All-Inside Arthroscopic Cancellous Allograft for the Large Cystic Osteochondral Defect of the Talus

Category: Arthroscopy; Sports; Trauma Introduction/Purpose: The purpose of this study was to evaluate the surgical technique and long-term clinical outcomes of all- inside arthroscopic treatment for large cystic osteochondral defect of the talus with the use of cancellous allograft. Methods: Eight patients admitted from January 2016 to October 2018 by our hospital for large cystic osteochondral defect of the talus was retrospectively analyzed with their complete follow-up data. The subjects consisted of 5 males and 3 females, aged between 27 to 50 years, and with an average age of 34.2 years. All of these cystic osteochondral defects were larger than 15 mm in diameter, sized 1.3cm3 to 5.2cm3. The visual analogue scale (VAS) score, American Orthopaedic Foot & Ankle Society (AOFAS) score, The Karlsson Ankle Functional Score (KAFS) and subjective satisfaction survey rating were obtained. CT scan and magnetic resonance imaging of the ankle were obtained before and after surgery. Results: All incisions were healed in the first stage, and no complications such as nerve, blood vessel and tendon injuries occurred. All patients were available for follow-up at a mean of 26.2 months (range, 18 to 48 months). By the last follow-up, the postoperatively AOFAS 、 KAFS scores were 86.5 and 84.2 compared with 60.8 and 59.3 preoperatively, respectively. And the mean VAS score decreased from 6.4 preoperatively to 1.1. The range of motion of the ankle joint was normal and returned to the pre-pain state for these patients. Six patients rated their result as excellent, 2 as good and none as fair. Conclusion: All-inside arthroscopic cancellous allograft was an effective option for the treatment of large cystic talus osteochondral defects.

Joint salvage and biological repair of massive-cavity bone defects after extensive curettage of giant cell tumor around the knee with vascularized fibular autograft and cancellous allograft

Background: Treatment of giant cell tumor (GCT) around knee remains challenging because GCT is prone to recurrence and metastasis. Herein, we reported on our clinical experience with knee joint salvage and biological repair of massive-cavity bone defects after extensive curettage of GCT around the knee with vascularized fibular autograft and cancellous allograft in 12 patients.Methods: All the patients underwent clinical evaluation, plain radiography and/or magnetic resonance imaging (MRI) of the knee right after admission. Their joint function was preserved, and the massive-cavity bone defects were repaired by vascularized fibular autografts and cancellous allograft after extensive curettage of GCT around the knee. All the patients were evaluated through clinical examinations, plain radiography of the knee and chest, and Musculoskeletal Tumor Society (MSTS) scores of the lower extremity in the follow-ups.Results: The follow-up duration ranged from 1.5 years to 12.0 years (mean 4.2 years). There were no local recurrences or lung metastasis in any of the 12 patients at the last follow-up. Ten patients had no pain or experienced occasional pain, and nine were able to resume their previous work. The mean range-of-motion of knee flexion was 117°, and the extension was -6°. The mean MSTS score was 24.7, and a total of 10 patients had excellent or good MSTS scores. Conclusion: Knee joint salvage and biological repair of massive-cavity bone defects could be achieved after extensive curettage with vascularized fibular autograft and cancellous allograft in patients with GCT around the knee.

Masquelet Technique for Hindfoot Fusion of Gustilo IIIA Open Ankle Dislocation with Complete Talar Extrusion and Loss

Category: Hindfoot, Trauma, Ankle Introduction/Purpose: Complete talar extrusion is a rare injury resulting from high-energy trauma, with dissociation of the talus from surrounding bony and soft-tissue structures. Complications after complete talar extrusion include infection, osteonecrosis, posttraumatic osteoarthritis, and leg-length discrepancy. There is a lack of consensus on the optimal treatment algorithm for complete talar extrusion, due in part to high complication rates associated with injury and treatment. Thus, we report a staged treatment method utilizing the Masquelet Technique with temporary cement spacer, followed by bone grafting with use of femoral shaft autograft and bulk cancellous allograft. Methods: 44-year-old male status post high-speed motorcycle collision presented with left ankle Gustilo IIIC open fracture dislocation with complete talar extrusion and loss, concomitant ipsilateral tibial plateau fracture and metatarsal shaft fractures. Twelve weeks post-injury, after multiple staged debridements, external fixation and extensive wound vac treatments, removal of the left leg multi-planar external fixator was performed with left distal tibial, fibular, navicular and calcaneal articular and subchondral bone debridement in preparation for Masquelet procedure and pantalar fusion. Open reduction and realignment of left ankle and foot with intramedullary fixation with hindfoot fusion nail was performed, with placement of antibiotic cement spacer for development of secondary reactive periosteal membrane. After nine weeks, intramedullary bone reaming aspiration tool was utilized for removal of left femur intramedullary bone marrow for autograft. Hindfoot pantalar fusion was performed using ipsilateral femoral shaft autograft and bulk cancellous allograft in place of antibiotic spacer. Results: Patient went on successfully to fusion and had one transfixation screw removed during the course of his recovery. Patient was also treated using a long leg ankle foot orthosis brace as a stress shielding device during heavy labor. Patient returned back to work and heavy labor as a landscaper and has had no residual pain. At 24 months postoperative, patient achieved an AOFAS ankle-hindfoot score of 83/100 (good). Conclusion: To our knowledge, this is the first case of complete talar extrusion treated with a Masquelet procedure with ipsilateral femoral shaft autograft and bulk cancellous allograft. While chronic pain is reported in as many as 75% of patients post- complete talar extrusion, and infection rates as high as 88%, our patient reports no residual pain and did not experience a postoperative infection. This technique represents a reasonable approach and warrants consideration for the treatment of this rare, complex injury.

Histomorphometric and 3D Cone-Beam Computerized Tomographic Evaluation of Socket Preservation in Molar Extraction Sites Using Human Particulate Mineralized Cancellous Allograft Bone With a Porcine Collagen Xenograft Barrier: A Case Series

The purpose of this study was to evaluate the results of socket preservation after extraction using human particulate mineralized cancellous allograft bone (MCAB) and type I porcine collagen membranes (PCM) as a guided bone regeneration barrier. Fourteen patients, 12 women and 2 men, were selected who had a diagnosis of one or more unsalvageable teeth with a treatment plan to replace them with implant-supported single crown restorations. Extractions were preformed atraumatically by sectioning teeth for removal to avoid damaging the socket walls and by immediately placing MCAB graft to fill the sockets. The sockets were occluded with a new PCM. The membranes were cut to overlap the facial and lingual (or palatal) socket rim by at least 5 mm (or more if necessary) to cover bony wall fenestration or dehiscence defects. Implants were then placed 16 weeks after the extractions and augmentation. The results were evaluated clinically, histomorphometrically, and with cone-beam computerized tomographic scanning. The formation of new bone in the treated sites averaged 11.2%, with a range of 1.8% to 43%, in bone biopsies trephined from the center of the grafted socket sites. Density, calculated with proprietary software and measured in Hounsfield units (HUs), was 543 HU with a range of 420 to 822 HU. The resulting new bone regeneration varied widely, but the barrier membranes showed potential for promoting significant bone regeneration. A larger sample of treated cases is needed. Wall defects did not appear to influence the histologic results, but the number of sites was too small to determine their significance.