scholarly journals Management of Hepple Stage V Osteochondral Lesion of the Talus with a Platelet-Rich Plasma Scaffold

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0043
Author(s):  
Zhongmin Shi
Keyword(s):  
Bone Graft ◽  
Cancellous Bone ◽  
Platelet Rich Plasma ◽  
Osteochondral Lesion ◽  
Osteochondral Lesions ◽  
Cancellous Bone Graft ◽  
Sf 36 ◽  
American Orthopaedic ◽  
Bone Autograft

Category: Ankle Introduction/Purpose: There has been no consensus on the treatment or prognosis of Hepple stage V osteochondral lesions of the talus (OLTs), especially for lesions greater than 1.5 cm2 in size. The objective of this study was to investigate the clinical outcomes achieved upon application of a platelet-rich plasma (PRP) scaffold with a cancellous bone autograft for Hepple stage V OLTs. Methods: Fourteen patients (mean age, 39 years) were treated with a cancellous bone graft and a PRP scaffold between 2013 and 2015. The mean time to surgical treatment was 23.5 months. Ankle X-ray and magnetic resonance imaging were performed at the final follow-up. Functional outcomes were evaluated according to the Visual Analog Scale (VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS) score, and Short Form36 (SF-36) score.The range of motion (ROM) of the ankle joint and complications also were recorded. Results: Thirteen patients completed the full follow-up, with a mean follow-up duration of 18 months. MRI demonstrated the complete regeneration of subchondral bone and cartilage in all patients.The postoperative VAS, AOFAS ankle and hindfoot, and SF-36 scores were improved significantly (all 𝑃 < 0.001) without obvious complications. Conclusion: We suggest that, for the Hepple stage V OLTs, management with cancellous bone graft and PRP scaffold may be a safe and effective treatment.

scholarly journals Management of Hepple Stage V Osteochondral Lesion of the Talus with a Platelet-Rich Plasma Scaffold

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Wenqi Gu ◽  
Tanzhu Li ◽  
Zhongmin Shi ◽  
Guohua Mei ◽  
Jianfeng Xue ◽  
...  
Keyword(s):  
Bone Graft ◽  
Cancellous Bone ◽  
Platelet Rich Plasma ◽  
Short Form ◽  
Osteochondral Lesion ◽  
Osteochondral Lesions ◽  
Cancellous Bone Graft ◽  
Sf 36 ◽  
American Orthopaedic

There has been no consensus on the treatment or prognosis of Hepple stage V osteochondral lesions of the talus (OLTs), especially for lesions greater than 1.5 cm2in size. The objective of this study was to investigate the clinical outcomes achieved upon application of a platelet-rich plasma (PRP) scaffold with a cancellous bone autograft for Hepple stage V OLTs. Fourteen patients (mean age, 39 years) were treated with a cancellous bone graft and a PRP scaffold between 2013 and 2015. The mean time to surgical treatment was 23.5 months. Ankle X-ray and magnetic resonance imaging were performed at the final follow-up. Functional outcomes were evaluated according to the Visual Analog Scale (VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS) score, and Short Form 36 (SF-36) score. The range of motion (ROM) of the ankle joint and complications also were recorded. Thirteen patients completed the full follow-up, with a mean follow-up duration of 18 months. MRI demonstrated the complete regeneration of subchondral bone and cartilage in all patients. The postoperative VAS, AOFAS ankle and hindfoot, and SF-36 scores were improved significantly (allP<0.001) without obvious complications. We suggest that, for the Hepple stage V OLTs, management with cancellous bone graft and PRP scaffold may be a safe and effective treatment.

scholarly journals Management of Hepple Stage V Osteochondral Lesion of Talus with Platelet-Rich Plasma (PRP) Scaffold

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0003
Author(s):  
Zhongmin Shi
Keyword(s):  
Bone Graft ◽  
Cancellous Bone ◽  
Platelet Rich Plasma ◽  
Short Form ◽  
Osteochondral Lesion ◽  
Surgical Techniques ◽  
Cancellous Bone Graft ◽  
Sf 36 ◽  
Osteochondral Lesion Of Talus

Category: Ankle Introduction/Purpose: There is no consensus on treatment or prognosis for Hepple stage V Osteochondral lesion of talus (OLTs), especially for lesion more than 1.5 cm2. This research was to investigate surgical techniques and clinical outcomes of platelet-rich plasma (PRP) scaffold for Hepple stage V OLTs. Methods: 14 patients were treated by cancellous bone graft with PRP gel scaffold between 2013 and 2015 with average age of 38.9 years old and mean set of 23.5 months. Ankle X-ray and MRI were obtained at the final follow-up for evaluation. Functional outcomes were scored by the Visual Analog Scale (VAS) score, American Orthopaedics Foot and Ankle Society (AOFAS) ankle- hindfoot score and Short Form (36) Survey score (SF-36). Range of motion (ROM) of ankle joint and complications were also recorded. Results: 13 patients got the final follow-up with a mean duration of 18 months. MRI showed complete regeneration of subchondral bone and cartilage in all patients. The post-operative VAS, AOFAS ankle-hindfoot score and SF-36 score improved significantly (P<0.0001) without obvious complications. Conclusion: We suggest that for the patients of Hepple stage V OLTs, cancellous bone graft with PRP scaffold may be a safe and effective treatment.

scholarly journals Osteochondral Lesions of the Talus: Few Patients Require Surgery

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0005
Author(s):  
Seung-Hwan Park ◽  
Sang Gyo Seo ◽  
Ho Seong Lee
Keyword(s):  
Osteochondral Lesion ◽  
Lesion Size ◽  
Nonoperative Treatment ◽  
Osteochondral Lesions ◽  
Sports Activity ◽  
Sf 36 ◽  
Outcome Scores ◽  
The Mean ◽  
Analogue Scales

Category: Ankle, Ankle Arthritis Introduction/Purpose: The frequency of progression of osteoarthritis and persistence of symptoms in untreated osteochondral lesion of the talus (OCL) is not well known. We report the outcome of a nonoperative treatment for symptomatic OCL. Methods: This study included 142 patients with OCLs from 2003 to 2013. The patients did not undergo immobilization and had no restrictions of physical activities. The mean follow-up time was 6 (3–10) years. Initial MRI and CT confirmed OCL and showed lesion size, location, and stage of the lesion. Progression of osteoarthritis was evaluated by standing radiographs. In 83 patients, CT was performed at the final follow-up for analyses of the lesion size. We surveyed patients for limitations of sports activity, and Visual Analogue Scales (VAS), AOFAS, and SF-36 were assessed. Results: No patients had progression of osteoarthritis. The lesion size as determined by CT did not change in 69/83 patients, decreased in 5, and increased in 9. The mean VAS score of the 142 patients decreased from 3.8 to 0.9 (p < 0.001), the mean AOFAS ankle–hindfoot score increased from 86 to 93 (p < 0.001), and the mean SF-36 score increased from 52 to 72 (p < 0.001). Only 9 patients reported limitations of sports activity. The size and location of the lesion did not correlate with any of the outcome scores. Conclusion: Nonoperative treatment can be considered a good option for patients with OCL.

scholarly journals The treatment of the atrophic clavicular nonunion by double-plate fixation with autogenous cancellous bone graft: a prospective study

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Jun Zhang ◽  
Peng Yin ◽  
Bo Han ◽  
Jianmin Zhao ◽  
Bo Yin
Keyword(s):  
Bone Graft ◽  
Cancellous Bone ◽  
Short Form ◽  
Plate Fixation ◽  
Statistical Significance ◽  
Bodily Pain ◽  
Clinical Results ◽  
Outcome Questionnaire ◽  
Cancellous Bone Graft ◽  
Sf 36

Abstract Background The objective of this study is to assess prospectively the effectiveness of double-plate fixation combined with autogenous cancellous bone graft in the treatment for the atrophic clavicular nonunion. Methods Between February 2013 and November 2017, a total of 12 patients with atrophic clavicular nonunion (mean age, 40.4 ± 9.0 years, range, 27–60 years) were treated by double-plate fixation with autogenous cancellous bone graft in our institute. The Constant Score System was used to evaluate the preoperative and final outcomes. The Short Form-36 (SF-36) outcome questionnaire was used to assess the final clinical results. Results All patients were followed-up, with the average follow-up of 34.7 ± 6.7 months (range, 24–48 months). The healing rate was 100% in our study. The mean time of bony union was 9 weeks (range, 8–10 weeks). One patient had a postoperative superficial infection, and the patient was cured by oral antibiotics and wound dressing. No implant-related complications (plate-screw loosening or breakage) were observed postoperatively. No vascular injury, neural impairment, or thoracic outlet syndrome was discovered preoperatively or postoperatively. There is a statistical significance between the preoperative and the postoperative constant scores (P < 0.05). All the patients were satisfied with their final clinical results by SF-36 outcome questionnaire. Average scores of the physical function and bodily pain components of the SF-36 were 94.2 ± 7.3 and 92.5 ± 5.8, respectively. Conclusion Our results presented that double-plate fixation with autogenous cancellous bone graft is an effective treatment for atrophic clavicular nonunion, especially for those with a significant bone defect.

scholarly journals Novel, vacuum-assisted method for harvesting autogenous cancellous bone graft and bone marrow from the proximal tibial metaphysis

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0014
Author(s):  
Paul Bagi ◽  
Raymond Walls
Keyword(s):  
Bone Marrow ◽  
Bone Graft ◽  
Cancellous Bone ◽  
Proximal Tibia ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Cancellous Bone Graft ◽  
Incision Length ◽  
Donor Site Pain

Category: Other Introduction/Purpose: Autogenous cancellous bone graft and bone marrow aspirate are commonly used in lower extremity fusion procedures. Autologous graft is considered the gold standard as it is osteogenic, osteoinductive, and osteoconductive, and is without the potential risks of graft-associated infection and immunologic reaction. Disadvantages include graft harvest time and donor site morbidity due to the surgical incision, approach and bone corticotomy. This study evaluated the safety and efficacy of a novel vacuum-assisted bone graft harvesting device which was able to obtain both cancellous bone and bone marrow for insertion into the arthrodesis sites of patients undergoing complex primary and revision lower extremity fusion procedures. Methods: Between March and November 2017, 9 patients had a foot and/or ankle complex primary or revision arthrodesis performed, with autogenous cancellous graft and bone marrow harvested from the ipsilateral proximal tibia. All patients were 18 years or older with no prior history of knee pain, injury, or surgery at the proximal tibia. Following a circular corticotomy, cancellous bone was harvested using a novel suction-powered, hand-driven bone curettage system (Avitus Orthopaedics, Farmington, CT). The donor site was backfilled with bone graft substitute. Incision length was recorded as well as surgical time from donor site incision to completion of graft acquisition. The volume of cancellous graft and bone marrow were separately recorded. All patients were non-weight bearing on the involved extremity for a minimum of 6 weeks post-operatively and all were evaluated at 2 and 6 weeks post-operatively for donor site pain and associated complications. Results: There were five male and four female patients with an average age of 51 years and 8 months. Procedures included six complex primary fusions and three revision subtalar or tibio-talar-calcaneal fusions for nonunion. Mean incision length was 2 cm (range 1.80-2.75 cm). Mean volume of obtained graft material included 25 cm3 of cancellous bone (range 9-30 cm3) and 21 cm3 bone marrow aspirate (range 10-40 cm3). Mean procedure time was 5 mins (range 4-8 mins), and average blood loss was less than 1 mL. Two patients had mild pain at 2 week follow-up; however, no patients reported donor site pain at 6 week follow-up. There were no major or minor complications including fracture, infection, hematoma formation, sensory changes, or wound healing issues. Conclusion: The use of an innovative, vacuum-assisted bone harvesting device allows large volumes of autogenous cancellous bone graft and marrow to be rapidly and readily obtained from the ipsilateral proximal tibia with minimal donor site morbidity.

scholarly journals Arthroscopically Assisted Bone Pegs Fixation Without Malleolar Osteotomy for Osteochondral Lesion of Talus

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0022
Author(s):  
Chul Hyun Park
Keyword(s):  
Osteochondral Lesion ◽  
Autogenous Bone ◽  
Osteotomy Site ◽  
Osteochondral Lesions ◽  
Aofas Score ◽  
Sf 36 ◽  
Ankle Joints ◽  
Arthroscopically Assisted ◽  
Osteochondral Lesions Of Talus

Category: Ankle, Arthroscopy Introduction/Purpose: Several surgical treatments have been suggested for osteochondral lesions of talus (OLT). Fixation of osteochondral fragment using bone pegs is physiologic and does not require removal of implants and has no risk of foreign body reaction. However, this procedure commonly requires osteotomy of malleolus to obtain sufficient surgical field. Therefore, it has longer rehabilitation and a risk of malunion of osteotomy site. We have performed bone pegs fixation without malleolar osteotomy through arthroscopic assistant. The purpose of this study was to introduce our technique and to evaluate clinical and radiographic outcomes of bone pegs fixation for OLT. Methods: Ten patients (10 ankles) with osteochondral lesions of talus were treated by arthroscopically assisted autogenous bone pegs fixation without malleolar osteotomy. Intraoperative assessments were evaluated site of lesion, size of fragment, and number of pegs. Clinical assessments were evaluated using VAS and AOFAS score preoperatively and at last follow-up. And SF-36 and ROM of ankle (comparing with uninvolved ankle (%)) was evaluated at last follow-up. Radiographic assessments were evaluated according to criteria as described by Kumai et al. Results: The lesion was on posteromedial side in 8 patients and anterolateral side in 2 patients. Mean fragment size was 9.6*13.5 mm. And mean number of used pegs were 2.6. VAS and AOFAS score significantly improved from 6.1 and 74.8 preoperatively to 1 and 93.7 at last follow-up. SF-36 was 80.5 at last follow-up. ROM of ankle joints revealed 97% of uninvolved ankle joints at the last follow-up. Radiographic results were good in 4 patients, fair in 5 patients, and poor in 1 patient. Conclusion: Arthroscopically assisted bone pegs fixation without malleolar osteotomy could be a treatment option for OTL with large fragment.

Seven-Year Follow-up of Matrix-Induced Autologous Implantation in Talus Articular Defects

2017 ◽  
Vol 11 (2) ◽  
pp. 133-137 ◽  
Author(s):  
Christopher Kreulen ◽  
Eric Giza ◽  
Judie Walton ◽  
Martin Sullivan
Keyword(s):  
Short Form ◽  
Bodily Pain ◽  
Case Series ◽  
Osteochondral Lesions ◽  
Clinical Evaluations ◽  
Sf 36 ◽  
Chondrocyte Implantation ◽  
Prospective Case Series ◽  
American Orthopaedic

Background. Osteochondral lesions of the talus (OLT) are difficult to treat because of the poor intrinsic healing capability of articular cartilage. Matrix-induced autologous chondrocyte implantation (MACI) has been shown to be a reliable method for treating cartilage lesions that fail to respond to traditional microfracture and debridement. The purpose of this study was to assess 7-year clinical follow-up data of this technique and demonstrate midterm success of this implant. Methods. A prospective investigation of MACI was performed on 10 patients with OLTs who had failed previous arthroscopic treatment. In all, 5 male and 5 female patients were included in the study. Of the 10 patients, 9 were available for 7-year follow-up. Functional and clinical evaluations were done at 7 years postoperatively using the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot evaluation and the Short Form Health Survey (SF-36) and compared with preoperative values. Results. SF-36 data at 7 years showed significant improvements in Physical Functioning (P < .01), Lack of Bodily Pain (P < .1), and Social Functioning (P < .001) compared with preoperative data. The mean AOFAS hindfoot scores of the 9 patients at 7 years was 78.3 ± 18.1 (P = .05) compared with their preoperative mean of 61.8 ± 14.3. Conclusions. MACI provides a stable midterm chondral replacement strategy for osteochondral lesions that fail initial microfracture. Levels of Evidence: Level IV: Prospective case series

Retrospective evaluation of outcomes of bone peg fixation for osteochondral lesion of the talus

2020 ◽  
Vol 102-B (10) ◽  
pp. 1349-1353
Author(s):  
Chul H. Park ◽  
Kwang-Soon Song ◽  
Jung R. Kim ◽  
Si-Wook Lee
Keyword(s):  
Osteochondral Lesion ◽  
Clinical Results ◽  
Osteochondral Lesions ◽  
Mri Findings ◽  
Aofas Score ◽  
Radiological Results ◽  
Osteochondral Fragment ◽  
The Mean ◽  
American Orthopaedic

Aims The hypothesis of this study was that bone peg fixation in the treatment of osteochondral lesions of the talus would show satisfactory clinical and radiological results, without complications. Methods Between September 2014 and July 2017, 25 patients with symptomatic osteochondritis of the talus and an osteochondral fragment, who were treated using bone peg fixation, were analyzed retrospectively. All were available for complete follow-up at a mean 22 of months (12 to 35). There were 15 males and ten females with a mean age of 19.6 years (11 to 34). The clinical results were evaluated using a visual analogue scale (VAS) and the American Orthopaedic Foot and Ankle Society (AOFAS) score preoperatively and at the final follow-up. The radiological results were evaluated using classification described by Hepple et al based on the MRI findings, the location of the lesion, the size of the osteochondral fragment, and the postoperative healing of the lesion. Results The mean VAS and AOFAS score improved significantly from 6.3 (4 to 8) and 70.6 (44 to 78) preoperatively to 1.6 (0 to 5) and 91.1 (77 to 100) at the final follow-up, respectively (p < 0.001). The classification on MRI was stage 2a in nine patients, stage 3 in 14, and stage 4 in two. The lesion was located on the posteromedial aspect of the dome of the talus in 19 patients, the anterolateral aspect in five, and the centrolateral aspect in one. The mean size of the fragment was 11.2 mm (5 to 20) horizontally, 10.4 mm (7 to 18) vertically, and 5.2 mm (3 to 10) deep, respectively. The postoperative healing state was good in 19 patients and fair in six. Conclusion Bone peg fixation for osteochondral lesions of the talus showed satisfactory clinical and radiographic results, without complications. This technique could be a good form of treatment for patients with this condition who have an osteochondral fragment. Cite this article: Bone Joint J 2020;102-B(10):1349–1353.

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