scholarly journals Frontiers in Orthobiologics for the Treatment of Osteochondral Lesions of the Ankle Joint

2020 ◽  
Vol 4 (2) ◽  
Author(s):  
Johnny Huard
Keyword(s):  
Ankle Joint ◽  
Osteochondral Lesions

scholarly journals AB0858 TREATMENT ALGORITHM FOR ANKLE OSTEOCHONDRAL LESIONS AND DEFECTS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1736.2-1736
Author(s):  
O. Burianov ◽  
L. Khimion ◽  
T. Omelchenko ◽  
E. Levitskyi ◽  
V. Lyanskorynsky
Keyword(s):  
Bone Marrow ◽  
Ankle Joint ◽  
Bone Marrow Cells ◽  
Traditional Approach ◽  
Treatment Algorithm ◽  
Main Group ◽  
Long Term Results ◽  
Osteochondral Lesions ◽  
Traditional Treatment

Background:traumatic ankle joint osteochondral lesions and defects (OHLD) is frequent cause of OA, chronic pain and loss of joint function; results of traditional treatment strategy are often unsatisfyingObjectives:to develop treatment algorithm for OHLD based on evaluation of previously determined main prognostic factors.Methods:the analysis of long-term (36 ± 4.5 months) treatment results of 239 patients after traumatic ankle joint OHLD revealed the following factors with the greatest predictive value (defined by PC – prognostic coefficient) for good result of treatment (defined as AOFAS function score 75-100 points): age < 40 years (PC = 8.5); size of OHLD ≤ 1.0 cm2; volume ≤ 1.5 cm3(PC = 8.0); osteoarthritis stage ≤ II (PC = 7.2). Based on these factors, a step-by-step, discrete and alternative algorithm for the choice of treatment tactics was created. The algorithm includes use of arthroscopic or open debridement, abrasive chondroplasty, bone marrow regeneration stimulation (microfracturing or tunneling), mosaic osteochondroplasty, arthroplasty or arthrodesis, the use of cellular regenerative technologies (bone marrow cells, platelet riched plasma), and others. Patients of older age with advanced OA need complex, step up approach, surgical treatment combined with regenerative cell technologies. The effectiveness of the differentiated approach to treatment was studied in 72 patients with OHLD (main group) in comparing to 72 patients in whom traditional treatment approaches were used, based on the stage of injury according to the Berndt & Hardy classification (comparison group).Results:compared to the traditional approach, the developed algorithm and treatment system allowed to half terms of hospitalization, to reduce the intensity of pain syndrome (by NRS) and increase the functional activity (by AOFAS) by 25%. In 3 years after trauma good/excellent results of treatment demonstrated 86% patients of main group and 32,2% of patients from comparing group (p<0,05).Conclusion:implementation of the developed treatment algorithm increases the number of good and excellent long-term results by 2.6 times and reduces the number of complications and unsatisfactory results by 4.9 times.Disclosure of Interests:None declared

scholarly journals Accessibility to Talar Dome in Neutral Position, Dorsiflexion, or Noninvasive Distraction in Posterior Ankle Arthroscopy

2019 ◽  
Vol 40 (8) ◽  
pp. 978-986 ◽  
Author(s):  
Lena Hirtler ◽  
Katarina Schellander ◽  
Reinhard Schuh
Keyword(s):  
Minimally Invasive ◽  
Ankle Joint ◽  
Clinical Relevance ◽  
Arthroscopic Treatment ◽  
Osteochondral Lesions ◽  
Neutral Position ◽  
Matched Pairs ◽  
Talar Dome ◽  
Statistical Comparison ◽  
Posterior Ankle Arthroscopy

Background: Osteochondral lesions of the talus are frequent pathologies of the ankle joint. Especially through arthroscopy, the treatment is kept as minimally invasive as possible. However, there are some drawbacks as to the reachability because of the high congruency of the ankle joint. Here, either noninvasive distraction or maximal dorsiflexion may be an option for better access to the lesion. The purpose of this study was to evaluate maximal dorsiflexion compared to neutral position or noninvasive distraction of the ankle joint in the arthroscopic reachability of the talar dome. The hypothesis of this study was that maximal dorsiflexion would allow for greater accessibility of the talar dome compared to neutral position or noninvasive distraction of the joint. Methods: Twenty matched pairs (n=40) of anatomical ankle specimens were used. The effects of neutral position, maximal dorsiflexion, and noninvasive distraction of the ankle joint on arthroscopic accessibility of the ankle joint were tested. After disarticulation of the talus, reach was measured and compared between the 3 positions. Results: In neutral position, 13.7±1.2 mm of the talar dome was reached laterally and 14.0±1.0 mm medially. In maximal dorsiflexion, the distance was 19.0±1.1mm laterally and 19.8±1.4 mm medially, and in noninvasive distraction it was 16.1±1.5 mm laterally and 15.7±1.0 mm medially. The statistical comparison showed a significantly better reach in dorsiflexion laterally ( P = .003) and medially ( P = .026). Conclusion: Accessibility of the talar dome in maximal dorsiflexion was superior to that in neutral position or noninvasive distraction. Clinical Relevance: Results of this study may allow for better planning in arthroscopic treatment of osteochondral lesions of the talus.

Computertomography/Robot-assisted Retrograde Drilling of Osteochondral Lesions of the Ankle Joint

2011 ◽  
Vol 10 (4) ◽  
pp. 139-143
Author(s):  
Martin Wiewiorski ◽  
Andre Leumann ◽  
Geert Pagenstert ◽  
Arno Frigg ◽  
Victor Valderrabano
Keyword(s):  
Ankle Joint ◽  
Osteochondral Lesions ◽  
Robot Assisted ◽  
Retrograde Drilling

scholarly journals Osteochondral Lesions of the Talus – A Biomechanical Explanation for Larger OLT Shoulder Lesions Leading to Increased Patient Risk

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0004
Author(s):  
Peter Lawson ◽  
Pam Kumparatana ◽  
Todd Baldini ◽  
Shanthan Challa ◽  
Daniel Moon ◽  
...  
Keyword(s):  
Surface Area ◽  
Ankle Joint ◽  
Contact Area ◽  
Peak Pressure ◽  
Defect Size ◽  
Cartilage Tissue ◽  
Osteochondral Lesions ◽  
Talar Dome ◽  
Increased Risk ◽  
Donor Characteristics

Category: Ankle, Trauma Introduction/Purpose: Osteochondral lesions of the talus (OLT) are a common injury that can result in pain, disability, and risk ankle degeneration, with poor outcomes when not managed properly. Unconstrained ‘shoulder’ lesions on the medial edge of the talar dome present a particular challenge. The objective of this study was to assess the effect of increasing size of a medial OLT shoulder lesion on ankle joint contact mechanics and to determine a threshold size that would warrant bulk grafting of the defect. Our hypothesis is that larger defects will demonstrate increased pressure applied over a lesser surface area, with peak pressure progressing towards the rim of the defect, resulting in an increased risk for tissue damage and need for treatment. Methods: Nine cadaver ankle joints were dissected without disrupting the medial and lateral stabilizing ligaments. A Tekscan pressure sensor was inserted into the ankle joint. Intact specimens were axially compressed up to 800 N with the foot in neutral and again at 20° inversion, simulating ankle position during inversion injury. The specimens were then tested with progressively larger semicircular osteochondral lesions at diameters of 8, 10, 12, 14, and 16 mm that were centered on the edge of the medial talar dome, followed by a final ovoid lesion of 16x20 mm. After each lesion was created the specimens were retested. Linear mixed models adjusted for donor characteristics and assessed changes in peak pressure (MPa), contact area (mm2), peak pressure location (mm), and distance from peak pressure location to the lateral rim of the defect (mm) by defect size and ankle position. Results: For all defect sizes, mean peak pressures were significantly higher in inversion compared to neutral. Mean peak pressure magnitude progressively increased with defect size in both ankle positions. Donor characteristics did not significantly affect mean peak pressure. Contact area decreased in both positions as defect size increased, but inversion led to significantly lower contact areas than in neutral. In neutral positions, the location of peak pressure moved laterally on the talar dome but also moved closer to the defect rim as the size of the defect increased. The rim-peak pressure distance stabilized for defect sizes of 10 mm and above. In inversion, however, the rim-peak pressure distance remained unchanged at about 8 mm for all defect sizes. Conclusion: As OLT defect sizes increased, we observed an increase in peak pressure, a decrease in contact surface area, and a lateral translation of peak pressure location relative to the defect rim. Distance between location of peak pressure and defect rim decreased with neutral loading until a 10 mm defect but remained consistent in inversion loading. These findings suggest a biomechanical explanation for secondary injuries and treatment failures in larger OLT shoulder lesions due to maladaptive cartilage tissue on the dome of the talus. Larger defects (=10 mm) remain a critical point of interest with predictive clinical value for OLT outcomes.

FRI0395 PROGNOSIS OF TREATMENT OUTCOMES IN PATIENTS WITH ANKLE JOINT OSTEOCHONDRAL LESIONS AND DEFECTS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 796.1-796
Author(s):  
O. Burianov ◽  
L. Khimion ◽  
T. Omelchenko ◽  
V. Lyanskorynsky ◽  
E. Levitskyi
Keyword(s):  
Treatment Outcomes ◽  
Ankle Joint ◽  
Predictive Value ◽  
Long Term Results ◽  
Bayesian Probability ◽  
Treatment Result ◽  
Osteochondral Lesions ◽  
Prognostic System ◽  
Severity Of Injury

Background:in most cases osteochondral lesions and defects (OHLD) in the ankle joint are the consequences of trauma, and the results of their treatment depend on a number of factors. Some factors are directly related to the area of damage (depth, localization, size), others are connected to the patients age, presence of degenerative changes in the affected joint, comorbidities, body mass index (BMI), etc.Objectives:to develop an effective system for predicting long-term outcomes in patients with ankle joint OHLD.Methods:24 prognostic factors (age, gender, severity of injury, Charlson comorbidity index, BMI, OA stage, size of defect, localization of injury, degree of osteoporosis, contracture, instability, etc.) influence on the long-term (36 ± 4.5 months) treatment outcomes was analyzed by Bayesian probability analysis in 223 patients after ankle joint OHLD. The prognostic coefficient (PC) was calculated by Wald sequential analysis for each prognostic factor and prognostic system was developed for prediction of high, medium or low probability of positive treatment result, which was determined as a functional joint outcome in AOFAS 75 - 100 points.Results:the greatest predictive value for the positive result of OHLD treatment had the following factors: age< 40 years (PC = 8.5); BMI < 25 kg/m2(PC=7.0), time from trauma < 1 year (PC = 4,1); OA stage < II (PC = 7.2); size of OHLD <1.0 cm2; volume <1.5 cm3(PC = 8.0). The prognostic system is based on the calculating of total factors values for individual patients case in points (Σ PC). If Σ PC is less (-20) the probability of achieving a positive joint-saving result is absent; at Σ PC from (-20) to (+40) the probability is medium; and at Σ PC above (+40) probability is high. The accuracy of the prognostic assessment was retrospectively tested with a 95% confidence interval, the accuaracy of predicitive method – 84,17% (76,59-89,62)%.Conclusion:the size and volume of osteochondral damage, BMI, age and time from trauma has the greatest predictive value for the determination of the long-term results of treatment in patients with ankle joint OHLD; use of the developed prognostic method can be used as a basis for the clinical decision making in choosing different approaches in treatment.Disclosure of Interests:None declared

Comparison of Ankle Joint Visualization Between the 70° and 30° Arthroscopes: A Cadaveric Study

2017 ◽  
Vol 11 (1) ◽  
pp. 72-76 ◽  
Author(s):  
Ichiro Tonogai ◽  
Fumio Hayashi ◽  
Yoshihiro Tsuruo ◽  
Koichi Sairyo
Keyword(s):  
Ankle Joint ◽  
Distal Tibia ◽  
Skin Incision ◽  
Surrounding Tissue ◽  
Osteochondral Lesions ◽  
Talar Dome ◽  
Kirschner Wires ◽  
Anterior Edge ◽  
Ankle Surgery ◽  
Anterior Ankle Impingement

Ankle arthroscopy is an important diagnostic and therapeutic tool. Arthroscopic ankle surgery for anterior ankle impingement or osteochondral lesions (OCLs) is mostly performed with a 30° arthroscope; however, visualization of lesions is sometimes difficult. This study sought to compare ankle joint visualization between 70° and 30° arthroscopes and clarify the effectiveness of 70° arthroscopy. Standard anterolateral and anteromedial portals were placed with 4-mm 70° or 30° angled arthroscopes in a fresh 77-year-old male cadaveric ankle. The medial ligament and surrounding tissue were dissected via a medial malleolar skin incision. Kirschner wires were inserted into the distal tibia anterior edge; 5-mm diameter OCLs were created on the medial talar gutter anteriorly, midway, and posteriorly. The talar dome and distal tibia anterior edge were visualized using both arthroscopes. The 70° arthroscope displayed the anterior edge of the distal tibia immediately in front of the arthroscope, allowing full visualization of the posterior OCL of the medial talar gutter more clearly than the 30° arthroscope. This study revealed better ankle joint visualization with the 70° arthroscope, and may enable accurate, safe, and complete debridement, especially in treatment of medial talar gutter posterior OCLs and removal of anterior distal tibial edge bony impediments. Levels of evidence: Level IV, Anatomic study

Prospective Computed Tomographic Analysis of Osteochondral Lesions of the Ankle Joint Associated With Ankle Fractures

2016 ◽  
Vol 37 (8) ◽  
pp. 829-834 ◽  
Author(s):  
Tomasz L. Nosewicz ◽  
M. Suzan H. Beerekamp ◽  
Robert-Jan O. De Muinck Keizer ◽  
Tim Schepers ◽  
Mario Maas ◽  
...  
Keyword(s):  
Ankle Joint ◽  
Ankle Fractures ◽  
Osteochondral Lesions ◽  
Computed Tomographic ◽  
Tomographic Analysis

Cement Casting to Optimize Reconstruction of Chronic Osteochondral Lesions of the Talus

2017 ◽  
Vol 10 (4) ◽  
pp. 333-336
Author(s):  
Jorge Pulgar ◽  
Mario Escudero ◽  
Giovanni Carcuro ◽  
Adam Schiff ◽  
Manuel Pellegrini
Keyword(s):  
Bone Cement ◽  
Ankle Joint ◽  
Surgical Techniques ◽  
Osteochondral Lesions ◽  
Limited Evidence ◽  
Levels Of Evidence ◽  
Novel Technique ◽  
Evidence Level

Few surgical techniques have been described for reconstruction in massive osteochondral lesions of the talus, and there is limited evidence of techniques for accurately reproducing native talar anatomy with bone auto/allograft techniques. In this article, we present a novel technique, which is highly reproducible, using bone cement to restore the congruence and anatomy of the ankle joint. Levels of Evidence: Level V: Technical tip

Sign in / Sign up

Export Citation Format

Share Document