scholarly journals Single-incision Non-weight-bearing Area Autologous Osteochondral Transplantation for the Treatment of Osteochondral Lesions of the Talus

2021 ◽  
Author(s):  
Yan Zhang ◽  
Jing-qi Liang ◽  
Xiao-dong Wen ◽  
Pei-long Liu ◽  
Jun Lu ◽  
...  
Keyword(s):  
Weight Bearing ◽  
Ankle Injuries ◽  
Osteotomy Site ◽  
Osteochondral Lesions ◽  
Medial Malleolus ◽  
Osteochondral Transplantation ◽  
Autologous Osteochondral Transplantation ◽  
Medial Malleolar Osteotomy ◽  
The Mean ◽  
Weight Bearing Area

Abstract Background: Autologous osteochondral transplantation (AOT) is one of the most effective treatments for osteochondral lesions of the talus (OLTs). Normally, medial malleolar osteotomy is used to expose posteromedial lesions. However, medial malleolar osteotomy causes additional ankle injuries and a risk of persistent pain in the ankle joint. The purpose of the current study was to evaluate a new medial malleolar triplane osteotomy method and the functional outcomes of AOT from a non-weight-bearing area of the talus for OLTs.Methods: Twenty-three patients (23 ankles), including 14 males and 9 females, received AOT with triplane osteotomy of the medial malleolus for symptomatic OLTs between September 2015 and December 2017. The mean age was 35.6 years. The mean size of the lesion area was 141.5 mm2. The visual analog scale (VAS) for pain during walking and the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score were used for the pre- and postoperative evaluations. In addition, the incorporation of the grafts was assessed by computed tomography (CT).Results: All patients had a minimum follow-up of 22 months, with an average of 37.1 months. The mean time from osteotomy to full weight-bearing activity was 8.1±2.3 weeks (range, 5-12 weeks). The VAS score improved from 4.34 preoperatively to 0.53 postoperatively (P <0.01). The AOFAS ankle-hindfoot score improved significantly in all domains (P<0 .01). Twenty-one patients returned to sport at their previous level, and 2 returned at a lower level compared with preinjury (mean return to play, 7.4 months). According to CT, the medial malleolus recovered in all patients, and the graft was incorporated well. One patient suffered from flexor hallucis longus tendon discomfort due to internal fixation screw irritation posteromedial to the ankle. The general complication rate was 4.3% (1/23).Conclusions: AOT combined with medial malleolus triplane osteotomy is a viable option for OLTs. Patients could perform weight-bearing exercise and return to sport as early as possible, with few complications at the osteotomy site and donor site.

scholarly journals Autologous Osteochondral Transplantation for Osteochondral Lesions of the Talus: Does Gender Impact Outcomes?

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0022
Author(s):  
Arianna L. Gianakos ◽  
Olasunmbo Okedele ◽  
Sean Flynn ◽  
John G. Kennedy ◽  
Christopher W. DiGiovanni
Keyword(s):  
Osteochondral Lesions ◽  
Symptom Duration ◽  
Osteochondral Transplantation ◽  
Autologous Osteochondral Transplantation ◽  
Duration Of Symptoms ◽  
Male And Female ◽  
Female Patients ◽  
Male Patients ◽  
The Mean

Category: Ankle; Arthroscopy Introduction/Purpose: Autologous osteochondral transplantation (AOT) is commonly used in the treatment of osteochondral lesions (OCL) of the talus. There is limited data comparing gender differences in the incidence, presentation, and outcomes following AOT. The purpose of this study is to compare these differences between male and female patients. Methods: Eighty-five consecutive patients who underwent AOT were retrospectively reviewed. Patients were divided into two groups based on gender. Demographic data and OCL defect characteristic data were recorded. Functional outcomes were assessed pre- and post-operatively using the Foot and Ankle Outcome Score (FAOS). The Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score was used to assess cartilage incorporation. The mean clinical follow-up was 47.2 months, with mean MRI follow-up of 24.8 months. Results: Fifty-five (65%) males and 30 (35%) females were included. OCL defect size was significantly larger in men (112.8mm2) when compared with women (88.7mm2) (p<0.0001). Male patients had a significantly longer duration of symptoms (p<0.001) and OCLs were more likely traumatic in nature (p=0.0006) when compared with female patients. Mean FAOS improved pre- to postoperatively from 50 to 81(P < .001) with a statistically significant increase in men (p<0.0001). The mean MOCART score was 82.1 and 86.7 in male and female patients, respectively (p<0.0001). Lesion size was negatively correlated with MOCART score (r = -0.36,P = .004). No differences were found in knee donor site morbidity, complication rate, or revision surgery. Conclusion: Our study demonstrates that male patients typically present with talar OCLs that are larger in size, traumatic in nature, and with longer symptom duration when compared with female patients. In addition, male patients had greater improvement in FAOS scores following AOT. Therefore, understanding these differences may influence the management and treatment of talar OCLs in male and female patients.

scholarly journals Platelet-Rich Plasma and Hyaluronic Acid Are Not Synergistic When Used as Biological Adjuncts with Autologous Osteochondral Transplantation

Cartilage ◽  
2017 ◽  
Vol 9 (3) ◽  
pp. 321-328 ◽  
Author(s):  
Niall A. Smyth ◽  
Keir A. Ross ◽  
Amgad M. Haleem ◽  
Charles P. Hannon ◽  
Christopher D. Murawski ◽  
...  
Keyword(s):  
Hyaluronic Acid ◽  
Platelet Rich Plasma ◽  
Treated Group ◽  
Saline Control ◽  
Osteochondral Lesions ◽  
Published Data ◽  
Osteochondral Transplantation ◽  
Autologous Osteochondral Transplantation ◽  
Histological Score ◽  
The Mean

Introduction Autologous osteochondral transplantation (AOT) is a treatment for osteochondral lesions with known concerns, including histological degradation of the graft and poor cartilage integration. Platelet-rich plasma (PRP) and hyaluronic acid (HA) have been described has having the potential to improve results. The aim of this study was to evaluate the effect of PRP and HA on AOT in a rabbit model. Methods Thirty-six rabbits underwent bilateral knee AOT treated with either the biological adjunct (PRP, n = 12; HA, n = 12; PRP + HA, n = 12) or saline (control). PRP and HA were administered as an intra-articular injection. The rabbits were euthanized at 3, 6, or 12 weeks postoperatively. The graft sections were assessed using the modified International Cartilage Repair Society (ICRS) scoring system. The results from the PRP alone group is from previously published data. Results The mean modified ICRS histological score for the PRP-treated group was higher than its control ( P = 0.002). The mean modified ICRS histological score for the HA-treated group showed no difference compared with its control ( P = 0.142). The mean modified ICRS histological score for the PRP + HA–treated group was higher than its control ( P = 0.006). There was no difference between the mean modified ICRS scores of the PRP- and the PRP + HA–treated grafts ( P = 0.445). Conclusion PRP may decrease graft degradation and improve chondral integration in an animal model. In this model, the addition of HA was not synergistic for the parameters assessed. Level of Evidence. Basic science, Level V. Clinical Relevance. PRP can be used as an adjunct to AOT, which may decrease graft degeneration and improve clinical outcomes. HA may not influence AOT.

scholarly journals The Effect of Containment Type on Clinical Outcome in Osteochondral Lesions of the Talus Treated with Autologous Osteochondral Transplantation

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0011
Author(s):  
Yoshiharu Shimozono ◽  
Youichi Yasui ◽  
Joseph Nguyen ◽  
John Kennedy
Keyword(s):  
Magnetic Resonance ◽  
Clinical Outcomes ◽  
Multivariate Regression ◽  
Regression Models ◽  
Osteochondral Lesions ◽  
Osteochondral Transplantation ◽  
Predictors Of Outcome ◽  
Autologous Osteochondral Transplantation ◽  
The Mean

Category: Ankle Introduction/Purpose: Operative management for osteochondral lesions of the talus (OLT) can be broadly divided into reparative techniques, including bone marrow stimulation (BMS), and replacement techniques, including autologous osteochondral transplantation (AOT). Predictors of outcome of BMS have been established as lesion size, containment of the lesion, and previous surgery. Predictors of outcome of AOT or allograft transplantation have been established as body mass index and the requirement for greater than 2 grafts. However, containment of the lesions has not been assessed as a predictor of outcome in patients undergoing AOT to date. Therefore, the purpose of the current study is to clarify the effect of the containment of OLT on clinical and radiological outcomes in patients who underwent AOT procedure for the treatment of OLT. Methods: A retrospective cohort study comparing patients with contained type and uncontained type OLT was undertaken, to include all patients who underwent AOT procedure for the treatment of OLT between 2006 and 2014. Analyses were performed by grouping the patients according to the containment type, location, and both the type of containment and location. Clinical outcomes were evaluated using the Foot and Ankle Outcome Scores (FAOS) and Short-Form 12 (SF-12) preoperatively and at the final follow-up. Magnetic resonance imaging (MRI) at 2 years follow-up was evaluated with modified magnetic resonance observation of cartilage repair tissue (MOCART) score. Comparisons between groups were made with the Man-Whitney U test for continuous variables and the?2 or Fisher exact test for categorical variables. Multivariate regression models were used to evaluate factors affecting postoperative FAOS, SF-12 and MOCART scores. A value of p < 0.05 was considered statistically significant. Results: Ninety-four patients were included, with 31 with a contained type OLT and 63 with an uncontained type OLT. The median follow-up time were 45 months in contained type and 52 months in uncontained type. The mean FAOS and SF-12 improved significantly after surgery in both contained and uncontained lesions (p<0.001). The mean postoperative FAOS in contained type was higher than uncontained type (89.5 vs 80.2, p=0.009), but no significant differences were found between uncontained and contained type in postoperative SF-12 and MOCART score. The multivariate regression models showed that patients with contained type OLT had approximately 10 points better scores in FAOS compared to uncontained type (p=0.006) (Table 1). Patients who had previous microfracture performed worse postoperative FAOS than those who did not (p =0.004). Conclusion: Patients with contained type OLT experienced better clinical outcomes than those with uncontained type OLT following AOT procedure for the treatment of OLT. However, the AOT procedure still provided good clinical and MRI outcomes in both contained type and uncontained type OLT at the mid-term follow-up.

Effect of the Containment Type on Clinical Outcomes in Osteochondral Lesions of the Talus Treated With Autologous Osteochondral Transplantation

2018 ◽  
Vol 46 (9) ◽  
pp. 2096-2102 ◽  
Author(s):  
Yoshiharu Shimozono ◽  
Johanna C.E. Donders ◽  
Youichi Yasui ◽  
Eoghan T. Hurley ◽  
Timothy W. Deyer ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Clinical Outcomes ◽  
Multivariate Regression ◽  
Regression Models ◽  
Short Form ◽  
Osteochondral Lesions ◽  
Osteochondral Transplantation ◽  
Autologous Osteochondral Transplantation ◽  
Type Group

Background: Uncontained-type osteochondral lesions of the talus (OLTs) have been shown to have inferior clinical outcomes after treatment with bone marrow stimulation. While autologous osteochondral transplantation (AOT) is indicated for larger lesions, no study has reported on the prognostic significance of the containment of OLTs treated with the AOT procedure. Purpose: To clarify the effect of the containment of OLTs on clinical and radiological outcomes in patients who underwent AOT for OLTs. Study Design: Case control study; Level of evidence, 3. Methods: A retrospective cohort study comparing patients with contained-type and uncontained-type OLTs was undertaken to include all patients who underwent AOT for the treatment of OLTs between 2006 and 2014. Analyses were performed by grouping the patients according to the containment type. Clinical outcomes were evaluated using the Foot and Ankle Outcome Score (FAOS) and the 12-Item Short Form Health Survey (SF-12) preoperatively and at final follow-up. Magnetic resonance imaging (MRI) at 2 years’ follow-up was evaluated with the modified magnetic resonance observation of cartilage repair tissue (MOCART) score. Multivariate regression models were used to evaluate factors affecting postoperative FAOS, SF-12, and MOCART scores. Results: Ninety-four patients were included: 31 patients with a contained-type OLT and 63 patients with an uncontained-type OLT. The median patient age was 34 years (interquartile range [IQR], 28-48 years) in the contained-type group and 36 years (IQR, 27-46 years) in the uncontained-type group. The median follow-up time was 45 months (IQR, 38-63 months) in the contained-type group and 52 months (IQR, 40-66 months) in the uncontained-type group. The median FAOS and SF-12 scores improved significantly after surgery in both contained-type and uncontained-type lesions ( P < .001). The median postoperative FAOS score of patients with contained-type OLTs was higher than that of patients with uncontained-type OLTs (91.7 vs 85.0, respectively; P = .009), but no significant differences were found between the contained-type and uncontained-type groups for postoperative SF-12 and MOCART scores. The multivariate regression models showed that patients with contained-type OLTs had an approximately 10-point better score on the FAOS compared with patients with uncontained-type OLTs ( P = .006). There was a nonsignificant trend for the rate of cystic occurrence in uncontained-type OLTs to be higher than that of contained-type OLTs (55.6% vs 38.7%, respectively; P = .125). Conclusion: Patients with contained-type OLTs experienced better clinical outcomes than those with uncontained-type OLTs after AOT for the treatment of OLTs. However, the AOT procedure still provided good clinical and MRI outcomes in both contained-type and uncontained-type OLTs at midterm follow-up.

Finite Element Analysis of Fixed Medial Malleolar Fractures

2013 ◽  
Author(s):  
Ruchi D. Chande ◽  
John R. Owen ◽  
Robert S. Adelaar ◽  
Jennifer S. Wayne
Keyword(s):  
Finite Element Analysis ◽  
Finite Element ◽  
Mechanical Performance ◽  
External Rotation ◽  
Weight Bearing ◽  
High Stress ◽  
Ankle Injuries ◽  
Deltoid Ligament ◽  
Medial Malleolus ◽  
Element Analysis

The ankle joint, comprised of the distal ends of the tibia and fibula as well as talus, is key in permitting movement of the foot and restricting excessive motion during weight-bearing activities. Medial ankle injury occurs as a result of pronation-abduction or pronation-external rotation loading scenarios in which avulsion of the medial malleolus or rupture of the deltoid ligament can result if the force is sufficient [1]. If left untreated, the joint may experience more severe conditions like osteoarthritis [2]. To avoid such consequences, medial ankle injuries — specifically bony injuries — are treated with open reduction and internal fixation via the use of plates, screws, wires, or some combination thereof [1, 3–4]. In this investigation, the mechanical performance of two such devices was compared by creating a 3-dimensional model of an earlier cadaveric study [5], validating the model against the cadaveric data via finite element analysis (FEA), and comparing regions of high stress to regions of experimental failure.

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