AMIC procedure for treatment of osteochondral lesions of talus – A systematic review of the current litterature

2021 ◽  
Author(s):  
Christopher Jantzen ◽  
Lars Bo Ebskov ◽  
Jens Kurt Johansen
Keyword(s):  
Systematic Review ◽  
Osteochondral Lesions ◽  
Osteochondral Lesions Of Talus

Mesenchymal Stem Cells in the Treatment of Cartilage Defects of the Knee: A Systematic Review of the Clinical Outcomes

2021 ◽  
pp. 036354652098681
Author(s):  
Monketh Jaibaji ◽  
Rawan Jaibaji ◽  
Andrea Volpin
Keyword(s):  
Systematic Review ◽  
Stem Cells ◽  
Mesenchymal Stem Cells ◽  
Stem Cell ◽  
Mesenchymal Stem Cell ◽  
Osteochondral Lesions ◽  
Common Source ◽  
Significant Heterogeneity ◽  
Osteochondral Defects

Background: Osteochondral lesions are a common clinical problem and their management has been historically challenging. Mesenchymal stem cells have the potential to differentiate into chondrocytes and thus restore hyaline cartilage to the defect, theoretically improving clincal outcomes in these patients. They can also be harvested with minimal donor site morbidity. Purpose: To assess the clinical and functional outcomes of mesenchymal stem cell implantation to treat isolated osteochondral defects of the knee. A secondary purpose is to assess the quality of the current available evidence as well as the radiological and histological outcomes. We also reviewed the cellular preparation and operative techniques for implantation. Study Design: Systematic review. Methods: A comprehensive literature search of 4 databases was carried out: CINAHL, Embase, MEDLINE, and PubMed. We searched for clinical studies reporting the outcomes on a minimum of 5 patients with at least 12 months of follow-up. Clinical, radiological, and histological outcomes were recorded. We also recorded demographics, stem cell source, culture technique, and operative technique. Methodological quality of each study was assessed using the modified Coleman methodology score, and risk of bias for the randomized controlled studies was assessed using the Cochrane Collaboration tool. Results: Seventeen studies were found, encompassing 367 patients. The mean patient age was 35.1 years. Bone marrow was the most common source of stem cells utilized. Mesenchymal stem cell therapy consistently demonstrated good short- to medium-term outcomes in the studies reviewed with no serious adverse events being recorded. There was significant heterogeneity in cell harvesting and preparation as well as in the reporting of outcomes. Conclusion: Mesenchymal stem cells demonstrated a clinically relevant improvement in outcomes in patients with osteochondral defects of the knee. More research is needed to establish an optimal treatment protocol, long-term outcomes, and superiority over other therapies. Registration: CRD42020179391 (PROSPERO).

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

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]

MR Imaging of Osteochondral Lesions of Talus

1987 ◽  
Vol 11 (2) ◽  
pp. 296-301 ◽  
Author(s):  
Barry S. Yulish ◽  
George P. Mulopulos ◽  
Donald B. Goodfellow ◽  
Patrick J. Bryan ◽  
Michael T. Modic ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Osteochondral Lesions ◽  
Osteochondral Lesions Of Talus

scholarly journals Osteochondral autograft transfer (mosaicplasty) for treatment of patients with osteochondral lesions of talus

2020 ◽  
Vol 23 (1) ◽  
pp. 60-62
Author(s):  
Amir Sabaghzadeh ◽  
Fateme Mirzaee ◽  
Heydar Shahriari Rad ◽  
Fateme Bahramian ◽  
Ardeshir Alidousti ◽  
...  
Keyword(s):  
Osteochondral Lesions ◽  
Osteochondral Autograft ◽  
Osteochondral Autograft Transfer ◽  
Osteochondral Lesions Of Talus

scholarly journals Mid-Term Outcomes of Bone Marrow Stimulation for Primary Osteochondral Lesions of the Talus: A Systematic Review

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0039
Author(s):  
Yoshiharu Shimozono ◽  
James Toale ◽  
Conor Mulvin ◽  
Jari Dahmen ◽  
Gino MMJ Kerkhoffs ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Outcomes ◽  
Reoperation Rate ◽  
Osteochondral Lesions ◽  
Long Term Outcomes ◽  
Weighted Mean ◽  
Bone Marrow Stimulation ◽  
The Mean

Category: Ankle, Arthroscopy, Sports Introduction/Purpose: Arthroscopic bone marrow stimulation (BMS) is the most common reparative surgical intervention in the treatment of small osteochondral lesions of the talus (OLT). BMS has shown favorable short term clinical outcomes but several recent studies have shown less satisfactory results in the mid- to long-term due to fibrocartilagenous repair tissue deterioration over time following BMS. However, conflicting results with good mid- to long-term outcomes following BMS have been reported. There is still a lack of evidence on the success rates of BMS at mid-term and longer-term follow-up. The purpose of this systematic review was to evaluate the clinical evidence of mid- to long-term outcomes following BMS for the treatment of OLT. Methods: A systematic search of the MEDLINE, EMBASE and Cochrane Library databases was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Methodological quality of evidence was decifered using the Modified Coleman methodology score (MCMS). Studies reporting outcomes of BMS for primary ostechndral lesions at a minimum 4-year follow-up were included. Clinical outcomes, radiological outcomes, and reported data were evaluated. Results: Fifteen studies containing 853 patients (858 ankles) were included at a weighted-mean follow-up time of 71.9 (48-141) months. The mean age was 35.3 (24.7-41.9) and the mean lesion size was 110.5mm2 (87-140). Nine studies (60%) used the AOFAS ankle hindfoot score with a weighted-mean postoperative score of 89.9 (78.4-91.8). Six studies showed both pre and post-operative AOFAS scores and showed a weighted-mean improvement of 24.5 (16-38.5). Four studies utilised the VAS score. The weighted-mean postoperative VAS scores were 2.4 (1.8-2.6). Three studies (20%) measured post-opeartive MRI at mid-term using the MOCART score and showed 48% complete filling, 74% complete integration, 76% surface damage, and 78% inhomogeneous repair tissue. Complication rate was 3.2% and reoperation rate was 6% following BMS at mid-term. Conclusion: This systematic review found good clinical outcomes following BMS for primary OLT at mid-term follow-up based on the AOFAS score. The complication rates were relatively low and the data showed a reoperation rate of 6% at mid-term. However, the radiological and MRI outcomes did not show similarly positive results, which may lead to recurrence and reoperation at long-term. Data were variable and numerous aspects largely under-reported in the literature relevant to the systematic review. Further high quality studies, a validated outcome scoring system and further MRI reports are required to accurately assess the success of BMS at mid-term.

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