scholarly journals Systematic review of bone marrow stimulation for osteochondral lesion of talus - evaluation for level and quality of clinical studies

2017 ◽  
Vol 8 (12) ◽  
pp. 956-963 ◽  
Author(s):  
Youichi Yasui ◽  
Laura Ramponi ◽  
Dexter Seow ◽  
Eoghan T Hurley ◽  
Wataru Miyamoto ◽  
...  
Keyword(s):  
Systematic Review ◽  
Bone Marrow ◽  
Clinical Studies ◽  
Osteochondral Lesion ◽  
Bone Marrow Stimulation ◽  
Marrow Stimulation ◽  
Osteochondral Lesion Of Talus

Extracellular Matrix Cartilage Allograft and Particulate Cartilage Allograft for Osteochondral Lesions of the Knee and Ankle Joints: A Systematic Review

2017 ◽  
Vol 46 (7) ◽  
pp. 1758-1766 ◽  
Author(s):  
Dexter Seow ◽  
Youichi Yasui ◽  
Eoghan T. Hurley ◽  
Andrew W. Ross ◽  
Christopher D. Murawski ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Studies ◽  
Cartilage Regeneration ◽  
Osteochondral Lesions ◽  
Level Of Evidence ◽  
Bone Marrow Stimulation ◽  
Marrow Stimulation ◽  
Ankle Joints

Background: Extracellular matrix cartilage allografts (EMCAs) and particulate cartilage allografts (PCAs) are relatively new biologics that may improve the quality of cartilage regeneration after bone marrow stimulation. The increasing popularity of these novel biologics in the treatment of osteochondral lesions (OCLs) of the knee and ankle joints prompts a systematic evaluation of their efficacies. Purpose: The purpose of this systematic review was to clarify the effectiveness of EMCAs and PCAs on cartilage regeneration. Study Design: Systematic review; Level of evidence, IV. Methods: Two reviewers searched MEDLINE and Embase in February 2016 based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Predetermined variables from each study were extracted and analyzed. Results: For EMCAs, 1 in vitro study and 2 clinical studies for OCLs of the ankle joint were found. For PCAs, 3 in vitro studies, 5 clinical studies for OCLs of the knee joint, and 5 clinical studies for OCLs of the ankle joint were found. For all studies, in vitro chondrogenesis and clinical outcomes favored EMCAs and PCAs. However, the highest level of evidence was IV, and the methodological quality of evidence was indicated to be poor. Conclusion: Both EMCAs and PCAs have yielded favorable outcomes in both in vitro and clinical studies. However, the available studies were of limited data with significant confounding factors. Therefore, it is unclear whether the effectiveness of these novel biologics is any greater than that of bone marrow stimulation alone in the repair of knee and ankle cartilage.

scholarly journals Impact of Early Weightbearing After Ankle Arthroscopy and Bone Marrow Stimulation for Osteochondral Lesions of the Talus

2021 ◽  
Vol 9 (9) ◽  
pp. 232596712110298
Author(s):  
Richard M. Danilkowicz ◽  
Nathan L. Grimm ◽  
Gloria X. Zhang ◽  
Thomas A. Lefebvre ◽  
Brian Lau ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Statistical Significance ◽  
Osteochondral Lesion ◽  
Ankle Arthroscopy ◽  
Categorical Variables ◽  
Cartilage Defects ◽  
Osteochondral Lesions ◽  
Bone Marrow Stimulation ◽  
Gold Standard Method ◽  
Marrow Stimulation

Background: Osteochondral lesion of the talus (OLT) may be caused by osteochondritis dissecans, osteochondral fractures, avascular necrosis, or focal arthritic changes. For certain focal cartilage defects, bone marrow stimulation (BMS) has been a widely used technique to restore a fibrocartilage substitute overlying the defect. There are various postoperative weightbearing protocols for this procedure, with no single gold standard method. Purpose: To retrospectively review the outcomes of patients undergoing ankle arthroscopy with concomitant BMS to determine outcomes based on postoperative weightbearing status. Study Design: Cohort study; Level of evidence, 3. Methods: We retrospectively reviewed the records of patients who underwent ankle arthroscopy with BMS for OLTs between 2015 and 2018. Patients were placed into 2 cohorts based on postoperative immobilization status: the nonweightbearing (NWB) group and the weightbearing-as-tolerated (WBAT) group. Patient characteristics obtained included age, sex, comorbidities, and etiology of talar pathology. Outcomes included the pain visual analog scale (VAS), range of motion (ROM), complications, time to first weightbearing, and the method and length of immobilization. Patients who were lost to follow-up before 30 days were excluded. The chi-square test was used to compare categorical variables between cohorts, and the t test was used for continuous variables. Results: A total of 69 patients met the inclusion criteria for this study, 18 in the WBAT group and 51 in the NWB group. The mean lesion size was 9.48 × 9.21 mm (range, 3-15 mm × 2-20 mm) for the NWB group and 9.36 × 9.72 mm (range, 5-14 mm × 6-20 mm) for the WBAT group ( P > .05). The VAS scores improved from 4.40 to 0.67 for the WBAT group and from 6.33 to 2.55 for the NWB group, with the difference in final values reaching statistical significance ( P = .0002). Postoperative ROM was not significantly different between the groups. There were 4 repeat operations within the NWB cohort. Conclusion: The surgical management of OLTs can be challenging, and the postoperative weightbearing protocol can be an extra obstacle for the patient to navigate. We found no difference in pain, ROM, or complications when allowing immediate, full WBAT.

scholarly journals Prior Bone Marrow Stimulation Surgery Influences Outcomes After Cell-Based Cartilage Restoration: A Systematic Review and Meta-analysis

2021 ◽  
Vol 9 (9) ◽  
pp. 232596712110353
Author(s):  
Charles J. Cogan ◽  
James Friedman ◽  
Jae You ◽  
Alan L. Zhang ◽  
Brian T. Feeley ◽  
...  
Keyword(s):  
Systematic Review ◽  
Bone Marrow ◽  
Failure Rate ◽  
Meta Analysis ◽  
Failure Rates ◽  
Bone Marrow Stimulation ◽  
Marrow Stimulation ◽  
Cartilage Restoration ◽  
History Of ◽  
The Mean

Background: Cell-based cartilage restoration with autologous chondrocyte implantation (ACI) is a safe and effective treatment for symptomatic cartilage lesions. Many patients undergoing ACI have a history of prior surgery, including bone marrow stimulation (BMS). There is mounting evidence that a history of prior BMS may impede healing of the ACI graft. Purpose/Hypothesis: The purpose of this study was to compare the failure rates of primary ACI with ACI after prior BMS. We hypothesized that ACI after BMS would have a significantly higher failure rate (defined as reoperation, conversion to arthroplasty, and/or imaging-based failure) compared with primary ACI. Study Design: Systematic review; Level of evidence, 4. Methods: A literature search was performed by use of PubMed and Embase databases for relevant articles published through October 2, 2020, to identify studies evaluating outcomes and failures rates of ACI after prior BMS in the knee. Results: Included were 11 studies comprising 1479 ACI procedures. The mean age at surgery ranged from 18.3 to 39.1 years, and the mean follow-up ranged from 3 to 20.6 years. All studies reported failure rates. The overall failure rate was significantly higher in the patients who underwent ACI after BMS, at 26.4% compared with 14.8% in the ACI group ( P < .001). Meta-analysis demonstrated an increased risk of failure in patients with a history of prior BMS (log odds ratio = –0.90 [95% confidence interval, –1.38 to –0.42]). Conclusion: This systematic review demonstrated that failure rates were significantly higher for patients treated with ACI after BMS relative to patients undergoing ACI without prior BMS. This finding has important implications when considering the use of BMS for defects that are amenable to cell-based restoration and when determining treatment options after failed BMS. Registration: PROSPERO (CRD42020180387).

scholarly journals Results of Arthroscopic Talar Osteochondral Lesions with Bone Marrow Stimulation and BST-CarGel

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0016
Author(s):  
Jagwinder Dhaliwal ◽  
Andrew Wines
Keyword(s):  
Quality Of Life ◽  
Bone Marrow ◽  
Functional Outcome ◽  
Osteochondral Lesions ◽  
Foot And Ankle ◽  
Bone Marrow Stimulation ◽  
Marrow Stimulation ◽  
The Mean

Category: Ankle, Trauma Introduction/Purpose: Osteochondral lesions (OCL) are described as any defect involving both the articular surface and the subchondral bone of the talus. They are commonly associated with acute ankle injuries occurring often in active population. Bone marrow stimulation with microfracture is a standard reparative treatment for OCD however decline in related functional outcome has been reported. BST-CarGel contains chitosan which binds to negatively charged cartilage surface acting as biocompatible scaffold. This allows repair tissue with significant filling volume and proper integration into the surroundings. There has been reported better quantitative and qualitative cartilage repair tissue at 12 months with BST-CarGel. We first report on clinical results of bone marrow stimulation and BST-Cargel for recalcitrant talar OCL in patients previously treated with microfracture alone in a prospective study. Methods: This prospective single surgeon series was limited to patients with symptomatic OCL who previously had arthroscopic debridement and microfracture for same lesion. The pre-operative evaluation of all patients involved clinical assessment, weight bearing plain radiographs and magnetic resonance imaging of ankle joint. Inclusion criteria were age 18-55 years, single focal OCL of talus less than 3 cm2 and previous microfracture. Exclusion criteria was evidence of ankle osteoarthritis and allergy to chitosan or known hypersensitivity to crustaceans such as shrimp, lobster, and crab. Functional outcome assessment was measured using Foot and Ankle outcome score (FAOS) and EQ5D (Health related quality of life) pre and post-operatively. We used paired Student’s t-test for statistical analysis. Values for p < 0.05 were regarded as significant. The surgical technique used have been previously described in literature for OCL of the talus treated with bone marrow stimulation and Cargel. Results: There were fourteen patients who were treated with arthroscopic BST-Cargel with BMS and followed up prospectively. There was no loss to follow-up. The mean follow-up post-operatively was 28 months. There were eight males and six females in the study group. Patient mean age at the time of operation was 42 years (21–60 years). The mean size of talar OCL treated was 2.8 cm2 . Mean FAOS score for symptoms pre-operatively was 41.7 and post-operative was 52.8 (P<0.01). Mean FAOS pain subscale pre-operatively was 45.7 and post-operatively 55.6 (P<0.01). FAOS function and daily living score pre-operatively was 41.4 and post-operatively was 55.8 (P<0.01). Mean FAOS quality of life score was 39.2 pre-operatively and post-operative score 57.2 (P<0.01). EQ5D pre-operatively was 15 and post-operatively was 8 (P<0.01). Conclusion: We noted statistically significant improvement in each subscale of The Foot and Ankle Outcome questionnaire scores post-operatively. There was also significant improvement in generic health status instrument EQ-5D. We also noted talar OCL improvement on MRI scan taken pre and post BST-CarGel treatment. Recalcitrant OCL of talus present considerable challenge with persistent pain, functional limitations and secondary osteoarthritis. BST-Cargel treatment in our clinical study improved functional outcome scores similar to previously reported hip and knee studies. It requires standard arthroscopic technique and no complications were observed in our study.

scholarly journals Arthroscopic Bone Marrow Stimulation in the Treatment of Osteochondral Lesions of the Talus

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0009
Author(s):  
Kwang Hwan Park ◽  
JaeHan Park ◽  
Jai Bum Kwon ◽  
Seung Hwan Han ◽  
Jin Woo Lee
Keyword(s):  
Bone Marrow ◽  
Clinical Outcomes ◽  
Osteochondral Lesion ◽  
Osteochondral Lesions ◽  
Bone Marrow Stimulation ◽  
Marrow Stimulation ◽  
Operation Rate ◽  
The Mean

Category: Arthroscopy Introduction/Purpose: Arthroscopic bone marrow stimulation for osteochondral lesions of the talus (OLT) has presented promising clinical outcomes in recent studies. However, there were few studies which had investigated long-term clinical outcomes. The purpose of this study is to evaluate the long-term outcomes of arthroscopic bone marrow stimulation for osteochondral lesion of the talus and to identify prognostic factors that affect the outcome. Methods: Between January 2001 and December 2007, 159 patients (172 ankles) with OLT underwent arthroscopic bone marrow stimulation as a primary surgery. Clinical outcomes were assessed using visual analog scale (VAS), American Orthopaedic Foot & Ankle Society (AOFAS) scores, Foot and Ankle Outcome Score (FAOS) and re-operation rate. Factors associated with re-operation were evaluated using bivariate analysis. Kaplan-Meier plot showed survival outcomes of OLT in long-term follow-up. Results: The mean follow-up time was 12.7 years (range 10.1-16.8) and the mean size of the lesion was 105.4 mm2 (range 19.8- 322.8). The mean VAS improved from 7.21 ± 1.71 to 1.76 ± 1.60. The mean preoperative AOFAS score was 57.98 ±14.43 and the mean postoperative AOFAS was 82.91 ± 11.58. FAOS at the time of final follow-up was comparable with those of previous literatures which showed outcomes of surgical treatments of OLT in short- and mid-term follow-up. Re-operation rate was 6.40% (11 patients with 12 revision surgery) including seven cases of re-arthroscopic bone marrow stimulation, and five cases of OAT. According to bivariate analysis, significant factor associated with re-operation was large sized OLT in preoperative MRI measurement. Conclusion: Arthroscopic bone marrow stimulation for osteochondral lesion of the talus has made satisfactory clinical outcomes through long-term follow-up over 10 years.

Talar osteochondral size influences outcome after bone marrow stimulation: a systematic review

2017 ◽  
Vol 2 (6) ◽  
pp. 318-324
Author(s):  
Vincenzo Candela ◽  
Umile Giuseppe Longo ◽  
Mauro Ciuffreda ◽  
Giuseppe Salvatore ◽  
Alessandra Berton ◽  
...  
Keyword(s):  
Systematic Review ◽  
Bone Marrow ◽  
Clinical Outcomes ◽  
Lesion Size ◽  
Osteochondral Lesions ◽  
Level Of Evidence ◽  
Bone Marrow Stimulation ◽  
Marrow Stimulation ◽  
Level I ◽  
High Level

ImportanceNo accepted definition of lesion size exists to treat osteochondral defects (OCD) of talus with bone marrow stimulation.ObjectiveThe aim of this study is to establish a relationship between the clinical outcomes and size of OCD lesion to identify the area or diameter best suited to be treated with arthroscopic bone marrow stimulation.Evidence reviewA search was conducted of level I through IV studies from January 2000 to August 2017, to identify studies reporting on talus OCDs treated with bone marrow stimulation. 21 articles were identified. The overall quality of evidence was fair.Findings21 articles were included in which 1303 ankles with OCD of talus were evaluated. Patients were assessed at a median follow-up period of 38.1 months, ranging from 6.3 to 217 months. Considering a cut-off of an area <1.5 cm2 or with a diameter ≤1.5 cm, the mean postoperative AOFAS (American Orthopaedic Foot and Ankle Society) value was 89.1±3 and 84.65±2.7, respectively (p=0.016).Conclusions and relevanceDespite the current lack of high-level evidence, our results suggest that bone marrow stimulation techniques provide an effective and reliable means to treat small to mid-sized OCD. Arthroscopic bone marrow stimulation for isolated osteochondral lesions of the talus is a safe and effective procedure that provides good clinical outcomes for lesions with an area less than 1.5 cm2 or with a diameter less than 1.5 cm. The attempt to find a new cut-off value to identify more precisely good outcome lesions was unsuccessful. However, the long-term benefits of bone marrow stimulation techniques should be tested in larger cohort of patients with longer term evaluations.Level of evidenceSystematic review, level III.

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