Location Of Osteochondral Lesions Research Articles

Identifying Intra-Articular Pathology With Arthroscopy Prior to Open Ankle Fracture Fixation

PurposeTo assess the prevalence of intra-articular findings with ankle arthroscopy in patients undergoing operative fixation for ankle fractures.MethodsThis is a retrospective review of ankle fractures that were treated with arthroscopy and open reduction and internal fixation by a single surgeon. Between August 2016 and July 2018, operative reports, office notes, and images were reviewed to identify intra-articular pathology and fracture type. An analysis was performed with regard to fracture type, presence and location of osteochondral lesions, loose-bodies, syndesmotic injury, and deltoid injury.ResultsFifty-seven ankle fractures were identified that met inclusion criteria. In total, 84.2% of the fractures had intra-articular pathology, most commonly a syndesmotic injury followed by presence of intra-articular loose bodies and osteochondral defects.ConclusionsIn our study, use of arthroscopy before open ankle fracture fixation identified intra-articular pathology in 84.2% of subjects. The most common pathology was syndesmotic injury. The addition of an arthroscopic assessment in patients with operatively treated ankle fractures may help improve treatment provided to patients during ankle fracture surgery.Level of EvidenceLevel 4 Therapeutic Case Series.

Arthroscopic Findings During Routine Ankle ORIF: What is Being Missed?

The aim of study is to document our experience and intra-articular findings at time of routine ankle arthroscopy during ankle open reduction internal fixation (ORIF) and to contribute to the growing body of literature that shows this to be a safe and effective treatment. This is a retrospective review of ankle fractures who were treated with ORIF and arthroscopy by a single surgeon. The patients’ charts including operative reports, office notes, and images were reviewed to identify intra-articular pathology and fracture type. Analysis was performed with regard to fracture type, presence and location of osteochondral lesions, presence of loose-body, syndesmotic injury, and deltoid injury. Fifty-seven ankle fractures were identified and met inclusion criteria. 84.2% of the fractures had intra-articular pathology, most commonly a syndesmotic injury followed by loose joint body and osteochondral defect. Orthopedic surgeons with any arthroscopic prowess should consider arthroscopic evaluation during ankle fracture ORIF, particularly pronation external rotation and supination external rotation patterns. The benefits include a more detailed examination of associated injuries and possible treatment of pathology at the time of arthroscopy. This is a safe and effective compliment to routine ORIF for ankle fractures.

Arthroscopic Findings During Routine Ankle ORIF: What is Being Missed?

Category:Ankle; Arthroscopy; TraumaIntroduction/Purpose:Ankle fractures are among the most common operatively treated injuries by orthopedic surgeons. However, up to 20% of patients will have continued pain and poor patient reported outcomes despite good/excellent radiographic results. Ankle fractures typically occur with varying degrees of intra-articular and soft tissue injury which can include ligamentous injury, loose bodies, and chondral lesions. The aim of study is to document intra-articular findings with ankle arthroscopy prior to ankle open reduction internal fixation (ORIF) and to contribute to the growing body of literature that shows this to be a safe adjunct to fracture fixation.Methods:IRB approval was obtained prior to chart review. This is a retrospective review of ankle fractures that were treated with arthroscopy and ORIF by a single surgeon. Between August 2016 and July 2018 Operative reports, office notes, and images were reviewed to identify intra-articular pathology and fracture type. Analysis was performed with regard to fracture type, presence and location of osteochondral lesions, presence of loose-body, syndesmotic injury, and deltoid injury.Results:Fifty-seven ankle fractures were identified that met inclusion criteria. 84.2% of the fractures had intra-articular pathology, most commonly a syndesmotic injury followed by loose joint body and osteochondral defect.Conclusion:Arthroscopic evaluation during ankle fracture ORIF, particularly pronation external rotation and supination external rotation patterns give a more detailed examination of associated pathology. Arthroscopy at the time of ankle fracture fixation is a safe adjunct and should be considered a potential compliment to routine ORIF of ankle fractures.

High incidence of (osteo)chondral lesions in ankle fractures

PurposeTo determine the incidence and location of osteochondral lesions (OCLs) following ankle fractures as well as to determine the association between fracture type and the presence of OCLs. Up to 50% of patients with ankle fractures that receive surgical treatment show suboptimal functional results with residual complaints at a long-term follow-up. This might be due to the presence of intra-articular osteochondral lesions (OCL).MethodsA literature search was carried out in PubMed (MEDLINE), EMBASE, CDSR, DARE and CENTRAL to identify relevant studies. Two authors separately and independently screened the search results and conducted the quality assessment using the MINORS criteria. Available full-text clinical articles on ankle fractures published in English, Dutch and German were eligible for inclusion. Per fracture classification, the OCL incidence and location were extracted from the included articles. Where possible, OCL incidence per fracture classification (Danis–Weber and/or Lauge–Hansen classification) was calculated and pooled. Two-sided p values of less than 0.05 were considered statistically significant.ResultsTwenty articles were included with a total of 1707 ankle fractures in 1707 patients. When focusing on ankle fractures that were assessed directly after the trauma, the OCL incidence was 45% (n = 1404). Furthermore, the most common location of an OCL following an ankle fractures was the talus (43% of all OCLs). A significant difference in OCL incidence was observed among Lauge–Hansen categories (p = 0.049). Post hoc pairwise comparisons between Lauge–Hansen categories (with adjusted significance level of 0.01) revealed no significant difference (n.s.).ConclusionOCLs are frequently seen in patients with ankle fractures when assessed both directly after and at least 12 months after initial trauma (45–47%, respectively). Moreover, the vast majority of post-traumatic OCLs were located in the talus (42.7% of all OCLs). A higher incidence of OCLs was observed with rotational type fractures. The clinical relevance of the present systematic review is that it provides an overview of the incidence and location of OCLs in ankle fractures, hereby raising awareness to surgeons of these treatable concomitant injuries. As a result, this may improve the clinical outcomes when directly addressed during index surgery.Level of evidenceIV.

Good clinical results but moderate osseointegration and defect filling of a cell-free multi-layered nano-composite scaffold for treatment of osteochondral lesions of the knee.

The aim of this retrospective study was to evaluate the clinical and radiological results of a nano-composite multi-layered three-dimensional biomaterial scaffold for treatment of osteochondral lesions (OCL) of the knee. It was a particular radiological interest to analyse the osseointegration, filling of the defects and the bone tracer uptake (BTU), and it was hypothesised that this scaffold, which was created to mimic the entire osteo-cartilaginous unit, is integrated within the bone 12months postoperatively and comes along with improved patients symptoms and function. Fourteen patients (male:female=11:3, mean age±SD 33.1±10.7years) treated for OCL (size 1.0-3.5cm2) were clinically and radiologically evaluated at 1year postoperatively. The data were prospectively collected including SPECT/CT, Tegner and Lysholm scores. BTU was anatomically localised and volumetrically quantified in SPECT/CT. Defect filling was analysed in CT. Spearman's rho and Wilcoxon test were used for correlation of BTU in SPECT/CT and clinical scores (p<0.05). A significant improvement in Lysholm knee score (p<0.001) and slight deterioration in Tegner score were found (p<0.01). A complete filling of the defect was shown in 14%, a partial filling in 14% and only minor filling was seen in 72%. A significant correlation (p<0.001) was found between location of osteochondral lesions and increased BTU. At the lesion sites pre- and postoperative BTU was markedly increased and did not show any decrease at 12-month follow-up. Median Tegner and mean Lysholm scores did not correlate with BTU at any time. Treatment of OCL in the knee joint with a nano-composite multi-layered three-dimensional biomaterial scaffold resulted in a significant clinical improvement at 1-year follow-up. However, osseointegration was still ongoing at 12-month follow-up. Case series, Level IV.