Large Subchondral Cyst Research Articles

Arthroscopic management of large subchondral talar cyst: a novel treatment strategy

Subchondroplasty is a novel and minimally invasive technique used to treat large subchondral talar cysts. It avoids soft tissue scarring, the need for osteotomies, bone grafting and its associated complications as seen with conventional approaches. Subchondroplasty involves arthroscopically approaching the cyst and injecting it with calcium phosphate paste injection, which undergoes an endothermic process and crystallizes in a manner that resembles cancellous bone to fill the defect. This case series presents two patients who underwent subchondroplasty: a 44-year-old female nurse with atraumatic right ankle pain of 2years with a CT scan revealing a large subchondral cyst over the medial talar dome and a 55-year-old male chemical plant worker with left ankle pain following a biking accident 6years ago whose CT scan too showed a large subchondral cyst in the medial talus. Both tolerated the surgery well, with significant reductions noted in MOXFQ scores at the 1-year follow-up.

A case of osteochondral lesion of the talus with a large subchondral cyst

A case of osteochondral lesion of the talus with a large subchondral cyst

Clinical Outcomes of Osteochondral Lesions of the Talus With Large Subchondral Cysts Treated With Osteotomy and Autologous Chondral Grafts: Minimum 2-Year Follow-up and Second-Look Evaluation.

Background:Osteochondral lesions of the talus (OLTs) with large subchondral cysts are challenging to treat.Purpose:To determine the safety and efficacy of autologous chondral grafting and malleolus osteotomy for treating OLTs associated with large subchondral cysts.Study Design:Case series; Level of evidence, 4.Methods:A total of 19 patients underwent autologous chondral grafting and malleolus osteotomy. We obtained the visual analog scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot, and magnetic resonance observation of cartilage repair tissue (MOCART) scores at 1 and 2 years postoperatively. The International Cartilage Repair Society (ICRS) score was collected 2 years postoperatively during second-look arthroscopic surgery.Results:In all patients, the osteotomy site healed without nonunion or malunion. Only 1 patient developed joint space narrowing. No donor site complications occurred. The mean AOFAS score significantly improved at 1 year (from 72.8 ± 4.8 preoperatively to 93.7 ± 4.6; t = –13.708; P < .0001). The 1- and 2-year AOFAS scores were similar (t = –0.755; P = .455), indicating stable improvement. The mean VAS score significantly decreased at 1 year (from 4.68 ± 0.67 preoperatively to 0.47 ± 0.69; t = 18.974; P < .0001). The 1- and 2-year VAS scores were similar (t = –0.705; P = .455), as were the 1- and 2-year MOCART scores (64.2 ± 7.5 vs 67.4 ± 7.3, respectively; t = –1.312; P = .198). The ICRS scores were as follows: 7 points (abnormal) in 1 (5.2%) patient, 8 to 11 points (nearly normal) in 9 (47.4%) patients, and 12 points (normal) in 9 (47.4%) patients.Conclusion:Osteotomy combined with autologous osteochondral transplantation provided good functional outcomes in patients with OLTs and large subchondral cysts. Second-look arthroscopic surgery showed healthy cartilage healing.

Outcome of Autologous Bone Grafting with Preservation of Articular Cartilage to Treat Osteochondral Lesions of the Talus with Large Subchondral Cysts

Category: Ankle Introduction/Purpose: Treatment options for osteochondral lesion of the talus (OLT) have substantially increased over the last decade. There are a wide variety of surgical treatments for OLT, and good clinical results have been reported. However, treatment for OLT with large subchondral bone cysts remains under discussion. The combination of autologous bone grafting for subchondral bone cyst with fixation of articular cartilage would be the desirable procedure for the repair of the large subchondral cyst preserving the original cartilage with native structure and geometry. The purpose of this study is to evaluate the clinical outcome of autologous cancellous bone graft and fixation of cartilage fragment for OLT with large subchondral cysts. Methods: Patients comprised seven men and five women, aged 14–70 (mean 35.9) years. All OLTs included full-thickness articular cartilage, extended through subchondral bone and were associated with subchondral cysts. The mean size of the cysts was 9 ×8.6 ×12.3 mm on preoperative CT. Medial lesions were exposed through an oblique medial malleolar osteotomy; lateral lesions through expansion of an anterolateral arthroscopic portal. After refreshed the subchondral cyst, it was grafted with autologous cancellous bone from the distal tibial metaphysis, then cartilage fragments were fixed with nylon suture to surrounding cartilage. Postoperative MRI and CT scans were acquired for all patients at one year after surgery. Seven patients requested screw removal although none had symptoms. The screws were removed and simultaneous arthroscopic examination was performed at 1.5–2 years after surgery with the patients’ permission. The cartilage repair was assessed according to the criteria of the International Cartilage Repair Society (ICRS). Results: Functional outcome was evaluated at 25.3 (15–50) months after surgery. Mean American Orthopedic Foot and Ankle Society ankle-hindfoot outcome score improved from 65.7 to 92 (90–100) postoperatively, with 100% patient satisfaction. All follow-up CT scans showed that the grafts were well consolidated with the surrounding subchondral bone. On MRI one year after surgery, no scans showed any signs of osteochondral graft instability. The mean ICRS arthroscopic score from follow-up arthroscopy was 11.1 (8–12) points, and represented nearly normal cartilage. Conclusion: Our study demonstrated good results of autologous bone grafting in preserving articular cartilage in cases of symptomatic OLT with subchondral cysts. In seven cases, we performed follow-up arthroscopy at 1.5–2 years after primary operation and the chondral fragment showed a smooth surface and good stability. The technique of autologous bone grafting with chondral fragment fixation could be a promising option for treatment of OLT with subchondral cysts.

CT Features of Naviculocuneiform Coalitions

Category: Midfoot/Forefoot Introduction/Purpose: The purpose of our study was to evaluate and compare the CT features in patients with symptomatic and asymptomatic naviculocuneiform coalition Methods: We retrospectively reviewed the CT images of 37 naviculocuneiform coalitions in 26 patients (mean age 30 years). The 26 patients were 12 males and 14 females, with 19 right and 18 left feet, including 11 patients with bilateral coalition. The CT images were analyzed with regard to irregular articular surface, subchondral sclerosis, subchondral cyst, bone spur, joint space distance, loose body and bony fusion. The size of subchondral cyst was measured. The location and extent of joint involvement was also evaluated. CT features were compared between symptomatic and asymptomatic feet. Results: There were 20 feet (54%) in symptomatic group and 17 feet (46%) in asymptomatic group. The mean size of the subchondral cyst was 6.3 mm in the symptomatic group and 2.5 mm in the asymptomatic group (statistically significant). Bone spurs were significantly more common in the symptomatic group (11 of 20 feet) than in the asymptomatic group (2 of 17 feet) (p &lt; 0.01). All 8 feet received operative treatment had subchondral cysts (mean size 6.7 mm) or bone spurs. Irregular articular surfaces were seen in all feet. Subchondral sclerosis, joint space distance, loose body, location and extent of joint involvement did not differ statistically significantly between two groups. Conclusion: Because of a statistically significant overlap of CT features, only large subchondral cysts and bone spurs can be more commonly detected with CT in the symptomatic feet compared to the asymptomatic feet, and may indicate aggressive treatment in patients with naviculocuneiform coalition.

An atypically located large subchondral cyst in an osteoarthritic hip joint: a case report

IntroductionOsteoarthritic subchondral cysts within or around the hip joint can sometimes be difficult to distinguish from primary osseous and soft tissue tumors due to their radiological appearance and uncommon location.Case presentationWe report the case of a 74-year-old Turkish man with a subchondral cyst arising from the hip joint, eroding the acetabulum and located on the medial side of the iliac bone, which imitated a soft tissue tumor. This cystic lesion was resected and the results of histopathological analysis of tissue samples were found to be consistent with an osteoarthritic cyst.ConclusionsThe present case illustrates how an osteoarthritic subchondral cyst can grow into the soft tissue planes in the presence of destruction of the articular cartilage and subchondral bone continuity, and present as an apparent soft tissue tumor.

Outcomes of autologous osteo-periosteal cylinder graft transplantation for Hepple V osteochondral lesions of the talus

Objective To study the outcomes of autologous osteo-periosteal cylinder graft transplan- tation for Hepple V osteochondral lesions of the talus （OLT） with large subchondral cyst. Methods The da- ta of 27 consecutive patients of OLT with subchondral cyst was retrospectively analyzed who were treated by autologous osteo-periosteal cylinder graft transplantation from October 2007 to September 2011. There were 26 males and 1 female with an average age of 35.8 years （range, 22-53 years）. Visual analogue score （VAS） for pain during daily activities, the American Orthopaedic Foot and Ankle Society （AOFAS） ankle and hind- foot score, and subjective satisfaction were investigated. The plain radiographs, magnetic resonance imaging （MRI） of the ankle, and second look arthroscopy were analyzed. Results All the 26 patients were followed up for 22.4 months. At the last follow-up, the VAS score decreased from 5.4±1.0 points preoperatively to 0.8±0.8 points postoperatively, and the mean （50%） AOFAS score improved from 73.9±3.1 points preopera- tively to 93.0±6.5 points postoperatively. In 26 cases, the radiolucent area of cysts disappeared on plain ra- diographs. The mean magnetic resonance observation of cartilage repair tissue （MOCART） score was 57.2, though small subchondral bone cyst was still found in 3 cases on postoperative MRI. The mean （50%） ICRS arthroscopic score of cartilage repair was 9.2 points according to second look arthroscopy of 18 cases. There were 16 cases receiving excellent effect, 8 good and 2 fair. The excellent and good rate was 92.3%（24/26）. There were no major complications. Conclusion Autologous osteo-periosteal cylinder graft transplantation could repair the osteochondral defects. It yields satisfactory results, and is suitable for treating OLT with large subchondral cyst. Key words: Talus; Osteochondritis; Transplantation, autologous; Bone cysts

Structural Allograft Reconstruction for Large Osteochondral Lesions of the Talus

Most osteochondral lesions of the talus (OLTs) may be managed successfully with arthroscopic debridement in combination with either microfracture or drilling. However, treatment with debridement and microfracture/drilling tends to be less reliable in large OLTs, OLTs associated with loss of the talar shoulder architecture, and OLTs associated with large subchondral cysts. When the talar shoulder is compromised due to a large OLT, then a structural graft may be considered to reconstruct the deficient portion of the talar dome. In this situation, fresh and fresh-frozen allograft tali have been used. Although reports of structural allograft reconstruction for the talar dome are sparse, the limited literature on this subject suggests that successful outcome is feasible. This article focuses on our experience with structural allograft reconstruction for large OLTs.

La hanche dégénérative

Hip degeneration is typically easily diagnosed, based on the combination of clinical findings and plain films showing the four classifical findings: joint space narrowing, osteophytes, subchondral sclerosis and subchondral cysts. Some degenerated hips may have misleading features such as when joint space narrowing is mainly posterior or the main finding is a large subchondral cyst. Rapidly destructive coxopathy results in joint space narrowing and joint destruction over a few months. MRI is helpful in early cases with normal radiographs or in patients with known hip degeneration presenting with acute worsening of symptoms. Follow-up is achieved by measuring the joint space on consecutive radiographs obtained using a standard technique.

Total knee arthroplasty for an osteoarthritic knee with large subchondral cyst: a case report

Total knee arthroplasty for an osteoarthritic knee with large subchondral cyst: a case report