Osteochondral Autograft Transplantation Research Articles

Knee Cartilage Injuries in Football Players: Clinical Outcomes and Return to Sport After Surgical Treatment: A Systematic Review of the Literature.

To systematically review the literature and analyze clinical outcomes and return-to-sport after surgical management of cartilage injuries in football players. A systematic literature review was performed in August 2023 on PubMed, WebOfScience, and Cochrane Library to collect studies on surgical strategies for cartilage lesions in football players. Methodological quality and risk of bias were assessed with the modified Coleman Methodology score and RoB2 and RoBANS2 tools. Fifteen studies on 409 football players (86% men, 14% women) were included: nine prospective and two retrospective case series, one randomized controlled trial, one prospective comparative study, one case report, and one survey. Bone marrow stimulation (BMS) techniques were the most documented. The lesion size influenced the treatment choice: debridement was used for small lesions (1.1 cm2), BMS, osteochondral autograft transplantation (OAT), matrix-assisted autologous chondrocytes transplantation (MACT), and scaffold-augmented BMS for small/mid-size lesions (2.2-3.0 cm2), and autologous chondrocytes implantation (ACI) for larger lesions (5.8 cm2). The surgical options yielded different results in terms of clinical outcome and return-to-sport, with fastest recovery for debridement and scaffold-augmented BMS. The current evidence is limited with large methodological quality variation (modified Coleman Methodology score 43.5/100) and a high risk of bias. Decision-making in cartilage injuries seems to privilege early return-to-sport, making debridement and microfractures the most used techniques. The lesion size influences the treatment choice. However, the current evidence is limited. Further studies are needed to confirm these findings and establish a case-based approach to treat cartilage injuries in football players based on the specific patient and lesion characteristics and the treatments' potential in terms of both return-to-sport and long-term results. Systematic review, level IV.

Modified osteochondral autograft transplantation for steroid-induced osteonecrosis of femoral head in idiopathic thrombocytopenic purpura: a case report and literature

Osteochondral autograft transplantation (OAT) has been commonly applied in the knee and ankle while the technique has not yet been a popularity in the femoral head. In this article, we present a 28-year-old female patient, who has a history of 1-year-use of glucocorticoid in the treatment of idiopathic thrombocytopenic purpura, with steroid-induced osteonecrosis of the femoral head (SONFH). She underwent surgical hip dislocation, osteochondroplasty, OAT, and internal fixation. Her Harris Hip Score improved from 64 to 82 in 36 months to follow-up. The case is valuable considering that a single, instead of several, 1.5 cm autograft was harvested from the non-bearing part of the same femoral head. This modification dispensed with the need of surgery for harvesting autograft from knee or ankle and reduced the structural vulnerability brought by the multihole donor part of the femoral head.

Evidence-based machine learning algorithm to predict failure following cartilage procedures in the knee

IntroductionClinical decision-making is highly based on expert opinion. Machine learning is increasingly used to develop patient-specific risk prediction analysis to improve patient selection prior to surgery. ObjectivesTo develop machine learning algorithms to predict failure of surgical procedures that address cartilage defects of the knee and detect variables associated with failure. MethodsAn institutional database was queried for cartilage procedures performed between 2000 and 2018. Failure was defined as revision cartilage surgery or knee arthroplasty. One hundred and one preoperative and intraoperative features were evaluated as potential predictors. Four machine learning algorithms were trained and internally validated. ResultsOne thousand and ninety-one patients with a minimum follow-up of 2 years were included and underwent chondroplasty (n = 560; 51%), osteochondral allograft transplantation (n = 306; 28%), microfracture (n = 150; 14%), autologous chondrocyte implantation (n = 39; 4%), or osteochondral autograft transplantation (n = 36; 3%). The Random Forest algorithm was the best-performing algorithm, with an area under the curve of 0.765 and a Brier score of 0.135. The most important features for predicting failure were symptom duration, age, body mass index, lesion grade, and total lesion area. Local Interpretable Model-agnostic Explanations analysis provided patient-specific comparisons for the risk of failure of an individual patient being assigned various types of cartilage procedures. ConclusionsMachine learning algorithms were accurate in predicting the risk of failure following cartilage procedures of the knee, with the most important features in descending order being symptom duration, age, body mass index, lesion grade, and total lesion area. Machine learning algorithms may be used to compare the risk of failure of specific patient-procedure combinations in the treatment of cartilage defects of the knee.

ArthroNavi framework: stereo endoscope-guided instrument localization for arthroscopic minimally invasive surgeries.

As an example of a minimally invasive arthroscopic surgical procedure, arthroscopic osteochondral autograft transplantation (OAT) is a common option for repairing focal cartilage defects in the knee joints. Arthroscopic OAT offers considerable benefits to patients, such as less post-operative pain and shorter hospital stays. However, performing OAT arthroscopically is an extremely demanding task because the osteochondral graft harvester must remain perpendicular to the cartilage surface to avoid differences in angulation. We present a practical ArthroNavi framework for instrument pose localization by combining a self-developed stereo endoscopy with electromagnetic computation, which equips surgeons with surgical navigation assistance that eases the operational constraints of arthroscopic OAT surgery. A prototype of a stereo endoscope specifically fit for a texture-less scene is introduced extensively. Then, the proposed framework employs the semi-global matching algorithm integrating the matching cubes method for real-time processing of the 3D point cloud. To address issues regarding initialization and occlusion, a displaying method based on patient tracking coordinates is proposed for intra-operative robust navigation. A geometrical constraint method that utilizes the 3D point cloud is used to compute a pose for the instrument. Finally, a hemisphere tabulation method is presented for pose accuracy evaluation. Experimental results show that our endoscope achieves 3D shape measurement with an accuracy of . The mean error of pose localization is 15.4deg (range of 10.3deg to 21.3deg; standard deviation of 3.08deg) in our ArthroNavi method, which is within the same order of magnitude as that achieved by experienced surgeons using a freehand technique. The effectiveness of the proposed ArthroNavi has been validated on a phantom femur. The potential contribution of this framework may provide a new computer-aided option for arthroscopic OAT surgery.

Osteoperiosteal Iliac Autograft Transplantation for Unreconstructable Tibial Plafond After Malunions of Pilon Fractures in Young Patients.

Malunion of tibial pilon fracture, especially with a large cartilage loss of the tibial plafond, is a tough clinical conundrum. This study describes a joint-preserving technique that mainly involves corrective intraarticular osteotomy and osteoperiosteal iliac autograft transplantation for treating these generally considered unreconstructable tibial plafond. Sixteen patients with an average age of 33.6 years who were treated with this joint-preserving method between 2013 and 2020 were retrospectively analyzed. Ankle distraction was applied in all patients. Additional osteochondral autograft transplantation for talus was performed in 4 patients and supramalleolar osteotomy in 2 patients. The visual analog scale (VAS) score, the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, the 36-Item Short Form Health Survey (SF-36) score, and the ankle range of motion (ROM) were used for outcome analysis. Radiographic assessment was conducted, and the complications were recorded. At a mean follow-up of 41.1 months, the mean VAS, AOFAS, and SF-36 scores improved from 6.3, 47.6, and 38.0 to 1.7, 84.4, and 70.8, respectively (P < .001 for each). The ankle ROM improved from 27.5 to 32.2 degrees (P = .023). The mean area of ilium blocks was 3.5 cm2, and the mean external fixation time was 94.1 days. Radiographs showed that good osteointegration was found in all patients and no significant progression of osteoarthritis in 15 patients. The major complications included poor incision healing in 2 patients and severe ankle stiffness in 2 patients, with one of them developing considerable varus-type osteoarthritis but reporting no pain. No deep infection, nonunion, or malunion occurred, and no secondary arthrodesis was performed during the final follow-up. Osteoperiosteal iliac autograft transplantation might be an alternative surgical option for reconstructing unreconstructable malunited pilon fractures with a large cartilage loss of the tibial plafond in young patients. Level IV, case series.

Update in diagnosis, treatment, and prevention of osteochondritis dissecans of the capitellum.

Osteochondritis dissecans of the capitellum is debilitating and is a potentially sports career-ending injury in a young and athletic population. Osteochondritis dissecans typically occurs in patients between the ages of 10 and 24 years, and boys are more commonly affected than girls. Conventional radiographs have low diagnostic accuracy, and magnetic resonance imaging (with or without contrast) or computed tomography may aid in accurate diagnosis. The primary indication for non-operative treatment is the presence of an intact cartilage cap on magnetic resonance imaging, indicating a "stable lesion." However, if operative treatment is necessary, various surgical procedures are available when operative treatment for an osteochondritis dissecans of the capitellum is considered, including open or arthroscopic removal of loose bodies, with or without microfracturing, fragment fixation, osteochondral autograft transplantation, and osteochondral allograft transplantation. The decision-making process for selecting the appropriate treatment considers factors such as the patient's characteristics, functional limitations, and lesion morphology.

Dual-tissue transplantation versus osteochondral autograft transplantation in the treatment of osteochondral defects: a porcine model study

BackgroundOsteochondral injury is a common sports injury, and hyaline cartilage does not regenerate spontaneously when injured. However, there is currently no gold standard for treating osteochondral defects. Osteochondral autograft transplantation (OAT) is widely used in clinical practice and is best used to treat small osteochondral lesions in the knee that are < 2 cm2 in size. Autologous dual-tissue transplantation (ADTT) is a promising method with wider indications for osteochondral injuries; however, ADTT has not been evaluated in many studies. This study aimed to compare the radiographic and histological results of ADTT and OAT for treating osteochondral defects in a porcine model.MethodsOsteochondral defects were made in the bilateral medial condyles of the knees of 12 Dian-nan small-ear pigs. The 24 knees were divided into the ADTT group (n = 8), OAT group (n = 8), and empty control group (n = 8). At 2 and 4 months postoperatively, the knees underwent gross evaluation based on the International Cartilage Repair Society (ICRS) score, radiographic assessment based on CT findings and the magnetic resonance observation of cartilage repair tissue (MOCART) score, and histological evaluation based on the O'Driscoll histological score of the repair tissue.ResultsAt 2 months postoperatively, the ICRS score, CT evaluation, MOCART score, and O'Driscoll histological score were significantly better in the OAT group than the ADTT group (all P < 0.05). At 4 months postoperatively, the ICRS score, CT evaluation, MOCART score, and O'Driscoll histological score tended to be better in the OAT group than the ADTT group, but these differences did not reach statistical significance (all P > 0.05).ConclusionsIn a porcine model, ADTT and OAT are both effective treatments for osteochondral defects in weight bearing areas. ADTT may be useful as an alternative procedure to OAT for treating osteochondral defects.

Osteochondral Autograft Transplantation for Proximal Pole Scaphoid Nonunions

Osteochondral autograft transplantation (OAT) is a technique to reconstruct the proximal pole scaphoid nonunion associated with an intact dorsal and volar scapholunate ligament. This study aimed to report the clinical and radiographic outcomes in patients who underwent OAT for this indication. A retrospective review of patients who underwent proximal pole scaphoid nonunion reconstruction with a femoral trochlea OAT was undertaken between 2018 and 2022. Patient demographics, scaphoid nonunion characteristics, surgery details, and clinical and radiographic outcomes were obtained. Eight patients underwent the procedure at an average of 18.2 months from injury. Four patients failed prior attempts at scaphoid union surgery, one of whom failed two prior surgeries. Four had no prior surgery. The average follow-up was 11.8 months. The postoperative wrist flexion-extension arc of motion was 125° or 87% of the contralateral wrist. Grip strength averaged 30.0 kg or 86% of the contralateral side. Adjusted grip strength for hand dominance was 81% of the contralateral side. All OATs healed. Computed tomography scan confirmed the union in 6 patients between 6 and 10 weeks. Two patients whose radiographs demonstrated OAT incorporation at the time of follow-up did not undergo advanced imaging. Osteochondral autograft transplantation is an attractive surgical reconstructive procedure for patients with proximal pole scaphoid nonunions associated with an intact scapholunate ligament. Osteochondral autograft transplantation mitigates the need for vascularized bone grafting, has a rapid time to osseous incorporation, and has a simple postoperative course in which patients can expect early union, near-full range of motion, and grip strength. Therapeutic V.

Cartilage Restoration for Isolated Patellar Chondral Defects: An Updated Systematic Review.

Patellar chondral lesions can be particularly challenging to manage in younger and more active populations. To synthesize, organize, and summarize the results and complication rates of various patellar cartilage restoration techniques. Systematic review; Level of evidence, 4. We performed this systematic review according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using the Medline, Embase, Scopus, and Cochrane databases. Studies were included that reported on surgical treatment of patellar chondral defects with ≥5 patients and 12 months of follow-up data. Relevant demographic data from the included studies were extracted, and patient-reported outcome scores, visual analog scale for pain results, return-to-sport rate, complications, and concomitant procedures were documented. There were 24 studies that met the inclusion criteria, with a total of 575 patients (male, n = 239; female, n = 336). In total, 6 surgical techniques were utilized. In 9 studies, the surgical procedure of choice was osteochondral autograft transplantation (OAT); 8 studies evaluated autologous chondrocyte implantation (ACI); 3 evaluated advanced microfracture/autologous matrix-induced chondrogenesis; 1 evaluated osteochondral allograft transplantation (OCA); 1 evaluated particulate juvenile articulated cartilage; and 2 evaluated a synthetic osteochondral graft. No uniform functional outcome score or assessment was utilized across studies. OAT was predominantly used for smaller chondral lesions (<2 cm2) and demonstrated minimal complication rates and satisfactory outcome scores. Advanced microfracture techniques showed promise, with improvement in outcome scores and zero complications. Matrix-induced ACI consistently exhibited higher mean improvement in the measured outcome scores and resulted in fewer complications when compared with previous generations of ACI. OAT and ACI were the most studied procedures for isolated patellar chondral defects. Advanced microfracture techniques showed promise, but indications (ie, size) and variability in techniques need to be elucidated in higher-level studies. Further prospective studies comparing OCA and matrix-induced ACI for larger patellar defects are necessary to determine the superior technique.

Design and Fabrication of Micro Saw Enabling Root-Side Cutting of Bone

A novel micro saw was fabricated using a combination of photolithography and electroplating techniques, resembling a miniature timing belt with sideways blades. The rotation or oscillation direction of the micro saw is designed to be perpendicular to the cutting direction so that transverse cutting of the bone is attainable to extract a preoperatively planned bone-cartilage donor for osteochondral auto-graft transplantation. The mechanical property of the fabricated micro saw obtained using the nanoindentation test shows that the mechanical properties of the micro saw are almost an order of magnitude higher than bone, which indicates its potential bone-cutting application. To demonstrate the cutting capability of the fabricated micro saw, an in vitro animal bone cutting was performed using a custom test rig consisting of a microcontroller, 3D printer, and other readily available parts.

Osteochondral autograft transplantation (mosaicplasty): What is the impact of plug diameter in cartilage repair?

To compare the mechanical stress applied to our grafted defect area according to the diameter of the plugs used in the treatment of osteochondral lesion with osteochondral autograft transplantation (OAT) procedure. A biomechanical study was conducted on eight cadaveric knees. A 20-mm defect was created in the weight-bearing zone on the medial femoral condyle then filled either with three plugs of 8mm, or with four plugs of 6mm, or with 6 plugs of 4mm diameter. After the preparation of the specimens, each knee was installed on a mechanical test bench (Instron 5566A). A continuous axial compression of 700N at 10mm.min-1 was exerted on the joint. A K-scan 4000-type pressure sheet was used to record the contact area (mm2), the mean pressure (MPa), and the maximum pressure (MPa) on the area of interest. The differences found between the conditions were not statistically significant but showed tendencies. Filling the defect with six plugs of 4mm restores a larger contact surface compared with the other plugs. The use of 8- and 6-mm grafts lead to a respective increase of 12% and 52% of the mean pressure compared with the 4mm grafts. This difference was also found for the maximum pressure (36% and 129%). Regardless of the diameter of the plugs used, filling the lesion reduces the mean pressure exerted on the healthy cartilage by 19%. A trend emerged towards a better restoration of the cartilage surface and a more harmonious distribution of the pressures exerted in favour of the grafts of smaller diameter. A larger study is needed to obtain a statistically significant result.

Harvest Technique Does Affect the Quality of Osteochondral Grafts: Histologic Evaluation Comparing Commercial Standards versus Scalpel Blade Technique.

While the percentage of viable cells is a major determinant of graft performance during osteochondral allograft (OCA) transplantation, the baseline chondrocyte viability at the periphery of osteochondral plugs is defined at the time of harvest. In this laboratory study, we aimed to determine the optimal technique for OCA plug harvest by evaluating commercial standard techniques compared to sharp blade harvest technique. Osteochondral explants were harvested from bovine and human samples using 3 different techniques: (1) standard OATS manual punch device (Osteochondral Autograft Transplant System OATS; Arthrex, Naples, FL), (2) powered trephine device, and (3) fresh scalpel blade. Chondrocyte viability and the dead area at the periphery of the tissue were evaluated by LIVE/DEAD staining. Safranin-O and fast-green were performed for structural evaluation. For both bovine and human samples, the dead area at the periphery of the explant was significantly smaller after scalpel blade preparation compared to harvest with OATS (P < 0.001) and powered trephine devices (P < 0.001). In addition, while powered device had a smaller remaining dead area compared to the OATS device (P < 0.001), there was significantly greater tissue loss and peripheral contour change for plugs harvested with the powered trephine device. Our study demonstrated that OCA plugs harvested with OATS and powered device lead to a significant mechanical injury at the periphery of the explants compared to a scalpel. We propose that the optimal technique for OCA harvest utilizes a combined approach incorporating a scalpel blade/circular scalpel to prepare the chondral surface and a powered trephine to prepare the osseous surface.

Biological Reconstruction of Localized Full-Thickness Cartilage Defects of the Knee: A Systematic Review of Level 1 Studies with a Minimum Follow-Up of 5 Years.

The objective of this study was to evaluate the best available mid- to long-term evidence of surgical procedures for the treatment of localized full-thickness cartilage defects of the knee. Systematic review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines of Level 1 randomized clinical trials (RCTs), meta-analyses of RCTs and systematic reviews with a minimum follow-up of 5 years. Data extracted included patient demographics, defect characteristics, clinical and radiological outcomes, as well as treatment failures. Six RCTs and 3 Level 1 systematic reviews were included. Two RCTs compared microfracture (MFx) to periosteum-covered autologous chondrocyte implantation (ACI-P), 1 to matrix-associated ACI (M-ACI) and 2 to osteochondral autograft transplantation (OAT). One study compared OAT to collagen membrane covered ACI (ACI-C). The 3 Level 1 systematic reviews/meta-analyses assessed the outcome of MFx, OAT, and various ACI methods in RCTs. OAT showed significantly better outcomes compared with MFx. In the 2 RCTs comparing ACI-P and MFx, no significant differences in clinical outcomes were seen, whereas significantly better outcomes were reported for M-ACI versus MFx in 1 study including patients with larger defects (5 cm2), and for ACI-C versus OAT in terms of Cincinnati Score. Higher failure rates were reported for MFx compared with OAT and for OAT compared with ACI-C, while no significant differences in failure rates were observed for ACI-P compared to MFx. Restorative cartilage procedures (ACI-C or M-ACI and OAT) are associated with better long-term clinical outcomes including lower complication and failure rates when compared with reparative techniques (MFx). Among the restorative procedures, OAT seems to be inferior to ACI especially in larger defects after longer follow-up periods. Level I: Systematic review of Level I studies.

Augmenting Osteochondral Autograft Transplantation and Bone Marrow Aspirate Concentrate with Particulate Cartilage Extracellular Matrix Is Associated With Improved Outcomes.

Osteochondral autograft transplant (OAT) is often used to treat large osteochondral lesions of the talus and is generally associated with good outcomes. The addition of adjuncts such as cartilage extracellular matrix with bone marrow aspirate concentrate (ECM-BMAC) may further improve the OAT procedure but have not been thoroughly studied. We hypothesized that the placement of ECM-BMAC around the OAT graft would improve radiographic and patient-reported outcomes following OAT. Patients who received OAT, with ECM-BMAC or BMAC alone, were screened and their charts were reviewed. For patients who did receive ECM-BMAC, the mixture was spread around the edges of the OAT plug and into any surrounding areas of cartilage damage. Survey and radiographic data were collected. Average follow-up in both groups was over 2 years. Magnetic resonance imaging scans were scored using the Magnetic Resonance Observation of Cartilage Tissue (MOCART) system. Outcomes were compared statistically between groups. Patients treated with ECM-BMAC (n = 34) demonstrated significantly greater improvement of scores in the FAOS categories Symptoms (17 vs -3; P = .02) and Sports Activities (40 vs 7; P = .02), and the MOCART category Subchondral Lamina (P = .008) compared to those treated with BMAC alone (n = 30). They also experienced significantly lower rates of postoperative cysts (53% vs 18%, P = .04) and edema (94% vs 59%, P = .02). The addition of ECM-BMAC to OAT was associated with improved imaging and clinical outcomes compared to OAT with BMAC alone.

Minimum 5-Year Outcomes of Osteochondral Autograft Transplantation with a Concomitant High Tibial Osteotomy for Spontaneous Osteonecrosis of the Knee with a Large Lesion.

The purpose of this study was to evaluate the mid-term clinical outcomes of osteochondral autograft transplantation (OAT) with concomitant high tibial osteotomy (HTO) in spontaneous osteonecrosis of the knee (SONK) with a large lesion. A total of 48 knees of 48 consecutive patients with SONK (lesion size ≥4 cm2, no age criteria) who underwent opening wedge HTO and concomitant OAT were retrospectively investigated, and those who were followed up postoperatively for at least 5 years were included in this case series study. Clinical outcomes were evaluated using knee and function scores of Knee Society Score, radiographic outcomes were evaluated using the anatomical femorotibial angle (FTA), and these outcomes were compared between patients aged ≥70 years and <70 years. Of the 48 cases, a total of 43 cases were available for review at a minimum of 5 years, and 5 cases were excluded from the analysis. Overall, the mean knee score improved from preoperative 48.8 ± 13.3 to postoperative 87.9 ± 8.6 at 1 year (P < 0.05) and 85.0 ± 10.4 at final follow-up (P < 0.05 vs. preop., N.S. vs. 1 year). The mean function score also improved from preoperative 60.1 ± 10.9 to postoperative 87.3 ± 12.2 at 1 year (P < 0.05) and 84.2 ± 12.4 at final follow-up (P < 0.05 vs. preop., N.S. vs. 1 year). The mean standing FTA was corrected significantly from 181.1° ± 2.7° preoperatively to 169.7° ± 2.4° at 1 year (P < 0.05) and 169.4° ± 3.1° at final follow-up (P < 0.05 vs. preop., N.S. vs. 1 year). There were no significant differences in clinical and radiographic outcomes between patients aged ≥70 years and <70 years. There were 4 cases of lateral hinge fracture around the osteotomy site and 1 case of delayed union. None of the patients underwent revision surgery during the follow-up period (survival rate of 100%). Mid-term clinical outcomes of patients with SONK who underwent HTO and OAT with a relatively large lesion were good.

Paper 38: Conservative Treatment of Osteochondritis Dissecans of the Humeral Capitellum among Young Baseball Players

Objectives:The goals of treatment of osteochondritis dissecans of the humeral capitellum (OCD) are morphological healing and early return to sports and these are often contradictive. The purpose of this study was to evaluate our conservative treatment of OCD and establish the appropriate treatment.Methods:We retrospectively reviewed 206 patients with OCD who were treated conservatively at first visit our hospital and affiliated institutions from 2009 to 2019. Exclusion criteria were loss and less than 1 year follow-up. Mean age was 12.1 years (8-15). All patients were advised to stop or limit throwing and underwent physical therapy. Depending on the stage and healing process, at least, after waiting for the lateral wall of the capitellum to heal throwing was permitted to resume. Age at first visited, OCD Stage (Ⅰ; radiolucent area, Ⅱ; nondisplaced fragmentation, Ⅲ; loose body), clinical result (complete healing, partial healing, surgery required), and when to return to play were evaluated statistically.Results:A total of 193 patients were enrolled. There were 115 patients that were stageⅠ with a mean age of 11.2 years, 63 patients that were stageⅡ with a mean age of 13.2 years, and 15 patients that were stageⅢ with a mean age of 14.1 years (Table 1), and these differences were statistically significant (p<0.01). Collectively, complete healing was observed in 70.4%, partial healing in 17.4%, surgery in 12.2% of stageⅠ, complete healing in 50.8%, partial healing in 12.7%, surgery in 36.5% of stageⅡ, and complete healing in 0%, partial healing in 26.7%, surgery in 73.3% of stageⅢ (Fig 1). Of the 47 patients who underwent surgery, arthroscopic debridement for OCD lesions was selected for 79%, osteochondral autograft transplantation was selected for 16%, and fixation was selected for 4% (Fig 2). The mean period of return to play was 8.6 months; < 6 months was 42%, 6 months- 1 year was 39%, 1 year-1.5 year was 16%, and 1.5%< was 3%.Conclusions:In this study, OCD lesions likely to heal when the OCD stage were early. Even if surgery was needed after failed conservative treatment, most of the patients were treated by arthroscopic debridement which was a relatively minimally invasive procedure. Conservative treatment of OCD was successful when the treatment is begun in early stage of the disease.UPLOAD-https://planion-client-files.s3.amazonaws.com/AOSSM/blobs/e5e18779-1cc0-4cc6-814b-a97204c6da85/1/file.pdf

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

Osteochondral lesions of the talar dome (OLT) are common injuries that involve cartilage and subchondral bone. These injuries appear in up to 42% of professional soccer players on magnetic resonance imaging (MRI). Typically, patients are 20 35-yearold male athletes experiencing chronic ankle pain, decreased range of motion, and joint effusion, especially during or after sports activities, and compromised quality of life. The low regeneration potential of chondrocytes and the recent findings revealing subchondral bone architecture's role in cartilage homeostasis, repair durability, and overall clinical outcomes make OLT treatment a challenging topic in orthopedics. The aim of this narrative review was to outline a surgical treatment algorithm for OLT management in the athlete. Debridement and bone marrow stimulation techniques remain the first-line treatment of OLT with satisfactory short- to long-term outcomes, a high return to sports (RTS) rate, and a rapid RTS, with improved results when augmented with PRP. Still, considering the controversy of its potential disadvantages, debridement should be limited to the International Cartilage Repair Society (ICRS) grade I-II injuries regardless of its size and with or without additional bone marrow stimulation (BMS)in ICRS III < 1.0 cm2 injuries. In the presence of larger lesions and subchondral plate and bone involvement, the benefits and disadvantages of osteochondral autologous transplantation system (OATS)/mosaicplasty and scaffold-based techniques should be considered for a tailored treatment approach either as a primary procedure or as an off-season procedure for better cartilage tissue quality, functional outcomes, and potentially increasing the player's professional career length. Osteochondral lesions of the talar dome (OLT) are common injuries that involve cartilage and subchondral bone. These injuries appear in up to 42% of professional soccer players on magnetic resonance imaging (MRI). Typically, patients are 20 35-yearold male athletes experiencing chronic ankle pain, decreased range of motion, and joint effusion, especially during or after sports activities, and compromised quality of life. The low regeneration potential of chondrocytes and the recent findings revealing subchondral bone architecture's role in cartilage homeostasis, repair durability, and overall clinical outcomes make OLT treatment a challenging topic in orthopedics. The aim of this narrative review was to outline a surgical treatment algorithm for OLT management in the athlete. Debridement and bone marrow stimulation techniques remain the first-line treatment of OLT with satisfactory short- to long-term outcomes, a high return to sports (RTS) rate, and a rapid RTS, with improved results when augmented with PRP. Still, considering the controversy of its potential disadvantages, debridement should be limited to the International Cartilage Repair Society (ICRS) grade I-II injuries regardless of its size and with or without additional bone marrow stimulation (BMS)in ICRS III < 1.0 cm2 injuries. In the presence of larger lesions and subchondral plate and bone involvement, the benefits and disadvantages of osteochondral autologous transplantation system (OATS)/mosaicplasty and scaffold-based techniques should be considered for a tailored treatment approach either as a primary procedure or as an off-season procedure for better cartilage tissue quality, functional outcomes, and potentially increasing the player's professional career length. Osteochondral lesions of the talar dome (OLT) are common injuries that involve the cartilage and subchondral bone. These injuries appear in up to 42% of professional soccer players on magnetic resonance imaging (MRI) (Figs. 1 and 2).1Bezuglov E. Khaitin V. Lazarev A. et al.Asymptomatic foot and ankle abnormalities in elite professional soccer players.Orthop J Sports Med. 2021; 9 (Published 2021 Jan 29)2325967120979994https://doi.org/10.1177/2325967120979994Crossref PubMed Scopus (3) Google Scholar, 2Brulc U. Drobnič M. Kolar M. Stražar K. A prospective, single-center study following operative treatment for osteochondral lesions of the talus [published online ahead of print, 2021 Aug 26].Foot Ankle Surg. 2021; S1268-7731 (00179-X)https://doi.org/10.1016/j.fas.2021.08.008Crossref Google Scholar, 3Badekas T. Takvorian M. Souras N. Treatment principles for osteochondral lesions in foot and ankle.Int Orthop. 2013; 37: 1697-1706https://doi.org/10.1007/s00264-013-2076-1Crossref PubMed Scopus (81) Google Scholar The etiology is diverse, including trauma, ischemia, avascular necrosis, ossification disorders, endocrine/metabolic diseases, genetic factors, and idiopathic causes.4Doğar F. Uzun E. Gürbüz K. et al.Comparison of arthroscopic treatment methods in talar osteochondral lesions: a Multicenter, Prospective, Randomized Clinical Trial.J Am Podiatr Med Assoc. 2021; 111 (Article): 5https://doi.org/10.7547/20-218Crossref Scopus (1) Google Scholar Traumatic injuries can occur in up to 70% of ankle fractures and sprains and are usually located in the anterolateral talar dome, in contrast to the posteromedial ischemic injuries.2Brulc U. Drobnič M. Kolar M. Stražar K. A prospective, single-center study following operative treatment for osteochondral lesions of the talus [published online ahead of print, 2021 Aug 26].Foot Ankle Surg. 2021; S1268-7731 (00179-X)https://doi.org/10.1016/j.fas.2021.08.008Crossref Google Scholar,4Doğar F. Uzun E. Gürbüz K. et al.Comparison of arthroscopic treatment methods in talar osteochondral lesions: a Multicenter, Prospective, Randomized Clinical Trial.J Am Podiatr Med Assoc. 2021; 111 (Article): 5https://doi.org/10.7547/20-218Crossref Scopus (1) Google Scholar, 5Eren T.K. Ataoğlu M.B. Eren A. Geylan D.E. Öner A.Y. Kanatlı U. Comparison of arthroscopic microfracture and cell-free scaffold implantation techniques in the treatment of talar osteochondral lesions.Eklem Hastalik Cerrahisi. 2019; 30: 97-105https://doi.org/10.5606/ehc.2019.64401Crossref PubMed Scopus (7) Google Scholar, 6Hannon C.P. Smyth N.A. 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Usuelli F.G Relationship between symptomatic osteochondral lesions of the talus and quality of life, body mass index, age, size and anatomic location.Foot Ankle Surg. 2018; 24: 365-372https://doi.org/10.1016/j.fas.2017.04.011Crossref PubMed Scopus (22) Google ScholarFig. 2Ankle coronal view magnetic resonance imaging showing a delaminated cartilage injury of the talar dome and subchondral edema. Asterisk (*) showing detail.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Due to the chondrocytes' low regeneration potential and the recent findings revealing subchondral bone architecture's role in cartilage homeostasis, repair durability, and overall clinical outcomes,11Shimozono Y. Coale M. Yasui Y. O'Halloran A. Deyer T.W. Kennedy J.G. Subchondral bone degradation after microfracture for osteochondral lesions of the talus: an MRI Analysis.Am J Sports Med. 2018; 46: 642-648https://doi.org/10.1177/0363546517739606Crossref PubMed Scopus (45) Google Scholar, 12Mitchell M.E. Giza E. Sullivan M.R. Cartilage transplantation techniques for talar cartilage lesions.J Am Acad Orthop Surg. 2009; 17: 407-414https://doi.org/10.5435/00124635-200907000-00001Crossref PubMed Scopus (46) Google Scholar, 13Rungprai C. Tennant J.N. Gentry R.D. Phisitkul P. Management of osteochondral lesions of the talar dome.Open Orthop J. 2017; 11 (Published 2017 Jul 31): 743-761https://doi.org/10.2174/1874325001711010743Crossref PubMed Google Scholar, 14Shimozono Y. Brown A.J. Batista J.P. et al.Subchondral pathology: proceedings of the international consensus meeting on cartilage repair of the ankle [published correction appears in foot ankle int. 2021 Feb;42(2):248].Foot Ankle Int. 2018; 39: 48S-53Shttps://doi.org/10.1177/1071100718781866Crossref PubMed Scopus (13) Google Scholar, 15Chen H. Hoemann C.D. Sun J. et al.Depth of subchondral perforation influences the outcome of bone marrow stimulation cartilage repair.J Orthop Res. 2011; 29: 1178-1184https://doi.org/10.1002/jor.21386Crossref PubMed Scopus (108) Google Scholar, 16Seow D. Yasui Y. Hutchinson I.D. Hurley E.T. Shimozono Y. Kennedy J.G. The subchondral bone is affected by bone marrow stimulation: a systematic review of preclinical animal studies.Cartilage. 2019; 10: 70-81https://doi.org/10.1177/1947603517711220Crossref PubMed Scopus (19) Google Scholar, 17Gianakos A.L. Yasui Y. Fraser E.J. et al.The effect of different bone marrow stimulation techniques on human talar subchondral bone: a Micro-Computed Tomography Evaluation.Arthroscopy. 2016; 32: 2110-2117https://doi.org/10.1016/j.arthro.2016.03.028Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar OLT treatment remains a challenging topic in orthopedics.4Doğar F. Uzun E. Gürbüz K. et al.Comparison of arthroscopic treatment methods in talar osteochondral lesions: a Multicenter, Prospective, Randomized Clinical Trial.J Am Podiatr Med Assoc. 2021; 111 (Article): 5https://doi.org/10.7547/20-218Crossref Scopus (1) Google Scholar,9Camurcu Y. Ucpunar H. Yapici F. et al.Clinical and magnetic resonance imaging outcomes of microfracture plus chitosan/blood implant vs Microfracture for Osteochondral Lesions of the Talus.Foot Ankle Int. 2020; 41: 1368-1375https://doi.org/10.1177/1071100720942173Crossref PubMed Scopus (4) Google Scholar,18Tahta M. Akkaya M. Gursoy S. Isik C. Bozkurt M. Arthroscopic treatment of osteochondral lesions of the talus: nanofracture versus hyaluronic acid-based cell-free scaffold with concentration of autologous bone marrow aspirate.J Orthop Surg (Hong Kong). 2017; 252309499017717870https://doi.org/10.1177/2309499017717870Crossref Scopus (7) Google Scholar Many surgical techniques have been developed during the last few decades for treatment18Tahta M. Akkaya M. Gursoy S. Isik C. Bozkurt M. Arthroscopic treatment of osteochondral lesions of the talus: nanofracture versus hyaluronic acid-based cell-free scaffold with concentration of autologous bone marrow aspirate.J Orthop Surg (Hong Kong). 2017; 252309499017717870https://doi.org/10.1177/2309499017717870Crossref Scopus (7) Google Scholar, 19Becher C. Malahias M.A. Ali M.M. Maffulli N. Thermann H. Arthroscopic microfracture vs arthroscopic autologous matrix-induced chondrogenesis for the treatment of articular cartilage defects of the talus.Knee Surg Sports Traumatol Arthrosc. 2019; 27: 2731-2736https://doi.org/10.1007/s00167-018-5278-7Crossref PubMed Scopus (30) Google Scholar, 20Shimozono Y. Coale M. Yasui Y. O'Halloran A. Deyer T.W. Kennedy J.G. Subchondral bone degradation after microfracture for osteochondral lesions of the talus: an MRI analysis.Am J Sports Med. 2018; 46: 642-648https://doi.org/10.1177/0363546517739606Crossref PubMed Scopus (45) Google Scholar, 21Vannini F. Costa G.G. Caravelli S. Pagliazzi G. Mosca M. Treatment of osteochondral lesions of the talus in athletes: what is the evidence?.Joints. 2016; 4 (Published 2016 Aug 18): 111-120https://doi.org/10.11138/jts/2016.4.2.111Crossref PubMed Scopus (8) Google Scholar and can be summarized in four strategical categories2,22:1.No treatment, in which incidentally found cartilage injuries are left in place without further intervention;2.Palliative, represented by cartilage debridement and irrigation, providing pain and mechanical symptoms relief;3.Reparative, profiting from intrinsic repairability of the cartilage tissue through bone marrow stimulation (BMS), including microfracture, nanofractures, drilling, and abrasion arthroplasty;4.Restorative, wherein the cartilage defect is filled or replaced, including osteochondral grafting or substitution, and scaffold and/or cell-based therapies. Despite success rates ranging from 76% to89%, there is limited evidence defining the ideal OLT surgical treatment.19Becher C. Malahias M.A. Ali M.M. Maffulli N. Thermann H. Arthroscopic microfracture vs arthroscopic autologous matrix-induced chondrogenesis for the treatment of articular cartilage defects of the talus.Knee Surg Sports Traumatol Arthrosc. 2019; 27: 2731-2736https://doi.org/10.1007/s00167-018-5278-7Crossref PubMed Scopus (30) Google Scholar,23Zengerink M. Struijs P.A. Tol J.L. van Dijk C.N. Treatment of osteochondral lesions of the talus: a systematic review.Knee Surg Sports Traumatol Arthrosc. 2010; 18: 238-246https://doi.org/10.1007/s00167-009-0942-6Crossref PubMed Scopus (408) Google Scholar However, the defect location, size, depth, and subchondral bone status are recognized as critical in the treatment decision-making and outcomes.2Brulc U. Drobnič M. Kolar M. Stražar K. A prospective, single-center study following operative treatment for osteochondral lesions of the talus [published online ahead of print, 2021 Aug 26].Foot Ankle Surg. 2021; S1268-7731 (00179-X)https://doi.org/10.1016/j.fas.2021.08.008Crossref Google Scholar,4Doğar F. Uzun E. Gürbüz K. et al.Comparison of arthroscopic treatment methods in talar osteochondral lesions: a Multicenter, Prospective, Randomized Clinical Trial.J Am Podiatr Med Assoc. 2021; 111 (Article): 5https://doi.org/10.7547/20-218Crossref Scopus (1) Google Scholar,5Eren T.K. Ataoğlu M.B. Eren A. Geylan D.E. Öner A.Y. Kanatlı U. Comparison of arthroscopic microfracture and cell-free scaffold implantation techniques in the treatment of talar osteochondral lesions.Eklem Hastalik Cerrahisi. 2019; 30: 97-105https://doi.org/10.5606/ehc.2019.64401Crossref PubMed Scopus (7) Google Scholar,19Becher C. Malahias M.A. Ali M.M. Maffulli N. Thermann H. Arthroscopic microfracture vs arthroscopic autologous matrix-induced chondrogenesis for the treatment of articular cartilage defects of the talus.Knee Surg Sports Traumatol Arthrosc. 2019; 27: 2731-2736https://doi.org/10.1007/s00167-018-5278-7Crossref PubMed Scopus (30) Google Scholar,24Ramponi L. Yasui Y. Murawski C.D. et al.Lesion Size Is a predictor of clinical outcomes after bone marrow stimulation for osteochondral lesions of the talus: a systematic review.Am J Sports Med. 2017; 45: 1698-1705https://doi.org/10.1177/0363546516668292Crossref PubMed Scopus (118) Google Scholar,25Park J.H. Park K.H. Cho J.Y. Han S.H. Lee J.W. Bone marrow stimulation for osteochondral lesions of the talus: are clinical outcomes maintained 10 years later?.Am J Sports Med. 2021; 49: 1220-1226https://doi.org/10.1177/0363546521992471Crossref PubMed Scopus (5) Google Scholar The aim of this narrative review was to outline a surgical treatment algorithm for OLT management in the athlete. Debridement alone or in combination with BMS techniques is the most common cartilage procedure performed in OLT treatment (Figs. 3 and 4).5Eren T.K. Ataoğlu M.B. Eren A. Geylan D.E. Öner A.Y. Kanatlı U. Comparison of arthroscopic microfracture and cell-free scaffold implantation techniques in the treatment of talar osteochondral lesions.Eklem Hastalik Cerrahisi. 2019; 30: 97-105https://doi.org/10.5606/ehc.2019.64401Crossref PubMed Scopus (7) Google Scholar,26Lee Y.K. Young K.W. Kim J.S. Lee H.S. Cho W.J. Kim H.N. Arthroscopic microfracture with atelocollagen augmentation for osteochondral lesion of the talus: a multicenter randomized controlled trial.BMC Musculoskelet Disord. 2020; 21 (Published 2020 Nov 3): 716https://doi.org/10.1186/s12891-020-03730-3Crossref PubMed Scopus (8) Google Scholar,27Marín Fermín T. Hovsepian J.M. D'Hooghe P. Papakostas E.T Arthroscopic debridement of osteochondral lesions of the talus: a systematic review.Foot (Edinb). 2021; 49101852https://doi.org/10.1016/j.foot.2021.101852Crossref PubMed Scopus (1) Google Scholar Debridement of a cartilage defect comprises the smoothening of the cartilage surface in the presence of fibrillation, flaps, or loose bodies and creating stable margins using a shaver or curette. Thus, improving mechanical symptoms and synovial inflammation.27Marín Fermín T. Hovsepian J.M. D'Hooghe P. Papakostas E.T Arthroscopic debridement of osteochondral lesions of the talus: a systematic review.Foot (Edinb). 2021; 49101852https://doi.org/10.1016/j.foot.2021.101852Crossref PubMed Scopus (1) Google Scholar Additionally, the defect's bed can be perforated with a wide variety of instruments to allow an influx of bone marrow, initiating a signaling cascade with the ulterior filling by fibrocartilage tissue.5Eren T.K. Ataoğlu M.B. Eren A. Geylan D.E. Öner A.Y. Kanatlı U. Comparison of arthroscopic microfracture and cell-free scaffold implantation techniques in the treatment of talar osteochondral lesions.Eklem Hastalik Cerrahisi. 2019; 30: 97-105https://doi.org/10.5606/ehc.2019.64401Crossref PubMed Scopus (7) Google Scholar,9Camurcu Y. Ucpunar H. Yapici F. et al.Clinical and magnetic resonance imaging outcomes of microfracture plus chitosan/blood implant vs Microfracture for Osteochondral Lesions of the Talus.Foot Ankle Int. 2020; 41: 1368-1375https://doi.org/10.1177/1071100720942173Crossref PubMed Scopus (4) Google Scholar,27Marín Fermín T. Hovsepian J.M. D'Hooghe P. Papakostas E.T Arthroscopic debridement of osteochondral lesions of the talus: a systematic review.Foot (Edinb). 2021; 49101852https://doi.org/10.1016/j.foot.2021.101852Crossref PubMed Scopus (1) Google ScholarFig. 4Chondral injury of the talar dome after bone marrow stimulation.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Until recently, debridement and BMS techniques were considered the initial treatment of OLT9Camurcu Y. Ucpunar H. Yapici F. et al.Clinical and magnetic resonance imaging outcomes of microfracture plus chitosan/blood implant vs Microfracture for Osteochondral Lesions of the Talus.Foot Ankle Int. 2020; 41: 1368-1375https://doi.org/10.1177/1071100720942173Crossref PubMed Scopus (4) Google Scholar,19Becher C. Malahias M.A. Ali M.M. Maffulli N. Thermann H. Arthroscopic microfracture vs arthroscopic autologous matrix-induced chondrogenesis for the treatment of articular cartilage defects of the talus.Knee Surg Sports Traumatol Arthrosc. 2019; 27: 2731-2736https://doi.org/10.1007/s00167-018-5278-7Crossref PubMed Scopus (30) Google Scholar This approach is relatively quick, easy, and inexpensive; patients can return to sports (RTS) quicker with a faster rehabilitation time, making it of particular interest for OLT management in athletes.4Doğar F. Uzun E. Gürbüz K. et al.Comparison of arthroscopic treatment methods in talar osteochondral lesions: a Multicenter, Prospective, Randomized Clinical Trial.J Am Podiatr Med Assoc. 2021; 111 (Article): 5https://doi.org/10.7547/20-218Crossref Scopus (1) Google Scholar,21Vannini F. Costa G.G. Caravelli S. Pagliazzi G. Mosca M. 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Arthroscopic microfracture with atelocollagen augmentation for osteochondral lesion of the talus: a multicenter randomized controlled trial.BMC Musculoskelet Disord. 2020; 21 (Published 2020 Nov 3): 716https://doi.org/10.1186/s12891-020-03730-3Crossref PubMed Scopus (8) Google Scholar,28Dahmen J. Lambers K.T.A. Reilingh M.L. van Bergen C.J.A. Stufkens S.A.S. Kerkhoffs G.M.M.J. No superior treatment for primary osteochondral defects of the talus.Knee Surg Sports Traumatol Arthrosc. 2018; 26: 2142-2157https://doi.org/10.1007/s00167-017-4616-5Crossref PubMed Scopus (76) Google Scholar A systematic review by Dahmen et al28Dahmen J. Lambers K.T.A. Reilingh M.L. van Bergen C.J.A. Stufkens S.A.S. Kerkhoffs G.M.M.J. No superior treatment for primary osteochondral defects of the talus.Knee Surg Sports Traumatol Arthrosc. 2018; 26: 2142-2157https://doi.org/10.1007/s00167-017-4616-5Crossref PubMed Scopus (76) Google Scholar reported a success rate of 82% after BMS in OLT. 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Return to sports after arthroscopic debridement and bone marrow stimulation of osteochondral talar defects: a 5- to 24-year follow-up study.Knee Surg Sports Traumatol Arthrosc. 2016; 24: 1311-1315https://doi.org/10.1007/s00167-016-3992-6Crossref PubMed Scopus (17) Google Scholar to 93.3% of survival rate, 84.4

Osteochondral Allograft Transplantation for a Cartilage Defect of the Humeral Capitellum

Background: Cartilage defects of the humeral capitellum most frequently present as osteochondritis dissecans (OCD) in young overhead athletes, such as baseball players. Historically, surgical options have included debridement, marrow stimulation, and osteochondral autograft transplantation. Fresh osteochondral allograft (OCA) transplantation comprises an additional treatment option that can structurally restore osteochondral defects and has demonstrated satisfactory outcomes without the donor-site morbidity associated with osteochondral autograft transplantation. Indication: OCA transplantation provides structural restoration of the articular surface and can be used for large (&gt;1 cm diameter) lesions not amenable to refixation. Additionally, OCA transplantation can address both chondral and subchondral pathology and is suited for the treatment of failed previous surgical interventions, such as debridement or marrow stimulation. Technique Description: Following diagnostic arthroscopy, an anconeus splitting mini-open approach was performed to expose the capitellar defect. The defect was measured to be 10 mm, and a central guide pin was placed. A 10-mm reamer was used to prepare the defect bed to a depth of 8 mm. An OCA plug was then cut from a fresh femoral hemicondyle to match the prepared defect. The graft was soaked in bone marrow aspirate concentrate harvested from the iliac crest, and the plug was then inserted into the defect and tamped to be concentric with the surrounding articular cartilage. Results: OCA transplantation of the capitellum allows for the restoration of the articular surface with a structural graft and can be used for large defects and revision cases. While OCA transplantation is well described in the knee with long-term efficacy, the application of this technique to the capitellum is relatively recent. Recent case series for the capitellum have displayed significant improvements in patient-reported outcome measures and predictable return to sports. Discussion/Conclusion: OCA transplantation for the humeral capitellum provides an effective treatment option for large, unstable cartilage lesions not amenable to refixation. The procedure allows for restoration of the articular surface and can provide improvements in pain and function as well as return to sport.

Rehabilitation Variability Following Osteochondral Autograft and Allograft Transplantation of the Knee.

ObjectiveThe aim of this study is to assess the variability of postoperative rehabilitation protocols used by orthopedic surgery residency programs for osteochondral autograft transplantation (OAT) and osteochondral allograft transplantation (OCA) of the knee.DesignOnline postoperative OAT and OCA rehabilitation protocols from US orthopedic programs and the scientific literature were reviewed. A custom scoring rubric was developed to analyze each protocol for the presence of discrete rehabilitation modalities and the timing of each intervention.ResultsA total of 16 programs (10.3%) from 155 US academic orthopedic programs published online protocols and a total of 35 protocols were analyzed. Twenty-one protocols (88%) recommended immediate postoperative bracing following OAT and 17 protocols (100%) recommended immediate postoperative bracing following OCA. The average time protocols permitted weight-bearing as tolerated (WBAT) was 5.2 weeks (range = 0-8 weeks) following OAT and 6.2 weeks (range = 0-8 weeks) following OCA. There was considerable variation in the inclusion and timing of strength, proprioception, agility, and pivoting exercises. Following OAT, 2 protocols (8%) recommended functional testing as criteria for return to sport at an average time of 12.0 weeks (range = 12-24 weeks). Following OCA, 1 protocol (6%) recommended functional testing as criteria for return to sport at an average time of 12.0 weeks (range = 12-24 weeks).ConclusionA minority of US academic orthopedic programs publish OAT and OCA rehabilitation protocols online. Among the protocols currently available, there is significant variability in the inclusion of specific rehabilitation components and timing of many modalities. Evidence-based standardization of elements of postoperative rehabilitation may help improve patient care and subsequent outcomes.

Realignment Surgery for Failed Osteochondral Autologous Transplantation in Osteochondral Lesions of the Talus Associated With Malalignment

Category:Ankle Arthritis; SportsIntroduction/Purpose:While osteochondral autograft transplantation (OAT) offers favorable results in most patients with osteochondral lesions of the talus (OLT), some patients continue to experience persistent pain following the procedure.Information regarding the etiology of this pain and outcomes of revision surgery are limited. This study aimed to report results of revision surgery with realignment procedures in patients with failed OAT who demonstrated concomitant malalignment at the distal tibia or hindfoot.Methods:Eight ankles with persistent pain following OAT underwent revision surgery with realignment procedures. All patients underwent primary OAT for treatment of medial OLTs. Patients were divided into two groups based on the main location of deformity; the Supramalleolar realignment group (SRG, five ankles) and the Hindfoot realignment group (HRG, three ankles). No direct procedure was performed on the osteochondral lesion at the time of revision surgery. Ankle and hindfoot alignment were evaluated using six parameters in weightbearing radiographs. Computed tomography (CT) was used to assess for medial gutter narrowing, spur formation, and cyst volume around transplanted osteochondral plug pre-and postoperatively. Clinical outcomes were assessed using foot function index and visual analogue scale.Results:All patients had medial gutter narrowing or spur formation, which are early signs of ankle arthritis. The SRG had varus distal tibial alignment with a median medial distal tibial angle of 85.7 degrees (Interquartile range [IQR], 3.2). The HRG had valgus hindfoot alignment and a lower medial longitudinal arch with a median hindfoot moment arm of 8.4 mm (IQR, 6.1) and a median Meary angle of 11.8 degrees (IQR, 1.4). Spontaneous restoration of the osteochondral lesion was observed after realignment surgery, with cyst volume decreasing from 0.2592cm3 to 0.0873cm3 (p<0.05, Figure 1 and Figure 2). Clinical scores improved in all patients.Conclusion:The current study shows the effectiveness of realignment surgery in a selected patient group in whom OAT has failed. Our study provides evidence for the role of realignment procedures in these cases, with results suggesting improved patient-reported outcomes and spontaneous restoration of osteochondral lesions.