scholarly journals Fixation Technique Using PLLA Pins Gives Good Clinical Results Regardless of Bone Condition in Osteochondral Lesion of Talar Dome

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0031
Author(s):  
Tomoyuki Nakasa ◽  
Yasunari Ikuta ◽  
Yusuke Tsuyuguchi ◽  
Yuki Ota ◽  
Munekazu Kanemitsu ◽  
...  
Keyword(s):  
Articular Cartilage ◽  
Subchondral Bone ◽  
Clinical Results ◽  
Subchondral Bone Plate ◽  
Fixation Technique ◽  
Aofas Score ◽  
Second Look ◽  
Osteochondral Fragment ◽  
Bone Condition

Category: Ankle Introduction/Purpose: Osteochondral lesion of the talus (OLT) has various treatment options which are chosen depending on the stage, size and cartilage condition. The fixation technique can restore the natural congruency with the hyaline cartilage. However, it is not clear whether a bone condition such as the disruption of the subchondral bone plate will affect the clinical results after the fixation of the osteochondral fragment. We hypothesized that even if the subchondral bone plate were disrupted, if the articular cartilage condition in the osteochondral fragment were good, then the clinical results of the fixation technique would be good. The aim of this study was to explore whether the fragment’s bone condition affects clinical outcomes including second look arthroscopy. Methods: Eighteen ankles in 17 patients, which had undergone the fixation technique using poly-L-lactide (PLLA) pins, were included. The mean follow-up period was 18.8±8.9 months. They consisted of 10 males and 7 females, with a mean age of 20.1±10.1 years. Based on the fragment’s bone condition on preoperative CT, ankles were divided into 3 groups; normal, segmentation, and absorption groups. The American Orthopaedic Foot & Ankle Society (AOFAS) score were evaluated both pre and post surgery. On MRI, the BME area was measured, and stability, incorporation, subsidence, and the surface of the articular cartilage of the fragment were evaluated. Second look arthroscopic findings were evaluated in 13 ankles. The repair of OLT was assessed according to the criteria of the ICRS which are allocated for the degree of filling defect by repair tissue, integration, and surface appearance of the repair site. Results: The AOFAS score before surgery significantly improved from 72.1±2.8 points to 98.6±3.3 points at the final follow-up in all ankles. In each group, the AOFAS score improved and there were no significant differences in AOFAS score among the 3 groups at final follow-up. MRI at 1 year showed good incorporation and cartilage surface in all groups, but the bone marrow lesion in the absorption group was significantly larger than that in the other groups. In the second look arthroscopic findings, the ICRS scale for the normal, segmentation, and absorption groups produced 10.6±1.7 points, 9.8±1.9 points, and 10.7±1.2 points, respectively. Conclusion: Good clinical results including those of second look arthroscopy for osteochondral fragment fixation using PLLA pins in OLT were obtained, even in the case of disruption of the subchondral bone plate. Since the fixation procedure can restore the native contour of the articular cartilage surface, this surgical procedure is a viable option for large OLT lesions regardless of bone condition in the osteochondral fragment.

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.

scholarly journals Abstaining from symptomatic implants of modified tension band wiring by nonabsorbable suture fixation for transverse patella fractures

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Puripun Jirangkul ◽  
Arkaphat Kosiyatrakul
Keyword(s):  
Steel Wire ◽  
Clinical Results ◽  
Tension Band ◽  
Fixation Technique ◽  
Nonabsorbable Suture ◽  
Patella Fractures ◽  
Sufficient Stability ◽  
The Mean ◽  
Conventional Stainless Steel

Abstract Background Modified tension band fixation has become commonly used for transverse patella fractures. The conventional stainless steel wire provides sufficient stability but may be associated with complications. Objective The study aimed to evaluate the effectiveness of a new modified tension band fixation technique for transverse patella fractures using a nonabsorbable suture. Material and methods We present the result of a prospective series using a nonabsorbable suture (FiberWire) for transverse patella fractures. The mean follow-up period totaled 12 months. A total of 16 patients were evaluated by radiographic and clinical review. The postoperative clinical evaluation employed Lysholm and Böstman scores. Result All clinical results on follow-up were good to excellent. Minimal intra-articular joint stepping and further fracture displacement were recorded. No patient needed re-operation, and functional outcomes of the knee were satisfactory. No significant differences were found between the injured and contralateral knee range of motion. No symptomatic implants and skin complications were noted, and all fractures were completed heal within 15 weeks. Conclusion FiberWire provided sufficient stability and reduced postoperative complications. The results proved appropriate, and the technique has merit, as it obviates the need for re-operation.

scholarly journals Morphological change of OLT after excision of osteochondral fragment with microfracture on MRI

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0049
Author(s):  
Yusuke Tsuyuguchi ◽  
Tomoyuki Nakasa ◽  
Mikiya Sawa ◽  
Masahiro Yoshikawa ◽  
Yuki Ota ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Clinical Outcomes ◽  
Subchondral Bone ◽  
Return To Sports ◽  
Aofas Score ◽  
Postoperative Mri ◽  
Original Shape ◽  
Arthroscopic Microfracture ◽  
Osteochondral Fragment ◽  
And Cartilage

Category: Ankle Introduction/Purpose: Osteochondral lesion of talus (OLT) is treated by several procedures such as bone marrow stimulation technique, cartilage fragment fixation, or autologous osteochondoral bone implantation. The choice of surgical methods depends on the size of lesion and cartilage condition. For unstable small lesion, excision of osteochondral fragment is usually performed. Good clinical results after this procedure is reported, but it is unclear that the morphological repair of subchondral bone and cartilage like tissue at the lesion. The purpose of this study is to evaluate the restoration of subchondral bone and cartilage like tissue after arthroscopic microfracture with excision of osteochondral fragment, and to investigate the clinical outcomes of this operation for the athletes. Methods: From 2005 to 2015, 11 patients (6 men and 5 women) were performed arthroscopic microfracture with excision of osteochondral fragment for OLT. Average age was 28.6 years old (17 - 59 years old). The site of OLT was 10 medial and 1 lateral. The cases of athletes were 7 of 11 cases. The size of preoperative OLT by MRI, measure the depth of the resected site on 3-month postoperative MRI. And we evaluated the appearance of the repair site on 1 year postoperative MRI, clinical outcome using American Orthopaedic Foot and Ankle Society Clinical Rating System (AOFAS), return rate to sports, and period of return to the sports. Results: Preoperative size of lesion on MRI was 9.8 mm in sagittal view, and 6.0 mm in coronal view. Depth of the resected site in 3 months postoperative MRI was 3.1 mm. On one year postoperative MRI, the resected site was filled with cartilage like tissue, and the shape of restored site was good that mimicked the original shape (Figure 1). As for clinical outcome, AOFAS score was 65.4 points preoperatively, and it improved to 93.4 points 1 year postoperatively. In clinical outcomes of the athletes, all cases could return to sports. Average period to return sports was 5.6 months. Only in 1 case, mild pain during sports activity was remained. Preoperative AOFAS score of athletes was 71.4 points and it improved to 98.5 points postoperatively. Conclusion: According to this study, even if a symptom is mild, an early operation will be more likely to result in the early return to sports and good outcomes. In addition, these good outcomes and good congruency on 1 year postoperative MRI suggest that the restored cartilage like tissue is enough for the high activities. The cartilage is repaired with maintaining original shape of talus cartilage. And this method was effective for athletes and was able to get them return to sports with good outcome.

scholarly journals Cell-Free Osteochondral Scaffold for the Treatment of Focal Articular Cartilage Defects in Early Knee OA: 5 Years’ Follow-Up Results

2019 ◽  
Vol 8 (11) ◽  
pp. 1978 ◽  
Author(s):  
Andrea Sessa ◽  
Luca Andriolo ◽  
Alessandro Di Martino ◽  
Iacopo Romandini ◽  
Roberto De Filippis ◽  
...  
Keyword(s):  
Articular Cartilage ◽  
International Knee Documentation Committee ◽  
Clinical Results ◽  
Activity Level ◽  
Cartilage Defects ◽  
Mri Findings ◽  
Clinical Criteria ◽  
Osteochondral Scaffold ◽  
Articular Cartilage Defects

The purpose of this study was to investigate the clinical results at five years’ follow-up of a tri-layered nanostructured biomimetic osteochondral scaffold used for focal articular cartilage defects in patients meeting the criteria of early osteoarthritis (EOA). The study population comprised 22 patients (mean age: 39 years), prospectively assessed before surgery, at 24 and 60 months’ follow-up. Inclusion criteria were: at least two episodes of knee pain for more than 10 days in the last year, Kellgren-Lawrence OA grade 0, I or II and arthroscopic or MRI findings according to the European Society of Sports Traumatology, Knee Surgery & Arthroscopy (ESSKA) criteria. Clinical results demonstrated significant improvement in International Knee Documentation Committee (IKDC) subjective and objective scores and in Tegner score, although activity level never reached the pre-injury level. The complication rate of this study was 8.3%. Two patients underwent re-operation (8.3%), while a comprehensive definition of failure (including both surgical and clinical criteria) identified four failed patients (16.6%) at this mid-term follow-up evaluation. The use of a free-cell osteochondral scaffold represented a safe and valid alternative for the treatment of focal articular cartilage defects in the setting of an EOA, and was able to permit a significant clinical improvement and stable outcome with low complication and failure rates.

Arthroscopic-Assisted Versus All-Arthroscopic Ankle Stabilization Technique

2020 ◽  
Vol 41 (11) ◽  
pp. 1360-1367 ◽  
Author(s):  
Matteo Guelfi ◽  
Gustavo Araujo Nunes ◽  
Francesc Malagelada ◽  
Guillaume Cordier ◽  
Miki Dalmau-Pastor ◽  
...  
Keyword(s):  
Ankle Instability ◽  
Clinical Results ◽  
Pain Scale ◽  
Chronic Ankle Instability ◽  
Percutaneous Technique ◽  
Aofas Score ◽  
Level Of Evidence ◽  
Vas Score ◽  
The Mean

Background: Both the percutaneous technique with arthroscopic assistance, also known as arthroscopic Broström (AB), and the arthroscopic all-inside ligament repair (AI) are widely used to treat chronic lateral ankle instability. The aim of this study was to compare the clinical outcomes of these 2 arthroscopic stabilizing techniques. Methods: Thirty-nine consecutive patients were arthroscopically treated for chronic ankle instability by 2 different surgeons. The AB group comprised 20 patients with a mean age of 30.2 (range, 18-42) years and a mean follow-up of 19.6 (range, 12-28) months. The AI group comprised 19 patients with a mean age of 30.9 (range, 18-46) years and mean follow-up of 20.7 (range, 13-32) months. Functional outcomes using the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score and visual analog pain scale (VAS) were assessed pre- and postoperatively. Range of motion (ROM) and complications were recorded. Results: In both groups the AOFAS and VAS scores significantly improved compared with preoperative values ( P < .001) with no difference ( P > .1) between groups. In the AB group the mean AOFAS score improved from 67 (range, 44-87) to 92 (range, 76-100) and the mean VAS score from 6.4 (range, 3-10) to 1.2 (range, 0-3). In the AI group the mean AOFAS score changed from 60 (range, 32-87) to 93 (range, 76-100) and the mean VAS score from 6.1 (range, 4-10) to 0.8 (range, 0-3). At the final follow-up 8 complications (40%) were recorded in the AB group. In the AI group 1 complication (5.3%) was observed ( P < .05). Conclusion: Both the AB and AI techniques are suitable surgical options to treat chronic ankle instability providing excellent clinical results. However, the AB had a higher overall complication rate than the AI group, particularly involving a painful restriction of ankle plantarflexion and neuritis of the superficial peroneal nerve. Level of Evidence: Level III, retrospective comparative study.

Surgical Preparation for Articular Cartilage Regeneration Without Penetration of the Subchondral Bone Plate

2011 ◽  
Vol 39 (3) ◽  
pp. 624-631 ◽  
Author(s):  
Joerg Mika ◽  
Thomas O. Clanton ◽  
David Pretzel ◽  
Gerlind Schneider ◽  
Catherine G. Ambrose ◽  
...  
Keyword(s):  
Articular Cartilage ◽  
Subchondral Bone ◽  
Cartilage Regeneration ◽  
Bone Plate ◽  
Subchondral Bone Plate ◽  
Surgical Preparation ◽  
Articular Cartilage Regeneration

Resection-Induced Leveling of Elevated Plug Cartilage in Osteochondral Autologous Transplantation of the Knee Achieves Acceptable Clinical Results

2017 ◽  
Vol 46 (3) ◽  
pp. 617-622 ◽  
Author(s):  
Kohei Nishitani ◽  
Yasuaki Nakagawa ◽  
Shinichiro Nakamura ◽  
Shogo Mukai ◽  
Shinichi Kuriyama ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Cartilage Repair ◽  
Japanese Orthopaedic Association ◽  
Autologous Transplantation ◽  
International Knee Documentation Committee ◽  
Clinical Results ◽  
Level Of Evidence ◽  
Second Look ◽  
Osteochondral Autologous Transplantation

Background: Plug protuberance occasionally occurs in osteochondral autologous transplantation (OAT). The incongruity of plugs results in poor clinical outcomes, especially in cases of protuberance. However, a surgical procedure to deal with this problem has not been reported. Purpose/Hypothesis: The purpose was to evaluate the efficacy and safety of cartilage resection of elevated plugs, with the hypothesis that patients whose elevated plugs were resected and leveled would achieve clinical outcomes equivalent to those of patients with flush plugs. Study Design: Cohort study; Level of evidence, 3. Methods: Cases (group P) included 22 patients who underwent OAT of the knee and whose plugs showed protuberance greater than 1 mm that was resected with a scalpel to obtain smooth congruity, while controls (group C) included 22 background-matched patients who did not require plug resection. The International Knee Documentation Committee (IKDC) subjective score, IKDC objective grade, and Japanese Orthopaedic Association score for knee osteoarthritis (JOA knee score) were used preoperatively and at the final follow-up (mean ± SD, 49.3 ± 18.1 months). International Cartilage Repair Society (ICRS) Cartilage Repair Assessment was used to evaluate lesion healing during the second-look arthroscopy. Results: IKDC subjective scores of group C (82.5 ± 11.8) and group P (82.1± 15.1) showed no difference at the final follow-up. On postoperative IKDC objective grading, 86% of group C and 82% of group P patients were graded as “nearly normal” or better ( P = .639). The mean JOA knee scores of group C (90.9 ± 8.9) and group P (90.1 ± 9.5) did not differ significantly ( P = .647). Nine second-look arthroscopies were performed in group C versus 8 in group P, and all patients had plugs that were graded as “nearly normal” or better by the ICRS Cartilage Repair Assessment. Larger plugs tended to be used in those patients who required resection. Conclusion: Resection of the elevated plug surface did not negatively affect patient outcomes in the midterm follow-up period.

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