scholarly journals Three-Dimensional Matrix-Induced Autologous Chondrocytes Implantation for Osteochondral Lesions of the Talus: Midterm Results

2012 ◽  
Vol 2012 ◽  
pp. 1-9 ◽  
Author(s):  
B. Magnan ◽  
E. Samaila ◽  
M. Bondi ◽  
E. Vecchini ◽  
G. M. Micheloni ◽  
...  
Keyword(s):  
Three Dimensional ◽  
Clinical Results ◽  
Lesion Size ◽  
Osteochondral Lesions ◽  
Mri Imaging ◽  
Midterm Results ◽  
Ankle Surgery ◽  
Autologous Chondrocytes Implantation ◽  
American Orthopaedic

Introduction. We evaluate the midterm results of thirty patients who underwent autologous chondrocytes implantation for talus osteochondral lesions treatment.Materials and Methods. From 2002 to 2009, 30 ankles with a mean lesion size of 2,36 cm2were treated. We evaluated patients using American Orthopaedic Foot and Ankle Surgery and Coughlin score, Van Dijk scale, recovering time, and Musculoskeletal Outcomes Data Evaluation and Management System.Results. The mean AOFAS score varied from 36.9 to 83.9 at follow-up. Average of Van Dijk scale was 141.1. Coughlin score was excellent/good in 24 patients. MOCART score varied from 6.3 to 3.8.Discussion. This matrix is easy to handle conformable to the lesion and apply by arthroscopy. No correlation between MRI imaging and clinical results is found.Conclusions. Our results, compared with those reported in literature with other surgical procedures, show no superiority evidence for our technique compared to the others regarding the size of the lesions.

scholarly journals Treatment of osteochondral lesions of the talus with autologous collagen-induced chondrogenesis: clinical and magnetic resonance evaluation at one-year follow-up

Joints ◽  
2016 ◽  
Vol 04 (02) ◽  
pp. 080-086 ◽  
Author(s):  
Federico Usuelli ◽  
Miriam Grassi ◽  
Luigi Manzi ◽  
Vincenzo Guarrella ◽  
Michele Boga ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Case Series ◽  
Clinical Results ◽  
Lesion Size ◽  
Osteochondral Lesions ◽  
Level Of Evidence ◽  
Imaging Results ◽  
American Orthopaedic ◽  
One Year

Purpose: the aim of this study is to report the clinical and imaging results recorded by a series of patients in whom osteochondral lesions of the talus (OLTs) were repaired using the autologous collagen-induced chondrogenesis (ACIC) technique with a completely arthroscopic approach. Methods: nine patients (mean age 37.4±10 years) affected by OLTs (lesion size 2.1±0.9 cm2) were treated with the ACIC technique. The patients were evaluated clinically both preoperatively and at 12 months after surgery using the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS) and a visual analog scale (VAS). For morphological evaluation, the magnetic resonance observation of cartilage repair tissue (MOCART) score was used. Results: the AOFAS score improved from 51.4±11.6 preoperatively to 71.8±20.6 postoperatively, while the VAS value decreased from 6.9±1.8 to 3.2±1.9. The mean MOCART score was 51.7±16.6 at 12 months of follow-up; these scores did not directly correlate with the clinical results. Conclusions: use of the ACIC technique for arthroscopic repair of OLTs allowed satisfactory clinical results to be obtained in most of the patients as soon as one year after surgery, with no major complications or delayed revision surgery. ACIC is a valid and lowinvasive surgical technique for the treatment of chondral and osteochondral defects of the talus. Level of evidence: therapeutic case series, level IV.

scholarly journals Return to Sports After Bone Marrow–Derived Cell Transplantation for Osteochondral Lesions of the Talus

Cartilage ◽  
2016 ◽  
Vol 8 (1) ◽  
pp. 80-87 ◽  
Author(s):  
Francesca Vannini ◽  
Marco Cavallo ◽  
Laura Ramponi ◽  
Francesco Castagnini ◽  
Simone Massimi ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Cell Transplantation ◽  
Case Series ◽  
Clinical Results ◽  
Osteochondral Lesions ◽  
Return To Sports ◽  
One Step ◽  
American Orthopaedic ◽  
Return To Activity

Objective Arthroscopic “one-step” technique based on bone marrow–derived cell transplantation (BMDCT) have achieved good results in repairing osteochondral lesions of the talus (OLT), overcoming important drawbacks of older techniques. It may be particularly adequate for the treatment of athletes in order to permit a safe and stable return to sports. The aim of this study was to report the results at 48 months of a series of athletes and the factors influencing the return to sports. Design Case series. A total of 140 athletes underwent a “one-step” BMDCT repair of OLT. All the patients had the cells harvested from the iliac crest, condensed and loaded on a scaffold, and then implanted. Patients were evaluated clinically by the American Orthopaedic Foot and Ankle Society (AOFAS) scores and Halasi score. Results AOFAS score improved from 58.7 ± 13.5 preoperatively to 90.6 ± 8.6 ( P < 0.005) at 24 months, and to 90.9 ± 10.7 at 48 months. Halasi score was 6.88 ± 1.8 preinjury, 4.08 ± 1.7 preoperatively, and 5.56 ± 2.0 at final follow-up. At the final follow-up, all the patients (beside 1 failure and 3 lost) were able to return to activity and 72.8% were able to resume sports at preinjury level. Conclusions “One-step” BMDCT repair of OLT had good clinical results that was durable over time in athletes, permitting a return to sports at preinjury level in the majority of patients. The preoperative presence of impingement and articular degeneration were the main negative prognostic factors.

Retrospective evaluation of outcomes of bone peg fixation for osteochondral lesion of the talus

2020 ◽  
Vol 102-B (10) ◽  
pp. 1349-1353
Author(s):  
Chul H. Park ◽  
Kwang-Soon Song ◽  
Jung R. Kim ◽  
Si-Wook Lee
Keyword(s):  
Osteochondral Lesion ◽  
Clinical Results ◽  
Osteochondral Lesions ◽  
Mri Findings ◽  
Aofas Score ◽  
Radiological Results ◽  
Osteochondral Fragment ◽  
The Mean ◽  
American Orthopaedic

Aims The hypothesis of this study was that bone peg fixation in the treatment of osteochondral lesions of the talus would show satisfactory clinical and radiological results, without complications. Methods Between September 2014 and July 2017, 25 patients with symptomatic osteochondritis of the talus and an osteochondral fragment, who were treated using bone peg fixation, were analyzed retrospectively. All were available for complete follow-up at a mean 22 of months (12 to 35). There were 15 males and ten females with a mean age of 19.6 years (11 to 34). The clinical results were evaluated using a visual analogue scale (VAS) and the American Orthopaedic Foot and Ankle Society (AOFAS) score preoperatively and at the final follow-up. The radiological results were evaluated using classification described by Hepple et al based on the MRI findings, the location of the lesion, the size of the osteochondral fragment, and the postoperative healing of the lesion. Results The mean VAS and AOFAS score improved significantly from 6.3 (4 to 8) and 70.6 (44 to 78) preoperatively to 1.6 (0 to 5) and 91.1 (77 to 100) at the final follow-up, respectively (p < 0.001). The classification on MRI was stage 2a in nine patients, stage 3 in 14, and stage 4 in two. The lesion was located on the posteromedial aspect of the dome of the talus in 19 patients, the anterolateral aspect in five, and the centrolateral aspect in one. The mean size of the fragment was 11.2 mm (5 to 20) horizontally, 10.4 mm (7 to 18) vertically, and 5.2 mm (3 to 10) deep, respectively. The postoperative healing state was good in 19 patients and fair in six. Conclusion Bone peg fixation for osteochondral lesions of the talus showed satisfactory clinical and radiographic results, without complications. This technique could be a good form of treatment for patients with this condition who have an osteochondral fragment. Cite this article: Bone Joint J 2020;102-B(10):1349–1353.

No Difference in Outcomes Following Osteochondral Allograft with Fresh Precut Cores Compared to Hemi-Condylar Allografts

Cartilage ◽  
2021 ◽  
pp. 194760352110219
Author(s):  
Danielle H. Markus ◽  
Anna M. Blaeser ◽  
Eoghan T. Hurley ◽  
Brian J. Mannino ◽  
Kirk A. Campbell ◽  
...  
Keyword(s):  
Patient Reported Outcomes ◽  
Knee Injury ◽  
Lesion Size ◽  
Osteochondral Allograft ◽  
Osteochondral Lesions ◽  
Radiographic Outcomes ◽  
Significant Difference ◽  
Patient Reported ◽  
The Mean

Objective The purpose of the current study is to evaluate the clinical and radiographic outcomes at early to midterm follow-up between fresh precut cores versus hemi-condylar osteochondral allograft (OCAs) in the treatment of symptomatic osteochondral lesions. Design A retrospective review of patients who underwent an OCA was performed. Patient matching between those with OCA harvested from an allograft condyle/patella or a fresh precut allograft core was performed to generate 2 comparable groups. The cartilage at the graft site was assessed with use of a modified Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) scoring system and patient-reported outcomes were collected. Results Overall, 52 total patients who underwent OCA with either fresh precut OCA cores ( n = 26) and hemi-condylar OCA ( n = 26) were pair matched at a mean follow-up of 34.0 months (range 12 months to 99 months). The mean ages were 31.5 ± 10.7 for fresh precut cores and 30.9 ± 9.8 for hemi-condylar ( P = 0.673). Males accounted for 36.4% of the overall cohort, and the mean lesion size for fresh precut OCA core was 19.6 mm2 compared to 21.2 mm2 for whole condyle ( P = 0.178). There was no significant difference in patient-reported outcomes including Visual Analogue Scale, Knee Injury and Osteoarthritis Outcome Score for Joint Replacement, and Tegner ( P > 0.5 for each), or in MOCART score (69.2 vs. 68.3, P = 0.93). Conclusions This study found that there was no difference in patient-reported clinical outcomes or MOCART scores following OCA implantation using fresh precut OCA cores or size matched condylar grafts at early to midterm follow-up.

scholarly journals Autologous Matrix-Induced Chondrogenesis With Lateral Ligament Stabilization for Osteochondral Lesions of the Talus in Patients With Ankle Instability

2021 ◽  
Vol 9 (5) ◽  
pp. 232596712110074
Author(s):  
Jakob Ackermann ◽  
Fabio A. Casari ◽  
Christoph Germann ◽  
Lizzy Weigelt ◽  
Stephan H. Wirth ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Clinical Outcomes ◽  
Cartilage Repair ◽  
Ankle Instability ◽  
Lesion Size ◽  
Lateral Ligament ◽  
Osteochondral Lesions ◽  
Level Of Evidence ◽  
Radiographic Outcomes

Background: Autologous matrix-induced chondrogenesis (AMIC) has been shown to result in favorable clinical outcomes in patients with osteochondral lesions of the talus (OLTs). Though, the influence of ankle instability on cartilage repair of the ankle has yet to be determined. Purpose/Hypothesis: To compare the clinical and radiographic outcomes in patients with and without concomitant lateral ligament stabilization (LLS) undergoing AMIC for the treatment of OLT. It was hypothesized that the outcomes would be comparable between these patient groups. Study Design: Cohort study; Level of evidence, 3. Methods: Twenty-six patients (13 with and 13 without concomitant ankle instability) who underwent AMIC with a mean follow-up of 4.2 ± 1.5 years were enrolled in this study. Patients were matched 1:1 according to age, body mass index (BMI), lesion size, and follow-up. Postoperative magnetic resonance imaging and Tegner, American Orthopaedic Foot & Ankle Society (AOFAS), and Cumberland Ankle Instability Tool (CAIT) scores were obtained at a minimum follow-up of 2 years. A musculoskeletal radiologist scored all grafts according to the MOCART (magnetic resonance observation of cartilage repair tissue) 1 and MOCART 2.0 scores. Results: The patients’ mean age was 33.4 ± 12.7 years, with a mean BMI of 26.2 ± 3.7. Patients with concomitant LLS showed worse clinical outcome measured by the AOFAS (85.1 ± 14.4 vs 96.3 ± 5.8; P = .034) and Tegner (3.8 ± 1.1 vs 4.4 ± 2.3; P = .012) scores. Postoperative CAIT and AOFAS scores were significantly correlated in patients with concomitant LLS ( r = 0.766; P = .002). A CAIT score >24 (no functional ankle instability) resulted in AOFAS scores comparable with scores in patients with isolated AMIC (90.1 ± 11.6 vs 95.3 ± 6.6; P = .442). No difference was seen between groups regarding MOCART 1 and 2.0 scores ( P = .714 and P = .371, respectively). Conclusion: Concurrently performed AMIC and LLS in patients with OLT and ankle instability resulted in clinical outcomes comparable with isolated AMIC if postoperative ankle stability was achieved. However, residual ankle instability was associated with worse postoperative outcomes, highlighting the need for adequate stabilization of ankle instability in patients with OLT.

Midterm Results of Fresh-Frozen Osteochondral Allografting for Osteochondral Lesions of the Talus

2020 ◽  
pp. 107110072094986
Author(s):  
Chung-Hua Chu ◽  
Ing-Ho Chen ◽  
Kai-Chiang Yang ◽  
Chen-Chie Wang
Keyword(s):  
Short Form ◽  
Case Series ◽  
Osteochondral Allograft ◽  
Osteochondral Lesions ◽  
Midterm Results ◽  
Level Of Evidence ◽  
Allograft Transplantation ◽  
Fresh Frozen ◽  
The Mean

Background: Osteochondral lesions of the talus (OLT) are relatively common. Following the failure of conservative treatment, many operative options have yielded varied results. In this study, midterm outcomes after fresh-frozen osteochondral allograft transplantation for the treatment of OLT were evaluated. Methods: Twenty-five patients (12 women and 13 men) with a mean age 40.4 (range 18-70) years between 2009 and 2014 were enrolled. Of 25 ankles, 3, 13, 4, and 4 were involved with the talus at Raikin zone 3, 4, 6, and 7 as well as one coexisted with zone 4 and 6 lesion. The mean OLT area was 1.82 cm2 (range, 1.1-3.0). The mean follow-up period was 5.5 years (range, 4-9.3). Outcomes evaluation included the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, visual analog scale score, and 12-item Short Form Health Survey (SF-12). Result: AOFAS ankle-hindfoot score increased from 74 preoperatively to 94 at 2 years postoperatively ( P < .001) and the SF-12 physical health component scores increased from 32 to 46 points ( P < .001). Incorporation was inspected in all patients in the latest follow-up, and graft subsidence and radiolucency were observed in 2 and 7 cases, respectively, whereas graft collapse and revision OLT graft were not observed. Bone sclerosis was found in 6 of 25 patients. Conclusion: With respect to midterm results, fresh, frozen-stored allograft transplantation might be an option in the management of symptomatic OLT. Level of Evidence: Level IV, retrospective case series.

scholarly journals Results after Percutaneous and Arthroscopically Assisted Osteosynthesis of Calcaneal Fractures

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0019
Author(s):  
Wolfram Grün ◽  
Marius Molund ◽  
Fredrik Nilsen ◽  
Are Stødle
Keyword(s):  
Subtalar Joint ◽  
Operation Time ◽  
Clinical Results ◽  
Lateral Approach ◽  
Calcaneal Fractures ◽  
Invasive Approach ◽  
Extensile Lateral Approach ◽  
Arthroscopically Assisted ◽  
American Orthopaedic

Category: Arthroscopy, Trauma Introduction/Purpose: Surgical treatment of calcaneal fractures using the extensile lateral approach is associated with high rates of infection and soft tissue complications. During the last years there was a trend towards less invasive fixation methods. Percutaneous and arthroscopically assisted calcaneal osteosynthesis (PACO) combines the advantages of good visualization of the posterior facet of the subtalar joint with a minimally invasive approach. We have performed this technique since 2014 in selected Sanders II and III fractures. Methods: We conducted a clinical and radiographic follow-up of 19 patients with 20 calcaneal fractures which had been treated by PACO with a minimum follow-up of 12 months. The follow-up rate was 66% (19 of 29 patients). 18 men and 1 woman with a median age of 44 years (range, 21-65) and a follow-up period of 18 months (12-33) were examined. There were 11 Sanders II and 9 Sanders III fractures. Radiographs of all feet were obtained at final follow-up to evaluate the reduction of the fractures as well as the presence of osteoarthritis of the subtalar joint. Our primary outcome was the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot score. Secondary outcomes were the Calcaneus Fracture Scoring System (CFSS), the Manchester- Oxford Foot Questionaire (MOxFQ), the Visual Analog Scale (VAS) for pain and the incidence of complications. Results: The patients were operated on after a median of 4 days after injury (range, 1-12). The operation time was 139.5 minutes (98-234). The patients were discharged 3 days (1-6) postoperatively. Postoperative radiographs showed a Böhler angle of 29.5 degrees (0-40). However, the follow-up radiographs showed subsidence of the fractures and a Böhler angle of 21 degrees (-16-36). 95% of the operated feet showed signs of posttraumatic subtalar osteoarthritis. There were no wound healing complications. Two patients were reoperated with screw removal due to prominent screws. The AOFAS score was 85 (50-100), the CFSS score 85 (26-100), the MOxFQ score 26.6 (0-73.4). The VAS pain score was 0 (0-5.7) at rest and 4 (0-8.2) during activity. Conclusion: Only a few articles have reported the outcome after percutaneous artroscopically assisted calcaneal osteosynthesis. Our results suggest that PACO gives good clinical results and a reduced risk of complications in selected calcaneal fractures. However, since this technique is technically challenging and has a steep learning curve, we expect to be able to further improve our results over time. Prospective longterm studies will be necessary to better document the potential advantages and limitations of this operating technique.

scholarly journals Osteochondral Lesions of the Talus: Few Patients Require Surgery

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0005
Author(s):  
Seung-Hwan Park ◽  
Sang Gyo Seo ◽  
Ho Seong Lee
Keyword(s):  
Osteochondral Lesion ◽  
Lesion Size ◽  
Nonoperative Treatment ◽  
Osteochondral Lesions ◽  
Sports Activity ◽  
Sf 36 ◽  
Outcome Scores ◽  
The Mean ◽  
Analogue Scales

Category: Ankle, Ankle Arthritis Introduction/Purpose: The frequency of progression of osteoarthritis and persistence of symptoms in untreated osteochondral lesion of the talus (OCL) is not well known. We report the outcome of a nonoperative treatment for symptomatic OCL. Methods: This study included 142 patients with OCLs from 2003 to 2013. The patients did not undergo immobilization and had no restrictions of physical activities. The mean follow-up time was 6 (3–10) years. Initial MRI and CT confirmed OCL and showed lesion size, location, and stage of the lesion. Progression of osteoarthritis was evaluated by standing radiographs. In 83 patients, CT was performed at the final follow-up for analyses of the lesion size. We surveyed patients for limitations of sports activity, and Visual Analogue Scales (VAS), AOFAS, and SF-36 were assessed. Results: No patients had progression of osteoarthritis. The lesion size as determined by CT did not change in 69/83 patients, decreased in 5, and increased in 9. The mean VAS score of the 142 patients decreased from 3.8 to 0.9 (p < 0.001), the mean AOFAS ankle–hindfoot score increased from 86 to 93 (p < 0.001), and the mean SF-36 score increased from 52 to 72 (p < 0.001). Only 9 patients reported limitations of sports activity. The size and location of the lesion did not correlate with any of the outcome scores. Conclusion: Nonoperative treatment can be considered a good option for patients with OCL.

scholarly journals MaioRegen Osteochondral Substitute for the Treatment of Knee Defects: A Systematic Review of the Literature

2019 ◽  
Vol 8 (6) ◽  
pp. 783 ◽  
Author(s):  
Riccardo D’Ambrosi ◽  
Federico Valli ◽  
Paola De Luca ◽  
Nicola Ursino ◽  
Federico Usuelli
Keyword(s):  
Systematic Review ◽  
Clinical Improvement ◽  
Three Dimensional ◽  
Lesion Size ◽  
Review Of The Literature ◽  
Level Of Evidence ◽  
Significant Clinical Improvement ◽  
Almost All ◽  
Femoral Condyles

Background: This study aims to investigate the clinical and radiological efficacy of three-dimensional acellular scaffolds (MaioRegen) in restoring osteochondral knee defects. Methods: MEDLINE, Scopus, CINAHL, Embase, and Cochrane Databases were searched for articles in which patients were treated with MaioRegen for osteochondral knee defects. Results: A total of 471 patients were included in the study (mean age 34.07 ± 5.28 years). The treatment involved 500 lesions divided as follows: 202 (40.4%) medial femoral condyles, 107 (21.4%) lateral femoral condyles, 28 (5.6%) tibial plateaus, 46 (9.2%) trochleas, 74 (14.8%) patellas, and 43 (8.6%) unspecified femoral condyles. Mean lesion size was 3.6 ± 0.85 cm2. Only four studies reported a follow-up longer than 24 months. Significant clinical improvement has been reported in almost all studies with further improvement up to 5 years after surgery. A total of 59 complications were reported of which 52 (11.1%) experienced minor complications and 7 (1.48%) major complications. A total of 16 (3.39%) failures were reported. Conclusion: This systematic review describes the current available evidence for the treatment of osteochondral knee defects with MaioRegen Osteochondral substitute reporting promising satisfactory and reliable results at mid-term follow-up. A low rate of complications and failure was reported, confirming the safety of this scaffold. Considering the low level of evidence of the study included in the review, this data does not support the superiority of the Maioregen in terms of clinical improvement at follow-up compared to conservative treatment or other cartilage techniques.

scholarly journals The role of bone marrow edema on autologous matrix induced chondrogenesis for the treatment of osteochondral lesions of the talus

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001
Author(s):  
Riccardo D’Ambrosi ◽  
Camilla Maccario ◽  
Federico Giuseppe Usuelli
Keyword(s):  
Bone Marrow ◽  
Repeated Measures ◽  
Bone Marrow Edema ◽  
Lesion Size ◽  
Osteochondral Lesions ◽  
Significant Difference ◽  
T1 And T2 ◽  
Marrow Edema

Category: Ankle, Arthroscopy, Basic Sciences/Biologics Introduction/Purpose: to assess the functional and radiological outcomes after AT-AMIC® (arthroscopic talus autologous matrix induced chondrogenesis) in 2 groups: patients with and without bone marrow edema (BME). Methods: Thirty-seven patients of which 24 without edema (GNE) and 13 with edema (GE) were evaluated. All patients were treated with AT-AMIC® repair for osteochondral talar lesion. MRI and CT-scan evaluations, as well as clinical evaluations measured by the VAS score for pain, AOFAS and SF-12 were performed preoperatively (T0) and at 6 (T1), 12 (T2), and 24 (T3) months postoperatively. Results: GNE consisted of 24 patients while GE consisted of 13 patients. In both groups we found a significant difference for clinical and radiological parameters with ANOVA for repeated measures through four time points(p<0.001). In GNE, AOFAS improved significantly at each follow-up(p<0.05); while CT and MRI showed a significant decrease between T1 and T2 and T2 and T3(p<0.05). In GE, AOFAS improved significantly between T0 and T1 and T2 and T3(p<0.05); CT decreased between T1 and T2(p<0.05), while MRI showed a reduction at each follow-up(p<0.05). Lesion size was significantly higher both in MRI and CT in GE in respect to GNE(p<0.05). In the GNE no patients presented edema at T3, while in GE only 23.08% of the patients presented edema at T3. Conclusion: The study revealed that osteochondral lesions of the talus were characterized by bigger size both in MRI and CT in patients with edema. We conclude that AT-AMIC® can be considered a safe and reliable procedure that allows effective healing, regardless of edema and more than half of patients did not present edema six months after surgery.

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