Defect Debridement Research Articles

Rejuvenation of bone volume with CGF and i-PRF in intra-osseous defects.

The risk of further periodontal breakdown increases with a deep intrabony defect. Non-surgical periodontal therapy could pose a challenge and surgical intervention is mainly required to manage the defect. Autologous platelet concentrates such as Injectable platelet rich fibrin (i-PRF) and concentrated growth factor (CGF) may improve surgical outcome due to its enrichment with growth factors. Total of 04 patients involved in this study. After conventional flap debridement of intrabony defects, CGF is placed in 2 patients and the other 2 patients received i-PRF in their respective intrabony defects. Volumetric analysis was done pre-operative and 6 months post operatively in both the groups. Bone volume is significantly increased in both CGF and i-PRF group but higher in CGF group when compared to i-PRF group has high regenerative and reconstructive growth factors which helps aids in early and high bone fill when compared to i-PRF.

Subchondral Drilling Independent of Drill Hole Number Improves Articular Cartilage Repair and Reduces Subchondral Bone Alterations Compared With Debridement in Adult Sheep

Background: Subchondral drilling is an established marrow stimulation technique for small cartilage defects, but whether drilling is required at all and if the drill hole density affects repair remains unclear. Hypotheses: Osteochondral repair is improved when the subchondral bone is perforated by a higher number of drill holes per unit area, and drilling is superior to defect debridement alone. Study Design: Controlled laboratory study. Methods: Rectangular full-thickness chondral defects (4 × 8 mm) were created in the trochlea of adult sheep (N = 16), debrided down to the subchondral bone plate without further treatment as controls (no treatment; n = 7) or treated with either 2 or 6 (n = 7 each) subchondral drill holes (diameter, 1.0 mm; depth, 10.0 mm). Osteochondral repair was assessed at 6 months postoperatively by standardized (semi-)quantitative macroscopic, histological, immunohistochemical, biochemical, and micro–computed tomography analyses. Results: Compared with defect debridement alone, histological overall cartilaginous repair tissue quality (P = .025) and the macroscopic aspect of the adjacent cartilage (P≤ .032) were improved after both drilling densities. Only drilling with 6 holes increased type 2 collagen content in the repair tissue compared with controls (P = .038). After debridement, bone mineral density was significantly decreased in the subchondral bone plate (P≤ .015) and the subarticular spongiosa (P≤ .041) compared with both drilling groups. Debridement also significantly increased intralesional osteophyte sectional area compared with drilling (P≤ .034). No other differences in osteochondral repair existed between subchondral drilling with 6 or 2 drill holes. Conclusion: Subchondral drilling independent of drill hole density significantly improves structural cartilage repair compared with sole defect debridement of full-thickness cartilage defects in sheep after 6 months. Subchondral drilling also leads to a better reconstitution of the subchondral bone compartment below the defects. Simultaneously, drilling reduced the formation of intralesional osteophytes caused by osseous overgrowth compared with debridement. Clinical Relevance: These results have important clinical implications, as they support subchondral drilling independent of drill hole number but discourage debridement alone for the treatment of small cartilage defects. Clinical studies are warranted to further quantify the effects of subchondral drilling in similar settings.

Osteochondral lesions of the talar dome in the athlete: what evidence leads to which treatment

Osteochondral lesions of the talar dome in the athlete: what evidence leads to which treatment

Efficiency of Hyaluronic Acid in Infrabony Defects: A Systematic Review of Human Clinical Trials

Background and objectives: The aim of this systematic review was to assess the electronic literature about the benefits of using hyaluronic acid (HA) in the surgical periodontal treatment of infrabony defects. Materials and methods: This review was conducted under the PRISMA guidelines. The electronic search was conducted on PubMed, Scopus, Web of Science, and Cochrane databases until February 2022. The inclusion criteria consisted of human clinical trials that reported the use of HA in open-flap debridement (OFD) for infrabony defects. The assessment of risk of bias was performed using the Cochrane risk of bias tool. Statistical analysis was performed using Review Manager. Results: Overall, three RCTs were found eligible for the statistical analysis. Probing depth (PD) reduction and clinical attachment level (CAL) gain in the HA test group presented WMs of −1.11 mm (95% CI −2.38 to 0.16 mm; p = 0.09) and −1.38 mm (95% CI −2.26 to −0.49 mm; p = 0.002), respectively. However, the heterogeneity of the RCTs was high, and the risk of bias, in general, was low. Conclusions: The use of hyaluronic acid seems to have beneficial effects in periodontal surgery using OFD, in terms of PD and CAL. To draw a clear conclusion, more adapted and well-designed clinical trials are needed to assess the advantage of this product in comparison with other products.

SUBCHONDRAL DRILLING INDEPENDENT OF DRILL HOLE NUMBER IMPROVES ARTICULAR CARTILAGE REPAIR AND REDUCES SUBCHONDRAL BONE ALTERATIONS COMPARED TO DEBRIDEMENT

Purpose: Subchondral drilling is an established marrow stimulation technique for symptomatic small articular cartilage defects, but the effect of drill hole number per unit area remains unclear. In the current study we first tested the hypothesis that osteochondral repair is improved when the subchondral bone plate is perforated with a higher number of drill holes. Second, we tested the hypothesis that subchondral drilling per se is superior to defect debridement alone.

Autologous matrix-induced chondrogenesis plus peripheral blood concentrate (AMIC+PBC) in chondral defects of the first metatarsophalangeal joint.

Chondral restoration in chondral defects of the 1st metatarsophalangeal joint (MTP1) using autologous matrix-induced chondrogenesis plus peripheral blood concentrate (AMIC+PBC). Chondral defects MTP1. Acute infection. Thigh tourniquet. Medial approach. Tenolysis of all tendons, arthrolysis, synovectomy. Bursectomy in case of bursitis. Resection osteophytes, optional cheilectomy. Debridement of chondral defects until surrounding cartilage stable. Microfracturing with 1.6 mm K‑wire. 15 cc peripheral venous blood harvested with double lumina syringe. Centrifugation (10 min, 1500 RPM). Aspiration of supernatant including the entire fluid layer directly above the erythrocyte layer (peripheral blood concentrate [PBC]). Chondro-Gide matrix was cut to size and impregnated in PBC 3 min (impregnation). Fixation of the matrix into the chondral defect with fibrin glue (AMIC+PBC). Joint motion to ensure stable fixation. Insertion drainage and wound infiltration catheter. Layer wise closure. Full weightbearing in adressing shoe. Joint motion exercise starting at the day of surgery. The aim of the study was to compare matrix-associated stem cell transplantation (MAST) with AMIC+PBC. Patients who were treated with MAST from October1, 2011 to July15, 2016 (n = 623) or with AMIC+PBC from July17, 2016 to March19, 2018 (n = 230) were included. In all, 480 (89%)/176 (89%) patients (MAST/AMIC+PBC) completed 2‑year follow-up. The average degree of osteoarthritis was 2.1/2.2. The chondral defect size was 0.9/1.0 cm2 on average. Visual Analogue Scale Foot and Ankle (VAS FA) and European Foot and Ankle Society score (EFAS score) improved to 72.4/74.1//16.8/17.1 (MAST//AMIC+PBC) at follow-up, respectively. No parameter significantly differed between the MAST and AMIC+PBC cohorts.

The Sound of Cartilage Repair: The Importance of Using Pitch and Volume Cues in Cartilage Restoration Surgery

Articular cartilage defects are common and can result in substantial pain and disability, prompting operative intervention, which commonly includes chondral debridement. Controlled defect preparation up to but not beyond the calcified cartilage layer is key to clinical success, but this remains technically challenging. We present a technique highlighting the substantial decrease in curette stroke volume and associated shift to a lower pitch when achieving satisfactory open cartilage defect debridement. These audiologic cues correlate well with histologic accuracy of debridement. Therefore, quantifiable pitch and volume changes serve as valuable technical cues for precise defect preparation at the time of joint preservation surgery. ClassificationsI: knee, II: cartilage.

A 12-month randomized controlled trial evaluating erythritol air-polishing versus curette/ultrasonic debridement of mandibular furcations in supportive periodontal therapy

BackgroundDue to complex morphology and limited access, the cleaning of the furcation area is extremely challenging. Therefore, novel therapeutic approaches need to be tested to potentially overcome debridement limitations. The aim of the present prospective 12-month study was to compare clinical and microbiological effects following erythritol air-polishing versus conventional mechanical debridement of furcation defects in a cohort of periodontal maintenance patients.MethodsTwenty patients with grade II mandibular molar furcation defects volunteered to enroll in this single-centre, examiner masked, randomized controlled trial. In a split-mouth study design, two furcation sites in each patient were randomly assigned to either receive subgingival debridement using erythritol air-polishing (test) or conventional ultrasonic/curette debridement (control) at baseline, and at 3, 6, 9 and 12 months. Probing depth, clinical attachment level and bleeding on probing were recorded at 3-month intervals. Subgingival microbiological samples obtained at baseline, 6 and 12 months were analyzed using checkerboard DNA–DNA hybridization. Discomfort from treatment was scored at 12 months using a visual analogue scale. The differences between treatments, and time-points, were tested using multilevel analysis (mixed effect models and robust variance estimates).ResultsA significant reduction in probing depth took place following both treatments (p < 0.001). Control sites experienced a significant mean gain in clinical attachment level of 0.5 mm (± 0.2) (p = 0.004), whereas a non-significant gain of 0.4 mm (± 0.3) was observed at test sites (p = 0.119). At 6 months, a significant between-treatment difference of 0.8 mm (± 0.4) was observed in favor of the control (p = 0.032). No significant between-treatment differences were observed in microbial load or composition. Notably, at 12 months patients experienced significantly less discomfort following air-polishing compared with control (p = 0.001).ConclusionsThe 12-month observations indicate that erythritol air-polishing and conventional mechanical debridement both support clinical improvements. A significant between-treatment difference in clinical attachment level was, however, detected in favour of control debridement at 6 months. In terms of patient comfort, erythritol air-polishing is superior.Trial Registration: The clinical trial was retrospectively registered in ClinicalTrial.gov with registration NCT04493398 (07/28/2020).

Экспериментальная модель хронического очагового остеомиелита для исследований in vivo

Introduction. The article describes an experimental model of chronic suppurative osteomyelitis in a rabbit. As new therapeutic and diagnostic algorithms for the supervision of patients with osteomyelitis appear, there is an growing need to compare the methods of surgical debridement and plasty of bone defects in an infectious process, in order to create experimental standardized pathological conditions as close to the clinical course of the disease in humans as possible. The aim of the study was to develop an experimental model of a standardized chronic purulent bone cavity, suitable for a comprehensive assessment of surgical debridement effectiveness and osteoplastic properties of bone substitute materials. Materials and methods. A standardized defect of the tibia in 24 rabbits was formed. The Staphylococcusaureus strain was used as an infectious agent. A dynamic assessment of the main indicators of blood counts in animals was carried out. The formation of chronic osteomyelitis was evaluated using radiography, com-puted tomography methods and histological studies. Results. It was shown that purulent bone wound developed in experimental animals with the technique cre-ated, and a defect with signs of a chronic purulent-inflammatory process was demonstrated. Conclusion. The proposed model of chronic osteomyelitis is reproducible. Operational flexibility and identi-cal in size and location bone defects allow to use this model in new osteoplastic material research. Keywords: chronic osteomyelitis, experiment, experimental animals

Analysis of the short term functional results of osteochondral defects in a stable knee treated by arthroscopic debridement and micro fracture technique at 1 year follow up using the lysholm knee scoring scale

Introduction: Articular cartilage is a complex tissue with an ability to withstand tremendous forces over many cycles and years, but at the same time it has no ability to heal even after a minor injury. The incidence of articular cartilage injuries varies from 60-66% during routine arthroscopic surgery [1, 2]. Objectives: To analyze the short term functional results of Osteochondral defects in a stable knee treated by Arthroscopic Debridement and Micro fracture technique at 1 year follow up using the Lysholm Knee Scoring Scale. Methodology: Source of data: All the patients with osteochondral injuries who were managed by arthroscopic micro fracture technique, and have come for follow up. All the patients who underwent arthroscopy for suspected intra-articular pathology and were diagnosed intraoperatively with osteochondral defects, and managed by micro fracture. All the patients admitted to SDM Hospital that are scheduled to undergo arthroscopic debridement and micro fracture for osteochondral defects of the knee based on clinical and MRI findings, who fit into inclusion criteria, within a period of 1 year, from November 2012 to October 2013. Conclusion: Articular cartilage injuries are more frequently encountered during routine arthroscopic surgeries of the knee, than thought. Arthroscopic debridement and micro fracture results in an improved functional outcome at 1 year follow up. Marrow stimulation by micro fracture technique does not require any specialized instruments or operative setup, and can be performed in any center where routine arthroscopic surgeries of the knee are done. Arthroscopic debridement and micro fracture is a single staged procedure as compared to Autologous Chondrocyte Implantation. The cost involved in arthroscopic debridement and micro fracture is far less compared to Autologous Chondrocyte Implantation and other cell based procedures. In comparison to other management modalities for osteochondral defects like Mosaicplasty, Autologous Chondrocyte Implantation and other cell based techniques, Micro fracture does not come in the way for repeat surgeries if required. We safely recommend Arthroscopic debridement and Micro fracture technique as a ‘first line’ management for the treatment of osteochondral defects in a stable knee, for lesions less than 4 cm2 in size.

Treatment of Cartilage Defects With the Matrix-Induced Autologous Chondrocyte Implantation Cookie Cutter Technique

Focal cartilage defects lead to significant pain and disability, prompting the development of various options for biologic restoration of the articular surface. Although each technique and biologic implant provides various advantages and associated limitations, matrix-induced autologous chondrocyte implantation (MACI) has gained popularity given promising long-term results. We present a technique for the facile implantation of MACI membranes using cookie cutter instrumentation to aid in defect debridement and graft preparation. The technique described allows for efficient operative workflow while ensuring the creation of vertical, stable defect edges and a form-fitting MACI membrane in a readily implemented fashion.

Clinical trial of adjunctive autologous platelet-rich plasma treatment following diamond-burr debridement for spontaneous chronic corneal epithelial defects in dogs.

OBJECTIVE To evaluate the effects of adjunctive treatment with autologous platelet-rich plasma (PRP) on corneal reepithelialization, vascularization, and fibrosis in dogs with spontaneous chronic corneal epithelial defects (SCCEDs). DESIGN Randomized, controlled, double-masked clinical trial. ANIMALS 40 client-owned dogs with uncomplicated SCCEDs. PROCEDURES All dogs were treated with diamond-burr epithelial debridement (DBD) of affected eyes, topical tobramycin solution and atropine sulfate ointment application, and Elizabethan collar placement for 4 weeks. Dogs were randomly assigned to topical ocular administration of autologous PRP (n = 20) or artificial tear solution (control group; 20) 4 times daily for 28 days. Recheck examinations were performed approximately 2 and 4 weeks after treatment began to evaluate SCCEDs for corneal reepithelialization, and semiquantitative corneal vascularization and corneal fibrosis scores were assigned according to affected corneal surface area. Results were compared between groups. RESULTS All dogs completed the study. The SCCEDs had completely reepithelialized in 11 (55%) control dogs and 12 (60%) PRP-treated dogs by the 2-week reevaluation, and in 15 (75%) control dogs and 18 (90%) PRP-treated dogs by the 4-week reevaluation. No significant differences were identified between groups in these proportions nor in mean differences from pretreatment scores for corneal vascularization and fibrosis. CONCLUSIONS AND CLINICAL RELEVANCE In this preliminary study involving dogs with uncomplicated SCCEDs, topical PRP administered as an adjunctive treatment following DBD had no significant effect on healing. A larger study is warranted to support or refute these findings and to determine the effects of adjunctive PRP treatment for dogs with complicated SCCEDs.

Dimensional evaluation of blood clot gap distances within intrabony defects following grafting and EDTA root surface treatment-experimental study in dogs.

Because it is important to establish and maintain a firm blood clot to the surrounding tissues within the intrabony lesion; we have to investigate the potentials of different materials in resisting clot retraction that disrupt clot adhesion to the root surface. This study was designed to measure the gap distance created by clot retraction within the defect following intrabony defects grafting with and without root surface EDTA etching. Eight mongrel dogs with surgically created acute-chronic bilateral mandibular interproximal intrabony defects in the premolar-molar areas were enrolled in this study (total 8 defects per dog). Intrabony defects were divided into four groups, the first group (OFD): control open flap debridement, the second group, (EDTA treated defects) in which debridement of the defects was followed by two minute root surface etching with a neutral 24% EDTA gel followed by two minute copious saline irrigation, the third group (only grafted defects): defects received closely packed β-TCP of a particle size ranged from 150 to 500 mm, and the fourth group, (Graft + EDTA treated defects): defects were etched for 2 minutes with a neutral 24% EDTA gel and saline irrigation followed by intrabony defect fill of β-TCP. Twenty four hours post treatment, animal euthanasia was carried out for histomorphometric analysis of the tooth and root side gap distances. EDTA treated group and EDTA + graft group showed statistically significant lower degree of clot shrinkage compared to both the control and only grafted group. Clot shrinkage in EDTA treated group showed no significant difference from that of the EDTA + graft group (p=0.197). OFD and only grafted groups were found to show statistically higher clot retraction percnetage compared to both EDTA and EDTA+graft groups. following intrabony defect debridement, blood clot undergoes clot retraction creating a micro gap with the root surface. EDTA root surface etching before graft application into the defect area significantly reduced the amount of gap distance.

Feasibility of the Use of RapiGraft and Skin Grafting in Reconstructive Surgery.

BackgroundSkin grafting is a relatively simple and thus widely used procedure. However, the elastic and structural quality of grafted skin is poor. Recently, various dermal substitutes have been developed to overcome this disadvantage of split-thickness skin grafts. The present study aims to determine the feasibility of RapiGraft as a new dermal substitute.MethodsThis prospective study included 20 patients with partial- or full-thickness skin defects; the patients were enrolled between January 2013 and March 2014. After skin defect debridement, the wound was divided into two parts by an imaginary line. Split-thickness skin grafting alone was performed on one side (group A), and RapiGraft and split-thickness skin grafting were used on the other side (group B). All patients were evaluated using photographs and self-questionnaires. The Manchester scar scale (MSS), a chromameter, and a durometer were used for the scar evaluation. The average follow-up period was 6 months.ResultsThe skin graft take rates were 93% in group A and 89% in group B, a non-significant difference (P=0.082). Statistically, group B had significantly lower MSS, vascularity, and pigmentation results than group A (P<0.05 for all). However, the groups did not differ significantly in pliability (P=0.155).ConclusionsThe present study indicates that a simultaneous application of RapiGraft and a split-thickness skin graft is safe and yields improved results. Therefore, we conclude that the use of RapiGraft along with skin grafting will be beneficial for patients requiring reconstructive surgery.

Irrigation endoscopic assisted percutaneous pars repair: technical note

Background ContextSpondylolysis is a common source of low back pain in children and adolescents. Despite the benign natural history of the pathology, however, it should be noted that as part of conservative management many young individuals are forced to discontinue their routine sports activities. In cases resistant to conservative management, direct repair of a pars defect is considered a safe and effective option in young adults with preserved discs. Recently, some reports of minimally invasive pars repair have been described, aiming at preservation of the paraspinal muscles and improvement of the postoperative course. PurposeThe study aimed to present a new minimally invasive endoscopic technique for pars repair. Study DesignThis is a technical note. Patient SampleSeven consecutive patients complaining of back pain due to spondylolysis and resistant to conservative management were included. Outcome MeasuresOutcome was assessed using the modified Macnab criteria, and bone union was assessed on postoperative radiographs. MethodsTwo portals of 0.5 cm were used on each side, 1 cm lateral to the midline. One portal is used for the endoscope and the second for the surgical instruments. Following endoscopic debridement of the defect, the inferior portal was used for percutaneous placement of the Buck screw. There was no source for external funding for this study and no potential conflict of interest to disclose. ResultsOutcome was excellent in six cases and good in one case. All patients returned back to their normal level of activities. Complete radiographic union was seen in all patients. The mean period of postoperative hospital stay and follow-up was 8 hours and 21 months, respectively. ConclusionsThe irrigation endoscopic technique has previously shown promising results in lumbar discectomy and laminectomy. Similar results were observed in the current study on the ability to achieve minimally invasive pars defect debridement and a smooth postoperative course. This is a pilot study and larger patient series and different surgeons' experience are required for further evaluation of the technique.

Induced membrane technique for the treatment of bone defects due to post-traumatic osteomyelitis.

ObjectivesInduced membrane technique is a relatively new technique in the reconstruction of large bone defects. It involves the implantation of polymethylmethacrylate (PMMA) cement in the bone defects to induce the formation of membranes after radical debridement and reconstruction of bone defects using an autologous cancellous bone graft in a span of four to eight weeks. The purpose of this study was to explore the clinical outcomes of the induced membrane technique for the treatment of post-traumatic osteomyelitis in 32 patients.MethodsA total of 32 cases of post-traumatic osteomyelitis were admitted to our department between August 2011 and October 2012. This retrospective study included 22 men and ten women, with a mean age of 40 years (19 to 70). Within this group there were 20 tibias and 12 femurs with a mean defect of 5 cm (1.5 to 12.5). Antibiotic-loaded PMMA cement was inserted into the defects after radical debridement. After approximately eight weeks, the defects were implanted with bone graft.ResultsThe patients were followed for 27.5 months (24 to 32). Radiographic bone union occurred at six months for 26 cases (81%) and clinical healing occurred in 29 cases (90%) at ten months. A total of six cases had a second debridement before bone grafting because of recurrence of infection and one patient required a third debridement. No cases of osteomyelitis had recurred at the time of the last follow-up visit.ConclusionThe induced membrane technique for the treatment of post-traumatic osteomyelitis is a simple, reliable method, with good early results. However, there are many challenges in determining the scope of the debridement, type of limb fixation and source of bone graft to be used.Cite this article: Dr Z. Xie. Induced membrane technique for the treatment of bone defects due to post-traumatic osteomyelitis. Bone Joint Res 2016;5:101–105. DOI: 10.1302/2046-3758.53.2000487.

Return to sports after arthroscopic debridement and bone marrow stimulation of osteochondral talar defects: a 5- to 24-year follow-up study.

PurposeOsteochondral defects (OCD) often have a severe impact on the quality of life due to deep ankle pain during and after weight bearing, which prevents young patients from leading an active life. Arthroscopic debridement and bone marrow stimulation are currently the gold standard treatment. The purpose of this study was to evaluate the number of patients that resume and maintain sports to their pre-injury activity level after arthroscopic debridement and bone marrow stimulation.MethodsThis retrospective study evaluated patients treated with arthroscopic debridement and bone marrow stimulation between 1989 and 2008. All patients who were participating in sports before injury were included. The Ankle Activity Scale (AAS) was used to determine activity levels during specific time points (before injury, before operation, after operation and at the time of final follow-up).ResultsNinety-three patients were included. Fifty-seven (76 %) patients continued participating in sports at final follow-up. The median AAS before injury of 8 (range 3–10) significantly decreased to 4 (range 2–10) at final follow-up.ConclusionIt is shown that 76 % of the patients were able to return to sports at long-term follow-up after arthroscopic debridement and bone marrow stimulation of talar OCDs. The activity level decreased at long-term follow-up and never reached the level of that before injury. The data of our study can be of importance to inform future patients on expectations after debridement and bone marrow stimulation of a talar OCD.Level of evidenceRetrospective case series, Level IV.

Practical execution of defect preparation prior to surgical cartilage intervention: results from a representative meeting survey among experts.

During a specialised orthopedic meeting held on ‘the state of the art in cartilage defect repair’, all previously fully-registered participants were requested to participate in an electronic survey by the use of a moderator-presented “Power Point Presentation-based” 9-item questionnaire. The aim of this survey was to assess indication, approach, and treatment execution of cartilage defect debridement prior to planned microfracture (MFX) or autologous chondrocyte implantation (ACI). All participants completed the questionnaire (n = 146) resulting in a return rate of 100 %. An uncertainty exists as to whether the removal of the calcifying layer prior to cartilage repair must be carried out or not. The same was true for the acceptability of subchondral bleeding prior to microfracturing and its handling prior to autologous chondrocyte implantation. There is a degree of unanimity among experts regarding the management of osteophytes and bone marrow edema. In a homogenous society collective of consultants that frequently deal with cartilage defective pathologies, there still remain a significant heterogeneity in selected topics of defect debridement.

Arthroscopic Treatment of Osteochondral Defects of the Talus

The primary aim of this study was to assess the long-term clinical and radiographic outcomes of arthroscopic debridement and bone marrow stimulation for talar osteochondral defects. The secondary aim was to identify prognostic factors that affect the long-term results. Fifty (88%) of fifty-seven eligible patients with a primary osteochondral defect treated with arthroscopic debridement and bone marrow stimulation were evaluated after a mean follow-up of twelve years (range, eight to twenty years). Clinical assessment included the Ogilvie-Harris score, Berndt and Harty outcome question, American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, and Short Form-36 (SF-36) as well as resumption of work and sports. Weight-bearing radiographs were compared with preoperative radiographs with use of an ankle osteoarthritis classification system. The size, location, and classification of the defect, patient age and body mass index, traumatic etiology, and duration of symptoms were recorded and analyzed with use of univariate logistic regression. The Ogilvie-Harris score was excellent in 20% of patients, good in 58%, fair in 22%, and poor in 0%. According to the Berndt and Harty outcome question, 74% of patients rated the ankle as good, 20% as fair, and 6% as poor. The median AOFAS score was 88 (range, 64 to 100). Of the eight subscales of the SF-36, six were comparable with population norms and two were superior in the study group. Ninety-four percent of patients had resumed work and 88% had resumed sports. The radiographs indicated an osteoarthritis grade of 0 in 33% of the patients, I in 63%, II in 4%, and III in 0%. Compared with the preoperative osteoarthritis classification, 67% of radiographs showed no progression and 33% showed progression by one grade. None of the prognostic factors was significantly associated with the Ogilvie-Harris score or progression of osteoarthritis. This study suggests that initial success of arthroscopic debridement and bone marrow stimulation for osteochondral defects of the talus are maintained over time. No factors that were predictive of the outcome could be identified.

Repair of pars interarticularis defect using a U-shaped rod–screw construct

Study design Retrospective study. Aim To evaluate the efficacy of pars repair using pedicle screws connected with a U-shaped rod in the treatment of traumatic pars defect of the lower lumbar spine after failed conservative treatment. Materials and methods Eighteen patients with traumatic pars defect were managed from 2004 to 2009 by pars repair using two pedicle screws inserted into the involved vertebra and connected by a U-shaped rod passing under a spinous process and tightened after careful defect debridement and grafting. An MRI was performed to exclude adjacent disc degeneration. The patients were followed up using plain radiographs, in anteroposterior, lateral and oblique views. A computed tomography scan was performed to ensure pars healing. Results All patients had bilateral traumatic pars defect; their ages ranged from 16 to 27 years. Follow-up ranged from 24 to 53 months. Fourteen patients showed improved symptoms and returned to activity with full range of motion by the end of the sixth postoperative month. Two patients developed radicular pain; one showed complete improvement in the seventh week, whereas the other required revision. Two patients showed pseudoarthrosis and persistent pain that required revision with posterior lumbar interbody fusion. Conclusion This technique is an easy, effective technique of short operative duration with the advantage of nonviolation of the neural canal, no requirement for postoperative bracing and safe return to activity by the end of the sixth month, with no requirement for further fusion.