require surgical intervention. Several different radiographic guidelines have been used to interpret and predict stability of the injured ankle. Holmes et al previously described a novel algorithm used to assess stability and the ability to treat the stable injuries non-operatively. The one year results demonstrated favorable outcomes of these non-operative patients, however there is a question about the durability of these results and whether these patients developed post-traumatic degenerative changes over mid to long term follow up. Methods: An observational study based on a previous cohort of 51 patients studied from 2010 to 2013 with isolated Weber B ankle fractures was performed. These were defined as stable at the time of injury when the medial clear space (MCS) was less than 7 mm on the initial gravity stress radiographs along with a normal mortise relationship on weight bearing radiographs. 27 patients that were treated non-surgically, were brought back for a mid-term follow up with a mean of 6.8 years. American Orthopaedic Foot & Ankle Society (AOFAS) Hindfoot scores, Olerud-Molander Ankle (OMA) Score, and visual analog scale (VAS) pain score were collected in accordance with the prior study. Patient Reported Outcome Measurement Information System (PROMIS) scores were also collected including lower extremity, physical function, depression, and pain interference. Standing bilateral ankle radiographs were obtained, and assessed for MCS widening, and ankle arthritis using the Kellgren-Lawrence grading scale. Results: Average functional score results were (in comparison to 1-year outcomes): AOFAS Hindfoot, 95.7 (93.2); OMA Score, 95.2 (91.0); and visual analog scale pain score, 0.24 (0.57). Using a Wilcox Signed Ranks Test, there was a statistically significant increase in 5-year AOFAS Hindfoot scores as compared to 1-year scores in those same patients (p=0.005) There was no evidence of significant post-traumatic osteoarthritis based on the Kellgren-Lawrence grading scale. Conclusion: The previously described, novel at the time, algorithm for assessing stability of isolated Weber B ankle fractures and nonsurgical treatment with protected weight bearing has shown to produce excellent results for mid-term follow up with an average of 6.8 years. Additionally, these patients are not at increased risk for rapid progression of post-traumatic osteoarthritis. This further supports initial weight bearing radiographs as a reasonable assessment of ankle stability and validates the aforementioned algorithm as a safe and cost-effective functional treatment regimen.

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Osteochondral allograft transplantation for large Hill-Sachs lesions: a retrospective case series with a minimum 2-year follow-up

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-019-1366-8 ◽

2019 ◽

Vol 14 (1) ◽

Cited By ~ 1

Author(s):

Hongwu Zhuo ◽

Yangkai Xu ◽

Fugui Zhu ◽

Ling Pan ◽

Jian Li

Keyword(s):

Clinical Outcomes ◽

Case Series ◽

Osteochondral Allograft ◽

Satisfaction Rate ◽

Allograft Transplantation ◽

Constant Murley Score ◽

Significant Difference ◽

The Mean ◽

Graft Resorption

Abstract Purpose To investigate the clinical outcomes after osteochondral allograft transplantation for large Hill-Sachs lesions. Methods Patients who underwent osteochondral allograft transplantation for large Hill-Sachs lesions were identified. Clinical assessment consisted of active range of motion (ROM), American Shoulder and Elbow Surgeons score (ASES), Constant-Murley score, Rowe score, and patient satisfaction rate. Radiographic assessment was performed with CT scan. Results Nineteen patients met the inclusion criteria. The mean age was 21.7 years. The mean preoperative size of the Hill-Sachs lesion was 35.70 ± 3.02%. The mean follow-up was 27.8 months. All grafts achieved union at an average of 3.47 months after surgery. At the final follow-up, graft resorption was observed in 43.1% of patients. The average size of residual humeral head articular arc loss was 12.31 ± 2.79%. Significant improvements (P < .001) were observed for the active ROM, ASES score, Constant-Murley score, and Rowe score. The overall satisfaction rate was 94.7%. No significant difference was found between the resorption group and the nonresorption group in postoperative clinical outcomes. Conclusion Osteochondral allograft transplantation is a useful treatment option for patients with large Hill-Sachs lesions. Although the incidence of graft resorption may be relatively high, the clinical outcomes at a minimum 2-year follow-up are favorable. Level of evidence Level IV, case series

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