Osteochondral Lesions of the Talus: Results of Repeat Arthroscopic Debridement

2007 ◽  
Vol 28 (6) ◽  
pp. 669-673 ◽  
Author(s):  
Nicholas Savva ◽  
Majid Jabur ◽  
Mark Davies ◽  
Terry Saxby
Keyword(s):  
Osteochondral Lesion ◽  
Professional Sports ◽  
Senior Author ◽  
Osteochondral Lesions ◽  
Arthroscopic Debridement ◽  
Foot And Ankle ◽  
Medium Term ◽  
Cartilage Transplantation ◽  
American Orthopaedic ◽  
Second Procedure

Background: Repeat arthroscopic debridement of osteochondral lesions of the talus has a poor reputation despite a paucity of evidence in the literature. Methods: We reviewed all patients who had repeat arthroscopic debridement of an osteochondral lesion performed by the senior author. They were scored using the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale, and lesions were graded using the system described by Berndt and Harty. Results: Between 1993 and 2002, 808 consecutive ankle arthroscopies were performed by the senior author, of which 215 were to treat osteochondral lesions of the talus. Of these, 12 had repeat arthroscopies because of unresolved symptoms. AOFAS scores improved from a mean of 34.8 prior to arthroscopy to 80.5 after repeat arthroscopy at a mean followup of 5.9 years (18 months to 11 years). Two patients returned to professional sports after the second procedure. Six patients returned to their preinjury levels of sporting activity and three returned to the same sports but played to a lesser standard or less frequently. One patient had already had a cartilage transplantation procedure. Conclusions: This is the first series specifically assessing patients who have had repeat arthroscopic debridement of osteochondral lesions of the talus, using the same debridement technique by a single surgeon. Our results question the assumption that repeat arthroscopic debridement yields poor results. They also provide a baseline for the newer chondral and osteochondral transplantation techniques to compare to at the medium term.

Does the Association of Microfractures for the Treatment of Osteochondral Lesions of the Talus Affect the Outcome Following Arthroscopic Treatment for Chronic Ankle Instability?

2021 ◽  
Vol 111 (1) ◽  
Author(s):  
Claudio Legnani ◽  
Enrico Borgo ◽  
Vittorio Macchi ◽  
Alberto Ventura
Keyword(s):  
Surgical Procedure ◽  
Ankle Instability ◽  
Osteochondral Lesion ◽  
Chronic Ankle Instability ◽  
Activity Level ◽  
Arthroscopic Treatment ◽  
Osteochondral Lesions ◽  
Foot And Ankle ◽  
Significant Difference ◽  
American Orthopaedic

Background The purpose of the present study was to retrospectively compare the outcomes of patients who underwent arthroscopic thermal capsular shrinkage with those who underwent both arthroscopic thermal capsular shrinkage and arthroscopic osteochondral lesion (OCL) treatment with microfractures. Our hypothesis was that the simultaneous treatment does not negatively affect the outcome of the combined surgical procedure by influencing the postoperative rehabilitation protocol and does not significantly differ from capsular shrinkage alone in terms of subjective and objective outcomes. Methods Seventy-six patients with chronic ankle instability were treated at our department from 2004 to 2012 and reviewed retrospectively. Forty-two patients underwent arthroscopic thermal-assisted capsular shrinkage (group A), and 34 patients underwent combined arthroscopic capsular shrinkage and microfractures for OCL lesions of the talus (group B). All patients underwent a four-step surgical procedure including synovectomy, debridement, capsular shrinkage, and bracing and nonweightbearing for 21 days. In patients with OCL lesions, microfractures of the OCL were associated. Clinical assessment included objective examination, the American Orthopaedic Foot and Ankle Society ankle and hindfoot scoring system, Karlsson-Peterson score, Tegner activity level, and Sefton articular stability scale. Results The median follow-up was 6 years (range, 2–9 years). The median postoperative visual analogue scale score, American Orthopaedic Foot and Ankle Society score, and Tegner score were improved from the preoperative level for both groups (P < .001). No significant difference was found between the two groups for the subjective scores and satisfaction rate (P = not significant). Similarly, no significant difference regarding the incidence of range-of-motion restriction was reported between the two groups (P = not significant). Conclusions The association of microfractures for the treatment of osteochondral lesions does not affect the outcome following arthroscopic treatment for chronic ankle instability up to 6 years from surgery.

Influence of the Medial Malleolus Osteotomy on the Clinical Outcome of M-BMS + I/III Collagen Scaffold in Medial Talar Osteochondral Lesion (German Cartilage Register/Knorpelregister DGOU)

Cartilage ◽  
2020 ◽  
pp. 194760352096116
Author(s):  
Oliver Gottschalk ◽  
Sebastian Felix Baumbach ◽  
Sebastian Altenberger ◽  
Daniel Körner ◽  
Matthias Aurich ◽  
...  
Keyword(s):  
Treatment Options ◽  
Osteochondral Lesion ◽  
Collagen Scaffold ◽  
Clinical Results ◽  
Osteochondral Lesions ◽  
Medial Malleolus ◽  
Foot And Ankle ◽  
Bone Marrow Stimulation ◽  
Medial Malleolar Osteotomy ◽  
Significant Difference

Objective Osteochondral lesions of the talus are common injuries, with one of the leading treatment options being the M-BMS (matrix-augmented bone marrow stimulation) + I/III collagen scaffold. Osteotomy of the medial malleolus is not unusual but presents the risk of malunion or irritation by hardware. The aim of the study was to analyze data from the German Cartilage Society (Knorpelregister DGOU) to evaluate the influence of medial malleolar osteotomy on clinical results of M-BMS + I/III collagen scaffold. Design The ankle module of the Cartilage Register includes a total of 718 patients, while 45 patients met the inclusion criteria. Patients were treated with an M-BMS + I/III collagen scaffold of the medial talus, 30 without and 15 with an osteotomy of the medial malleolus. The follow-up evaluations included FAAM (Foot and Ankle Ability Measure), FAOS (Foot and Ankle Outcome Score), and VAS (visual analogue scale). Results Forty-five patients (22 male, 23 female) aged between 18 and 69 years (mean: 34 years) were included in this study. Between preoperative and 12 months postoperative, we noted a significant improvement in FAAM-ADL (Activity of Daily Living) ( P = 0.004) as well as FAOS-Pain ( P = 0.001), FAOS-Stiffness ( P = 0.047), FAOS-ADL ( P = 0.002), FAOS-Sport ( P = 0.001), and FAOS Quality of Life ( P = 0.009). There was no significant difference between patients who underwent an osteotomy or not. Conclusion The results show a significant improvement in patients’ outcome scores following a M-BMS + I/III collagen scaffold. No statistical difference was noted among those undergoing medial malleolar osteotomy.

Arthroscopic Treatment of Osteochondral Lesions of the Talus in a Pediatric Population: A Minimum 2-Year Follow-up

2020 ◽  
Vol 48 (8) ◽  
pp. 1989-1998
Author(s):  
Michael J. Carlson ◽  
Tomasz T. Antkowiak ◽  
Nicholas J. Larsen ◽  
Gregory R. Applegate ◽  
Richard D. Ferkel
Keyword(s):  
Patient Satisfaction ◽  
Short Form ◽  
Arthroscopic Treatment ◽  
Osteochondral Lesions ◽  
Study Group ◽  
Foot And Ankle ◽  
Analog Scale ◽  
Foot Function ◽  
American Orthopaedic

Background: Treatment of osteochondral lesions of the talus (OLTs) in children presents a difficult clinical challenge, with few large series reported. Purpose: To evaluate functional and radiographic outcomes for children and adolescents undergoing arthroscopic treatment of symptomatic OLT with a minimum follow-up of 2 years. Study Design: Case series; Level of evidence, 4. Methods: Patients were identified who had symptomatic OLT treated arthroscopically with marrow stimulation techniques. Inclusion criteria were age ≤18 years, symptomatic chronic OLT as the surgical indication, failure of nonoperative treatment, and minimum follow-up of 24 months. Outcome measures included Foot Function Index, American Orthopaedic Foot and Ankle Society Hindfoot Score, Tegner Activity Scale, 36-Item Short Form Health Survey (Short Form-36, v 2), visual analog scale, ankle range of motion, and patient satisfaction survey. Weightbearing radiographs were compared with preoperative radiographs via an ankle arthritis classification system. Magnetic resonance imaging (MRI) was used to evaluate postoperative lesion characteristics per the MOCART scale (magnetic resonance observation of cartilage repair tissue). The size, location, lesion stability, traumatic etiology, skeletal maturity, and length of follow-up were recorded and analyzed through univariate logistic regression. Results: The study group consisted of 22 patients (11 male, 11 female) with a mean age of 14.4 years (range, 8-18 years) and a mean follow-up of 8.3 years (range, 2-27 years). Of 22 patients, 20 were satisfied with the results from surgery and would recommend it to others. Mean follow-up visual analog scale for pain was reported as 2.2 on a 10-point scale, and mean American Orthopaedic Foot and Ankle Society score at follow-up was 86.6. Mean postoperative Foot Function Index scores for the study group were as follows: pain, 17.1; disability, 16.5; activity, 4.7; and overall, 38.7. Mean Short Form-36 physical component score was 50.7. Postoperative radiographs indicated a van Dijk osteoarthritis grade of 0 in 56%, I in 38%, II in 6%, and III in 0%. Postoperative MRI MOCART scores showed complete filling of the cartilage in 27% of cases, complete graft integration in 22%, and intact repair surface in 22%, with a mean MOCART score of 48.0. No correlation was found between radiographic and MRI findings and clinical outcomes. None of the prognostic factors were significantly associated with patient satisfaction, progression of arthritis, or MOCART scores. Conclusion: Arthroscopic treatment of symptomatic OLT in adolescent patients (≤18 years) demonstrated high functional outcomes, high clinical satisfaction rates, and minimal radiographic osteoarthritic progression despite low MOCART scores.

scholarly journals Nontraumatic Osteochondral Lesion of the Talar Head: A Case Report and Description of Operative Technique for Arthroscopic Debridement

2014 ◽  
Vol 1 (1) ◽  
pp. 34-37
Author(s):  
A Patel ◽  
J Mangwani ◽  
W Al-Jundi ◽  
A Askari ◽  
D Moore
Keyword(s):  
Case Report ◽  
Operative Technique ◽  
Osteochondral Lesion ◽  
Asia Pacific ◽  
Osteochondral Lesions ◽  
Arthroscopic Debridement ◽  
Talar Dome ◽  
Bone Marrow Stimulation ◽  
Talar Head

ABSTRACT Osteochondral lesions of the talar dome are well described. To our knowledge, there are no published reports of osteochondral lesion of the talar head. We report the case of a 16-year-old girl who presented with a nontraumatic osteochondral lesion of talar head, which was treated with arthroscopic debridement and bone marrow stimulation. At 6-month follow-up, the patient was symptom free and the radiograph showed signs of healing of the lesion. How to cite this article Mangwani J, Patel A, Al-Jundi W, Askari A, Moore D. Nontraumatic Osteochondral Lesion of the Talar Head: A Case Report and Description of Operative Technique for Arthroscopic Debridement. J Foot Ankle Surg (Asia-Pacific) 2014;1(1):34-37.

Symptom and Disability Measurement by Common Foot and Ankle–Specific Outcome Rating Scales

2020 ◽  
Vol 41 (7) ◽  
pp. 849-858 ◽  
Author(s):  
James P. Sieradzki ◽  
Nicholas Larsen ◽  
Ivan Wong ◽  
Richard D. Ferkel
Keyword(s):  
Rating Scales ◽  
Ankle Instability ◽  
Osteochondral Lesion ◽  
Patient Survey ◽  
Osteochondral Lesions ◽  
Foot And Ankle ◽  
Ankle Osteoarthritis ◽  
Level Of Evidence ◽  
Relative Score ◽  
Specific Outcome

Background: Well-designed foot and ankle clinical outcomes research requires region-specific subjective outcome measures. Many foot and ankle–specific instruments are now available. Determining which instruments to choose is daunting. We present a patient survey to determine the most relevant questions pertaining to them. Methods: Sixteen foot and ankle–specific outcome instruments were chosen based on popularity, emphasizing valid, reliable, responsive scores. Subjective portions were consolidated and given to 109 patients with osteochondral lesion of the talus (OLT) (39), ankle instability (35), and ankle arthritis (35). Outcome instruments were measured according to 4 criteria: number of questions endorsed by 51%, number with high mean importance, number with low mean importance, and number with the highest-ranking frequency importance product. Instruments were then ranked based on relative score, with the highest scores indicating the instrument was the most useful for that sample. Results: The Foot and Ankle Outcome Score (FAOS) achieved the highest score in all 4 categories for OLT, followed by Foot and Ankle Ability Measure (FAAM) and American Academy of Orthopaedic Surgeons (AAOS) Foot and Ankle Score. The FAOS achieved the highest score in all 4 categories for ankle instability, followed by FAAM and AAOS. For osteoarthritis, the FAOS achieved the highest relative score followed by FAAM and AAOS. The AOF, Ankle Osteoarthritis Score, and AAS are instruments commonly used that had lower relative scores. Conclusion: The FAOS, FAAM, and AAOS Foot and Ankle Score contain several items important to patients with osteochondral lesions of the talus, ankle instability, and ankle osteoarthritis. Level of Evidence: Level II, prospective comparative study.

Arthroscopic Treatment of Osteochondral Lesions of the Distal Tibia

2007 ◽  
Vol 28 (8) ◽  
pp. 865-872 ◽  
Author(s):  
Timothy S. Mologne ◽  
Richard D. Ferkel
Keyword(s):  
Bone Grafting ◽  
Treatment Guidelines ◽  
Distal Tibia ◽  
Osteochondral Lesion ◽  
Arthroscopic Treatment ◽  
Rank Test ◽  
Osteochondral Lesions ◽  
Signed Rank ◽  
Signed Rank Test ◽  
American Orthopaedic

Background: Osteochondral lesions of the tibia are much less frequent than those of the talus, and treatment guidelines have not been established. We hypothesized that arthroscopic treatment methods used for osteochondral lesion of the talus would also be effective for those of the distal tibia. Methods: A review of 880 consecutive ankle arthroscopies identified 23 patients (2.6%) with osteochondral lesions of the distal tibia. Four patients were excluded because of concomitant acute ankle fractures requiring open reduction and internal fixation and two were lost to followup, leaving 17 in the study. The mean age was 38 (19 to 71) years. Six (35%) had osteochondral lesions of the tibia and talus; 11 had isolated lesions of the distal tibia. Treatment included excision, curettage, and abrasion arthroplasty in all patients. Five patients had transmalleolar drilling of the lesion, two had microfracture, and two had iliac bone grafting. At last followup, patients were evaluated with a questionnaire, physical examination, and ankle radiographs. Results: Mean followup was 44 (24 to 99) months. Preoperatively, the median American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot score was 52; postoperatively, it was 87. Using the Wilcoxon signed-rank test to compare preoperative and postoperative scores, there was significant improvement in the ankle-hindfoot score postoperatively ( p < 0.001). Seven patients had excellent results, seven had good results, one had a fair result, and two had poor results. Conclusions: Osteochondral lesions of the distal tibia present a challenge to the orthopedic surgeon. Arthroscopic treatment by means of debridement, curettage, abrasion arthroplasty, and, in some patients, transmalleolar drilling, microfracture, or iliac crest bone grafting, resulted in excellent and good results in 14 of 17 patients at medium-term followup.

scholarly journals Management of Hepple Stage V Osteochondral Lesion of the Talus with a Platelet-Rich Plasma Scaffold

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Wenqi Gu ◽  
Tanzhu Li ◽  
Zhongmin Shi ◽  
Guohua Mei ◽  
Jianfeng Xue ◽  
...  
Keyword(s):  
Bone Graft ◽  
Cancellous Bone ◽  
Platelet Rich Plasma ◽  
Short Form ◽  
Osteochondral Lesion ◽  
Osteochondral Lesions ◽  
Cancellous Bone Graft ◽  
Sf 36 ◽  
American Orthopaedic

There has been no consensus on the treatment or prognosis of Hepple stage V osteochondral lesions of the talus (OLTs), especially for lesions greater than 1.5 cm2in size. The objective of this study was to investigate the clinical outcomes achieved upon application of a platelet-rich plasma (PRP) scaffold with a cancellous bone autograft for Hepple stage V OLTs. Fourteen patients (mean age, 39 years) were treated with a cancellous bone graft and a PRP scaffold between 2013 and 2015. The mean time to surgical treatment was 23.5 months. Ankle X-ray and magnetic resonance imaging were performed at the final follow-up. Functional outcomes were evaluated according to the Visual Analog Scale (VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS) score, and Short Form 36 (SF-36) score. The range of motion (ROM) of the ankle joint and complications also were recorded. Thirteen patients completed the full follow-up, with a mean follow-up duration of 18 months. MRI demonstrated the complete regeneration of subchondral bone and cartilage in all patients. The postoperative VAS, AOFAS ankle and hindfoot, and SF-36 scores were improved significantly (allP<0.001) without obvious complications. We suggest that, for the Hepple stage V OLTs, management with cancellous bone graft and PRP scaffold may be a safe and effective treatment.

scholarly journals Management of Hepple Stage V Osteochondral Lesion of the Talus with a Platelet-Rich Plasma Scaffold

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0043
Author(s):  
Zhongmin Shi
Keyword(s):  
Bone Graft ◽  
Cancellous Bone ◽  
Platelet Rich Plasma ◽  
Osteochondral Lesion ◽  
Osteochondral Lesions ◽  
Cancellous Bone Graft ◽  
Sf 36 ◽  
American Orthopaedic ◽  
Bone Autograft

Category: Ankle Introduction/Purpose: There has been no consensus on the treatment or prognosis of Hepple stage V osteochondral lesions of the talus (OLTs), especially for lesions greater than 1.5 cm2 in size. The objective of this study was to investigate the clinical outcomes achieved upon application of a platelet-rich plasma (PRP) scaffold with a cancellous bone autograft for Hepple stage V OLTs. Methods: Fourteen patients (mean age, 39 years) were treated with a cancellous bone graft and a PRP scaffold between 2013 and 2015. The mean time to surgical treatment was 23.5 months. Ankle X-ray and magnetic resonance imaging were performed at the final follow-up. Functional outcomes were evaluated according to the Visual Analog Scale (VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS) score, and Short Form36 (SF-36) score.The range of motion (ROM) of the ankle joint and complications also were recorded. Results: Thirteen patients completed the full follow-up, with a mean follow-up duration of 18 months. MRI demonstrated the complete regeneration of subchondral bone and cartilage in all patients.The postoperative VAS, AOFAS ankle and hindfoot, and SF-36 scores were improved significantly (all 𝑃 < 0.001) without obvious complications. Conclusion: We suggest that, for the Hepple stage V OLTs, management with cancellous bone graft and PRP scaffold may be a safe and effective treatment.

Treatment of Osteochondral Lesion of the First Metatarsal Head: Osteochondral Graft Transplantation Combined With Moberg Osteotomy: Case Report

2021 ◽  
pp. 193864002110019
Author(s):  
Machado A. Bruno ◽  
Rassi F. Marcos ◽  
Fonseca V. Wagner ◽  
Filho V. Wagner
Keyword(s):  
Case Report ◽  
Surgical Treatment ◽  
Alternative Treatment ◽  
Osteochondral Lesion ◽  
Metatarsal Head ◽  
Osteochondral Lesions ◽  
Osteochondral Graft ◽  
Foot And Ankle ◽  
Level Of Evidence ◽  
First Metatarsal

Most osteochondral lesions of the first metatarsal head are likely traumatic in etiology. The treatment ranges from microfractures to mosaicplasty. In this case report, we describe a central osteochondral lesion of the first metatarsal head treated with osteochondral graft obtained from the head of the same metatarsal in combination with Moberg osteotomy. After surgical treatment, the patient’s American Orthopedic Foot and Ankle Society Forefoot Scale score improved from 58 to 85, and the range of motion also improved. This technique may be an alternative treatment modality for osteochondral lesions of the first metatarsal. Level of Evidence: Level V

scholarly journals Medium-term results of the HINTEGRA total ankle arthroplasty

2020 ◽  
Vol 14 (3) ◽  
pp. 231-238
Author(s):  
Mohammadali Khademi ◽  
Paulo Ferrao ◽  
Nikiforos Saragas
Keyword(s):  
Case Series ◽  
Ankle Arthrodesis ◽  
Total Ankle Arthroplasty ◽  
Foot And Ankle ◽  
Medium Term ◽  
Level Of Evidence ◽  
Ankle Arthroplasty ◽  
Secondary Objective ◽  
American Orthopaedic

Objective: The aim of this study was to determine patient satisfaction, survivorship, and revision rate of the HINTEGRA total ankle arthroplasty (TAA). Our secondary objective was to assess hindfoot function. Methods: All patients who underwent a HINTEGRA TAA between 2007 and 2014 were evaluated. We included a total of 69 patients (69 ankles), who were subjected to clinical and radiological examination and completed a visual analogue scale (VAS) for pain, the American Orthopaedic Foot and Ankle Society (AOFAS) ankle score, and the self-reported foot and ankle score (SEFAS). Hindfoot function was assessed using the AOFAS hindfoot score. Mean follow-up was 62 (57–101) months. Results: The mean VAS score was 2 (0–3) and the SEFAS was 37 (26–48) at the most recent follow-up, while the AOFAS ankle score improved from 57 (52–62) to 87 (82–93). The AOFAS hindfoot score improved from 82 to 92 postoperatively. Eight patients had periprosthetic osteolysis and 5 underwent bone grafting of cysts. We detected polyethylene and hydroxyapatite particles in specimens obtained from the cysts. Eight patients had their procedures converted to an ankle arthrodesis. Conclusion: In select patients, TAA improved quality of life. Our medium-term follow-up of the HINTEGRA TAA observed a survivorship of 89% at 5 years with an improvement in the AOFAS score and a mean SEFAS score of 37. We recommend that large periprosthetic cysts, which may be caused by the hydroxyapatite coating and polyethylene particles, be bone grafted prophylactically. We found hindfoot function to be preserved. Level of Evidence IV; Therapeutic Studies; Case Series.

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