Second-Look Arthroscopic Evaluation and Clinical Outcome After Supramalleolar Osteotomy for Medial Compartment Ankle Osteoarthritis

2017 ◽  
Vol 38 (12) ◽  
pp. 1311-1317 ◽  
Author(s):  
Hong-Geun Jung ◽  
Dong-Oh Lee ◽  
Sang-Hun Lee ◽  
Joon-Sang Eom
Keyword(s):  
Clinical Outcome ◽  
Medial Compartment ◽  
Ankle Osteoarthritis ◽  
Second Look ◽  
Supramalleolar Osteotomy ◽  
Arthroscopic Evaluation

scholarly journals Second-Look Arthroscopic Evaluation and Clinical Outcome after the Supramalleolar Osteotomy for the Medial Compartment Ankle Osteoarthritis

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0000
Author(s):  
Hong-Geun Jung ◽  
Joon-Sang Eom ◽  
Dong-Oh Lee ◽  
Mao Yuan Sun ◽  
Hwa Jun Kang
Keyword(s):  
Bone Marrow ◽  
Articular Cartilage ◽  
Cartilage Regeneration ◽  
Medial Compartment ◽  
Ankle Osteoarthritis ◽  
Bone Marrow Stimulation ◽  
Second Look ◽  
Supramalleolar Osteotomy ◽  
The Mean ◽  
Articular Cartilage Regeneration

Category: Ankle, Ankle Arthritis, Arthroscopy, Hindfoot Introduction/Purpose: This study aimed to evaluate the clinical and radiological outcomes of asymmetric ankle osteoarthritis after supramalleolar osteotomy (SMO) without BMSP(bone marrow stimulation procedure) and confirm cartilage recovery by second look arthroscopy. The hypothesis was that SMO without BMSP for medial compartment ankle osteoarthritis would show tibio-talar articular cartilage regeneration in the medial compartment, as well as satisfactory clinical and radiological outcomes. Methods: We retrospectively reviewed 20 ankles of 18 consecutive patients who were followed up for over 1 year after SMO from August 2007 to February 2013. Visual analog scale (VAS) pain scores and the AOFAS ankle-hindfoot scores were used for the functional evaluations. The tibial anterior surface angles and the tibial lateral surface angles were measured on radiographs, and the ankle osteoarthritis was classified by the Takakura stage. Among the 20cases, 19 caseshad ankle arthroscopy performedprior to SMO, and second-look ankle arthroscopywas performed in 14 cases at postoperative 1 year. Tibio-talarcartilage regeneration was evaluatedaccording to the modified Outerbridge classification for the 12 cases that had undergone SMO without a bone marrow–stimulating procedure (BMSP). Results: The mean VAS and AOFAS scores significantly improved from 6.7 preoperatively to 1.2 postoperatively and from 60.9 preoperatively to 87.9 postoperatively, respectively (P<0.05). The mean TAS and TLS angles significantly improved from 83.5? and 76.5preoperatively to 94.4? and 80.3? postoperatively respectively (P<0.05). All preoperative TakakurastageIIIa cases and 1 case of preoperative stage IIIb improved to postoperative stage II. At 2nd look arthroscopy, articular cartilage regeneration of the medial compartment of the tibio-talar joint was observed in 10 of 12 cases (83%), whereas cartilage deterioration was not observed in any case.Cartilage grading, however, did not show correlations with clinical outcomes. Conclusion: SMO without BMSP for medial compartment ankle osteoarthritis demonstrated marked tibio-talar articular cartilage regeneration in the medial compartment (83%) by second look arthroscopy, as well as satisfactory clinical and radiological outcomes.

scholarly journals The Effect of Supramalleolar Osteotomy without Marrow Stimulation on Cartilage Regeneration for Medial Compartment Ankle Osteoarthritis: Second-Look Arthroscopic Evaluation of Cartilage Regeneration

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0005
Author(s):  
Jung-Won Lim ◽  
Hong-Geun Jung
Keyword(s):  
Patient Satisfaction ◽  
Articular Cartilage ◽  
Cartilage Regeneration ◽  
Ankle Arthroscopy ◽  
Medial Compartment ◽  
Ankle Osteoarthritis ◽  
Second Look ◽  
The Mean ◽  
Surface Angle ◽  
Articular Cartilage Regeneration

Category: Ankle Arthritis; Ankle; Arthroscopy Introduction/Purpose: The effect of supramalleolar osteotomy (SMO) without an additional bone marrow-stimulating procedure (BMSP) on articular cartilage regeneration in ankle joint still remains unknown. This study aimed to investigate whether SMO yielded favorable clinical and radiologic outcomes, and to evaluate whether the regeneration of articular cartilage could be observed after SMO without BMSP by second-look arthroscopy. Methods: 43 ankles after SMO (mean follow-up: 35.5 months) were retrospectively reviewed. Visual analog scale (VAS) pain score, American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, patient satisfaction were used for functional evaluations. The tibial anterior surface angle (TAS) and tibial lateral surface angle (TLS) were measured on radiographs, and ankle osteoarthritis was classified by Takakura stage. Among the 43 patients, 31 underwent ankle arthroscopy prior to SMO, and second-look arthroscopy was performed at 1-year postoperatively. Tibiotalar cartilage regeneration was evaluated according to the modified Outerbridge classification for the 29 patients who had undergone SMO without BMSP. Results: The mean VAS score and AOFAS score significantly improved from 6.4 preoperatively to 1.4 postoperatively and from 61.1 preoperatively to 88.4 postoperatively, respectively (P < 0.05). Regarding overall postoperative patient satisfaction, 18 (41.8%) patients reported their satisfaction as excellent, 23 (53.5%) as satisfied. The mean TAS and TLS significantly improved from 83.8° and 94.8° preoperatively to 78.4° and 82.2° postoperatively, respectively (P < 0.05). 23 out of 28 preoperative Takakura stage IIIa cases and 3 out of 7 IIIb cases improved to postoperative stage II. On second-look arthroscopy, cartilage regeneration of the medial compartment of the tibiotalar joint was observed in 26 of 29 patients (89.7%), whereas cartilage deterioration was not observed in any patient. Conclusion: Medial tibio-talar articular cartilage regeneration was observed in most cases (89.7%) of medial compartment ankle osteoarthritis after SMO without BMSP, which was confirmed with second-look arthroscopic evaluation. It also showed satisfactory clinical and radiologic outcomes with high patient satisfaction.

scholarly journals Changes of density distribution of the subchondral bone plate after supramalleolar osteotomy for valgus ankle osteoarthritis

2014 ◽  
Vol 32 (10) ◽  
pp. 1356-1361 ◽  
Author(s):  
Christian Egloff ◽  
Jochen Paul ◽  
Geert Pagenstert ◽  
Patrick Vavken ◽  
Beat Hintermann ◽  
...  
Keyword(s):  
Density Distribution ◽  
Subchondral Bone ◽  
Bone Plate ◽  
Subchondral Bone Plate ◽  
Ankle Osteoarthritis ◽  
Supramalleolar Osteotomy

scholarly journals Radiological and clinical outcome of lateral ankle instability with medial compartment osteoarthritis

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0002
Author(s):  
Sungwook Kim ◽  
Hong-Geun Jung ◽  
Jong-Soo Lee ◽  
Hwa Jun Kang ◽  
Mao Yuan Sun
Keyword(s):  
Clinical Outcome ◽  
Pain Score ◽  
Ligament Reconstruction ◽  
Ankle Instability ◽  
Degenerative Change ◽  
Medial Compartment ◽  
Functional Score ◽  
Lateral Ankle ◽  
Lateral Ankle Instability

Category: Ankle, Ankle Arthritis, osteoarthritis, ankle instability Introduction/Purpose: When lateral ankle instability (LAI) is not treated for long period, unbalanced loading on medial ankle may proceed to osteoarthritis (OA). Outcome studies about osteoarthritis with lateral ankle instability after stabilization, however, have rarely been reported. The authors have investigated the radiological and clinical outcome of ligament stabilization for LAI with medial compartment OA. Methods: The study is based on 25 ankles of LAI with medial compartment ankle OA that underwent lateral ankle ligament reconstruction from 2007 to 2014 with at least 1 year follow-up. The medial ankle OA was diagnosed with degenerative change of medial ankle on plain X-ray or MRI or arthroscopic findings. The OA was classified using Takakura stage, and arthroscopic degenerative change was classified by modified Outerbridge grading. Ligament stabilization surgery was done using either modified Broström procedure or lateral ligament reconstruction using semitendinosus tendon allograft. Arthroscopic synovectomy, debridement, and microfracture for osteochondral lesion were performed when needed. Clinical outcomes were evaluated using visual analogue scale (VAS) pain score, American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, Karlsson- Peterson score, and subjective patient satisfaction. Statistical analysis were done using Wilcoxon signed rank test. Results: The average instability duration was 98 (range, 12-480) months and the average follow up period was 46 (range, 13-108) months. Preoperative Takakura stage was mostly I (n=19, 76%) and II (n=4, 17%), and was same postoperatively. MRI OA findings of 18 ankles were medial cartilage denudation (17%), cartilage thinning/erosion (44%), medial osteophyte (50%), and loose bodies (30%). Modified Outerbridge grade 2 and 4 were most common (both 41%). The VAS pain score decreased from 6.1 ± 1.6 preoperatively to 1.8 ± 1.6 postoperatively (P<0.05). The AOFAS score improved from 61.8 ± 14.7 preoperatively to 90.0 ± 6.3 postoperatively, and the Karlsson-Peterson score improved from 54.5 ±14.4 to 89.4 ± 8.4 (P<0.05). There were no significant complications. All patients were satisfied. Conclusion: Ligament stabilization accompanied with arthroscopic procedure could draw good outcome, even without structural bony deformity correction. Even with no improvement in plain radiograph, functional score could be improved.

Arthroscopic Matrix-Encapsulated Autologous Chondrocyte Implantation: A Pilot Multicenter Investigation in Latin America

Cartilage ◽  
2020 ◽  
pp. 194760352091863
Author(s):  
Enrique Villalobos ◽  
Antonio Madrazo-Ibarra ◽  
Valentín Martínez ◽  
Anell Olivos-Meza ◽  
Cristina Velasquillo ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Cell Viability ◽  
Cartilage Repair ◽  
Autologous Chondrocyte Implantation ◽  
T2 Mapping ◽  
Second Look ◽  
Arthroscopic Evaluation ◽  
Chondrocyte Implantation ◽  
Autologous Chondrocyte

Objective. To evaluate minimum biosecurity parameters (MBP) for arthroscopic matrix-encapsulated autologous chondrocyte implantation (AMECI) based on patients’ clinical outcomes, magnetic resonance imaging (MRI) T2-mapping, Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score, and International Cartilage Repair Society (ICRS) second-look arthroscopic evaluation, laying the basis for a future multicenter study. Design. Pilot clinical study. We analyzed the logistics to perform AMECI to treat focal chondral lesions in different hospitals following strict biosecurity parameters related to tissue and construct transportation, chondrocyte isolation, and cell expansion. Patient progress was analyzed with patient-reported outcome measures, MRI T2-mapping, MOCART, and ICRS arthroscopic second-look evaluation. Results. Thirty-five lesions in 30 patients treated in 7 different hospitals were evaluated. Cell viability before implantation was >90%. Cell viability in construct remnants was 87% ± 11% at 24 hours, 75% ± 17.1% at 48 hours, and 60% ± 8% at 72 hours after implantation. Mean final follow-up was 37 months (12-72 months). Patients showed statistically significant improvement in all clinical scores and MOCART evaluations. MRI T2-mapping evaluation showed significant decrease in relaxation time from 61.2 ± 14.3 to 42.9 ± 7.2 ms ( P < 0.05). Arthroscopic second-look evaluation showed grade II “near normal” tissue in 83% of patients. Two treatment failures were documented. Conclusions. It was feasible to perform AMECI in 7 different institutions in a large metropolitan area following our biosecurity measures without any implant-related complication. Treated patients showed improvement in clinical, MRI T2-mapping, and MOCART scores, as well as a low failure rate and a favorable ICRS arthroscopic evaluation at a mid-term follow-up. Level of Evidence. 2b.

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