Osteochondral Lesions Of The Talus Research Articles

Outcomes Following the Use of Extracellular Matrix Cartilage Allograft for the Management of Osteochondral Lesions of the Talus: A Systematic Review.

Extracellular matrix cartilage allograft (EMCA) is a novel biological strategy utilized to augment the repair of osteochondral lesions of the talus (OLTs). However, there is no consensus on the precise role and outcomes following its use in the treatment of OLTs. The purpose of this systematic review was to evaluate the clinical and radiological outcomes following the use of EMCA for the treatment of OLT.During July 2023, the PubMed, Embase, and Cochrane Library databases were systematically reviewed to identify clinical studies examining outcomes following EMCA for the management of OLTs.In total, 162 patients (162 ankles) across five studies received EMCA as part of their surgical procedure at a weighted mean follow-up time of 23.8±4.2 months. Across all five studies, there were improvements in subjective clinical outcomes following the use of EMCA, regardless of the clinical scoring tool utilized. Two studies demonstrated superior postoperative magnetic resonance observation of cartilage repair tissue (MOCART) scores in the EMCA cohort compared to the bone marrow stimulation (BMS) cohort alone.In the EMCA-BMS cohort, there were seven complications (9%) and three failures (4.1%). In the autologous osteochondral transplantation (AOT) cohort, there were 10 complications (38.5%), zero failures, and six secondary surgical procedures (23.1%). In the EMCA alone cohort, there were zero complications and three failures (4.3%), all of which underwent an unspecified revision procedure. This current systematic review demonstrated improvements in both clinical and radiological outcomes following the use of EMCA for the treatment of OLTs.Further prospective comparative studies with longer follow-up times are warranted to determine the precise role of EMCA in the management of OLT.

Anatomical factors in the development of medial-sided osteochondral lesion of the talus: a comparative analysis.

The aim of this study was to determine anatomical predictors for the occurrence of medial osteochondral lesions of the talus (OLT), by analyzing morphometric variables obtained from magnetic resonance imaging (MRI). A total of 430 ankles with 215 ankle MRIs from patients with nontraumatic OLTs on the medial side of the talar dome and an equal number of age, sex, and side-matched healthy controls were analyzed in this retrospective study. The specific MRI parameters that were measured include the anterior opening angle of the talus (AOT), the angle between the tibial axis and medial malleolus (TMM), the angle of the tibial plafond to the malleoli (PMA), the angle between the anterior and posterior talofibular ligaments (ATFL-PTFL angle), length of the trochlea tali arc (TAL), sagittal length of distal tibial articular surface (TAS), the ratio of the sagittal length of distal tibial articular surface to the length of the trochlea tali arc (TAS/TAL), and the depth of the incisura fibularis (IncDep). AOT, IncDep, ATFL-PTFL angle, PMA, TMM, TAL, and TAS/TAL exhibited significant differences between the two groups. The established cut-off values were 13° (AUC 0.875) for AOT, 3.7mm (AUC 0.565) for IncDep, 78° (AUC 0.729) for ATFL-PTFL angle, 14° (AUC 0.581) for PMA, 15° (AUC 0.907) for TMM, 34.3mm (AUC 0.599) for TAL, and 0.81 (AUC 0.719) for TAS/TAL. Multivariate logistic regression analysis revealed Odds Ratio (OR) = 22.22 for AOT > 13°, OR = 4.23 for ATFL-PTFL angle > 78°, OR = 1.99 for PMA ≤ 14°, OR = 31.598 for TMM > 15°, OR = 3.79 for TAS/TAL ≤ 0.81. This study highlights the significance of anatomical parameters, particularly the TMM and AOT, as key predictors of OLT.

Medial malleolar osteotomy in the treatment of osteochondral lesions of the Talus – incidence and impact on functional outcome: a retrospective analysis based on data from the German Cartilage Register (KnorpelRegister DGOU)

BackgroundThere has long been discussion regarding the impact of medial malleolar osteotomies (MMO) as an adjunctive treatment for osteochondral lesions of the talus (OCLT). MMO may improve the visibility and accessibility of the talus, but they also pose a risk of periprocedural morbidity. There is a lack of research about the prevalence and consequences of MMO in the surgical treatment of OCLT.MethodsThis study retrospectively evaluated data from the German Cartilage Register (KnorpelRegister DGOU) from its implementation in 2015 to December 2020. The impact of MMO on patient-reported outcome measures (PROMs) was investigated. Wherever possible, subgroups were built and matched using a propensity score which matched a group undergoing OCLT without MMO. Matching included age, sex, weight, localization of the OCLT, the international cartilage repair society (ICRS) grading, surgical procedure and preoperative symptoms using the Foot and Ankle Ability Measure (FAAM) and the Activities of Daily Living Subscale (ADL).ResultsThe prevalence of MMO in the operative treatment of OCLT was 15.9%. Most of the osteotomies were performed in OCL of the medial talar dome (76.8%) and in more serious lesions with an ICRS grade of III (29.1%) and IV (61.4%). More than half of the osteotomies (55.6%) were performed during revision surgery. A matched pair analysis of n = 44 patients who underwent AMIC® via arthrotomy and MMO vs. arthrotomy alone showed no significant differences in patient-reported outcome measures (PROMs, i.e. FAAM-ADL, and FAOS) at 6,12 and 24 months.ConclusionsMMO are mostly used in the treatment of severe (≥ ICRS grade 3) OCL of the medial talar dome and in revision surgery. Functional and patient-reported outcome measures are not significantly affected by MMO compared to arthrotomy alone.Trial registrationThe German Cartilage Register (KnorpelRegister DGOU) was initially registered at the German Clinical Trials Register (https://www.drks.de, register number DRKS00005617, Date of registration 03.01.2014) and was later expanded by the ankle module.

Autologous osteoperiosteal transplantation is effective in the treatment of single cystic osteochondral lesions of the talus and the prognostic impact of age should be emphasized.

To investigate the clinical efficacy and prognostic factors associated with autologous osteoperiosteal transplantation for the treatment of single cystic osteochondral lesions of the talus (OLT). The clinical data of patients with single cystic OLT undergoing autologous osteoperiosteal transplantation at the Department of Foot and Ankle Surgery of our hospital between 2018 and 2022, including complete follow-up, were retrospectively analyzed. Imaging data from each patient were imported into Mimics software to measure the surface area, volumeand depth of the lesions. Then, the talus nine-compartment partitioning method was used to partition the injury site. Preoperative and final follow-up assessments were performed using the American Orthopaedic Foot and Ankle Society (AOFAS) score, visual analogue scale (VAS) for painand 36-item Short-Form Health Survey (SF-36) to evaluate treatment efficacy and analyze prognostic factors. Of the 31 patients with single cystic OLT with a complete set of follow-up data, there were 17 males and 14 females, with a mean age of 43.3 ± 13.6 years, a mean follow-up time of 30.1 ± 14.0 monthsand a mean illness duration of 30.4 ± 20.0 months. The postoperative final follow-up AOFAS score was 90.7 ± 5.5; this represented significant improvement when compared to the preoperative score of 57.0 ± 8.5 (P < 0.001). The final postoperative follow-up VAS score was 18.5 ± 8.3; this was significantly better than the preoperative score of 57.8 ± 8.7 (P < 0.001). The physical component summary (PCS)score and mental component summary (MCS)score on the SF-36 scale showed significant improvement at the final postoperative follow-up when compared to preoperative scores (p < 0.001). No other complications were observed during follow-up, such as wound infection or pain at the donor site. One of the patients showed less improvement, which may be related to premature weight-bearing or re-sprained ankle after surgery. There was no significant correlation between the duration of illness, genderand the location, depth, surface areaand volume of the OLTand the postoperative scores. However, patient age showed a significant negative correlation with the postoperative SF-36 PCS and MCS scores. Autologous osteoperiosteal transplantation for single cystic OLT demonstrated good clinical efficacy with a low incidence of complications. Furthermore, age represents an important factor influencing prognosis. Level II.

Comparative analysis of short-term efficacy between robot-assisted retrograde drilling and arthroscopic microfracture for osteochondral lesions of the talus.

To investigate the short-term clinical efficacy of robot-assisted retrograde drilling and arthroscopic microfracture for osteochondral lesions of the talus (OCLT). This study was divided into two groups: experimental group: robot-assisted retrograde drilling group; control group: arthroscopic microfracture group. A total of 6 OCLT patients who were treated with robot navigation-assisted retrograde drilling and 10 OCLT patients who were treated with arthroscopic microfracture between October 2020 and October 2021 were retrospectively analyzed. There were 11 males and five females, with a mean age of 36 years. The patients were followed up for 6-12 months to compare the changes in the OCLT lesion area by magnetic resonance imaging (MRI), visual analogue scale/score (VAS) and American Orthopedic Foot and Ankle Society score (AOFAS) before and after surgery. All 16 patients were followed up for an average of 8 months, and no complications such as joint infection, nerve injury, or active bleeding occurred during the follow-up period. Only one patient suffered discomfort involving transient postoperative pain in the operative area, but did not experience long-term numbness or chronic pain. Postoperative MRI revealed that none of the patients had severe signs of osteonecrosis, osteolysis or cystic changes of the talus, with lesion areas smaller than those before surgery. The difference was statistically significant (P < 0.01). The patients in the experimental group showed a more significant improvement in the last 3 months than in the first 3 months of the follow-up period. At the last follow-up, the VAS score was 3 points in the experimental group and 2.2 points in the control group, and the AOFAS score was 88.6 points in the experimental group and 88 points in the control group, all of which were significantly higher than those before operation, and the differences were statistically significant, but there was no statistically significant difference between the groups. Both robot navigation-assisted retrograde drilling and arthroscopic microfracture for bone marrow stimulation (BMS) to treat OCLT in all patients obtained satisfactory effects in the short term. In addition, the follow-up revealed that with excellent efficacy and few complications, robot navigation-assisted retrograde drilling was safe and minimally invasive, and greatly reduced operative time. Consequently, robot navigation-assisted retrograde drilling for BMS was a safe and effective procedure for the treatment of OCLT.

Effect of Cigarette Smoking on Postoperative Outcomes After Arthroscopic Bone Marrow Stimulation for Osteochondral Lesions of the Talus.

Bone marrow stimulation (BMS) is presently considered first-line surgical treatment for osteochondral lesions of the talus (OLTs); however, some patients still experience pain or dysfunction after surgery, and the reasons for success or failure remain somewhat unclear. This study aimed to investigate the effect of smoking on postoperative outcomes after arthroscopic BMS for OLTs. Consecutive patients with OLTs who underwent BMS between January 2017 and January 2020 were included. Smokers were defined as patients who actively consumed cigarettes before surgery and postoperatively, whereas nonsmokers were patients who never smoked. Visual analog scale (VAS), American Orthopaedic Foot & Ankle Society ankle hindfoot score (AOFAS), Karlsson-Peterson, and Tegner scores were assessed preoperatively and at follow-up. Additionally, a general linear model (GLM) was performed, followed by the interaction analysis to explore the potential influence of smoking. The study enrolled 104 patients with a mean follow-up of 30.91 ± 7.03 months, including 28 smokers and 76 nonsmokers. There were no significant differences in patient age (35.2 ± 10.0 years vs 37.6 ± 9.7 years, P = .282) or OLT area (63.7 ± 38.7 mm2 vs 52.8 ± 37.0 mm2, P = .782). Both univariate analysis and GLM revealed that smoking was associated with worse postoperative pain levels, Karlsson-Peterson, and AOFAS scores (P < .05). The interaction analysis showed a significant interaction between smoking and OLT area for postoperative Karlsson-Peterson scores (general ankle function) (P = .031). Simple main effects analysis revealed that the negative effect of smoking on Tegner score significantly increased among patients >32 years old or with OLT area>50 mm2 (P < .05). Smoking was associated with worse clinical outcomes following BMS of OLTs. As the size of OLTs increased, the difference in general ankle function between smokers and nonsmokers also increased. Furthermore, smokers who were older than 32 years or had larger OLTs were less likely to resume participation in high-level activities.

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 (&gt;150mm2) within an athletic population. The study population was limited to professional or amateur athletes (Tegner score &gt;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&lt; 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.

Surgical treatment for talus Osteochondral Lesions: What's new?

Osteochondral lesions of the talus (OLTs) are a common pathology encountered by foot and ankle surgeons. Symptomatic cartilage lesions in the ankle pose a significant challenge and often require surgical intervention to alleviate pain, improve joint function, and restore the integrity of the articular surface. Possible treatment options, including operative and nonoperative management, havebeen widely discussed in the literature, with substantial heterogeneity regarding treatment approaches and resulting patient-reportedoutcomes and joint function metrics. A general problem regarding OLT is that this entity is not clearly defined, nor its description,location, or best treatment for each type that may be required in some symptomatic presentations. The focus of our paper was to show the proper treatment for each lesion, including location, deepness, vascularity, and capability of healing. Level of evidence V; Expert opinion.

Ten-Year Survival Rate of 82% in 262 Cases of Arthroscopic Bone Marrow Stimulation for Osteochondral Lesions of the Talus.

The long-term sustainability of arthroscopic bone marrow stimulation (BMS) for osteochondral lesions of the talus (OLT) remains a matter of debate. The primary aim of the present study was to assess the 10-year survival free from revision in ankles that had undergone arthroscopic BMS for an OLT. The secondary aim was to evaluate the influence of baseline patient and lesion characteristics on survival. Patients who underwent arthroscopic BMS for a symptomatic OLT and had a minimum follow-up of 10 years were included to assess procedure survival. The primary outcome, the 10-year cumulative survival rate, was analyzed by the Kaplan-Meier survival method. Secondary outcomes were the median time to revision and the effects of baseline factors (lesion size, primary or non-primary lesion type, preoperative cysts, and obesity as defined by a body mass index [BMI] of ≥30 kg/m 2 ) on survival, analyzed with a Cox regression model and reported using hazard ratios (HRs). The 262 included patients had a mean follow-up of 15.3 ± 4.8 years. The 10-year cumulative survival rate of the arthroscopic BMS procedures was 82% (95% confidence interval [CI]: 77% to 87%). At 15 years of follow-up, the cumulative survival rate was 82% (95% CI: 76% to 86%). The median time to revision was 2.4 years (interquartile range: 1.3 to 5.1 years). Of the baseline factors, obesity (HR: 3.0 [95% CI: 1.44 to 6.43], p < 0.01) was associated with decreased survival. Lesion size (HR: 0.9 [95% CI: 0.5 to 1.8], p = 0.8), non-primary lesion type (HR: 1.8 [95% CI: 0.9 to 3.4], p = 0.1), and the presence of preoperative cysts (HR: 1.0 [95% CI: 0.6 to 1.9], p = 0.9) were not significantly associated with survival. At a minimum follow-up of 10 years, the survival rate of arthroscopic BMS for OLT was 82%. At 15 and 20 years of follow-up, survival appeared to remain stable. Obesity (BMI ≥ 30 kg/m 2 ) was associated with a higher likelihood of revision surgery. This risk factor should be incorporated into the treatment algorithm for OLT when counseling patients regarding surgery. Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.

AUTOLOGOUS MATRIX-INDUCED CHONDROGENESIS (AMIC)-AIDED RECONSTRUCTION OF OSTEOCHONDRAL LESIONS OF THE TALUS: FIVE-YEAR FOLLOW-UP

IntroductionAutologous Matrix Induced Chondrogenesis (AMIC) for surgical treatment of osteochondral lesions of the talus (OCLT) has shown excellent clinical and radiological results at short term follow up two years after surgery. However, no mid-term follow up data is available.Aim1. To evaluate the clinical outcome after AMIC-aided reconstruction of osteochondral lesions of the talus at a minimum follow up time of five years. 2. To evaluate the morphology and quality of the regenerated cartilage by magnetic resonance imaging (MRI) at on at a minimum follow up time of five years.MethodsSeventeen patients prospectively underwent surgery receiving a AMIC-aided repair of OCLT consisting of debridement, autologous grafting, and sealing of the defect with a collagen scaffold (Chondro-Gide, Geistlich Surgery, Wolhusen, Switzerland). Clinical and radiological assessment was performed before and after a minimum of 60 months after surgery (average 78 months, range, 60–120). Clinical examination included the American Orthopaedic Foot &amp; Ankle Society (AOFAS) ankle score and the Visual Analogue Scale (VAS). Radiological imaging consisted of MRI. The Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score was applied.ResultsThe AOFAS ankle score improved significantly from a mean of 60 points preoperatively (range, 17–79) to 91 points (range, 70–100) postoperatively (p&lt; 0.01). The preoperative pain score averaged a VAS of 5 (range, 2–8), improving to an average of 1.1 (range 0–8) (p&lt; 0.01). The MOCART score for cartilage repair tissue on postoperative MRI averaged 71 points (range, 50–90).ConclusionThe AMIC-procedure is safe for the treatment of OCLT with overall good clinical and magnetic resonance imaging results at five years follow up.

Medial Cystic Osteochondral Lesions of the Talus Exhibited Lower Sports Levels, Higher Cyst Presence Rate, and Inferior Radiological Outcomes Compared With Lateral Lesions Following Arthroscopic Bone Marrow Stimulation

To compare the patient-reported outcomes and radiological outcomes of the patients with medial- and lateral-cystic osteochondral lesions of the talus (OLTs) following bone marrow stimulation (BMS). Patients with cystic OLTs who underwent BMS between January 2016 and February 2021 were retrospectively analyzed, and the minimum follow-up time was more than 24 months. Patients were paired in a 1:1 ratio (medial-: lateral-cystic OLT; MC-OLT: LC-OLT) based on the OLT area within 30mm2, follow-up within 1 year, age within 5 years, and ligament surgery (Yes/No). The Visual analog scale, Foot and Ankle Ability Measure (FAAM)-Activities of Daily Life and Sports scores were assessed preoperatively and postoperatively. The magnetic resonance observation of cartilage repair tissue (MOCART) scores, and presence of cysts after BMS were also evaluated. Additionally, the receiver operating characteristic curve was performed. The matched patients were divided into the MC-OLT(n=31, 43.35±12.32 months) and LC-OLT groups (n=31, 43.32±14.88 months, P=.986). Thirty patients of each group achieved a power of 80% and an α = 0.05 in this study. The MC-OLT group showed significantly less improvement in FAAM-ADL and sports scores (P = .034, P <0.001, respectively), lower MOCART scores (80.80±11.91 vs. 86.00±8.50, P = .010), and higher presence-rate of cyst after BMS (45.16% vs. 16.12%, P = .013). Regarding FAAM sports scores, the LC-OLT group had significantly more patients exceeding the MCID (80.64% vs. 51.61%, P = .031). Furthermore, an OLT depth of 7.23mm (sensitivity: 78.6%; specificity: 70.6%) might serve as a cut-off value for predicting the presence of cysts in medial-cystic OLTs following BMS. Medial cystic OLTs exhibited markedly lower sports levels, higher cyst-presence rate, and inferior radiological outcomes following BMS than lateral counterparts. Additionally, an OLT depth of 7.23mm could be the cut-off value for predicting the presence of cysts regarding medial-cystic OLTs after BMS. Level III, retrospective comparative study.

Factors predicting the outcome of arthroscopic debridement and microfracture technique in treatment of osteochondral lesions of talus

Aims and Scope: Osteochondral lesions of the talus (OLT) are common injuries that occur following ankle sprains and fractures. Surgical management, either through open or arthroscopic technique, is required to eliminate the pain and restore the ankle’s function. This study aims to evaluate the prognostic significance of demographic variables and lesion’s characteristics. Method and Techniques: In this study, 40 ankle (40 patients), who underwent arthroscopic debridement and microfracture technique to treat osteochondral lesion of the talus, were evaluated retrospectively after two years. The functional outcome of the ankle joint was assessed by using foot – ankle disability score, (FADS), pain analysing scale score (PASS), American orthopaedic foot and ankle society (AOFAS) score, and Ogilvie-Harris scaling system. Then the association between patients’ age and gender, and the lesions’ characteristics, including size, grade, and location, were evaluated. Results: Outcome results varied according to the scoring system, but all patients achieved satisfied outcome and pain relieve. Younger patients with smaller lesions achieved a better clinical result. All measures including PASS, AOFAS, Ogilvie-Harris, FADS appeared to be significantly better in smaller lesions. (P-value &lt;0.05) PASS and Ogilvie-Harris scales showed better results in younger patients. Ogilvie-Harris test result was notably superior in the lateral lesions. Conclusion: The patient’s age and size of the lesion are two prognostic factors of arthroscopic debridement and microfracture of OLTs. We believe arthroscopic management can be associated with a better outcome in lesions smaller than 1.5 cm in diameter and patients younger than 40-years-old. Level of Clinical Evidence: Level 2 – prognostic study

Enhancing precision in osteochondral lesions of the talus measurements and improving agreement in surgical decision-making using weight-bearing computed tomography and distance mapping.

Weight-bearing computed tomography (WBCT) enables the creation of a three-dimensional (3D) model that represents the ankle morphology in a standing position. Distance mapping (DM) is a complementary feature that uses color coding to represent the relative intraarticular distance and can be used to outline intraarticular defects. Consequently, DM offers a novel approach to delineating osteochondral lesions of the talus (OLT), allowing for the quantification of its surface, volumeand depth. The reliability of DM for OLT measurements has yet to be thoroughly evaluated. This study primarily aims to determine the reliability of DM in measuring the surface, depthand volume of OLT. A secondary objective is to ascertain whether measurements obtained through DM, when integrated with a predefined treatment algorithm, can facilitate consensus among surgeons regarding the optimal surgical intervention. This cohort comprised 36 patients with 40 OLTs evaluated using WBCT and DM. Two raters used DM to determine the lesion boundary (LB) and lesion fundus (LF) and calculate the lesion depth, surfaceand volume. The raters were asked to choose between bone marrow stimulation, autologous matrix-induced chondrogenesisand osteochondral transposition based on the measurement. Inter-rater and intra-rater agreement was measured. Interclass correlation of the lesion's depth surface produced an excellent inter-rater and intra-rater agreement of 0.90-0.94 p < 0.001. Cohen's κ agreement analysis of the preferable preoperative plan produced a κ = 0.834, p < 0.001, indicating a near-perfect agreement. WBCT-based 3D modules and DM can be used to measure the lesion'ssurface, depth and volume with excellent inter-rater and inter-rater agreement; using this measurement and a predetermined treatment algorithm, a near-perfect inter-rater agreement for the preoperative planning was reached. WBCT in conjunction with AI capabilities could help determine the type of surgery needed preoperatively, evaluate the hindfoot alignmentand assess if additional surgeries are needed. Level III.

Return to Sports Activity After Microfracture for Osteochondral Lesion of the Talus in Skeletally Immature Children.

Osteochondral lesions of the talus (OLTs) are among the common sports-related injuries. However, there are few reports on the return to sports after OLT surgery in skeletally immature children. This study was performed to evaluate the return to sports after microfracture for OLTs in skeletally immature children. This study involved 17 ankles of 16 patients (mean age, 13.2 years; range, 10-16 years) with open tibial epiphyses on magnetic resonance imaging (MRI) who underwent microfracture for OLTs <10 mm in diameter and confirmation of lesion instability under arthroscopy. Nine of 17 ankles had additional lateral ankle ligament stabilization. All patients were participating in some form of sports. The Japanese Society for Surgery of the Foot (JSSF) score, Ankle Activity Score (AAS), return to sports rate, lesion size, grade of subchondral bone marrow edema, and Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score on MRI were evaluated after microfracture. The mean postoperative follow-up period was 53.5 months. The mean JSSF score significantly improved from 76.1 points preoperatively to 94.9 points at the final follow-up (P < .01). The mean AAS showed no change from preoperative state to final follow-up. The return to sports rate was 100%. The lesion size significantly decreased from 76.3 to 56.7 mm2 in area (P = .02) and from 283.2 to 185.6 mm3 in volume (P = .05). The bone marrow edema grade decreased in 8 of 17 ankles. The total MOCART score showed a significant improvement from 6 months to 1 year postoperatively (P = .05). All skeletally immature children who underwent microfracture for OLTs in this study were able to return to sports activity and showed improvements in clinical scores and MRI parameters. Microfracture may be considered an effective first-line treatment for OLTs <10 mm in diameter in skeletally immature athletes. Level IV, retrospective case-control study.

Improvement in Clinical and Radiographic Outcomes After Isolated Realignment Surgery in Patients With Large Cystic Osteochondral Lesion of the Talar Shoulder and Concurrent Malalignment.

Malalignment has been suggested as a predisposing factor for the development of osteochondral lesions of the talus (OLTs). To evaluate the clinical and radiographic outcomes of realignment surgery in patients with a large cystic OLT of the talar shoulder and concurrent malalignment of the foot and ankle. Case series; Level of evidence, 4. The authors reviewed consecutive patients with large cystic OLTs (diameter, >10 mm) of the talar shoulder and concurrent malalignment of the foot and ankle who underwent realignment surgery between September 2013 and April 2021. The type of realignment procedure was determined based on patient symptoms and findings on plain radiographs and weightbearing computed tomography. Clinical improvement was assessed using pre- and postoperative Foot Function Index (FFI) scores and the visual analog scale (VAS) for pain. The OLT location was categorized according to Raikin zone, and the OLT area and volume were measured and compared pre- and postoperatively. The comparative analysis was performed using the Wilcoxon signed-rank test. In total, 27 ankles in 27 patients (mean age, 34.4 ± 11.9 years) were included in the analysis. There were 25 patients with a medial lesion (zone 4 [n = 19], zone 7 [n = 5], and zone 1 [n = 1]), and 2 patients with a lateral lesion (zone 6). Despite OLT location, patients' symptoms varied; 15 (55.6%) patients reported both medial- and lateral-sided pain, 10 (37%) reported lateral-sided pain, and 2 (7%) reported medial-sided pain. Supramalleolar osteotomy was performed in 18 patients, while foot and hindfoot correction without supramalleolar osteotomy was performed in 9 patients. Postoperatively, both the median FFI (from 44.4 [interquartile range (IQR), 35.7-52.2] to 9.1 [IQR, 5.2-13.9]) and median VAS pain score (from 6 [IQR, 5-6] to 1 [IQR, 1-2]) improved significantly (P < .0001 for both), and the median lesion size (from 25.8 mm2 [IQR, 19.3-45.2 mm2] to 13.8 mm2 [IQR, 6.8-26.5 mm2]) and median volume (from 2226.8 mm3 [IQR, 1311-3104 mm3] to 1326.5 mm3 [IQR, 714-2100 mm3]) decreased significantly (P < .0001 for both). During the mean follow-up of 4.1 ± 2.1 years, no subsequent surgery for OLT was necessary. The results suggest that realignment procedures can improve the symptoms and radiographic profile of OLTs in patients with large cystic OLTs of the talar shoulder and malalignment of the foot and ankle.

Outcomes Following Extracellular Matrix Cartilage Allograft for the Management of Osteochondral Lesions of the Talus: A Systematic Review

Introduction/Purpose: The purpose of this systematic review was to evaluate the clinical and radiographic outcomes in patients who received extracellular matrix cartilage allograft (EMCA) during surgical intervention for osteochondral lesions of the talus (OLT). Methods: During January 2023, the PubMed, Embase and Cochrane library databases were systematically reviewed to identify clinical studies evaluating outcomes in patients who received EMCA during surgical intervention for osteochondral lesions of the talus. Data regarding lesion characteristics, surgical characteristics, subjective clinical outcomes, radiographic outcomes, complication rates, failure rates and secondary surgical procedure rates were extracted and analysed. In total, 5 clinical studies were included in this review. Results: In total, 162 patients received EMCA during surgical intervention for OLT at a weighted mean follow-up of 23.8 ± 4.2 months. The weighted mean lesion area was 77.9 ± 42.6 mm2. Overall, 111 (68.5%) of OLTs were located medially, 45 (27.8%) of OLTs were located laterally and 6 (3.7%) OLTs were located centrally. Four studies performed arthroscopic debridement and bone marrow stimulation with ECMA, 3 studies utilized concentrated bone marrow aspirate and 1 study performed autologous osteochondral transplantation. Improvements were noted in AOFAS, FAOS and VAS scores following surgical intervention. The weighted mean post-operative MOCART score was 76.3 ± 2.9. In total, 17 (10.5%) complications were reported across the 5 studies. Twelve failures (7.4%) were recorded, all of which required further surgical intervention. Conclusion: This systematic review demonstrated improvements in subjective clinical outcomes and radiological outcomes at short-term follow-up following surgical intervention for OLTs augmented with ECMA. A low failure rate and moderate complication rate was noted. However, there was marked heterogeneity between the included studies with regards to surgical technique utilized, lesion size and patient cohort size. Further research is warranted to determine the optimal role of ECMA in the management of OLT.

Skeletal Features of Talus in Hepple V Lesion

The present study was to determine the characteristics of the ankle skeletal structure in patients with talus Hepple V type. We conducted a retrospective study on the skeletal structure of the talus in 110 patients with Hepple V osteochondral lesions of the talus and in control participants. The radiographic measurements taken include the following: in the coronal plane - depth of talus frontal curvature, length of the lateral and medial malleolus; in the sagittal plane - radius and height of talus, angle of tibial lateral surface, tibiotalar sector, and vertical neck angle. The osteochondral lesion of the talus showed a significantly larger mean radius (mean ± SD, 21.4 ± 2.5 mm; p < .001) and height (mean ± SD, 26.0 ± 2.7 mm; p < .005). It also demonstrated a longer mean medial malleolus length (mean ± SD, 15.7 ± 2.4 mm; p < .005), a larger mean vertical neck angle (mean ± SD, 86.2 ± 5.4°; p < .050), and a greater mean tibial lateral surface angle (mean ± SD, 80.0 ± 4.5°; p < .001). And there was a greater mean frontal curvature depth (mean ± SD, 3.9 ± 0.6 mm; p < .005). Overall, this study found that patients with Hepple V osteochondral lesions of the talus had a larger vertical neck angle and tibial lateral surface angle, a longer talus radius and medial malleolus length, a higher talus height, and a deeper frontal curvature depth. Study DesignsRetrospective Case-Control Study.

Significant Clinical Improvement After Arthroscopic Autologous Matrix-Induced Chondrogenesis for Osteochondral Lesions of the Talus: A 5-Year Follow-Up.

This study aims to evaluate the clinical outcomes of arthroscopic autologous matrix-induced chondrogenesis (A-AMIC) for osteochondral lesions of the talus (OLT) at 24 months and 60 months of follow-up. The secondary aim was to assess whether age, body mass index (BMI), and lesion surface affect outcomes. Sixty-three patients (32 males, 31 females) with a median age of 37 years [interquartile range (IQR): 25-48] were included. Preoperative and postoperative (24 months and 60 months) clinical outcomes were evaluated using a Visual Analog Score (VAS) for pain during walking, the American Orthopaedic Foot and Ankle Society (AOFAS), Short-Form Survey (SF-12), the Halasi, and the University of California, Los Angeles (UCLA) scores. Patients were categorized according to age, BMI, and lesion surface (1-1.5 cm2 and over 1.5 cm2). The effect of each category was evaluated. There were significant improvements in the VAS, AOFAS, SF-12, and UCLA, comparing the preoperative scores to the 60-month follow-up scores (P < 0.001). There were no significant differences in the above-mentioned outcomes between the follow-up periods. Patients older than 33 years had lower SF-12, Halasi, and UCLA scores (P = 0.005, 0.004, and <0.001, respectively). Overweight patients had lower VAS, SF-12, Halasi, and UCLA scores (P = 0.006, 0.002, 0.024, and 0.007, respectively). Lesion size was uninfluential. A-AMIC yielded clinical improvements at a minimum follow-up of 60 months in patients with symptomatic OLTs, with clinical improvement peaking in the first 2 years, followed by a plateau period. Increased age and BMI were significantly associated with inferior outcomes.

Comparison of the medial midline and the anterolateral portal in ankle arthroscopy for the treatment of osteochondral lesions of the medial talus.

To compare the clinical efficacy and complication rates between the medial midline and anterolateral portals in ankle arthroscopy for treating medial osteochondral lesions of the talus (OLTs). We retrospectively analyzed patients with medial OLTs who underwent either a dual medial approach (via the medial midline and anteromedial portal) or a traditional approach (via the anterolateral and anteromedial portal) between June 2017 and January 2023. The degree of injury was evaluated by radiographs, computed tomography, and magnetic resonance imaging. Clinical outcomes were assessed using the visual analog scale (VAS), the American Orthopaedic Foot and Ankle Society (AOFAS) score, and the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) scoring system. The incidence of postoperative complications, including superficial peroneal nerve (SPN) injury, was evaluated in all patients. There were 39 patients in total; 16 patients underwent the dual medial approach, and 23 patients underwent the traditional approach. The mean age was 39.4 ± 9.0years, and the mean follow-up duration was 18.7 ± 6.4months. The clinical outcomes improved significantly in both groups (*P < 0.05), but there was no significant difference between the two groups (P > 0.05). Postoperative complications were mainly SPN injury. The incidence of SPN injury was 13.0% in the traditional approach group and 0% in the dual medial approach group, with no significant difference between the two groups (P > 0.05), but a trend of reduction in SPN injury was observed in the dual medial approach group. The dual medial approach can also treat medial OLTs well, providing clear visualization and more convenient operation and reducing the possibility of injury to the SPN compared with the traditional approach. Therefore, we consider that the MM portal would be a good alternative to the anterolateral portal in treating medial OLTs.

Evidence-Based Update on the Surgical Technique and Clinical Outcomes of Retrograde Drilling: A Systematic Review.

Retrograde drilling is an established surgical technique to treat osteochondral lesions of the talus (OLT). It involves non-trans-articular drilling to induce subchondral bone revascularization and bone formation without damaging the overlying articular cartilage. The present study aimed to elucidate the heterogeneity of clinical studies on retrograde drilling for OLT. A systematic search of the MEDLINE, Web of Science, EMBASE, and Cochrane Library databases for studies published between January 1996 and August 27, 2022, was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines by two independent reviewers. The included studies were evaluated for their level of evidence (LoE) and quality of evidence (QoE) using the Modified Coleman Methodology Score. Variables reporting surgical and clinical outcomes and complications were evaluated. Eleven studies with 207 ankles were included (mean follow-up period = 31.1 months). The mean LoE was 3.8 (LoE 3: two studies, LoE 4: nine studies), and the mean QoE was 50.8 (fair: three studies, poor: eight studies). Ten studies used the American Orthopedic Foot and Ankle Society (AOFAS) score, which improved from 57.9 preoperatively to 86.1 postoperatively. The period and protocol of conservative treatment, lesion character, surgical technique, and postoperative protocol were inconsistent or underreported. This systematic review revealed that low LoE and poor QoE, coupled with heterogeneity among the included studies, impede definitive conclusions regarding the effectiveness of this technique. Consequently, well-designed clinical trials are essential to develop standardized clinical guidelines for using retrograde drilling in OLT.