Outcome of autologous bone grafting with preservation of articular cartilage to treat osteochondral lesions of the talus with large associated subchondral cysts

2018 ◽  
Vol 100-B (5) ◽  
pp. 590-595 ◽  
Author(s):  
M. Sawa ◽  
T. Nakasa ◽  
Y. Ikuta ◽  
M. Yoshikawa ◽  
Y. Tsuyuguchi ◽  
...  
Keyword(s):  
Articular Cartilage ◽  
Bone Grafting ◽  
Osteochondral Lesions ◽  
Autologous Bone Grafting ◽  
Subchondral Cyst ◽  
Medial Malleolar Osteotomy ◽  
The Mean ◽  
Autologous Bone ◽  
American Orthopaedic

Aims The aim of this study was to evaluate antegrade autologous bone grafting with the preservation of articular cartilage in the treatment of symptomatic osteochondral lesions of the talus with subchondral cysts. Patients and Methods The study involved seven men and five women; their mean age was 35.9 years (14 to 70). All lesions included full-thickness articular cartilage extending through subchondral bone and were associated with subchondral cysts. Medial lesions were exposed through an oblique medial malleolar osteotomy, and one lateral lesion was exposed by expanding an anterolateral arthroscopic portal. After refreshing the subchondral cyst, it was grafted with autologous cancellous bone from the distal tibial metaphysis. The fragments of cartilage were fixed with 5-0 nylon sutures to the surrounding cartilage. Function was assessed at a mean follow-up of 25.3 months (15 to 50), using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot outcome score. The radiological outcome was assessed using MRI and CT scans. Results The mean AOFAS score improved from 65.7 (47 to 81) preoperatively to 92 (90 to 100) at final follow-up, with 100% patient satisfaction. The radiolucent area of the cysts almost disappeared on plain radiographs in all patients immediately after surgery, and there were no recurrences at the most recent follow-up. The medial malleolar screws were removed in seven patients, although none had symptoms. At this time, further arthroscopy was undertaken, when it was found that the mean International Cartilage Repair Society (ICRS) arthroscopic score represented near-normal cartilage. Conclusion Autologous bone grafting with fixation of chondral fragments preserves the original cartilage in the short term, and could be considered in the treatment for adult patients with symptomatic osteochondral defect and subchondral cysts. Cite this article: Bone Joint J 2018;100-B:590–5

scholarly journals Outcome of Autologous Bone Grafting with Preservation of Articular Cartilage to Treat Osteochondral Lesions of the Talus with Large Subchondral Cysts

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0010
Author(s):  
Mikiya Sawa ◽  
Tomoyuki Nakasa ◽  
Masahiro Yoshikawa ◽  
Yusuke Tsuyuguchi ◽  
Munekazu Kanemitsu ◽  
...  
Keyword(s):  
Articular Cartilage ◽  
Subchondral Bone ◽  
Bone Grafting ◽  
Ct Scans ◽  
Autologous Bone Grafting ◽  
Subchondral Cyst ◽  
The Mean ◽  
Autologous Bone ◽  
One Year

Category: Ankle Introduction/Purpose: Treatment options for osteochondral lesion of the talus (OLT) have substantially increased over the last decade. There are a wide variety of surgical treatments for OLT, and good clinical results have been reported. However, treatment for OLT with large subchondral bone cysts remains under discussion. The combination of autologous bone grafting for subchondral bone cyst with fixation of articular cartilage would be the desirable procedure for the repair of the large subchondral cyst preserving the original cartilage with native structure and geometry. The purpose of this study is to evaluate the clinical outcome of autologous cancellous bone graft and fixation of cartilage fragment for OLT with large subchondral cysts. Methods: Patients comprised seven men and five women, aged 14–70 (mean 35.9) years. All OLTs included full-thickness articular cartilage, extended through subchondral bone and were associated with subchondral cysts. The mean size of the cysts was 9 ×8.6 ×12.3 mm on preoperative CT. Medial lesions were exposed through an oblique medial malleolar osteotomy; lateral lesions through expansion of an anterolateral arthroscopic portal. After refreshed the subchondral cyst, it was grafted with autologous cancellous bone from the distal tibial metaphysis, then cartilage fragments were fixed with nylon suture to surrounding cartilage. Postoperative MRI and CT scans were acquired for all patients at one year after surgery. Seven patients requested screw removal although none had symptoms. The screws were removed and simultaneous arthroscopic examination was performed at 1.5–2 years after surgery with the patients’ permission. The cartilage repair was assessed according to the criteria of the International Cartilage Repair Society (ICRS). Results: Functional outcome was evaluated at 25.3 (15–50) months after surgery. Mean American Orthopedic Foot and Ankle Society ankle-hindfoot outcome score improved from 65.7 to 92 (90–100) postoperatively, with 100% patient satisfaction. All follow-up CT scans showed that the grafts were well consolidated with the surrounding subchondral bone. On MRI one year after surgery, no scans showed any signs of osteochondral graft instability. The mean ICRS arthroscopic score from follow-up arthroscopy was 11.1 (8–12) points, and represented nearly normal cartilage. Conclusion: Our study demonstrated good results of autologous bone grafting in preserving articular cartilage in cases of symptomatic OLT with subchondral cysts. In seven cases, we performed follow-up arthroscopy at 1.5–2 years after primary operation and the chondral fragment showed a smooth surface and good stability. The technique of autologous bone grafting with chondral fragment fixation could be a promising option for treatment of OLT with subchondral cysts.

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

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.

scholarly journals An evaluation of the efficacy of the locked plate with bone grafting in Sanders type III and IV intra-articular calcaneus fractures

2021 ◽  
Vol 9 ◽  
pp. 205031212110409
Author(s):  
Ali Varol ◽  
Yunus Oc ◽  
Bekir Eray Kilinc
Keyword(s):  
Bone Grafting ◽  
Plate Osteosynthesis ◽  
Locking Plates ◽  
Foot And Ankle ◽  
Calcaneal Fractures ◽  
Type Iii ◽  
Heel Height ◽  
The Mean ◽  
American Orthopaedic

Objective: To demonstrate the efficacy of locking plate osteosynthesis performed by an L-shaped lateral approach in patients with Sanders type III and IV intra-articular calcaneal fractures with posterior facet displacement. Methods: Fifty-three patients with Sanders type III or IV unilateral calcaneal fractures treated with locking plates and additional bone grafting were included in the study. Böhler and Gissane angles, and heel height values were measured on the radiological examinations. Clinical results of the patients were evaluated using the American Orthopaedic Foot and Ankle Society and Maryland evaluation criteria. The presence of arthrosis was investigated with Broden’s view. Preoperative and postoperative values were evaluated. Results: The mean Gissane angle was 119.32°, the mean Böhler angle was 9.47° and the mean heel height was 40.82 mm on radiographs at initial presentation of the patients. The mean Gissane angle was 114.63°, the mean Böhler angle was 23.33° and the mean heel height was 47.84 mm on the early postoperative radiographs of the patients. In patients, a mean 4.69° recovery was achieved in the Gissane angle, 13.86° in Böhler angle and 7.02 mm in heel height. On the most recent follow-up, Böhler angle was 21.49°, Gissane was 114.88° and the mean heel height was 46.95 mm. The mean American Orthopaedic Foot and Ankle Society score and Maryland score were 86.91 and 86.53, respectively, on the last follow-up. Conclusion: Internal fixation and grephonage using low-profile locking plates provides good functional results to patients since it facilitates anatomic restoration of the subtalar joint and correction of calcaneal height, width and varus/valgus heel.

Outcome of autologous bone grafting to osteochondral lesion of the talus with subchondral cyst

2017 ◽  
Vol 23 ◽  
pp. 114 ◽  
Author(s):  
M. Sawa ◽  
T. Nakasa ◽  
M. Yoshikawa ◽  
Y. Tsuyuguchi ◽  
N. Adachi
Keyword(s):  
Bone Grafting ◽  
Osteochondral Lesion ◽  
Autologous Bone Grafting ◽  
Subchondral Cyst ◽  
Autologous Bone

scholarly journals A case of subtrochanteric femur fracture nonunion with failed implant in situ treated with exchange nailing using interlock nail and autologous bone grafting: a case report

2021 ◽  
Vol 7 (4) ◽  
pp. 864
Author(s):  
Neetin P. Mahajan ◽  
Pranay Kondewar ◽  
Lalkar Gadod ◽  
Amey Sadar ◽  
Shubham Atal
Keyword(s):  
Clinical Outcome ◽  
Bone Grafting ◽  
Femur Fracture ◽  
Good Clinical Outcome ◽  
Non Union ◽  
Autologous Bone Grafting ◽  
Exchange Nailing ◽  
Autologous Bone ◽  
Subtrochanteric Femur Fracture

<p class="abstract">Subtrochanteric femur fracture accounts for 25% of all hip fracture and may land up in non-union due to the inadequate reduction and fixation tech, local muscle pull over fragments, biomechanical stress in subtrochanteric region and soft tissue interposition etc., non-union are managed with various choices of implants like exchange nailing , angle blade plate , dynamic condylar screw, augmentation of previous hardware with plate and by providing biological environments at fracture site using  bone graft. Strict adherence to principles of providing stability to fracture and providing environment for bony growth gives good clinical outcome. A 52 years old male with subtrochanteric femur fracture was operated with long PFN, later presented to us after 18 months with failure of the hardware and atrophic non-union manifesting as pain during walking and limping. Patient was operated with removal of implant and exchange nailing using femur interlock nail and autologous bone grafting from iliac crest graft. 1 year follow up showed complete bony union and abundant of callus formation. Patient is currently doing all the daily activities and have no complaints at present. At 1 year follow up there is complete union at non-union site and good clinical outcome is achieved. Exchange nailing with interlock nail and autologous bone grafting for treatment of atrophic non-union of subtrochanteric femur fractures gives good clinical outcome.</p>

scholarly journals Matrix-associated autologous chondrocyte implantation with autologous bone grafting of osteochondral lesions of the talus in adolescents: patient-reported outcomes with a median follow-up of 6 years

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Daniel Körner ◽  
Christoph E. Gonser ◽  
Stefan Döbele ◽  
Christian Konrads ◽  
Fabian Springer ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Bone Grafting ◽  
Autologous Chondrocyte Implantation ◽  
Osteochondral Lesions ◽  
Foot And Ankle ◽  
Autologous Bone Grafting ◽  
Patient Reported ◽  
Chondrocyte Implantation ◽  
Autologous Bone ◽  
Autologous Chondrocyte

Abstract Background This study presents patient-reported outcome measures after combined matrix-associated autologous chondrocyte implantation and autologous bone grafting in high-stage osteochondral lesions of the talus in adolescents. Methods A total of 12 adolescent patients (13 ankles) received matrix-associated autologous chondrocyte implantation and autologous bone grafting for a solitary osteochondral lesion of the talus at a single centre. The Foot and Ankle Outcome Score and Foot and Ankle Ability Measure were defined as outcome measures (median follow-up 80 months [range 22–107 months]). Pre- and postoperative ankle radiographs were evaluated according to the van Dijk ankle osteoarthritis scale. Results The study population consisted of four male and nine female cases (mean age at the time of surgery, 17.7 ± 2.1 years). Eight lesions were classified as traumatic and five as idiopathic. Twelve lesions were located medial vs one lateral in the coronal plane and all central in the sagittal plane. The median lesion size and depth were 1.3 cm2 (range 0.9–3.2 cm2) and 5 mm (range 5–9 mm), respectively. There were no perioperative complications in any of the cases. In 9 cases patient-reported outcome measures were available. The results of the Foot and Ankle Outcome Score subscales were symptoms, 70 ± 14; pain, 83 ± 10; activities of daily living, 89 ± 12; sports/recreational activities, 66 ± 26; and quality of life, 51 ± 17. The mean overall Foot and Ankle Outcome Score was 78 ± 13. The results of the Foot and Ankle Ability Measure subscales were activities of daily living, 81 ± 20; function/activities of daily living, 84 ± 13; sports, 65 ± 29; and function/sports, 73 ± 27. According to the function overall subscale of the Foot and Ankle Ability Measure, in two cases, the patients assessed the ankle function as normal, in three as nearly normal, and in three as abnormal (missing data, n = 1). Preoperative van Dijk scale: stage 0 in five cases and stage I in eight cases; postoperative van Dijk scale: stage 0 in four cases, stage I in 9 cases Conclusions Patient-reported outcome measures following matrix-associated autologous chondrocyte implantation and autologous bone grafting for high-stage osteochondral lesions of the talus in adolescents show heterogeneous results. Long-term limitations mainly affect sports and recreational activities. Osteochondral lesions of the talus are associated with osteoarthritis, even preoperatively. However, we did not find significant osteoarthritis progression after matrix-associated autologous chondrocyte implantation and autologous bone grafting in the long term.

Bone Autograft Coupled with Locking Plates Repairs Symptomatic Rib Fracture Nonunions

2018 ◽  
Vol 84 (6) ◽  
pp. 844-850
Author(s):  
Matthew C. Hernandez ◽  
Janani S. Reisenauer ◽  
Johnathon M. Aho ◽  
Muhammad Zeb ◽  
Cornelius A. Thiels ◽  
...  
Keyword(s):  
Bone Grafting ◽  
Rare Complication ◽  
Plate Fixation ◽  
Rib Fracture ◽  
Autologous Bone Grafting ◽  
Rib Fixation ◽  
Patient Reported ◽  
Autologous Bone ◽  
Bone Autograft

Symptomatic rib nonunions are a rare complication after rib fractures. Methods used to address these nonunions range from pain management, rib resection, and rib fixation with plates and occasional autologous bone grafting. Given potential complications associated with rib resections such as pulmonary hernia, we hypothesized that plate fixation and autologous bone grafting would yield satisfactory long-term outcomes and a high union rate. Patients (aged ≥18 years) at a single institution with a symptomatic rib nonunion who underwent surgical rib stabilization of the nonunion coupled with bone autograft were evaluated (2010–2014). Pertinent clinical, operative, radiologic, and follow-up data were abstracted. Univariate analyses to assess the relationship of clinical outcomes were performed. Six patients underwent nonunion repair with autograft and plating. The mean time from injury to surgical repair of nonunion was 15 (66.1) months. A median of 3 [1–3] ribs were repaired with surgery. Postoperative radiographic union was demonstrated on cross-sectional imaging at three months in four patients (57%) and in all patients at five months postoperatively. No patients developed postoperative pulmonary hernia during follow-up. All patients had a significant reduction in median patient-reported pain at follow-up. Surgical rib fixation and bone autograft can provide acceptable outcomes for patients with rib fracture nonunion. This method provides pain relief and promotes healing of the nonunion gap without pulmonary hernia development. Operative fixation and bone autograft should be considered as a viable technical alternative to resection alone for rib nonunion.

Autologous Chondrocyte Implantation “Sandwich” Technique Compared With Autologous Bone Grafting for Deep Osteochondral Lesions in the Knee

2017 ◽  
Vol 46 (2) ◽  
pp. 322-332 ◽  
Author(s):  
Tom Minas ◽  
Takahiro Ogura ◽  
Jeff Headrick ◽  
Tim Bryant
Keyword(s):  
Autologous Chondrocyte Implantation ◽  
Osteochondral Lesions ◽  
Sandwich Technique ◽  
Autologous Bone Grafting ◽  
Patient Satisfaction Survey ◽  
Chondrocyte Implantation ◽  
Autologous Bone ◽  
Autologous Chondrocyte

Background: Treating symptomatic osteochondral defects is challenging, especially in young adults with deep (>8-10 mm) empty defects after osteochondritis dissecans (OCD) or collapsed condyles secondary to avascular necrosis (AVN). For this population, osteoarthritis (OA) is inevitable if articular congruence is not restored. Purpose: To describe the autologous chondrocyte implantation (ACI) “sandwich” technique with autologous bone grafting (ABG) and compare it with ABG alone for restoration of the osteochondral unit. The midterm to long-term outcomes in patients after the treatment for OCD and AVN will be reported and compared. Study Design: Cohort study; Level of evidence, 3. Methods: The outcomes for a consecutive cohort of 24 patients who underwent combined ABG with the ACI sandwich technique between 2001 and 2013 (ACI sandwich group) was compared with a historical control group of 17 consecutive patients who underwent ABG alone between 1995 and 2002 (ABG group) by a single surgeon for symptomatic deep (>8 mm) osteochondral lesions. Patients who were followed up with a minimum of 2 years were included in this study. The modified Cincinnati Knee Rating System, the Western Ontario and McMaster Universities Osteoarthritis Index, a visual analog scale (VAS), the Short Form–36, and a patient satisfaction survey were used to evaluate clinical outcomes. Survival analysis was performed using the Kaplan-Meier method, with no clinical improvement, graft failure, or conversion to prosthetic arthroplasty as the endpoint (failure). Kellgren-Lawrence (K-L) grading to assess OA progression was also performed. Results: In the ABG group, 13 of 17 patients (76%) were available with a mean follow-up of 15.7 years postoperatively (range, 5-21 years). In the ACI sandwich group, all 24 patients were available with a mean follow-up of 7.8 years postoperatively (range, 2-15 years). No significant differences were observed between the groups in terms of age, sex, side of the operated knee, body mass index, lesion type, lesion size, lesion depth, lesion location, or the need for realignment osteotomy. Eight patients (62%) were considered failures in the ABG group, while 3 patients (13%) were considered failures in the ACI sandwich group. The survival rate was significantly better in the ACI sandwich group than the ABG group (87% vs 54% at 5 years, respectively; P = .0025). All functional scores in patients with retained grafts significantly improved in the ACI sandwich group, whereas only the VAS score showed significant improvement in the ABG group. The patient satisfaction survey showed a very high satisfaction rate in the ACI sandwich group, with over 90% of patients reporting their knees as good or excellent and being satisfied with the procedure. In the ACI sandwich group, K-L grading demonstrated no significant OA progression from preoperatively to a mean 5.1 years postoperatively. Conclusion: Our study showed that the ACI sandwich technique provided excellent and superior survival rates compared to ABG alone and significant improvements over midterm to long-term follow-up. This unique treatment offers native joint preservation for conditions that naturally will progress to OA and eventually require prosthetic arthroplasty.

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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