Arthroscopic-assisted Retrograde Drilling for the Treatment of Osteochondral Lesions of the Femoral Head

AbstractThe aim of the present study was to present clinical and radiological outcome of a hip fracture-dislocation of the femoral head treated with biomimetic osteochondral scaffold.An 18-year-old male was admitted to the hospital after a motorcycle-accident. He presented with an obturator hip dislocation with a type IVA femoral head fracture according to Brumback classification system. The patient underwent surgery 5 days after accident. The largest osteochondral fragment was reduced and stabilized with 2 screws, and the small fragments were removed. The residual osteochondral area was replaced by a biomimetic nanostructured osteochondral scaffold. At 1-year follow-up the patient did not complain of hip pain and could walk without limp. At 2-year follow-up he was able to run with no pain and he returned to practice sports. Repeated radiographs and magnetic resonance imaging studies of the hip showed no signs of osteoarthritis or evidence of avascular necrosis. A hyaline-like signal on the surface of the scaffold was observed with restoration of the articular surface and progressive decrease of the subchondral edema.The results of the present study showed that the biomimetic nanostructured osteochondral scaffold could be a promising and safe option for the treatment of traumatic osteochondral lesions of the femoral head.Study Design: Case report.

Download Full-text

Re-operation rate after surgical treatment of osteochondral lesions of the talus in paediatric and adolescent patients

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02282-z ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Daniel Körner ◽

Christoph E. Gonser ◽

Stefan Döbele ◽

Christian Konrads ◽

Fabian Springer ◽

...

Keyword(s):

Surgical Treatment ◽

Bone Grafting ◽

Cartilage Damage ◽

Osteochondral Lesions ◽

Retrograde Drilling ◽

Autologous Bone Grafting ◽

Operation Rate ◽

Group A ◽

Autologous Bone ◽

Group B

Abstract Background The aim of this study is to analyse the re-operation rate after surgical treatment of osteochondral lesions of the talus (OCLTs) in children and adolescents. Methods Between 2009 and 2019, 27 consecutive patients with a solitary OCLT (10 male, 17 female; mean age 16.9 ± 2.2 years; 8 idiopathic vs. 19 traumatic) received primary operative treatment (arthroscopy + bone marrow stimulation [BMS], n = 8; arthroscopy + retrograde drilling, n = 8; autologous chondrocyte implantation [ACI]/autologous bone grafting, n = 9; arthroscopy + BMS + retrograde drilling; n = 1; flake fixation, n = 1). Seventeen OCLTs were located at the medial and ten at the lateral talus. ‘Re-operation’ as the outcome measure was evaluated after a median follow-up of 42 months (range 6–117 months). Patients were further subdivided into groups A (re-operation, n = 7) and B (no re-operation, n = 20). Groups A and B were compared with respect to epidemiological, lesion- and therapy-related variables. Results Seven of 27 patients needed a re-operation (re-operation rate 25.9% after a median interval of 31 months [range 13–61 months]). The following operative techniques were initially used in these seven patients: arthroscopy + BMS n = 2, arthroscopy + retrograde drilling n = 4, ACI + autologous bone grafting n = 1. A comparison of group A with group B revealed different OCLT characteristics between both groups. The intraoperative findings according to the International Cartilage Repair Society (ICRS) classification revealed significantly more advanced cartilage damage in group B than in group A (p = 0.001). Conclusions We detected a re-operation rate of 25.9% after primary surgical OCLT treatment. Patients with re-operation had significantly lower ICRS classification stages compared to patients without re-operation.

Download Full-text

Arthroscopy-Assisted Retrograde Drilling of Osteochondral Lesions of the Talar Dome

Journal of the American Podiatric Medical Association ◽

10.7547/0950091 ◽

2005 ◽

Vol 95 (1) ◽

pp. 91-96 ◽

Cited By ~ 11

Author(s):

Scott C. Nelson ◽

Darryl M. Haycock

Keyword(s):

Clinical Presentation ◽

Osteochondral Lesion ◽

Final Diagnosis ◽

Osteochondral Lesions ◽

Resonance Imaging ◽

Talar Dome ◽

Advanced Imaging ◽

Retrograde Drilling ◽

High Index Of Suspicion

Traumatic ankle conditions can lead to long-term sequelae if a pathologic process is misdiagnosed. The clinical presentation of an osteochondral lesion of the talar dome requires the clinician to have a high index of suspicion, and advanced imaging is often necessary to make the final diagnosis. Treatment should be initiated once the lesion is appropriately staged by radiologic or magnetic resonance imaging. We discuss the use of arthroscopy-assisted retrograde drilling of the medial talar dome that spares the articular cartilage within the talotibial articulation. (J Am Podiatr Med Assoc 95(1): 91–96, 2005)

Download Full-text