Osteochondral Lesions of the Talus: Predictors of Clinical Outcome

2011 ◽  
Vol 32 (11) ◽  
pp. 1045-1051 ◽  
Author(s):  
Daniel J. Cuttica ◽  
W. Bret Smith ◽  
Christopher F. Hyer ◽  
Terrence M. Philbin ◽  
Gregory C. Berlet
Keyword(s):  
Clinical Outcome ◽  
Treatment Plan ◽  
Case Series ◽  
Retrospective Chart Review ◽  
Nonoperative Treatment ◽  
Treatment Modalities ◽  
Osteochondral Lesions ◽  
Foot And Ankle ◽  
Retrospective Case ◽  
Level Of Evidence

Background: Osteochondral lesions of the talus (OLT) are a common and challenging condition treated by the orthopedic foot and ankle surgeon. Multiple operative treatment modalities have been recommended, and there are several factors that need to be considered when devising a treatment plan. In this study, we retrospectively reviewed a group of patients treated operatively for osteochondral lesions of the talus to determine factors that may have affected outcome. Methods: A retrospective chart review of clinical, radiographic and operative records was performed for all patients treated for OLTs via marrow stimulation technique. All had a minimum followup of 6 months or until return to full activity, preoperative magnetic resonance imaging (MRI) of the OLT to determine size, and failure of nonoperative treatment. Results: A total of 130 patients were included in the study. This included 64 males and 66 females. The average patient age at the time of surgery was 35.1 ± 13.7 (range, 12 to 73) years. The average followup was 37.2 ± 40.2 (range, 7.43 to 247) weeks. The average size of the lesion was 0.84 ± 0.67 cm2. There were 20 lesions larger than 1.5 cm2 and 110 lesions smaller than 1.5 cm2. There were 113 contained lesions and 17 uncontained lesions. OLTs larger than 1.5 cm2 and uncontained lesions were associated with a poor clinical outcome. Conclusions: The treatment of osteochondral lesions of the talus remains a challenge to the foot and ankle surgeon. Arthroscopic debridement and drilling will often provide satisfactory results. However, larger lesions and uncontained lesions are often associated with inferior functional outcomes and may require a more extensive initial procedure. Level of Evidence: IV, Retrospective Case Series

The Role of Demineralized Allograft Subchondral Bone in the Treatment of Talar Cystic OCD Lesions That Have Failed Microfracture

2014 ◽  
Vol 7 (5) ◽  
pp. 377-386 ◽  
Author(s):  
Stephen A. Brigido ◽  
Nicole M. Protzman ◽  
Melissa M. Galli ◽  
Scott T. Bleazey
Keyword(s):  
Subchondral Bone ◽  
Case Series ◽  
Retrospective Chart Review ◽  
Osteochondral Lesions ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Medial Malleolar Osteotomy ◽  
And Function ◽  
Bone Plug

Cystic talar shoulder defects are particularly challenging osteochondral lesions. A retrospective chart review was performed on 13 adults that previously failed microfracture, presented with medial cystic osteochondral lesions of the talus, and were treated with malleolar osteotomy and subchondral allograft reconstruction. The aim of the study was to evaluate the effect of a medial malleolar osteotomy and allograft subchondral bone plug on pain and function. We hypothesized that following surgery, pain and function would significantly improve. Compared with preoperative measures, pain (first step in the morning, during walking, at the end of the day) and function (descending the stairs, ascending the stairs, and ambulating up to 4 blocks) improved postoperatively at 6 and 12 months ( P ≤ .001). During each activity, pain improved postoperatively from 6 to 12 months ( P ≤ .006). Postoperatively, from 6 to 12 months, the level of disability improved while descending the stairs ( P = .004), and the level of disability experienced while ascending the stairs and ambulating up to 4 blocks was maintained ( P ≥ .02). Multiple regression analyses identified body mass index as a predictor of preoperative function ( R2 = .34, P = .04). No variables were identified as significant predictors of postoperative pain or function. With all osteotomies healing, no graft rejection, and a single deep venous thrombosis, allograft subchondral plugs appear to successfully treat osteochondral lesions of the talus with improvements in pain and function as well as an acceptable complication rate. Level of Evidence: Therapeutic, Level IV: Retrospective Case Series.

Arthroscopic Treatment of Osteochondral Lesions of the Tibial Plafond

2012 ◽  
Vol 33 (8) ◽  
pp. 662-668 ◽  
Author(s):  
Daniel J. Cuttica ◽  
W. Bret Smith ◽  
Christopher F. Hyer ◽  
Terrence M. Philbin ◽  
Gregory C. Berlet
Keyword(s):  
Case Series ◽  
Retrospective Chart Review ◽  
Arthroscopic Treatment ◽  
Osteochondral Lesions ◽  
Retrospective Case ◽  
Aofas Score ◽  
Level Of Evidence ◽  
Tibial Plafond ◽  
Average Patient ◽  
Poor Outcomes

Background: Osteochondral lesions of the distal tibial plafond (OLTPs) are an uncommon problem. The purpose of this study was to evaluate clinical outcomes following arthroscopic treatment of OLTPs. Methods: Retrospective chart review was performed on all patients treated arthroscopically for OLTPs. Treatment consisted of generalized synovectomy followed by curettage of the lesion and microfracture. If a cartilage cap was intact, antegrade drilling was performed. Cystic defects were treated with curettage of the cyst and filling of any defect with bone graft. Results: A total of 13 patients were included. Nine patients had isolated lesions, while four had lesions of the distal tibial plafond and talar dome. Average followup was 156 (range, 38 to 402 ± 117.9) weeks and average patient age was 32.9 (range, 14 to 50 ± 11.8) years. Eleven of 13 patients were available for followup modified AOFAS score. The average preoperative score was 35.2 (range, 24 to 49 ± 7.1). The average postoperative modified AOFAS score was 50.4 (range, 33 to 56 ± 7.6). There were four patients (30.8%) with a poor outcome. Conclusion: OLTPs can be challenging to treat. Arthroscopic treatment can lead to improved outcomes. However, the higher incidence of poor outcomes in our series may indicate less predictability in the treatment of OLTPs and that outcomes may not be equivalent to previous reported studies on OLTPs or osteochondral lesions of the talus. Level of Evidence: IV, Retrospective Case Series

scholarly journals Lateral open wedge calcaneus osteotomy with bony allograft augmentation in adult acquired flatfoot deformity. Clinical and radiological results

2021 ◽  
Author(s):  
Gabriele Colo’ ◽  
Mattia Alessio Mazzola ◽  
Giulio Pilone ◽  
Giacomo Dagnino ◽  
Lamberto Felli
Keyword(s):  
Range Of Motion ◽  
Case Series ◽  
Deformity Correction ◽  
Tibialis Posterior ◽  
Open Wedge ◽  
Foot And Ankle ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Adult Acquired Flatfoot Deformity

Abstract The aim of this study is to evaluate the results of patients underwent lateral open wedge calcaneus osteotomy with bony allograft augmentation combined with tibialis posterior and tibialis anterior tenodesis. Twenty-two patients underwent adult-acquired flatfoot deformity were retrospectively evaluated with a minimum 2-year follow-up. Radiographic preoperative and final comparison of tibio-calcaneal angle, talo–first metatarsal and calcaneal pitch angles have been performed. The Visual Analog Scale, American Orthopedic Foot and Ankle Score, the Foot and Ankle Disability Index and the Foot and Ankle Ability Measure were used for subjective and functional assessment. The instrumental range of motion has been also assessed at latest follow-up evaluation and compared with preoperative value. There was a significant improvement of final mean values of clinical scores (p < 0.001). Nineteen out of 22 (86.4%) patients resulted very satisfied or satisfied for the clinical result. There was a significant improvement of the radiographic parameters (p < 0.001). There were no differences between preoperative and final values of range of motion. One failure occurred 7 years after surgery. Adult-acquired flatfoot deformity correction demonstrated good mid-term results and low recurrence and complications rate. Level of evidence Level 4, retrospective case series.

scholarly journals Incidence and Risk Factors of Symptomatic Venous Thromboembolism Following Foot and Ankle Surgery

2018 ◽  
Vol 40 (1) ◽  
pp. 98-104 ◽  
Author(s):  
Johanna Marie Richey ◽  
Miranda Lucia Ritterman Weintraub ◽  
John M. Schuberth
Keyword(s):  
Risk Factors ◽  
Hormone Replacement ◽  
Case Series ◽  
Foot And Ankle ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Ankle Surgery ◽  
History Of ◽  
Low Incidence ◽  
Predictive Risk

Background: The incidence rate of venous thrombotic events (VTEs) following foot and ankle surgery is low. Currently, there is no consensus regarding postoperative prophylaxis or evidence to support risk stratification. Methods: A 2-part study assessing the incidence and factors for the development of VTE was conducted: (1) a retrospective observational cohort study of 22 486 adults to calculate the overall incidence following foot and/or ankle surgery from January 2008 to May 2011 and (2) a retrospective matched case-control study to identify risk factors for development of VTE postsurgery. One control per VTE case matched on age and sex was randomly selected from the remaining patients. Results: The overall incidence of VTE was 0.9%. Predictive risk factors in bivariate analyses included obesity, history of VTE, history of trauma, use of hormonal replacement or oral contraception therapy, anatomic location of surgery, procedure duration 60 minutes or more, general anesthesia, postoperative nonweightbearing immobilization greater than 2 weeks, and use of anticoagulation. When significant variables from bivariate analyses were placed into the multivariable regression model, 4 remained statistically significant: adjusted odds ratio (aOR) for obesity, 6.1; history of VTE, 15.7; use of hormone replacement therapy, 8.9; and postoperative nonweightbearing immobilization greater than 2 weeks, 9.0. The risk of VTE increased significantly with 3 or more risk factors ( P = .001). Conclusion: The overall low incidence of VTE following foot and ankle surgery does not support routine prophylaxis for all patients. Among patients with 3 or more risk factors, the use of chemoprophylaxis may be warranted. Level of Evidence: Level III, retrospective case series.

scholarly journals Arthroscopic-assisted arthrodesis in the foot and ankle. Subtalar, tibiotalar, tibiocalcaneal, and metatarsophalangeal: 25 years of experience

2021 ◽  
Vol 0 ◽  
pp. 1-7
Author(s):  
Luis Perez-Carro ◽  
Carlos Rodrigo-Arriaza ◽  
Lorena Trueba-Sanchez ◽  
Gustavo Gutierrez-Castanedo ◽  
Guillermo Menendez-Solana ◽  
...  
Keyword(s):  
Case Series ◽  
Invasive Procedure ◽  
Foot And Ankle ◽  
Retrospective Case ◽  
Aofas Score ◽  
Level Of Evidence ◽  
Non Union ◽  
End Stage ◽  
Mean Time ◽  
Radiographic Union

Objectives: Arthritis of the foot and ankle joints provoke pain and restricts function. The arthroscopic assisted arthrodesis (AAA) is a minimally invasive procedure for end stage arthritis to eliminate pain and achieve painless mobilization, with numerous benefits like faster time to union, less blood loss, less morbidity, less infection rate, and less soft tissue complications compared with open surgery. The objective of this paper is to retrospectively evaluate our case series (136 patients) of arthroscopic assisted foot and ankle fusion that includes the subtalar, tibiocalcaneal, tibiotalar and metatarsophalangeal joint in our last 25 years of practice. Level of Evidence: Level IV, retrospective case series. Materials and Methods: Patients who underwent arthroscopic assisted arthrodesis in the foot and ankle were identified by review of a registry. Minimum follow-up was 24 months. Patient demographics characteristics, time to radiographic union, and preoperative and postoperative American Orthopaedic Foot and Ankle Society score (AOFAS) were obtained. Results: Subtalar fusion: 43 patients. Radiographic union was seen in 40 patients at a mean time of 10 weeks (8-14) and non union was seen in three patients, of which 1 required open revision surgery. AOFAS score improved from 43 preoperatively (27-57) to 83 (67-93) postoperatively. Tibiotalar fusion: 55 patients. Radiographic union in a mean time of 12 weeks (7-15) in all 55 cases. AOFAS score improved from 50.5 preoperatively (25-60) to 82 (62-94) postoperatively. Tibiotalocalcaneal fusion: 3 patients. 2 patients with radiographic union at 14 and 16 weeks and 1 showed a fibrotic union of the subtalar joint without pain. AOFAS score improved from 43 preoperatively (34-58) to 78 (67-81) postoperatively. Metatarsophalangeal fusion: 35 patients. Radiographic union in 33 patients at a mean time of 8 weeks (6-11). Two patients presented asymptomatic non union. AOFAS score improved from 38 preoperatively (30-60) to 86 (75-93) postoperatively. Conclusion: Arthroscopic assisted arthrodesis in the foot and ankle is an excellent procedure for end stage degenerated joint.

Surgical Treatment for Stenosing Peroneal Tenosynovitis

2018 ◽  
Vol 40 (3) ◽  
pp. 282-286 ◽  
Author(s):  
Geoffrey I. Watson ◽  
Sydney C. Karnovsky ◽  
David S. Levine ◽  
Mark C. Drakos
Keyword(s):  
Case Series ◽  
Retrospective Chart Review ◽  
Tendon Sheath ◽  
Symptomatic Improvement ◽  
Peroneal Tendon ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
History Of ◽  
Diagnostic Injection

Background: Stenosing peroneal tenosynovitis (SPT) is an uncommon entity that is equally difficult to diagnose. We evaluated our outcomes with a local anesthetic diagnostic injection followed by surgical release of the sheath and calcaneal exostectomy. Methods: Eleven patients diagnosed with SPT underwent surgery between 2006 and 2014. Upon initial presentation, all patients reported a persistent history of pain along the ankle. Ultrasound-guided injections of anesthetics were administered into the peroneal tendon sheath to confirm the diagnosis. In patients with a confirmed diagnosis of SPT, we proceeded with surgical intervention with release of the peroneal tendon sheath and debridement of the calcaneal exostosis. Retrospective chart review was performed, and functional outcomes were assessed using the Foot and Ankle Outcome Score (FAOS). FAOS results were collected pre- and postoperatively and were successfully obtained at 1 year or greater. Results: Of these patients, all showed significant improvements ( P < .05) in 4 of 5 categories of the FAOS (pain, daily activities, sports activities, and quality of life). Conclusion: We present a case series in which the peroneal tendon sheath was diagnostically injected with anesthetic to confirm a diagnosis of SPT. In each of these cases, symptomatic improvement was obtained following the injection. With the fact that many of these patients had advanced imaging denoting no significant tears, we believe that this diagnostic injection is paramount for the success of surgical outcome. Level of Evidence: Level IV, retrospective case series.

Management of Long-Term Sequelae of Compartment Syndrome Involving the Foot and Ankle

2009 ◽  
Vol 30 (9) ◽  
pp. 847-853 ◽  
Author(s):  
Francois Lintz ◽  
Jean A. Colombier ◽  
Joseph Letenneur ◽  
Francois Gouin
Keyword(s):  
Compartment Syndrome ◽  
Case Series ◽  
Personal Data ◽  
Functional Results ◽  
Ankle Arthrodesis ◽  
Foot And Ankle ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Muscle Fibrosis

Background: Lower leg compartment syndrome can lead to severe sequelae affecting patient autonomy. Ischemic muscle fibrosis and retraction result in foot and ankle deformities ranging from claw toes to complex multiplanar dislocations with soft tissue impairment requiring amputation. Although these deformities have been reported in relation to compartment syndrome, they have rarely been discussed specifically in the light of a long term follow up. Materials and Methods: Between 1981 and 2006, 151 patients were treated in our hospital for compartment syndrome of the lower limb. Ten of them later required further surgery to treat sequelae on the foot and ankle and were followed up prospectively. Personal data and surgical events were recorded, as well as potential risk factors for sequelae and functional outcome. The data was analyzed and compared to that available in previous literature. We analyzed and describe the different surgical procedures available for the management of this condition including arthroscopic ankle arthrodesis which could be a less invasive and efficient technique in mild equinus deformities. Results: All ten patients were diagnosed late for compartment syndrome. The anterior and lateral compartments were most often involved but rarely accounted for late sequelae. The deep posterior compartment seems to be the key element in generating after effects. Functional results were good in eight patients. Two required amputation after failed secondary surgery. Conclusion: The late, post-compartment syndrome affecting the foot and ankle can be treated efficiently provided surgery is performed acurately, taking into account the multiplanar deformity. However, the best treatment for this condition remains prevention. Level of Evidence: IV, Retrospective Case Series

scholarly journals Large Osteochondral Lesions of the Talus Treated With Autologous Bone Graft and Periosteum Transfer

2019 ◽  
Vol 4 (3) ◽  
pp. 247301141987403
Author(s):  
Dimitrios Nikolopoulos ◽  
Neoptolemos Sergides ◽  
George Safos ◽  
Konstantinos Moustakas ◽  
Petros Safos ◽  
...  
Keyword(s):  
Bone Graft ◽  
Donor Site ◽  
Autologous Transplantation ◽  
Case Series ◽  
Autologous Bone Graft ◽  
Osteochondral Lesions ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Functional Scores ◽  
Autologous Bone

Background: The treatment of large osteochondral lesions of the talus (OLTs) is challenging due to the poor intrinsic reparative capability of the damaged articular cartilage. Autologous transfer of bone and periosteum has been used successfully in the treatment of large defects in animals, and therefore it was believed that this technique might show similar results in humans. The purpose of this study was to assess the outcome of an innovative technique for autologous transplantation of cancellous tibial graft with periosteal transfer in large OLTs. Methods: Forty-one patients (22 females, 19 males), with a mean age of 34.9 years (range, 18-72 years), with a large OLT (>200 mm2) were treated with autologous bone graft and periosteum transfer. OLTs averaging 310 mm2 were identified on a preoperative computed tomography scan. The procedure consisted of malleolar osteotomy, curettage of sclerotic bone, autologous bone graft from the proximal tibia, and transfixion of periosteum over the graft. Outcome measures, including the pain visual analog scale (VAS), ankle range of motion (ROM), American Orthopaedic Foot & Ankle Society (AOFAS) score, and Foot & Ankle Disability Index (FADI), were compared between preoperative and 1 and 2 years following surgery. Results: There were significant improvements in VAS pain score from 7.7 before surgery to 1.1 at 1 year after surgery and 0.4 at 2 years or more after surgery. The AOFAS and FADI scores were also significantly improved from 40.3 and 53.3 preoperatively to 95 and 93.2 postoperatively at 1 year and 95 and 93.2 at 2 or more years postoperatively, respectively. Postoperative complications included 2 patients who required removal of medial malleolar osteotomy tension bands due to symptomatic hardware. There were no nonunions or malunions of the osteotomies and no donor site complications. Conclusion: Autologous bone graft and periosteum transfer was an effective treatment for large OLTs leading to significant decreases in pain and improvement in functional scores at more than 2 years after surgery. Level of Evidence: Level IV, retrospective case series.

Arthroscopic Treatment of Osteochondral Lesions of the Talus in a Suspended Position With the Patient in a Prone Position

2019 ◽  
Vol 40 (7) ◽  
pp. 811-817
Author(s):  
Chenyu Wang ◽  
Min Wook Kang ◽  
Hyong Nyun Kim
Keyword(s):  
Compartment Syndrome ◽  
Prone Position ◽  
Case Series ◽  
Arthroscopic Treatment ◽  
Osteochondral Lesions ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Arthroscopic Microfracture ◽  
The Mean

Background:The purpose of this study was to evaluate the clinical results and the safety of arthroscopic microfracture with the ankle suspended on a shoulder-holding traction frame for simultaneous anterior and posterior ankle arthroscopy in the prone position.Methods:Between May 2010 and January 2016, 31 patients with posterior osteochondral lesions of the talus (OLTs) were treated with arthroscopic microfracture in a suspended position with the patient prone. Ankle distraction was achieved by suspending the affected ankle on a shoulder-holding traction frame. The 100 mm visual analog scale (VAS) and the Foot Function Index (FFI) were checked preoperatively and at final follow-up. Postoperative complications related to the suspended position were analyzed. Lower leg intramuscular compartment pressure was checked after the surgery to determine if there was any risk of compartment syndrome.Results:The mean 100-mm VAS score, and FFI improved from 62.8 ±11.3 and 48.5 ± 12.1, respectively, preoperatively to 15.8 ± 10.4 and 16.4 ± 9.2, respectively, at final follow-up ( P = .025, and P = .005, respectively). The mean anterior, lateral, superficial posterior, and deep posterior compartment pressures were 7.3 ± 1.5, 8.1 ± 1.1, 5.6 ± 1.9, and 9.2 ± 2.4 mmHg, respectively. No compartment syndrome occurred.Conclusion:Arthroscopic treatment of OLT in a prone position with the ankle suspended on a shoulder-holding traction frame allowed the use of simultaneous anterior and posterior portals for viewing and instrumentation without major operative complications, such as compartment syndrome.Level of Evidence:Level IV, retrospective case series.

Posteromedial Approach for Osteochondral Lesions of the Talus

2020 ◽  
pp. 107110072094884
Author(s):  
Bilgehan Tosun
Keyword(s):  
Osteochondral Lesion ◽  
Case Series ◽  
Stage Iv ◽  
Osteochondral Lesions ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Osteochondral Grafts ◽  
Medial Malleolar Osteotomy ◽  
Osteochondral Fragment ◽  
Single Approach

Background: Medial malleolar osteotomy is an established procedure for accessing the medial localized osteochondral lesions of the talus. The purpose of this study was to describe a single approach, which allows perpendicular access to the lesion without a malleolar osteotomy. Methods: Six patients were treated surgically for medial localized talar osteochondral lesions. Four patients had stage III and 2 patients had stage IV lesions. A single posteromedial approach was used for accessing the medial talar dome. Results: The method of treatment was mosaicplasty in 4 patients and osteochondral fragment fixation in 2 patients. One patient who was treated with a fragment fixation procedure showed screw loosening. Incorporation of the osteochondral grafts was proved by magnetic resonance imaging in all mosaicplasty cases. Conclusion: A single posteromedial approach was sufficient in the posteromedial localized osteochondral lesion of the talus. As the lesion was approached by soft tissue exposure only, a malleolar osteotomy was not required. Thus, osteotomy-related complications were avoided. Level of Evidence: Level IV, retrospective case series.

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