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.

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.

Prognostic Significance of the Containment and Location of Osteochondral Lesions of the Talus

2012 ◽  
Vol 41 (1) ◽  
pp. 126-133 ◽  
Author(s):  
Woo Jin Choi ◽  
Gi Won Choi ◽  
Jun Shik Kim ◽  
Jin Woo Lee
Keyword(s):  
Clinical Outcome ◽  
Prognostic Significance ◽  
Osteochondral Lesion ◽  
Cox Proportional Hazards ◽  
Arthroscopic Treatment ◽  
Osteochondral Lesions ◽  
Clinical Failure ◽  
Level Of Evidence ◽  
Increased Risk ◽  
Significant Difference

Background: Uncontained osteochondral lesions of the talar shoulder are associated with an increased risk of clinical failure in patients treated with current cylindrical osteochondral autograft techniques. Whether the same holds true in patients undergoing arthroscopic treatment is unknown. Purpose: To determine the relative prognostic significance of the containment (shoulder vs nonshoulder type) and location (medial vs lateral) of an osteochondral lesion of the talus (OLT). Hypothesis: Arthroscopic treatment may not be ideal for uncontained lesions of the talar shoulder due to a lack of structural support. Study Design: Cohort study; Level of evidence, 3. Methods: Arthroscopic treatment for OLT was performed on the ankles of 399 patients between 2001 and 2009. Analyses were performed by grouping the patients according to type of containment (shoulder, n = 181; nonshoulder, n = 218), location (medial, n = 274; lateral, n = 125), and both type of containment and location (medial shoulder, n = 129; medial nonshoulder, n = 145; lateral shoulder, n = 52; lateral nonshoulder, n = 73). To evaluate the role of containment and location independently of OLT size, patients were grouped according to quartile of defect size, and outcomes were analyzed within each group. Results: Patients with shoulder-type OLT had a substantially worse clinical outcome than did those with nonshoulder-type OLT, even after adjustment for OLT size ( P < .05). However, there was no significant difference in clinical outcome between patients with medial OLT and those with lateral OLT, and the clinical failure rates of the 2 groups were similar ( P > .05). A Cox proportional hazards regression model demonstrated that OLT containment, but not location, exerted an independent prognostic effect. Conclusion: Patients with uncontained OLT of the talar shoulder experienced a more complicated clinical outcome than did those with contained, nonshoulder-type OLT even after adjustment for OLT size and regardless of location.

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.

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.

Autograft versus allograft tenodesis for chronic ankle instability: a single-center retrospective comparative study

2020 ◽  
Author(s):  
Claudio Legnani ◽  
Enrico Borgo ◽  
Vittorio Macchi ◽  
Alberto Ventura
Keyword(s):  
Ankle Instability ◽  
Surgical Techniques ◽  
Chronic Ankle Instability ◽  
Foot And Ankle ◽  
Lateral Tenodesis ◽  
Peroneus Brevis ◽  
American Orthopaedic ◽  
Objective Outcomes ◽  
Retrospective Comparative Study ◽  
Autograft Group

Aim: To compare the outcomes of patients who underwent autograft tenodesis with those who underwent allograft tenodesis for the treatment of chronic mechanical ankle instability. Patients & methods: Ten patients who underwent allograft lateral tenodesis were compared with 15 patients who underwent lateral tenodesis using a split peroneus brevis tendon. Patients were followed up after an average time of 10.5 years. Results: No statistically significant differences concerning American Orthopaedic Foot and Ankle Society and Karlsson–Peterson scores were reported (p = n.s.). A reduced average radiographic anterior talar translation was observed in the autograft group compared with the allograft group (1.4 and 4.0 mm respectively, p < 0.001). Conclusion: Both surgical techniques significantly improved subjective and objective outcomes in patients suffering from chronic ankle instability compared with pre-operatory status. Autograft stabilization provided reduced post-operative anterior talar translation compared with allograft tenodesis.

scholarly journals Weightbearing CT Analysis of Hindfoot Alignment in Chronic Lateral Ankle Instability

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0000
Author(s):  
Francois Lintz ◽  
Alessio Bernasconi ◽  
Nazim Mehdi ◽  
Cesar de Cesar Netto ◽  
Louise Baschet ◽  
...  
Keyword(s):  
Odds Ratio ◽  
Ankle Instability ◽  
Weight Bearing ◽  
Univariate Analysis ◽  
Chronic Ankle Instability ◽  
Foot And Ankle ◽  
Hindfoot Alignment ◽  
Significant Difference ◽  
History Of ◽  
Weightbearing Ct

Category: Ankle, Hindfoot, Imaging, Ankle Instability Introduction/Purpose: Varus hindfoot deformity may increase the risk of chronic ankle instability (CAI).Weightbearing CT (WBCT) semi-automated measurements and built-in databases may contribute to investigate the relationship between clinical and radiographic data. The objective of this study was to analyze hindfoot alignment (HA) in relation with CAI in a series of patients using these new tools. We hypothesized that there would be a positive correlation between a varus morphotype and a history of CAI. Methods: This is a Level 3 retrospective comparative study of a continuous series of 124 feet (63 patients) referred from July to December 2016. and subsequently assessed by WBCT (PedCAT®, CurveBeam LLC). The measurement software (Talas®, Curvebeam LLC), gave HA as a value of Foot and Ankle Offset (FAO). This measures the offset between the center of the ankle joint and the median line of the foot joining the centers of the calcaneus and forefoot weight bearing surfaces. Data was prospectively saved in a database (CubeView®, CurveBeam, PA, USA). The definition of CAI was a history of at least 3 ankle sprains during a 6 months period. Exclusion criteria were medial instability and syndesmotic injuries (2 cases).A univariate analysis was conducted to study CAI against the following variables: gender (Fisher), BMI and FAO (Kurskal-Wallis). The significant variables were subsequently included in a multivariate logistic model. Results: Nineteen feet had CAI, in 12 patients. Gender (p=0.0467 –the proportion of women for patients with CAI was 72.3%, compared to 33.3% without CAI) and FAO (p=0 .0002) were significant in the univariate analysis. The mean FAO was respectively -1.40 (SD: 5.50) and 3.56 (SD: 5.31) with and without a history of CAI. No significant difference of age or BMI was shown. After verification of log-linearity between odds of CAI and FAO, the multivariate logistic regression adjusted for gender demonstrated a 15% increase of odds of CAI per unit increase of varus (adjusted Odds Ratio (CI95%): 0.858 (0.771-0.943) p=0.003), and no more significant effect of gender after adjustment on FAO (Odds ratio (CI95%) Female versus Male: 0.548 (0.185 -1.669) p=0.277). Conclusion: A positive linear relationship was found between Varus Hindfoot Alignment measured using a semi-automatic tool in WBCT and the odds ratio for Chronic Ankle Instability, thus confirming and quantifying previous findings. The recent development of semi-automatic measurements and prospective databases opens future perspectives for big data and multivariate analysis in foot and ankle pathology.

scholarly journals Influence of Foot Progression Angle on Center of Pressure During Stair Ascending in Subjects With Chronic Ankle Instability

2021 ◽  
Vol 15 ◽  
pp. 350-354
Author(s):  
Jung-Hyun Ban ◽  
Tae-Ho Kim
Keyword(s):  
Center Of Pressure ◽  
Ankle Instability ◽  
Chronic Ankle Instability ◽  
Foot Progression Angle ◽  
Significant Difference ◽  
The Stability ◽  
Neutral Posture ◽  
Criteria For Selection ◽  
Anterior Posterior ◽  
Selection Of

The purpose of this study was to identify changes in the center of pressure during stair ascending in subjects with chronic ankle instability while different angles of foot are applied. The subjects of this study were 20 male and female adults with chronic ankle instability were selected from among the employees of D Hospital in Daegu Metropolitan City. The criteria for selection of subjects with chronic ankle instability were those who felt wobbling in the ankle joint and scored not higher than 24 points in a test using the Cumberland Ankle Instability Tool (CAIT). The subjects carried out stair ascending in neutral, toe-in and toe-out postures, respectively, and changes in the center of pressure (COP) were compared and analyzed. The results of this study, no statistically significant difference appeared in the comparison between the toe-in posture and neutral posture or between the neutral posture and the toe-out posture but medial/lateral movements of the center of pressure showed significant differences between the toe-in and toe-out postures. In addition, the total travel range and the moving range of the center of pressure, the average velocity, and the anterior/posterior movements of the center of pressure showed no statistically significant difference among all three postures. As a result, it could be seen that when adults with chronic ankle instability climb the stairs, the toe-in posture reduce the medial/lateral movements of the center of pressure thereby increasing the stability of the ankle and effectively preventing re-injuries.

scholarly journals The Effect of Peroneal Muscle Strength on Functional Outcomes After the Modified Broström Procedure for Chronic Ankle Instability

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0019
Author(s):  
Byung-Ki Cho ◽  
Seung-myung Choi
Keyword(s):  
Muscle Strength ◽  
Functional Outcomes ◽  
Ankle Instability ◽  
Peak Torque ◽  
Chronic Ankle Instability ◽  
Functional Evaluation ◽  
Foot And Ankle ◽  
Patient Reported ◽  
Functional Outcome Measures ◽  
Modified Broström Procedure

Category: Sports Introduction/Purpose: Although the peroneal muscle is known to be a major dynamic lateral stabilizer of the ankle, few informations are available regarding the changes of muscle strength and relationship with the outcomes after lateral ligaments repair surgery. The purpose of this study was to identify the effects of peroneal strength on the validated functional outcome measures after the modified Broström procedure(MBP) for chronic ankle instability. Methods: Forty-one patients (41 ankles) underwent MBP using suture anchors were eligible and followed up to 2 years postoperatively. Functional evaluation consisted of the Foot and Ankle Outcome Score(FAOS), Foot and Ankle Ability Measure(FAAM). The changes of peroneal strength were evaluated using isokinetic dynamometer. Differences in the functional outcomes between the 3 groups divided according to recovery rate of peroneal strength were analysed. Results: Peak torque and total work for eversion in 60º/sec angular velocity significantly improved from a mean 8.1 Nm, 5.2 Nm preoperatively to 11.4 Nm, 6.9 Nm at postoperative 2 years, respectively (P < .001, P = .038). Deficit ratio of peak torque for eversion significantly improved from a mean 38.6% to 17.4%, and a significant side to side difference was found (P = .011). There were no significant differences in FAOS, FAAM, and measurements of stress radiograph between the 3 groups. Conclusion: Although restoration of peroneal strength postoperatively was about 82.6% of unaffected ankle, patient-reported function in daily and sport activities were satisfactorily improved. Postoperative isokinetic strength of the peroneus demonstrated no statistically significant effects on the functional outcomes after MBP.

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