Arthroscopic Treatment of Chronic Osteochondral Lesions of the Talus: Long-term Results

2009 ◽  
Vol 2009 ◽  
pp. 141-142
Author(s):  
B.F. Morrey
Keyword(s):  
Arthroscopic Treatment ◽  
Long Term Results ◽  
Osteochondral Lesions

scholarly journals AB0858 TREATMENT ALGORITHM FOR ANKLE OSTEOCHONDRAL LESIONS AND DEFECTS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1736.2-1736
Author(s):  
O. Burianov ◽  
L. Khimion ◽  
T. Omelchenko ◽  
E. Levitskyi ◽  
V. Lyanskorynsky
Keyword(s):  
Bone Marrow ◽  
Ankle Joint ◽  
Bone Marrow Cells ◽  
Traditional Approach ◽  
Treatment Algorithm ◽  
Main Group ◽  
Long Term Results ◽  
Osteochondral Lesions ◽  
Traditional Treatment

Background:traumatic ankle joint osteochondral lesions and defects (OHLD) is frequent cause of OA, chronic pain and loss of joint function; results of traditional treatment strategy are often unsatisfyingObjectives:to develop treatment algorithm for OHLD based on evaluation of previously determined main prognostic factors.Methods:the analysis of long-term (36 ± 4.5 months) treatment results of 239 patients after traumatic ankle joint OHLD revealed the following factors with the greatest predictive value (defined by PC – prognostic coefficient) for good result of treatment (defined as AOFAS function score 75-100 points): age < 40 years (PC = 8.5); size of OHLD ≤ 1.0 cm2; volume ≤ 1.5 cm3(PC = 8.0); osteoarthritis stage ≤ II (PC = 7.2). Based on these factors, a step-by-step, discrete and alternative algorithm for the choice of treatment tactics was created. The algorithm includes use of arthroscopic or open debridement, abrasive chondroplasty, bone marrow regeneration stimulation (microfracturing or tunneling), mosaic osteochondroplasty, arthroplasty or arthrodesis, the use of cellular regenerative technologies (bone marrow cells, platelet riched plasma), and others. Patients of older age with advanced OA need complex, step up approach, surgical treatment combined with regenerative cell technologies. The effectiveness of the differentiated approach to treatment was studied in 72 patients with OHLD (main group) in comparing to 72 patients in whom traditional treatment approaches were used, based on the stage of injury according to the Berndt & Hardy classification (comparison group).Results:compared to the traditional approach, the developed algorithm and treatment system allowed to half terms of hospitalization, to reduce the intensity of pain syndrome (by NRS) and increase the functional activity (by AOFAS) by 25%. In 3 years after trauma good/excellent results of treatment demonstrated 86% patients of main group and 32,2% of patients from comparing group (p<0,05).Conclusion:implementation of the developed treatment algorithm increases the number of good and excellent long-term results by 2.6 times and reduces the number of complications and unsatisfactory results by 4.9 times.Disclosure of Interests:None declared

scholarly journals 13-year Follow-up of Treatment of Osteochondral Lesions with MACI

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0004 ◽  
Author(s):  
Chris Kreulen ◽  
Trevor Shelton ◽  
Jacqueline Nguyen ◽  
Eric Giza ◽  
Martin Sullivan
Keyword(s):  
Social Functioning ◽  
Physical Functioning ◽  
Bodily Pain ◽  
Long Term Results ◽  
Osteochondral Lesions ◽  
Sf 36 ◽  
Significant Difference ◽  
And Function

Category: Ankle, Arthroscopy, Hindfoot, Sports, Trauma Introduction/Purpose: Surgical management of osteochondral lesions of the talus (OLT) present an ongoing treatment challenge. Previously, matrix-induced autologous chondrocyte implantation (MACI) demonstrated improved pain and function at 7-years postoperative, providing evidence that MACI is a reliable method for treating cartilage. However, it is unknown the long- term results of MACI in OLT. The purpose of this study was to assess 13-year clinical follow-up data and the long-term success of this implant by comparing patient reported outcome measures (PROMs) pre-operatively, at 7-years post-operative, and at 13- years post-operative. Methods: A prospective investigation of MACI was performed on 10 patients with OLTs who had failed previous arthroscopic treatment. Of the 10 patients, 9 were available for 7-year and 13-year follow-up. Short Form Health Survey (SF-36) and the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot evaluation were utilized at pre-operative, 7-year, a 13-year postoperative. For each patient, a paired t-test was used to compare 13-year post-operative PROMs to pre-operative PROMs. A single factor analysis of variance (ANOVA) determined whether PROMs were different between pre-operative, 7-year post- operative, and 13-year post-operative time intervals. When a significant difference was detected, a post-hoc Tukey’s determined which time periods were different. Results: SF-36 data at 13-years showed significant improvements in Physical Functioning (p=0.012), Lack of Bodily Pain (p=0.017), and Social Functioning (p=0.007) compared with preoperative data. There were no differences in other components of the SF-36 outcomes (p>0.05). Although the AOFAS was on average 12 points higher at 13-years postoperative, this was not statistically significant (p=0.173). As for comparing PROMs over time, 13-years post-operative PROMs were comparable to 7-years post- operative (Table 1). There were better PROMs for Physical Functioning, Bodily Pain, and Social Functioning at 7- and 13-years post-operative compared to pre-operative while Physical Role Functioning was also better at 7-years post-operative compared to pre-operative. Conclusion: This study shows MACI provides greater pain relief and function at 13-years post-operative with stable long-term follow-up. MACI should be considered for osteochondral lesions that fail initial microfracture.

Long-term results after arthroscopic treatment of symptomatic Ellman grade 2 PASTA lesions

2019 ◽  
Vol 28 (7) ◽  
pp. 1356-1362 ◽  
Author(s):  
Fabian Plachel ◽  
Gundobert Korn ◽  
Andreas Traweger ◽  
Reinhold Ortmaier ◽  
Herbert Resch ◽  
...  
Keyword(s):  
Arthroscopic Treatment ◽  
Long Term Results

Osteochondral Transplantation in the Elbow Leads to Good Clinical and Radiologic Long-term Results

2011 ◽  
Vol 39 (12) ◽  
pp. 2619-2625 ◽  
Author(s):  
Stephan Vogt ◽  
Sebastian Siebenlist ◽  
Daniel Hensler ◽  
Lizzy Weigelt ◽  
Patrick Ansah ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Case Series ◽  
Magnetic Resonance Images ◽  
Weight Lifting ◽  
Long Term Results ◽  
Osteochondral Lesions ◽  
Osteochondral Transplantation ◽  
Level Of Evidence

Background: In the long-term follow-up after debridement, microfracture, or drilling of osteochondral lesions in the elbow, subsequent osteoarthritis is a problem. Osteochondral transplantation for these defects has become a more common procedure. However, long-term results are unknown. Purpose: This study was undertaken to evaluate long-term clinical and radiologic outcomes of advanced osteochondral lesions in the elbow treated with osteochondral transplantation. Study Design: Case series; Level of evidence, 4. Methods: The study included 8 patients with osteochondral lesions in the elbow who were treated by autologous osteochondral transplantation between 1996 and 2002. Patients (average age, 17 years) were evaluated pre- and postoperatively by Broberg-Morrey score to assess elbow function and by American Shoulder and Elbow Surgeons (ASES) score for pain analysis. In addition, radiographs (at the first postoperative day, and at 5-year and 10-year follow-up) and magnetic resonance images (8 to 12 weeks postoperatively, and at 5-year and 10-year follow-up) were made to evaluate the joint status. At last follow-up (range, 8-14 years postoperatively), 7 of 8 patients were seen for clinical examination and radiologic analysis. Results: The Broberg-Morrey score increased from an average of 75.9 ± 13.1 to 96.4 ± 2.4 and ASES score significantly improved as follows: worst pain, 7.9 ± 1.1 to 1.6 ± 1.9; rest pain, 3.14 ± 2.7 to 0.6 ± 1.5; weight-lifting pain, 7.6 ± 0.8 to 3.1 ± 1.6; and repetitive movement pain, 5.3 ± 2.4 to 1.6 ± 1.5. Compared with the contralateral side, there was a mean preoperative flexion lag of 12.5° ± 11.6°. At the final follow-up, flexion was free. The mean extension lag was reduced from average 5.4° ± 5.7° to 0°. Radiographs of 2 patients made at final follow-up showed mild signs of osteoarthritis (Kellgren and Lawrence grade I). Postoperative magnetic resonance images showed graft viability in all and a congruent chondral surface in 6 of 7 patients. Conclusion: Clinical long-term results after osteochondral transplantation in the elbow are good to excellent and comparable with midterm results in the literature. Therefore, this technique is a reliable option for satisfactory long-term results regarding treatment of advanced osteochondral lesions in the elbow.

FRI0395 PROGNOSIS OF TREATMENT OUTCOMES IN PATIENTS WITH ANKLE JOINT OSTEOCHONDRAL LESIONS AND DEFECTS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 796.1-796
Author(s):  
O. Burianov ◽  
L. Khimion ◽  
T. Omelchenko ◽  
V. Lyanskorynsky ◽  
E. Levitskyi
Keyword(s):  
Treatment Outcomes ◽  
Ankle Joint ◽  
Predictive Value ◽  
Long Term Results ◽  
Bayesian Probability ◽  
Treatment Result ◽  
Osteochondral Lesions ◽  
Prognostic System ◽  
Severity Of Injury

Background:in most cases osteochondral lesions and defects (OHLD) in the ankle joint are the consequences of trauma, and the results of their treatment depend on a number of factors. Some factors are directly related to the area of damage (depth, localization, size), others are connected to the patients age, presence of degenerative changes in the affected joint, comorbidities, body mass index (BMI), etc.Objectives:to develop an effective system for predicting long-term outcomes in patients with ankle joint OHLD.Methods:24 prognostic factors (age, gender, severity of injury, Charlson comorbidity index, BMI, OA stage, size of defect, localization of injury, degree of osteoporosis, contracture, instability, etc.) influence on the long-term (36 ± 4.5 months) treatment outcomes was analyzed by Bayesian probability analysis in 223 patients after ankle joint OHLD. The prognostic coefficient (PC) was calculated by Wald sequential analysis for each prognostic factor and prognostic system was developed for prediction of high, medium or low probability of positive treatment result, which was determined as a functional joint outcome in AOFAS 75 - 100 points.Results:the greatest predictive value for the positive result of OHLD treatment had the following factors: age< 40 years (PC = 8.5); BMI < 25 kg/m2(PC=7.0), time from trauma < 1 year (PC = 4,1); OA stage < II (PC = 7.2); size of OHLD <1.0 cm2; volume <1.5 cm3(PC = 8.0). The prognostic system is based on the calculating of total factors values for individual patients case in points (Σ PC). If Σ PC is less (-20) the probability of achieving a positive joint-saving result is absent; at Σ PC from (-20) to (+40) the probability is medium; and at Σ PC above (+40) probability is high. The accuracy of the prognostic assessment was retrospectively tested with a 95% confidence interval, the accuaracy of predicitive method – 84,17% (76,59-89,62)%.Conclusion:the size and volume of osteochondral damage, BMI, age and time from trauma has the greatest predictive value for the determination of the long-term results of treatment in patients with ankle joint OHLD; use of the developed prognostic method can be used as a basis for the clinical decision making in choosing different approaches in treatment.Disclosure of Interests:None declared

Long-term results of microfracture in the treatment of talus osteochondral lesions

2016 ◽  
Vol 24 (4) ◽  
pp. 1299-1303 ◽  
Author(s):  
Gökhan Polat ◽  
Ali Erşen ◽  
Mehmet Emin Erdil ◽  
Taha Kızılkurt ◽  
Önder Kılıçoğlu ◽  
...  
Keyword(s):  
Long Term Results ◽  
Osteochondral Lesions
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