scholarly journals Effect Analysis of Iliac Bone Autografting for Hepple V Osteochondral Lesions of The Talus

2021 ◽  
Author(s):  
Xin Wang ◽  
Dong Zhang ◽  
Fengqi Zhang ◽  
Lin Jin ◽  
Donglin Shi ◽  
...  
Keyword(s):  
Ankle Joint ◽  
Donor Site ◽  
Iliac Bone ◽  
Osteochondral Lesions ◽  
Medial Malleolus ◽  
X Rays ◽  
The Difference ◽  
Ankle Function ◽  
Preoperative Score

Abstract BackgroundThis study aimed to analyze the efficacy of iliac bone autografting for Hepple V osteochondral lesions of the talus.MethodsThis retrospective study included 32 patients surgically treated for Hepple V osteochondral lesions of the talus from January 2015 to January 2020. All patients underwent open surgery. Ipsilateral iliac bone grafts were taken and filled with talar cartilage injury area. The improvement of postoperative ankle pain was evaluated by Visual Analogue Scale (VAS), and the improvement of ankle function was evaluated by the American Orthopaedic Foot & Ankle Society (AOFAS). During the postoperative follow-up, X-ray examination of the front and side of the ankle joint and CT of the ankle joint were performed to evaluate the bone cartilage healing in the graft area.ResultsThirty-two patients (32 ankles) (100%) returned for clinical and radiologic follow-up at an average of 28 (range, 24–36) months postoperatively. At 3 months postoperatively and at the last follow-up, the AOFAS scores were (80.4±3.6) and (89.2±6.4) respectively, which were significantly improved compared with the preoperative score (49.7 ± 8.1), and the difference was statistically significant (P<0.05). The VAS scores were (2.1±0.9) and (1.5±0.8) respectively, which were significantly better than the preoperative score (6.2±1.7), and the difference was statistically significant(P < 0.05). Re-examination of the front and side of the ankle joint x-rays and CT showed that the bone bone healing at the osteotomy of medial malleolus and osteochondral transplantation area. All patients had no pain at the donor site. No complications occurred in 32 patients at the last follow-up.ConclusionsWith iliac bone autografting for Hepple V osteochondral lesions of the talus can effectively relieve ankle joint pain and significantly improved ankle function. The clinical effect is remarkable.Level of evidence：Leve III, Retrospective series.

scholarly journals Effect analysis of iliac bone autografting for Hepple V osteochondral lesions of the talus

2022 ◽  
Vol 17 (1) ◽  
Author(s):  
Xin Wang ◽  
Dong Zhang ◽  
Fengqi Zhang ◽  
Lin Jin ◽  
Donglin Shi ◽  
...  
Keyword(s):  
Ankle Joint ◽  
Donor Site ◽  
Iliac Bone ◽  
Cartilage Injury ◽  
Osteochondral Lesions ◽  
Osteochondral Transplantation ◽  
The Difference ◽  
Ankle Function ◽  
Preoperative Score

Abstract Background Talar cartilage injury is a kind of disease that causes long-term and chronic pain of ankle joint. Autologous osteochondral transplantation has been viewed as an alternative choice for treating these lesions, but donor-site morbidity has limited its application. This study aimed to analyze the efficacy of iliac bone autografting for Hepple V osteochondral lesions of the talus. Methods This retrospective study included 32 patients surgically treated for Hepple V osteochondral lesions of the talus from January 2015 to January 2020. All patients underwent open surgery. Ipsilateral iliac bone grafts were taken and filled with talar cartilage injury area. The improvement of postoperative ankle pain was evaluated by Visual Analogue Scale (VAS), and the improvement of ankle function was evaluated by the American Orthopaedic Foot & Ankle Society (AOFAS). During the postoperative follow-up, X-ray examination of the front and side of the ankle joint and CT of the ankle joint were performed to evaluate the bone cartilage healing in the graft area. Results Thirty-two patients (32 ankles) (100%) returned for clinical and radiologic follow-up at an average of 28 (range 24–36) months postoperatively. At 3 months postoperatively and at the last follow-up, the AOFAS scores were (80.4 ± 3.6) and (89.2 ± 6.4), respectively, which were significantly improved compared with the preoperative score (49.7 ± 8.1), and the difference was statistically significant (P < 0.05). The VAS scores were (2.1 ± 0.9) and (1.5 ± 0.8), respectively, which were significantly better than the preoperative score (6.2 ± 1.7), and the difference was statistically significant (P < 0.05). Re-examination of the front and side of the ankle joint X-rays and CT showed that the bone healing at the osteotomy of medial malleolus and osteochondral transplantation area. All patients had no pain at the donor site. No complications occurred in 32 patients at the last follow-up. Conclusions With iliac bone autografting for Hepple V osteochondral lesions of the talus can effectively relieve ankle joint pain and significantly improved ankle function. Level of evidence Level III, Retrospective series.

Mosaicplasty for Osteochondral Lesions of the Talus

2013 ◽  
Vol 103 (1) ◽  
pp. 81-86 ◽  
Author(s):  
Chieh Chiang ◽  
Man-Kuan Au
Keyword(s):  
Recovery Of Function ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Osteochondral Lesions ◽  
Foot And Ankle ◽  
Resonance Imaging ◽  
No Donor ◽  
Medial Malleolar Osteotomy ◽  
Ankle Function

Two women (24 and 27 years old) noted pain in the affected ankle of several years’ duration. Radiography and magnetic resonance imaging revealed osteochondral lesions of the talus in both patients. The lesion sites measured 1.3 × 1.0 × 0.4 cm (0.52 cm3) and 2.0 × 1.9 × 0.5 cm (1.9 cm3). Each patient received a medial malleolar osteotomy with mosaicplasty. Donor plugs were obtained from the ipsilateral knee in both patients. Surgery was performed successfully in both patients without complications. At 2-year follow-up, both patients had recovered good ankle function, with no donor site morbidity. American Orthopedic Foot and Ankle Society ankle/hindfoot scores improved in the affected ankles from 16 to 84 in case 1 and from 43 to 87 in case 2. Mosaicplasty is effective in treating stage III or IV osteochondral lesions of the talus and results in good-to-excellent recovery of function. (J Am Podiatr Med Assoc 103(1): 81–86, 2013)

Is Subacromial Balloon Spacer Appropriate for Treatment of Irreparable Rotator Cuff Tears in Elderly Patients?

2019 ◽  
Vol 21 (6) ◽  
pp. 417-426
Author(s):  
Kamil Yamak ◽  
Hüseyin Gökhan Karahan ◽  
Taşkın Altay ◽  
Cemil Kayalı ◽  
Fırat Ozan
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Tears ◽  
Dash Score ◽  
X Rays ◽  
Preoperative Period ◽  
Subacromial Space ◽  
Significant Difference ◽  
The Difference ◽  
Quick Dash

Background. The aim of this study was to evaluate the clinical and radiographic results of surgical treatment of irreparable rotator cuff tears by subacromial balloon spacer insertion in patients over 65 years old. Material and methods. Results of patients with failed conservative treatment for irreparable rotator cuff tears and who underwent subacromial balloon spacer insertion were evaluated retrospectively. The VAS and Quick-DASH scores were used for clinical and functional assessment. Results. Eleven patients were included. Mean age of patients was 69.1 (range: 65-77) years old. Evaluation of anteroposterior shoulder x-rays revealed Hamada grade 2 and grade 1 arthropathy in 10 patients (91%) and 1 patient (9%),respectively. Mean duration of follow-up was 45.09 (±5.43,37-52) months. The difference in the subacromial space measured from standard AP shoulder x-rays in the preoperative period, in the 6th postoperative month, and at the end of follow-up was 5.44 mm (2.29), 6.51 mm (±2.23), and 5.08 mm (±2.13), respectively. Mean Quick-DASH score was 74.49(±14.36) in the preoperative period, compared to 72.19 (±14.38) at the end of follow-up. There was no statistically significant difference between preoperative period and end of follow-up scores in terms of mean Quick-DASH scores (p= 0.232). Mean VAS score was 7.09 (±0.831) in the preoperative period and 6.64 (±0.809) at the end of follow-up. No statistically significant difference was revealed in terms of mean VAS scores when preoperative and end of follow-up scores were compared (p=0.333). Conclusion. Clinical and radiographic results of subacromial balloon spacer insertion in the treatment of irreparable rotator cuff tears could not be evaluated as satisfactory.

scholarly journals The Association of the One-Abutment at One-Time Concept with Marginal Bone Loss around the SLA and Platform Switch and Conical Abutment Implants

2021 ◽  
Vol 11 (1) ◽  
pp. 74
Author(s):  
Nasreen Hamudi ◽  
Eitan Barnea ◽  
Evgeny Weinberg ◽  
Amir Laviv ◽  
Eitan Mijiritsky ◽  
...  
Keyword(s):  
Bone Loss ◽  
Test Group ◽  
Mucosal Barrier ◽  
Control Group ◽  
X Rays ◽  
Marginal Bone Loss ◽  
Bone Level ◽  
The Difference ◽  
The One

Objectives: Repeated abutment disconnection/reconnection may compromise the mucosal barrier and result in crestal bone level changes. The clinical significance of this phenomenon is not yet clear, as most studies on this topic are short-term. Therefore, the aim of the present study was to evaluate the influence of abutment disconnections and reconnections on peri-implant marginal bone loss over a medium-term follow-up period. Material and methods: Twenty-one patients (6 men and 15 women) with a mean age 66.23 ± 9.35 year at the time of implant placement were included. All patients who received two adjacent nonsubmerged implants were randomly assigned into one of the two groups: definitive multiunit abutments (DEFs) connected to the implant that were not removed (test group) or healing abutments (HEAs) placed at surgery, which were disconnected and reconnected 3–5 times during the prosthetic phase (control group). Peri-implant marginal bone levels (MBL) were measured through periapical X-rays images acquired immediately after the surgery (baseline), at 4–7 months immediately after prosthetic delivery, and at 1-year and 3-year follow-up visits. Results: No implant was lost or presented bone loss of more than 1.9 mm during the 3-year follow-up; thus, the survival and success rate was 100%. Peri-implant mucositis was noticed in 38.1% DEFs and 41.9% of HEAs at the 3-year follow-up assessment. At the end of 3 years, the MBL was −0.35 ± 0.69 mm for participants in the DEFs group and −0.57 ± 0.80 mm for the HEAs group, with significant statistical difference between groups. Conclusions: Immediate connection of the multiunit abutments reduced bone loss in comparison with 3–5 disconnections noted in the healing abutments 3 years after prosthetic delivery. However, the difference between the groups was minimal; thus, the clinical relevance of those results is doubtful.

scholarly journals Ligament Balancing During TAR in Varus Deformity by Open Wedge Osteotomy of the Medial Malleolus

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0000
Author(s):  
Joe Wagener ◽  
Christine Schweizer ◽  
Lukas Zwicky ◽  
Beat Hintermann
Keyword(s):  
Ankle Joint ◽  
Wedge Osteotomy ◽  
Deltoid Ligament ◽  
Medial Malleolus ◽  
Open Wedge ◽  
Open Wedge Osteotomy ◽  
Ankle Arthritis ◽  
Ligament Balancing ◽  
Ankle Replacement

Category: Ankle Arthritis Introduction/Purpose: After reducing the tilted talus during total ankle replacement (TAR) in severe varus deformities, the surgeon is faced to a contract medial joint and an abducted medial malleolus leaving a wide gutter. A sliding osteotomy will release the deltoid ligament but the “horizontal” position of the medial malleolus remains and bony containment of the ankle joint is not restored. We propose an open wedge osteotomy, which will both lengthen and adduct the medial malleolus and restore ligament balancing. Fixation is done by either screw or plate fixation. We present our primary results with this new technique. Methods: From 2008-2015 Total Ankle Replacement combined with open wedge medial malleolar osteotomy was done in 50 ankles (48 patients). Inclusion criteria: Takakura stages 3 and 4 ankle arthritis. Minimum follow-up was defined as one year. Results: Neutral alignment was achieved in all ankles at last follow-up. AOFAS score increased from 36 preoperative to 82 at last follow-up. In 15 Ankles an additional bony procedure was done during the TAR surgery (Calcaneus Osteotomy: 5, Dorsiflexion Osteotomy of first ray: 6, Fibula Osteotomy: 4, peritalar fusion: 4) Complications included one non-union of the medial malleolus, which resolved after revision. One deep infection that was treated in a staged procedure with reimplantation of a TAR and no recurrence of infection. Two luxations of the polyethylene due to insufficient lateral ligaments and syndesmotic dehiscence, both were stable at final follow-up after revision (ligament reconstruction and tight-rope Fixation). Conclusion: Open wedge osteotomy of the medial malleolus restores the bony containment of the ankle joint and decreases the tension of the deltoid ligament. It is a valuable tool for ligament balancing during TAR.

Distally Based Adipofascial Sural Flap for Foot and Ankle Reconstruction

2011 ◽  
Vol 101 (1) ◽  
pp. 41-48 ◽  
Author(s):  
Ali Mojallal ◽  
Christo D. Shipkov ◽  
Fabienne Braye ◽  
Pierre Breton
Keyword(s):  
Donor Site ◽  
Case Series ◽  
Dorsal Side ◽  
Medial Malleolus ◽  
Foot And Ankle ◽  
Sural Flap ◽  
Post Traumatic ◽  
Distally Based ◽  
Age Range

Background: This retrospective study of a case series analyzed the results from the application of a distally based adipofascial sural flap for nonweightbearing defects of the foot and ankle. Methods: Twenty-eight patients with post-traumatic ankle and foot defects (ten women and 18 men; age range, 17–63 years) underwent surgery between November 1, 2003, and November 30, 2008. Distally based adipofascial sural flaps were used in ten open fractures, 14 soft-tissue post-traumatic defects, and four deep burns. Defects were on the dorsal side of the foot (eight cases), the lateral malleolus (four cases), the medial malleolus and inframalleolar region (four cases), the Achilles tendon region (eight cases), and the anterior surface of the ankle (four cases). Surgical procedures were performed by a single surgeon (A.M.). Results: All of the flaps healed uneventfully. There was no partial or total flap loss. All 28 patients walked normally at the time of follow-up. Three delayed healings occurred at the donor site. Conclusions: This is a homogeneous series of lower-limb reconstructions with the distally based adipofascial sural flap, which permits better analysis of the results. This flap has a constant and reliable blood supply. It can be used for the reconstruction of nonweightbearing foot and ankle regions to avoid the bulky volume of the fasciocutaneous flap in this area and to minimize the donor site scar. (J Am Podiatr Med Assoc 101(1): 41–48, 2011)

Relationship Between Tibiotalar Joint Space and Ankle Function Following Ankle Surgery

2020 ◽  
pp. 107110072096249
Author(s):  
Jess Mullens ◽  
Ingrid K. Stake ◽  
Lauren M. Matheny ◽  
Blake Daney ◽  
Thomas O. Clanton
Keyword(s):  
Ankle Joint ◽  
Physical Component Summary ◽  
Short Form ◽  
Joint Space ◽  
Ankle Arthrodesis ◽  
Level Of Evidence ◽  
Joint Preserving Surgery ◽  
Ankle Surgery ◽  
Ankle Function

Background: Joint-preserving procedures of the ankle may postpone the need for ankle arthrodesis (AA) or total ankle replacement (TAR). The challenge for the surgeon is to determine which patients may benefit from these joint-preserving procedures. We hypothesized that patents with less than 2 mm of ankle joint space on preoperative radiographs would report inferior outcomes following joint-preserving surgery compared with those with 2 mm or greater joint space. Methods: Patients 18 years of age or older treated with joint-preserving ankle surgery with a minimum of 2 years of follow-up were considered for study inclusion. The ankle joint space was measured on standardized weightbearing preoperative radiographs. At follow-up, patients completed questionnaires including the Foot and Ankle Ability Measure (FAAM) Activities of Daily Living (ADL) and Sports subscales, the Short Form-12 (SF-12) Physical Component Summary and Mental Component Summary, the Tegner Activity Scale, and satisfaction with outcome. Results: A total of 251 patients were included in the study. Forty-three patients had an ankle joint space of less than 2 mm. Compared with the 208 patients with an ankle joint space of 2 mm or greater, they had inferior FAAM ADL, FAAM Sports, and SF-12 Physical Component Summary scores ( P = .001, P = .001, and P = .006, respectively). Additionally, a statistically significant positive correlation between joint space distance and the FAAM ADL ( P = .012, r = 0.158), FAAM Sports ( P < .001, r = 0.301), and SF-12 Physical Component Summary ( P < .010, r = 0.163) scores was found. Conclusion: Patients with a preoperatively narrowed ankle joint space of less than 2 mm had significantly lower outcome scores following joint-preserving ankle surgery compared with patients with preserved ankle joint space. These results may assist clinicians in selecting patients who may benefit from ankle joint–preserving procedures, as well as counseling patients with a narrowed ankle joint space regarding expected outcome after joint-preserving ankle surgery. Level of Evidence: Level II, prognostic comparative study.

scholarly journals The outcome of a single percutaneous cannulated screw fixation in posterior malleolus fracture accompanied by medial or lateral malleolus fracture

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0037
Author(s):  
Yoo Jung Park ◽  
Yougun Won
Keyword(s):  
Range Of Motion ◽  
Ankle Joint ◽  
Screw Fixation ◽  
Cannulated Screw ◽  
Medial Malleolus ◽  
Posterior Malleolus ◽  
Significant Difference ◽  
Group 2 ◽  
Group 1

Category: Trauma Introduction/Purpose: Posterior malleolus fractures occur most commonly in the setting of a rotational ankle fracture. In the treatment of posterior malleolus fractures, the indications for the surgical procedure are determined by the size of the fragment and the articular congruity of the tibiotalar joint. In general, the size of the bone fragment is known to be an indication of surgery if it involves more than 25% of the joint surface, and if it is less than that, anatomical reduction and fixation of only lateral or medial malleolus was suggested. We evaluate the clinical and radiological results of fixation and early range of motion exercise using a single cannulated screw when the fragment of the posterior malleolus fracture is less than 25%. Methods: Among 60 patients with SER stage 3 or 4 who had undergone surgery from March 2010 to March 2014, percutaneous cannulated screw fixation was performed for posterior malleolus in 30 cases (Group 1). In the other 30 cases (Group 2), we did not perform the fixation for posterior malleolus fracture and only cast immobilization was done after fixation for lateral or medial malleolus. Mean follow-up period was 14.8 weeks(12~18) for the Group 1, 12.9 weeks(12~18) for Group 2. Mean age of patients was 46.6(19~78) for Group 1, 50.2(19~74) for Group 2. The range of motion was checked at week 2, 4, 12, and at last follow-up. Results: There was no significant difference of time to union and union rate between two groups, and AOFAS score between two groups also showed no significant difference(91.94(83~100) vs 90.8(85~100), p = 0.45). The range of motion of ankle joint at the final follow-up showed significant difference (Ankle ROM 52.7’ (45’~65’) vs 45.3’(35’~65’), (p<0.01) and complications between two groups also showed no significant difference. Conclusion: A single percutaneous cannulated screw fixation in posterior malleolus fracture accompanied by medial or lateral malleolus fracture can be performed in fractures with small fragment size and minimal displacement. We found that it can be a effective method to achieve early and wide range of motion of ankle joint after posterior mallolus fracture.

scholarly journals Aesthetic Treatment of Tillaux-Chaput fractures

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0022
Author(s):  
Shi-Ming Feng
Keyword(s):  
Internal Fixation ◽  
Closed Reduction ◽  
Weight Bearing ◽  
Ankle Arthroscopy ◽  
X Rays ◽  
The Mean ◽  
American Orthopaedic ◽  
Ankle Function ◽  
Primary Healing

Category: Arthroscopy Introduction/Purpose: This study aim to investigate the clinical result of treating Tillaux-Chaput fractures using the all-inside ankle arthroscopy technique. Methods: We retrospectively evaluated 23 Tillaux-Chaput fractures patients who underwent all-inside ankle arthroscopy technique and were follow-up from May 2013 to June 2016. There were 15 males and 8 females, with the mean age of 30.4 years (range, 10-57 years). Right ankle was involved in 15 patients and left ankle in 8 patients. Eighteen patients had single Tillaux-Chaput fractures and 5 patients had combined proximal fibular fractures. While 20 cases were diagnosed by X-rays and 3 cases by CT. Ankle arthroscopy was used through the anterolateral and anteriormedal approaches for closed reduction and internal fixation using Herbert screw(s). The joints function was performed using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle hindfoot scale score. Results: Operative incisions of 23 cases were primary healing without complications of nerve, vessel and tendon injuries. The period of follow-up was 19.6 months (range, 12-25 months) and the time of Fracture union was 23.3 weeks (range, 12-36 weeks). At the time of last follow-up, none of the patients had any restriction in the ankle function and range of motion, with the ankle pain and weight-bearing walking pain. AOFAS score was changed from preoperative 53.3 points to 92.1 points, with the excellent-good rate of 100%. Conclusion: All-arthroscopy teatment by the anterolateral and anteriormedal approaches is a precise and effective method for closed reduction and internal fixation of Tillaux-Chaput fractures and deserves clinical application.

Evaluation of Alveolar Bone Grafting: A Survey of ACPA Teams

2005 ◽  
Vol 42 (1) ◽  
pp. 99-101 ◽  
Author(s):  
Ananth S. Murthy ◽  
James A. Lehman
Keyword(s):  
North America ◽  
Cleft Palate ◽  
Bone Grafting ◽  
Iliac Crest ◽  
Alveolar Bone ◽  
Donor Site ◽  
X Rays ◽  
Alveolar Bone Grafting ◽  
Missing Tooth

Objective To evaluate the management of alveolar clefts by cleft palate and craniofacial teams in North America. Design An anonymous survey was mailed to 240 American Cleft Palate– Craniofacial Association teams across North America regarding alveolar bone grafting. The questionnaire included multiple questions about each team's approach to alveolar bone grafting and options for the missing tooth. Results Consensus was achieved in three areas: 90% of centers performed secondary alveolar bone grafting, 78% performed grafting between ages 6 and 9 years, and iliac crest donor site was the most popular site (83%). There was no consensus with respect to dental criteria for the timing of grafting, follow-up x-rays, or the use of a grading system for evaluating results. In addition, there was no consensus on the management of the missing tooth. Conclusion There is wide acceptance of secondary bone grafting and there is a consensus for the age of grafting (6 to 9 years) and donor site (iliac crest). The disturbing finding was the lack of postoperative x-ray evaluation of the results. With so much variability in management, the use of a routine, standardized scale to measure postoperative results would allow for better outcome studies in alveolar bone grafting.

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