Osteochondral Defects Of Talus Research Articles

AUTOLOGOUS OSTEOCHONDRAL TRANSPLANTATION FOR LARGE OSTEOCHONDRAL LESIONS OF THE TALUS IS A VIABLE OPTION IN AN ATHLETIC POPULATION

Autologous osteochondral transplantation (AOT) is an effective treatment for large Osteochondral Lesions of the Talus (OLT), however little is reported on an athletic population, who are likely to place higher demands on the reconstruction. The aim is to report the outcomes of large OLT (>150mm2) within an athletic population. The study population was limited to professional or amateur athletes (Tegner score >6) with an OLT of size 150mm2 or greater. The surgical intervention was AOT with a donor site from the lateral femoral condyle. Clinical outcomes at a minimum of 24 months included Return to Sport, VAS and FAOS Scores. In addition, graft incorporation was evaluated by MRI using MOCART scores at 12 months post-surgery. 38 athletes including 11 professional athletes were assessed. Mean follow-up was 46 months. Mean lesion size was 249mm2. 33 patients returned to sport at their previous level and one did not return to sport (mean return to play 8.2 months). Visual analogue scores improved from 4.53 pre-operatively to 0.63 post-operatively (p=0.002). FAOS Scores improved significantly in all domains (p< 0.001). Two patients developed knee donor site pain, and both had three osteochondral plugs harvested. Univariant analysis demonstrated no association between pre-operative patient or lesion characteristics and ability to return to sport. However, there was a strong correlation between MOCART scores and ability to return to sport (AUC=0.89). Our study suggests that AOT is a viable option in the management of large osteochondral talar defects in an athletic population, with favourable return to sport levels, patient satisfaction, and FAOS/VAS scores. The ability to return to sport is predicated upon good graft incorporation and further research is required to optimise this technique. Our data also suggests that patients should be aware of the increased risk of developing knee donor site pain when three osteochondral plugs are harvested.

Talus Osteochondral Defect Treatment With Biological Scaffold.

Talus Osteochondral defects (OCDs) are challenging and there is no consensus in literature regarding which is the best method of treatment. New techniques coming from regenerative medicine are being considered good alternatives of treatment and are being used exponentially in orthopaedic surgery. Platelet-rich fibrin (PRF) is the second generation of platelet concentrates. It has a convenient method of acquisition and can be used to create a biological scaffold which is able to seal up cavitary lesions. In this article, the authors describe a talus OCD treated with a biological scaffold, reporting the technique details and its results clinical and radiological results. The case report objective is to portray the use of this kind of biological material, its advantages, and limitations.Level of Evidence: Level 5.

The Effect of Stem Cells on Ankle Injuries

Ankle injuries lead to joint pain, limitation of movement, occasional effusion, and quality of life impairment. It is estimated that one injury occurs for every 10,000 people each day due to inversion of the ankle. 7-10% of all admissions to hospital emergency departments are a result of ankle injuries. It was found that 70% of acute ankle sprains and fractures display some osteochondral defects (OCD) of the talus. Twenty five percent of all injuries of the musculoskeletal system are related to inversion injuries. About 50% of these injuries are related to sports. Full thickness focal chondral defects in athletes have an overall prevalence of 36%. The ankle is the most injured area of the body for 24 of 70 sports that were studied. Basketball, soccer, football, volleyball, running, and dancing are the sports in which these athletic injuries are most common. Individuals under 35 years of age demonstrate majority of these ankle injuries. The most common age group is for those are between the ages of 15 and 19 years. Etiology of ankle OCDs can either be non-traumatic or traumatic. Seventy percent of acute ankle sprains and fractures occur in the OCD of talus. Potential side effects or medical complications may result from OCD surgeries. Animal and human subjects are commonly used by researchers to investigate the overall effectiveness of stem cells for OCD injuries. Mesenchymal stem cells (MSC) are often the source of preference for orthopedic procedures as they have the ability to differentiate into a variety of tissues. These tissues include bone, muscle, cartilage, and fat. Stem cell transplantation has shown improved tissue quality and rate of healing, sustained gains functionally, decreased pain, and enhanced clinical outcomes. Researchers believed the use of stem cells may offer choices for patients with orthopedic injuries including OCD to reduce recovery time and osteoarthritis as well as enhance function.

Treatment of talus osteochondral defects with arthroscopy debridement and bone marrow concentrate: a 6-month follow-up case report study

Abstract Talus osteochondral defects are a common cause of ankle pain and disability, and require prompt and effective treatment to prevent further damage and improve function. While surgical interventions, such as arthroscopy debridement and bone marrow concentrate therapy, have been used separately to treat these injuries, their combination may offer synergistic benefits. A 28-year-old male patient presented with a history of ankle pain and difficulty with weight-bearing activities. Post-operatively, the patient reported significant improvement in pain and function.

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

The effect of talus osteochondral defects of different area size on ankle joint stability: a finite element analysis

BackgroundOsteochondral lesion of the talus (OLT) is one of the most common ankle injuries, which will lead to biomechanical changes in the ankle joint and ultimately affect ankle function. Finite element analysis (FEA) is used to clarify the effect of talus osteochondral defects on the stability of the ankle joint at different depths. However, no research has been conducted on talus osteochondral defect areas that require prompt intervention. In this research, FEA was used to simulate the effect of the area size of talus osteochondral defect on the stress and stability of the ankle joint under a specific depth defect.MethodsDifferent area sizes (normal, 2 mm* 2 mm, 4 mm* 4 mm, 6 mm* 6 mm, 8 mm* 8 mm, 10 mm* 10 mm, and 12 mm* 12 mm) of the three-dimensional finite element model of osteochondral defects were established. The model was used to simulate and calculate joint stress and displacement of the articular surface of the distal tibia and the proximal talus when the ankle joint was in the heel-strike, midstance, and push-off phases.ResultsWhen OLT occurred, the contact pressure of the articular surface, the equivalent stress of the proximal talus, the tibial cartilage, and the talus cartilage did not change significantly with an increase in the size of the osteochondral defect area when the heel-strike phase was below 6 mm * 6 mm. Gradual increases started at 6 mm * 6 mm in the midstance and push-off phases. Maximum changes were reached when the defect area size was 12 mm * 12 mm. The same patterns were observed in the talus displacement.ConclusionsThe effect of the defect area of the ankle talus cartilage on the ankle biomechanics is evident in the midstance and push-off phases. When the size of the defect reaches 6 mm * 6 mm, the most apparent change in the stability of the ankle joint occurs, and the effect does not increase linearly with the increase in the size of the defect.

OSTEOCHONDRAL AUTOLOGOUS TRANSPLANTATION VERSUS ARTHROSCOPIC DEBRIDEMENT WITH DRILLING IN THE TREATMENT OF TALAR OSTEOCHONDRAL LESIONS AND DEFECTS

The aim: To conduct a comparative analysis of the results of arthroscopic debridement with drilling (ADD) versus osteochondral autologous transplantation (OAT) in the treatment of talar osteochondral lesions and defects (OHLD) based on the assessment of the function of the ankle joint, the level of pain and changes in the range of movements (ROM) in the affected joint. Materials and methods: The study included 40 patients with OHLD, with an average area of 3.14 cm2 and a depth of 1.15 cm, located in the posterior and middle medial part of the talus block. In the group 1 performed ADD. In group 2 - OAT. The results were evaluated before surgery, at 12 and 24 months. The level of pain to VAS, the function to AOFAS, the ROM in the joint were studied. Results: After treatment, there was a significant reduction in pain with the best result in group 2 (p<0.05). AOFAS showed that after 12 and 24 months the functional state of the joint in group 2 was better than in group 1 (p<0.01). After 12 months, ROM increased significantly in both groups. After 24 months, there was no increase in ROM in group 1, and in group 2 the growth was statistically significant (p<0.01), which confirmed the higher prospects and stability of the result when performing OAT. Conclusions: OAT is better than ADD for talar OHLD, provides maximum recovery of the joint surface, significantly reduces pain and improves ankle function.

Talar Osteoperiostic Grafting from the Iliac Crest (TOPIC): 2-Year Results of a Novel Press-Fit Surgical Treatment for Large Talar Osteochondral Lesions

Category:AnkleIntroduction/Purpose:The purpose of this study was to present the surgical technique and to evaluate the clinical and radiological outcomes of a new press-fit OATS technique for large primary and secondary talar osteochondral defects of the talus, Talar OsteoPeriostic grafting from the Iliac Crest (TOPIC).Methods:Forty patients underwent a press-fit TOPIC procedure. Mean age was 38 years (SD 4.6). Pre- and postoperative clinical assessment at 12- and 24-months follow-up included the American Orthopaedic Foot & Ankle Society (AOFAS) score, the Short- Form 36 (SF-36) Mental Component Scale (MCS) and Physical Component Scale (PCS), the Numeric Rating Scales (NRS) of pain at rest, during walking and stairclimbing, and the Foot and Ankle Outcome Score (FAOS). Return to work was assessed in time and rate. Remodeling of the contour of the talus, bone ingrowth and consolidation of the implanted graft were assessed on computed tomography (CT) one year post-operatively.Results:All patients were available for the two-year follow-up. The AOFAS improved from 48 to 90 (p<0.05). All NRS scores improved: the NRS during rest from 3 to 0 (p<0.05), the NRS during walking from 5 to 1 p<0.05), and the NRS during stairclimbing from 5 to 1 (p<0.05). Both components of the SF-36 improved. The PCS improved from 34 to 47 (p<0.05) and the MCS from 37 to 66 (p<0.05). All FAOS subscales significantly improved. 70% returned to sport at pre-injury sports level and mean time to return to sports was 9 months (SD 2.4). All patients showed remodeling of the talus and all grafts showed consolidation as well as bone ingrowth on the CT scans. All patients returned to work, at a mean time of 4 months post-operatively (SD 4.4). One patient had a temporary loss of n. saphenous sensibility.Conclusion:The TOPIC procedure is a highly promising surgical treatment option for large primary and secondary talar OCDs. Despite these good mid-terms clinical, sports and radiological outcomes, longer follow-up is necessary to assess the clinical outcome and the progression of osteoarthritis at the long term.

Allograft Versus Autograft Osteochondral Transplant for Chondral Defects of the Talus: Systematic Review and Meta-analysis

Background: It is unclear whether the results of osteochondral transplant using autografts or allografts for talar osteochondral defect are equivalent. Purpose: A systematic review of the literature was conducted to compare allografts and autografts in terms of patient-reported outcome measures (PROMs), MRI findings, and complications. Study Design: Systematic review; Level of evidence, 4. Methods: This study was conducted according to the PRISMA guidelines. The literature search was conducted in February 2021. All studies investigating the outcomes of allograft and/or autograft osteochondral transplant as management for osteochondral defects of the talus were accessed. The outcomes of interest were visual analog scale (VAS) score for pain, American Orthopaedic Foot and Ankle Society (AOFAS) score, and Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score. Data concerning the rates of failure and revision surgery were also collected. Continuous data were analyzed using the mean difference (MD), whereas binary data were evaluated with the odds ratio (OR) effect measure. Results: Data from 40 studies (1174 procedures) with a mean follow-up of 46.5 ± 25 months were retrieved. There was comparability concerning the length of follow-up, male to female ratio, mean age, body mass index, defect size, VAS score, and AOFAS score (P > .1) between the groups at baseline. At the last follow-up, the MOCART (MD, 10.5; P = .04) and AOFAS (MD, 4.8; P = .04) scores were better in the autograft group. The VAS score was similar between the 2 groups (P = .4). At the last follow-up, autografts demonstrated lower rate of revision surgery (OR, 7.2; P < .0001) and failure (OR, 5.1; P < .0001). Conclusion: Based on the main findings of the present systematic review, talar osteochondral transplant using allografts was associated with higher rates of failure and revision compared with autografts at midterm follow-up.

The Ankle Spacer-ahemiarthroplasty for treatment of severe osteochondral defects of the talus.

The Ankle Spacer system has been developed as ajoint-preserving option for patients with failed treatment of large talar osteochondral defects (OCDs). It is aone-piece implant system that replaces the articulating upper talus surface of the tibiotalar joint. Large OCDs with failed prior surgical intervention(s) and/or multiple talar OCDs on the talar surface, posttraumatic or degenerative osteoarthritis, or avascular necrosis of the talus. Severe malalignment exceeding7° and other ankle deformities that would not allow proper rasping of the talus, obesity, blood supply limitations, severe osteopenia, and previous or active infections. The surgery is carried out via acentral approach to the ankle joint. The tibiotalar joint was distracted to remove the cartilage on the upper talar surface with special talus rasps and to perform microfracture of the entire talar surface. The appropriate Ankle Spacer trial was then inserted into the joint and fluoroscopy was used to check for proper trial size and positioning. After thorough cleaning of the prepared bone bed, the Ankle Spacer was inserted with aspecial seating instrument. One surgeon in our center implanted ten Ankle Spacers between April 2018 and October 2019. The first short-term data with follow-up of 3months were collated. No implant-related complications were recorded. American Orthopaedic Foot and Ankle Society (AOFAS) score increased from55.5 to 79.5points, European Foot and Ankle Society (EFAS) score increased from 5.6 to 13.5points, and pain score decreased from3 to 1.1points. None of the patients' radiographs showed signs of loosening or osteoarthritis progression.

Cadaveric Analysis of Exposure of the Talar Articular Surface Through the Posteromedial Approach

The purpose of this cadaveric study is to assess the talar articular surface visible through a modified posterior medial approach to the ankle joint for talar osteochondral defects. Ten fresh frozen cadaveric specimens were included. The talar surface area was outlined utilizing a marker. The talus was removed to measure the medial to lateral length and posterior to anterior length using a flexible ruler. A skin incision was made posterior to the medial malleolus. The incision was deepened through the flexor retinaculum. Dissection was carried between the posterior tibial and flexor digitorum longus tendons through the posterior tibial tendon sheath in order to access the posteromedial ankle joint. The posterior tibiofibular ligament should remain intact. A Hintermann distractor was then inserted to distract the ankle joint. The average articular cartilage visible from medial to lateral was 1.90 (68.6%) centimeters, while from posterior to anterior was 2.00 (43.6%) centimeters. Medial malleolar osteotomy is often required to visualize posteromedial talar osteochondral defects that are difficult to visualize with standard anterior ankle arthroscopy. Our study suggests that the modified posteromedial approach between the posterior tibial and flexor digitorum longus tendons and utilizing a Hintermann distractor allows for visualization of common posterior and central-medial lesions. When considering the anatomic 9-zone grid scheme proposed by Raikin etal, zone 4, 7, and 8 lesions can be assessed with this approach. A clinical study should be undertaken to evaluate the morbidity of this approach.

Long-term Outcomes of Microfracture for Treatment of Osteochondral Lesions of the Talus.

Microfracture is the most common reparative surgery for osteochondral lesions of the talus (OLTs). While shown to be effective in short- to midterm outcomes, the fibrocartilage that microfracture produces is both biomechanically and biologically inferior to that of native hyaline cartilage and is susceptible to possible deterioration over time following repair. With orthobiologics being proposed to augment repair, there exists a clear gap in the study of long-term clinical outcomes of microfracture to determine if this added expense is necessary. A retrospective review of patients undergoing microfracture of an OLT with a single fellowship-trained orthopedic surgeon from 2007 to 2009 was performed. Patients meeting the inclusion criteria were contacted to complete the Foot and Ankle Ability Measure (FAAM) Activities of Daily Living (ADL) and Sports subscales and visual analog scale (VAS) for pain, as well as surveyed regarding their satisfaction with the outcome of the procedure and their likelihood to recommend the procedure to a friend with the same problem using 5-point Likert scales. Patient demographics were reviewed and included for statistical analysis. Of 45 respondents, 3 patients required additional surgery on their ankle for the osteochondral defect, yielding a 10-year survival rate of 93.3%. Of surviving cases, 90.4% (38/42) reported being "extremely satisfied" or "satisfied" with the outcome of the procedure. The VAS score at follow-up averaged 14 out of 100 (range, 0-75), while the FAAM-ADL and FAAM-Sports scores averaged 90.29 out of 100 and 82 out of 100, respectively. Thirty-six patients (85.7%) stated that their ankle did not prevent them from participating in the sports of their choice. The current study represents a minimum 10-year follow-up of patients undergoing isolated arthroscopic microfracture for talar osteochondral defects, with a 93.3% survival rate and 85.7% return to sport. While biological adjuvants may play a role in improving the long-term outcomes of microfracture procedures, larger and longer-term follow-up studies are required for procedures using orthobiologics before their cost can be justified for routine use. Level IV, retrospective cohort case series study.

Clinical Study of Autologous Cartilage Transplantation Based on Nano-Hydroxyapatite in the Treatment of Talar Osteochondral Injury.

Talus osteochondral damage is one of the common symptoms of chronic ankle pain in people's lives. The cartilage regeneration and self-repair ability are extremely limited, the joint cartilage lesions are often accompanied by the lesions of the subchondral bone, and the subchondral bone lesions can affect the metabolism of the cartilage above it, which brings certain difficulties to clinical treatment. Traditional methods of treating cartilage damage include microfractures and drilling. Due to large trauma, inconsistent clinical efficacy reports, poor tissue repair results, and limited donor sources, etc., the application of traditional treatment methods in the clinic has been largely limited. Therefore, finding an ideal treatment method for bone injury has been a hot spot in clinical research in orthopedics. Studies have shown that autologous cartilage transplantation via nano-hydroxyapatite has become a new treatment model, providing new ideas for clinical treatment of talar osteochondral damage. Nano-hydroxyapatite and its composites have good histocompatibility, biological activity, and bone conductivity. They are an ideal bone defect repair material, and have been initially applied in clinical practice. The preparation of nano-hydroxyapatite, its biological characteristics and the repairing effect on the composite defect of osteochondral bone were studied experimentally, and its feasibility for repairing osteochondral damage was discussed. In this paper, the unique structure and properties of natural cartilage layers are studied. In combination with bionics theory and methods, nano-hydroxyapatite micro-particle composite samples are prepared by the gel method, and the bone-forming properties of nano-composites are measured by in vitro drug release experiments. To establish a model of infectious bone injury in New Zealand white rabbits, and nano-hydroxyapatite composites were implanted into local lesions of New Zealand white rabbit models by autologous cartilage transplantation, and evaluated by imaging, blood biochemistry, histology, infection control and bone repair. The experimental results show that using the unique physical and chemical and biological properties of nano-hydroxyapatite materials. It is innovatively introduced into the treatment of talar osteochondral defects caused by open fractures. It has been proven in vitro and in vivo experiments that nano-hydroxyapatite materials can be used. As an ideal tissue engineering scaffold for the treatment of talar osteochondral defects, this provides a new way to solve clinical orthopedic problems using new nanomaterials.

Location of Talar Osteochondral Defects in Chronic Lateral Ankle Instability in an Asian Population

Osteochondral defect of the talus is traditionally described to involve the anterolateral and posteromedial portion of the talar dome in patients with chronic lateral ankle instability. Recent studies challenged this notion with advances in preoperative imaging and arthroscopy. Since Asian patients are more prone to ligamentous laxity, we postulate that the morphology and severity of osteochondral defects may be different in this population. Intraoperative records of 272 patients undergoing modified Broström-Gould procedure were reviewed for arthroscopic evidence of osteochondral defects. We characterized the morphology according to an anatomical 9-grid classification. Talar osteochondral defects were seen in 52 (19.1%) patients with a double lesion present in 1 patient. Medial-sided lesions account for nearly 3-quarters (n = 38, 73.1%) of all lesions and tend to be larger (79.4 ± 55.7 mm2 vs 51.0 ± 28.6 mm2, p =.08). There was no osteochondral defect seen in the central zones. There was no significant gender or age differences between patients with medial and lateral lesions. The most commonly performed procedure was microfracture. Osteochondral defects are commonly encountered in our Asian patients undergoing surgery for chronic lateral ankle instability. Contrary to published data, medial lesions are prevalent with no central lesions seen.

Maximum Ankle Plantarflexion and Dorsiflexion Allow for Optimal Arthroscopic Access to the Talar Dome: An Anatomic 3-Dimensional Radiography Study

(1) to improve the comprehension of the topographical position of the talar dome beneath the inferior articular surface of the tibia and, (2) to illustrate the changes of possible access to the articular surface of the talar dome during arthroscopic treatment of talar osteochondral defects in an anatomical model. Twenty matched pairs (n= 40) of anatomical ankle specimen were used. All specimens were mounted in a standardized fashion, 3-dimensional radiography was performed in 4 defined positions (maximum dorsiflexion, neutral position, noninvasive distraction, and maximum plantarflexion). All radiographs were analyzed and statistically compared. Anterior accessibility was highest in maximum plantarflexion (medial: 49.20 ± 9.86%, lateral: 48.19 ± 8.85%), followed by non-invasive distraction (medial: 33.60 ± 7.96%, lateral: 31.98 ± 8.30%). Neutral position (medial: 19.34 ± 6.90%, lateral: 17.54 ± 6.63%) and dorsiflexion (medial: 15.36 ± 5.03%, lateral: 13.88 ± 4.33%) were not able to significantly increase accessibility. Posterior accessibility was greatest in maximum dorsiflexion (medial: 56.69 ± 9.65%, lateral: 46.82 ± 8.36%), followed by neutral position of the ankle joint (medial: 40.95 ± 8.28%, lateral: 31.06 ± 6.92%). Noninvasive distraction (medial: 31.41 ± 8.18%, lateral: 22.99 ± 7.63%) was still significantly better than plantarflexion (medial: 14.54 ± 5.10%, lateral: 13.89 ± 3.14%) and slightly increased accessibility to the talar dome. Medially, a central area of 5.89 ± 9.76% was accessible by maximum plantarflexion and maximum dorsiflexion from anterior and posterior, respectively, laterally a central blind spot of 4.99 ± 8.61% was detected. From an anatomical point of view, maximum joint positions of the ankle (i.e., plantarflexion and dorsiflexion) allow for better access to the talar dome in anterior and posterior ankle arthroscopy. Noninvasive distraction may increase accessibility in anterior approaches, but has no benefit from posterior. This study provides insight into the morphology of the ankle joint in a standardized laboratory setup and illustrates the influence of different surgically relevant ankle joint positions. The presented data allow for better preoperative planning for the arthroscopic treatment of talar osteochondral defects.

All-Inside Arthroscopic Cancellous Allograft for the Large Cystic Osteochondral Defect of the Talus

Category:Arthroscopy; Sports; TraumaIntroduction/Purpose:The purpose of this study was to evaluate the surgical technique and long-term clinical outcomes of all- inside arthroscopic treatment for large cystic osteochondral defect of the talus with the use of cancellous allograft.Methods:Eight patients admitted from January 2016 to October 2018 by our hospital for large cystic osteochondral defect of the talus was retrospectively analyzed with their complete follow-up data. The subjects consisted of 5 males and 3 females, aged between 27 to 50 years, and with an average age of 34.2 years. All of these cystic osteochondral defects were larger than 15 mm in diameter, sized 1.3cm3 to 5.2cm3. The visual analogue scale (VAS) score, American Orthopaedic Foot & Ankle Society (AOFAS) score, The Karlsson Ankle Functional Score (KAFS) and subjective satisfaction survey rating were obtained. CT scan and magnetic resonance imaging of the ankle were obtained before and after surgery.Results:All incisions were healed in the first stage, and no complications such as nerve, blood vessel and tendon injuries occurred. All patients were available for follow-up at a mean of 26.2 months (range, 18 to 48 months). By the last follow-up, the postoperatively AOFAS 、 KAFS scores were 86.5 and 84.2 compared with 60.8 and 59.3 preoperatively, respectively. And the mean VAS score decreased from 6.4 preoperatively to 1.1. The range of motion of the ankle joint was normal and returned to the pre-pain state for these patients. Six patients rated their result as excellent, 2 as good and none as fair.Conclusion:All-inside arthroscopic cancellous allograft was an effective option for the treatment of large cystic talus osteochondral defects.

Talar OsteoPeriostic grafting from the Iliac Crest (TOPIC) for large medial talar osteochondral defects : Operative technique.

ObjectiveProvision of a natural scaffold, good quality cells, and growth factors in order to facilitate the replacement of the complete osteochondral unit with matching talar curvature for large medial primary and secondary osteochondral defects of the talus.IndicationsSymptomatic primary and secondary medial osteochondral defects of the talus not responding to conservative treatment; anterior–posterior or medial–lateral diameter >10 mm on computed tomography (CT); closed distal tibial physis in young patients.ContraindicationsTibiotalar osteoarthritis grade III; multiple osteochondral defects on the medial, central, and lateral talar dome; malignancy; active infectious ankle joint pathology.Surgical techniqueA medial distal tibial osteotomy is performed, after which the osteochondral defect is excised in toto from the talar dome. The recipient site is microdrilled in order to disrupt subchondral bone vessels. Then, the autograft is harvested from the ipsilateral iliac crest with an oscillating saw, after which the graft is adjusted to an exact fitting shape to match the extracted osteochondral defect and the talar morphology as well as curvature. The graft is implanted with a press-fit technique after which the osteotomy is reduced with two 3.5 mm lag screws and the incision layers are closed. In cases of a large osteotomy, an additional third tubular buttress plate is added, or a third screw at the apex of the osteotomy.Postoperative managementNon-weight bearing cast for 6 weeks, followed by another 6 weeks with a walking boot. After 12 weeks, a CT scan is performed to assess consolidation of the osteotomy and the inserted autograft. The patient is referred to a physiotherapist.ResultsTen cases underwent the TOPIC procedure, and at 1 year follow-up all clinical scores improved. Radiological outcomes showed consolidation of all osteotomies and all inserted grafts showed consolidation. Complications included one spina iliaca anterior avulsion and one hypaesthesia of the saphenous nerve; in two patients the fixation screws of the medial malleolar osteotomy were removed.

Chronic lateral ankle instability: Results of two-staged approach, correlation with magnetic resonance imaging findings, and incidence of associated pathologies – A 4-year follow-up study

Objectives: About 20% of ankle sprains have persistent symptoms even after 6 weeks–3 months of conservative treatment of physiotherapy and bracing. We followed a two-staged operative treatment protocol for the management of patients with persistent chronic lateral ankle instability. This study aims to analyze the outcomes of this two-staged treatment protocol and also to compare the magnetic resonance imaging (MRI) and arthroscopic findings in such patients and note the presence of associated pathologies. Materials and Methods: This is a retrospective study of 87 patients operated for chronic lateral ankle instability in two stages: (1) Diagnostic examination under anesthesia and ankle arthroscopy and (2) modified Brostrom procedure. Results: With a mean follow-up of 4 years, 31% of the patients had a complete resolution of their symptoms 4 months after the first procedure. Mean American Orthopaedic Foot and Ankle Score (AOFAS) and visual analog scale (VAS) scores show a significant improvement in functional outcomes in both the groups (P &lt; 0.05). Moreover, the MRI findings were equivocal or false negative in 60% of the patients. We also observed associated pathologies such as synovitis, osteochondral defect of talus, and anterolateral impingement in 40% of the patients. Conclusion: The two-staged treatment of ankle arthroscopy and modified Brostrom procedure is highly effective in resolution of the symptoms of patients with chronic lateral ankle instability. As MRI is not very sensitive and because of the associated intra-articular lesions found in this spectrum of patients, a primary ankle arthroscopy followed by a staged Brostrom procedure has shown to improve outcomes significantly with optimal intervention.

Matrix-Induced Autologous Chondrocyte Implantation (MACI) Grafting for Osteochondral Lesions of the Talus.

Matrix-induced autologous chondrocyte implantation (MACI) is an established treatment method for larger joints and has shown promising results in the ankle as well. We present a series of patients after ankle MACI with long-term follow-up of clinical and radiological outcomes. We present the follow-up of 15 patients who underwent MACI grafting from August 2003 to February 2006. The mean follow-up was 12.9 years. Clinical evaluations were conducted using the American Orthopaedic Foot & Ankle Society (AOFAS), Foot and Ankle Activity Measurement (FAAM), and visual analog scale (VAS) scoring systems and the magnetic resonance observation of cartilage repair tissue (MOCART) scoring system for radiological evaluation. The mean size of the talar osteochondral defects was 204 mm2. We found a significant improvement in mean AOFAS score from 60 preoperatively to a mean of 84 at 12 years postoperatively. The 12-year FAAM score for Activities of Daily Living was 89% (range, 62%-99%). The mean 12-year MOCART score was 65 points (range, 30-100 points) with significant agreement between assessors (P < .001). However, the MOCART scores did not correlate with the FAAM scores (P = .86). Considering our long-term follow-up, we believe MACI is a reliable treatment method for talar osteochondral defects providing lasting pain relief and satisfying clinical results. However, with an equivalent outcome, but at higher costs, and the requirement for 2 operative procedures, the results do not seem to be superior to other established methods. The clinical utility of the MOCART score requires further scrutiny since we were not able to show any correlation between the score and clinical outcome. Level IV, case series.

Scranton Type V Osteochondral Defects of Talus: Does one-stage Arthroscopic Debridement, Microfracture and Plasma Rich in Growth Factor cause the Healing of Cyst and Cessation of Progression to Osteoarthritis?Scranton Type V Osteochondral Defects of Talus: Does one-stage Arthroscopic Debridement, Microfracture and Plasma Rich in Growth Factor cause the Healing of Cyst and Cessation of Progression to Osteoarthritis?

Introduction:The study was conducted to evaluate the efficacy of arthroscopic debridement, microfracture and plasma rich in growth factor (PRGF) injection in the management of type V (Scranton) osteochondral lesions of talus and its role in healing the subchondral cyst and cessation of progression of ankle osteoarthritis.Material and Methods:This is a prospective case series conducted on patients who were diagnosed with type V osteochondral lesions of talus. All the cases were treated with arthroscopic debridement, microfracture, and PRGF injections. The patients were evaluated for the healing of subchondral cysts and progression of osteoarthritis with radiography (plain radiographs and computerised tomography Scan). Also, the patients’ outcome was evaluated with Quadruple Visual Analogue Scale, Ankle Range of Motion, Foot and Ankle Disability Index, Foot and Ankle Outcome Instrument and a Satisfaction Questionnaire.Results:Five male patients underwent arthroscopic debridement, microfracture and PRGF injection for type V osteochondral lesion of talus. The mean age of patients was 27.4 years (19-47 years). All the patients gave history of minor twisting injury. Subchondral cyst healing was achieved in all patients by six months post-surgery. However, four out of five patients had developed early osteoarthritic changes of the ankle by their last follow-up [mean follow-up 29 months (ranged 15-36 months)]. Despite arthritic changes, all the patients reported ‘Good’ to ‘Excellent’ results on satisfaction questionnaire and Foot and Ankle Disability Index and could perform their day to day activities including sports.Conclusion:Arthroscopic debridement, microfracture, and PRGF causes healing of the subchondral cyst but does not cause cessation of progression to osteoarthritis of ankle in type V osteochondral defects of talus. However, despite progress to osteoarthritis, patient satisfaction post-procedure is good to excellent at short-term follow-up.