Osteochondral Lesions Of The Talus Research Articles

Comparison of Intermediate-Term Clinical Outcomes Between Medial and Lateral Osteochondral Lesions of the Talus Treated With Autologous Osteochondral Transplantation.

The conventional operative method to treat an osteochondral lesion of the talus (OLT) is through bone marrow stimulation (BMS). Autologous osteochondral transplantation (AOT) is being used as an alternative option in cases with a large OLT, accompanying subchondral cyst, and/or failed BMS. We aimed to compare the intermediate-term clinical and radiologic results between medial and lateral OLTs after an AOT procedure. Among the patients who underwent AOT, 45 cases with at least 3 years' follow-up were included in this retrospective study. We had 15 cases of lateral lesions and selected 30 cases of medial lesions matched for age and gender. Lateral lesions were resurfaced without an osteotomy; medial lesion resurfacing was combined with a medial malleolar osteotomy. Clinical assessment was performed using the Foot and Ankle Outcome Score (FAOS) and Foot and Ankle Ability Measure (FAAM). Radiographic assessment included the irregularity of articular surface (subchondral plate), the progression of degenerative arthritis, and the change of the talar tilt. The mean FAOS and FAAM scores significantly improved after surgery in both groups. Up to 1 year postoperatively, there was significant difference in FAAM scores between the both groups (mean 75.3 points in medial group and 87.2 points in lateral group, P < .001). Delayed union or malunion of the malleolar osteotomy was found in 4 cases (13%) in the medial group. In addition, the progression of joint degeneration was observed in 3 cases (10%) in the medial group. There were no significant differences in the irregularity of articular surface and the change of talar tilt between both groups. A comparison between medial and lateral OLTs treated with AOT demonstrated comparable intermediate-term clinical outcomes. However, patients with medial OLT required a longer period to restore ability for daily and sport activities. In addition, we found more complications and higher rate of progression in the radiologic arthritis grade after medial malleolar osteotomy. Level IV, retrospective comparative study.

Osteochondral lesion of the talus: presentation and management - A case report

Osteochondral lesions of the talus (OLT) involve the chondral and subchondral region typically. Most are secondary to trauma. The patients present with pain, stiffness, swelling. Diagnosis is made typically by clinical and radiological correlation. Treatment strategies employed can be conservative or surgical. This case report is of a 24-year-old male, who presented with pain on the right ankle ,for a chronic period following trauma. The patient was diagnosed with OLT and underwent surgical treatment (Right medial malleolus osteotomy +curettage of right talus + bone grafting + reconstruction of the medial malleolus). This case study is aimed at understanding the various treatment strategies for OLT, both surgical and non-surgical and thus arriving at a conclusion. Treatment of osteochondral lesions is mainly by early screening in high-risk patients (trauma). Although outcomes are favorable in most of the cases, treatment should be individualized to every patient with adequate counseling of outcomes and complications.

Retrograde Drilling, Ossoscopy, and Autologous Bone Grafting: An Alternative Technique for Treatment of Osteochondral Lesion of the Talus Stage 2 and 3 in Adults.

Symptomatic osteochondral lesions of the talus (OLTs) often require surgical intervention. There are various surgical methods. A generally valid, stage-dependent therapeutic algorithm does not exist. The aim of our study is to show long- term results of an alternative technique that combines retrograde drilling, debridement performed under arthroscopic visualization, and autologous bone grafting. The surgical technique was performed in 24 patients with medial or lateral OLTs, and the data were analyzed retrospectively. In our technique, the affected subchondral bone was overdrilled retrogradely and resected under arthroscopic visualization (ossoscopy) without violating the cartilage. The resulting defect was filled with autologous bone from the medial tibia metaphysis. Outcome parameters were the numeric rating scale (NRS), the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, and range of motion (ROM). The Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score was assessed and a possible correlation with the clinical outcome scores was calculated. Data concerning complication rates were also collected. The mean surface size of the OLTs was 0.9 ± 0.3 cm2. The mean follow-up was 89 months. The AOFAS score improved significantly from 57.7 points preoperatively to 88.8 points at the final follow-up (P < .0001). The pain value measured by the NRS decreased significantly from 8 to a pain level of 2. ROM improved in 37.5% of the patients for dorsiflexion and 29.2% for plantarflexion. There were no significant correlations between the MOCART score and the AOFAS score or the pain value on NRS. Retrograde drilling, ossoscopy, and autologous bone grafting for OLTs is a promising technique with good long-term results. The patients' satisfaction rate, especially in OLT stages 2 and 3, was excellent. Level IV, case series.

The Biomechanical Influence of Defected Cartilage on the Progression of Osteochondral Lesions of the Talus: A Three‐dimensional Finite Element Analysis

Osteochondral lesions of the talus (OLTs) are common injuries in the general population. Abnormal mechanical conditions applied to defected cartilage are believed to be the culprits to deteriorating OLTs. This study aims to investigate the biomechanical effects of defect size of talar cartilage on OLTs during ankle movements. A finite element model of the ankle joint was created based on the computed tomography images of a healthy male volunteer. Different defect sizes (S = 0.25, 0.5, 0.75, 1.0, 1.25, 1.5, 1.75, and 2.0 cm2 ) of talar cartilage were modeled to simulate the progression of OLTs. Mechanical moments were applied to the model to generate different ankle movements, including dorsiflexion, plantarflexion, inversion, and eversion. The effects of varying defect sizes on peak stress and its location were evaluated. The maximum stress on the talar cartilage increased as the area of the defect enlarged. Additionally, as the defect size of OLTs increased, the areas with peak stress on talar cartilage tended to move closer to where the injury was located. High stresses were present in the medial and lateral areas of the talus at the neutral position of the ankle joint. The concentrated stresses were mainly located in the anterior and posterior defect areas. The peak stress in the medial region was higher than on the lateral side. The order of peak stress from highest to lowest was dorsiflexion, internal rotation, inversion, external rotation, plantar flexion, and eversion. Osteochondral defect size and ankle joint movements significantly modulate the biomechanical features of the articular cartilage in osteochondral lesions of the talus. The progression of osteochondral lesions in a talus deteriorates the biomechanical well-being of the bone tissues of the talus.

Juvenile Osteochondral Lesions of the Talus: Current Concepts Review and an Update on the Literature.

Osteochondral lesions of the talus (OLTs) are lesions that occur before the physis closes and are frequently associated with acute ankle trauma. These lesions are often difficult to diagnose due to swelling and inflammation that are present after the initial injury. A growing body of literature has assessed the effects of OLTs in the adult population. However, the literature examining these lesions in the juvenile population is sparse. The purpose of this review is to provide a thorough understanding of OLTs, with a specific focus on the juvenile population. We evaluate the recent literature regarding the outcomes of various surgical treatment; modalities in the pediatric patient. While the outcomes after surgical treatment of pediatric OLTs are generally favorable, the paucity of investigation in this demographic is alarming. Further research is needed to better inform practitioners and families regarding these outcomes, as treatment plans are highly dependent on the individual patient in question.

Development of convolutional neural network model for diagnosing osteochondral lesions of the talus using anteroposterior ankle radiographs.

Deep learning is an advanced machine learning technique that is used in several medical fields to diagnose diseases and predict therapeutic outcomes. In this study, using anteroposterior ankle radiographs, we developed a convolutional neural network (CNN) model to diagnose osteochondral lesions of the talus (OLTs) using ankle radiographs as input data. We evaluated whether a CNN model trained on anteroposterior ankle radiographs could help diagnose the presence of OLT. We retrospectively collected 379 cases (OLT cases = 133, non-OLT cases = 246) of anteroposterior ankle radiographs taken at a university hospital between January 2010 and December 2020. The OLT was diagnosed using ankle magnetic resonance images of each patient. Among the 379 cases, 70% of the included data were randomly selected as the training set, 10% as the validation set, and the remaining 20% were assigned to the test set to evaluate the model performance. To accurately classify OLT and non-OLT, we cropped the area of the ankle on anteroposterior ankle radiographs, resized the image to 224 × 224, and used it as the input data. We then used the Visual Geometry Group Network model to determine whether the input image was OLT or non-OLT. The performance of the CNN model for the area under the curve, accuracy, positive predictive value, and negative predictive value on the test data were 0.774 (95% confidence interval [CI], 0.673-0.875), 81.58% (95% CI, 0.729-0.903), 80.95% (95% CI, 0.773-0.846), and 81.82% (95% CI, 0.804-0.832), respectively. A CNN model trained on anteroposterior ankle radiographs achieved meaningful accuracy in diagnosing OLT and demonstrated that it could help diagnose OLT.

Retrograde Autologous Talar Osteocancellous Bone Grafting for the Treatment of Osteochondral Lesions of the Talus: A Technical Note.

Osteochondral lesions of the talus (OLT) are common injuries in young athletes. Various kinds of surgical procedures are available for orthopaedic surgeons, but which surgical technique is the best remains controversial. Many surgical procedures require malleolar osteotomy to obtain appropriate surgical exposure to the OLT because of the anatomic characteristics of the ankle joint. However, malleolar osteotomy is invasive and has a potential risk of complications, such as tibial chondral damage and pseudoarthrosis. This article aims to introduce a novel surgical procedure for the treatment of OLTs: retrograde autologous talar osteocancellous bone grafting without the need for osteotomy and harvesting a graft from anywhere other than the talus. First, an arthroscopic evaluation is performed to verify the location, size, and cartilage quality of the OLT as well as concomitant lesions. After confirming the position of the guide pin using a guide device arthroscopically, a talar osteocancellous bone plug is harvested using a coring reamer. The OLT of the harvested talar bone plug is removed, and under arthroscopy, the talar osteocancellous bone plug is retrogradely inserted into the talar bone tunnel. To stabilize the implanted bone plug, one or two bioabsorbable pins are inserted from the lateral wall of the talus while applying counterforce to the articular surface of the bone plug. The present surgical technique can minimally invasively address the OLT without the need for malleolar osteotomy and harvesting a graft from the knee joint or iliac bone.

Concomitant Subchondral Bone Cysts Negatively Affect Clinical Outcomes Following Arthroscopic Bone Marrow Stimulation for Osteochondral Lesions of the Talus

To study the effects of concomitant subchondral bone cysts (SBCs) on prognosis after arthroscopic bone marrow stimulation (BMS) for osteochondral lesions of the talus (OLTs) less than 100 mm2 and to further assess the correlation between cystic OLT area, depth, or volume and postoperative outcomes. We retrospectively analyzed consecutive patients with OLTs (<100 mm2) who received BMS between April 2017 and May 2020 with a minimum follow-up of 24 months. Lesion area, depth, and volume were collected on preoperative magnetic resonance imaging. Visual analog scale (VAS), American Orthopedic Foot and Ankle Society, Karlsson-Peterson, Tegner, Foot and Ankle Ability Measure (FAAM)-Activities of Daily Life and Sports scores were assessed before surgery and at the latest follow-up. Additionally, a general linear model (GLM) and a Pearson correlation analysis (PCA) were performed to investigate the effects of concomitant cysts on postoperative results. Eighty-two patients with a mean follow-up of 39.22 ± 12.53 months were divided into non-cyst (n= 45; 39.91 ± 13.03 months) and cyst (n= 37; 38.37 ± 12.02 months) groups. There was no significant difference in the OLT area between the non-cyst and cyst groups (46.98 ± 19.95 mm2 vs 56.08 ± 22.92 mm2; P= .093), but the cyst group showed significantly greater depth (6.06 ± 1.99 mm vs 3.96 ± 1.44 mm; P= .000) and volume (248.26 ± 156.81 mm3 vs 134.58 ± 89.68 mm3; P= .002). The non-cyst group showed significantly more improvement in VAS pain, Karlsson-Peterson, Tegner, and FAAM scores than the cyst group (P < .05). The GLM indicated that SBCs negatively affected VAS pain and Tegner scores (P < .05). For OLTs with cysts, the PCA showed that an area of 90.91 mm2, depth of 7.56 mm, and volume of 428.13 mm3 were potential cutoff values associated with poor outcomes. The concomitant SBCs negatively affected the prognosis of OLTs after BMS. For OLTs with cysts, an area of 90.91 mm2, depth of 7.56 mm, and volume of 428.13 mm3 were the potential cutoff values associated with poor outcomes after BMS. Level III, retrospective comparative study.

Etiology, Classification, Diagnostics, and Conservative Management of Osteochondral Lesions of the Talus. 2023 Recommendations of the Working Group "Clinical Tissue Regeneration" of the German Society of Orthopedics and Traumatology.

Peer-reviewed literature was analyzed regarding different topics relevant to osteochondral lesions of the talus (OLTs) treatment. This process concluded with a statement for each topic reflecting the best scientific evidence available for a particular diagnostic or therapeutic concept, including the grade of recommendation. Besides the scientific evidence, all group members rated the statements to identify possible gaps between literature and current clinical practice. In patients with minimal symptoms, OLT progression to ankle osteoarthritis is unlikely. Risk factors for progression are the depth of the lesion on MRI, subchondral cyst formation, and the extent of bone marrow edema. Conservative management is the adaptation of activities to the performance of the ankle joint. A follow-up imaging after 12 months helps not to miss any progression. It is impossible to estimate the probability of success of conservative management from initial symptoms and imaging. Cast immobilization is an option in OLTs in children, with a success rate of approximately 50%, although complete healing, estimated from imaging, is rare. In adults, improvement by conservative management ranges between 45% and 59%. Rest and restrictions for sports activities seem to be more successful than immobilization. Intra-articular injections of hyaluronic acid and platelet-rich plasma can improve pain and functional scores for more than 6 months. If 3 months of conservative management does not improve symptoms, surgery can be recommended.

The Efficacy of Microfracture Combined with Extracorporeal Shock Wave Therapy for Treating Osteochondral Lesion of the Talus and the Quality of Regenerated Cartilage: A Retrospective Cohort Study and MRI Assessment.

osteochondral lesion of the talus (OLT) is a common disease in the physically active population, and extracorporeal shock wave therapy (ESWT) is a noninvasive treatment. We hypothesized that microfracture (MF) combined with ESWT may have great potential to become a novel combination treatment of OLT. the OLT patients who received MF + ESWT or MF + platelet-rich plasma (PRP) injection were retrospectively included, with a minimal follow up of 2y. The daily activating VAS, exercising VAS, and American Orthopedic Foot and Ankle Society Ankle-Hindfoot Score (AOFAS) were used to assess the efficacy and functional outcome, and ankle MRI T2 mapping was used to evaluate the quality of regenerated cartilage in the OLT patients. only transient synovium-stimulated complications were found during the treatment sessions; the complication rate and daily activating VAS did not have differences between groups. MF + ESWT had a higher AOFAS and a lower T2 mapping value than MF + PRP at the 2y follow up. the MF + ESWT had superior efficacy for treating OLT, which resulted in better ankle function and more hyaline-like regenerated cartilage, superior to the traditional MF + PRP.

Computed tomography arthrography versus magnetic resonance imaging for diagnosis of osteochondral lesions of the talus.

Osteochondral lesions of the talus (OLT) usually have non-specific clinical symptoms, and radiographs have a low sensitivity for detecting OLT. The purpose of this study is to compare the diagnostic value of CT arthrography (CTa) with that of MRI using arthroscopy as the reference standard for grading OLT. We retrospectively reviewed patients who had OLT between 2015 and 2020. Patients with symptomatic OLT as a surgical indication, who were treated arthroscopically, and underwent both CTa and MRI before surgery were included. OLT was evaluated by both CTa and MRI using arthroscopy as the standard. We graded CTa, MRI, arthroscopic findings using Mintz classification. Thirty-five patients were included. Accuracy rates of MRI and CTa for grading OLT, compared to those of arthroscopy, were 57.1% and 88.6%, respectively. Among 15 mismatched cases in MRI, 12 lesions (80%) were matched in CTa and arthroscopy. CTa had significantly higher diagnostic performance than MRI for the detection of grade III lesions (p = 0.041). Using the receiver operating characteristics curves, the area under the curve values for lesion grading were 0.893 for CTa and 0.762 for MRI. CTa was statistically significantly better in detecting chondral flapping or subchondral exposure lesions for OLT than MRI on using arthroscopy as the reference standard. Because the stability of the OLT is essential in determining the treatment method, if an OLT is observed on MRI and is suspected to cause ankle pain, we recommend additional CTa examination to determine the more correct treatment strategies for OLT. Diagnostic Level III.

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

While osteochondral autologous 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. Eight patients (8 ankles), who had been experiencing persistent pain for more than 1 year following OAT, underwent realignment procedures during revision surgery. All patients underwent primary OAT for the treatment of medial OLTs. Patients were divided into 2 groups based on the main location of deformity: the supramalleolar realignment group (SRG, 5 ankles) and the hindfoot realignment group (HRG, 3 ankles). No direct procedure was performed on the osteochondral lesion at the time of revision surgery. Ankle and hindfoot alignment were evaluated using 6 parameters in weightbearing radiographs. Computed tomography (CT) was used to assess for medial gutter narrowing, spur formation, and cyst volume around transplanted osteochondral plug preoperatively and postoperatively. Clinical outcomes were assessed using Foot Function Index and Visual Analogue Scale. 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's angle of 11.8 degrees (IQR, 1.4). Spontaneous restoration of the osteochondral lesion was observed after realignment surgery, with cyst volume decreasing from 0.2592 to 0.0873 cm3 (P < .05). Clinical scores improved in all patients. The current study demonstrates the effectiveness of realignment surgery in a selected patient group who experienced persistent pain and showed radiographic evidence of malalignment after primary OAT. Our study provides evidence supporting the use of realignment procedures in these cases, with results indicating improved patient-reported outcomes and spontaneous restoration of osteochondral lesions. Level IV: Case series.

Rethinking Cartilage Lesions of the Ankle: An Update on the Role of Biologic Adjuvants.

Osteochondral lesions of the talus are common injuries in the ankle joint often resulting in early-onset osteoarthritis if left untreated. The avascular nature of articular cartilage limits healing capacity; therefore, surgical strategies are typically used in the treatment of these injuries. These treatments often result in the production of fibrocartilage rather than the native hyaline cartilage, which has decreased mechanical and tribological properties. Strategies to improve the ability of fibrocartilage to be more hyaline-like and thus more mechanically robust have been widely investigated. Biologic augmentation, including concentrated bone marrow aspirate, platelet-rich plasma, hyaluronic acid, and micronized adipose tissue, has been used in the augmentation of cartilage healing, with studies demonstrating promise. This article provides an overview and update on the various biologic adjuvants used in the treatment of cartilage injuries in the ankle joint.

The Frequency and Severity of Complications in Surgical Treatment of Osteochondral Lesions of the Talus: A Systematic Review and Meta-Analysis of 6,962 Lesions.

The primary aim was to determine and compare the complication rate of different surgical treatment options for osteochondral lesions of the talus (OLTs). The secondary aim was to analyze and compare the severity and types of complications. A literature search was performed in MEDLINE (PubMed), EMBASE (Ovid), and the Cochrane Library. Methodological quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS). Primary outcome was the complication rate per surgical treatment option. Secondary outcomes included the severity (using the Modified Clavien-Dindo-Sink Complication Classification System for Orthopedic Surgery) and types of complications. The primary outcome, the severity, and the sub-analyses were analyzed using a random effects model. A moderator test for subgroup-analysis was used to determine differences. The types of complications were presented as rates. In all, 178 articles from the literature search were included for analysis, comprising 6,962 OLTs with a pooled mean age of 35.5 years and follow-up of 46.3 months. Methodological quality was fair. The overall complication rate was 5% (4%-6%; treatment group effect, P = 0.0015). Analysis resulted in rates from 3% (2%-4%) for matrix-assisted bone marrow stimulation to 15% (5%-35%) for metal implants. Nerve injury was the most observed complication. In 1 out of 20 patients treated surgically for an OLT, a complication occurs. Metal implants have a significantly higher complication rate compared with other treatment modalities. No life-threatening complications were reported.

Sustained clinical success at 7-year follow-up after arthroscopic Lift-Drill-Fill-Fix (LDFF) of primary osteochondral lesions of the talus

PurposeTo describe the long-term clinical results of arthroscopic fragment fixation for chronic primary osteochondral lesions of the talus (OLT), using the Lift-Drill-Fill-Fix (LDFF) technique.MethodsEighteen patients (20 ankles) underwent fixation for a primary OLT with an osteochondral fragment using arthroscopic LDFF and were evaluated at a minimum of 5-year follow-up. Pre- and postoperative clinical assessment was prospectively performed by measuring the Numeric Rating Scale (NRS) of pain at rest, during walking and when running. Additionally, the change in Foot and Ankle Outcome Score (FAOS) and the procedure survival (i.e., no reoperation for the OLT) at final follow-up was assessed.ResultsAt a mean follow-up of 7 years, the median NRS during walking significantly improved from 7 (IQR 5–8) pre-operatively to 0 (IQR 0–1.5) at final follow-up (p = < 0.001). This result was sustained from 1-year follow-up to final follow-up. The NRS during running significantly improved from 8 (IQR 6−10) to 2 (IQR 0–4.5) (p < 0.001) and the NRS in rest from 2.5 (IQR 1–3) to 0 (IQR 0–0) (p = < 0.001). The median FAOS at final follow-up was 94 out of 100 for pain, 71 for other symptoms, 99 for activities of daily living, 80 for sport and 56 for quality of life. The FOAS remained significantly improved post-operatively on all subscales, except for the symptoms subscale. The procedure survival rate is 87% at final follow-up.ConclusionArthroscopic LDFF for fixable chronic primary OLTs results in excellent pain reduction and improved patient-reported outcomes, with sustained results at long-term follow-up. These results indicate that surgeons may consider arthroscopic LDFF as treatment of choice for fragmentous OLT.Level of evidenceLevel IV, prospective case series.

The relationship between osteochondral lesion of the talus and the foot arch angles in adults: A retrospective study

Objective: The current study aimed to compare the arch angles of the foot, Achilles tendinopathy, subcutaneous fat tissue thickness of the heel, and epin calcanei (EC) in patients with osteochondral lesion of the talus (OLT). Methods:The magnetic resonance images (MRI) of the ankle performed by the radiology clinic between March 2020 and October 2021 were examined.Based on the MRI findings, the patients diagnosed with OLT were included in the study group (n = 55) and those not diagnosed with OLT formed the control group (n = 118). All the patients included in the study were investigated for their demographic characteristics and presence of EC. Weight-bearing lateral X-ray images were used to measure the lateral talus-first metatarsal angle (Meary’s angle), lateral talocalcaneal angle (LTCA), and calcaneal inclination angle (also known as the calcaneal pitch). Results: The study and control groups had no significant difference in terms of gender distribution (P = 0.575). The patients in the study group had a significantly higher mean age than the control group (P &lt; 0.001). Evaluation of the arch angles of the foot showed the patients with OLT to have higher LTCA and calcaneal pitch angles and greater subcutaneous fat thicknesses (p &lt; 0.001, p &lt; 0.001, and p = 0.004, respectively). In addition, the study group showed higher rates of patients with EC and Achilles tendinopathy (p = 0.076 and p = 0.019, respectively).Conclusion: Our study demonstrated that sex had no effect on OLT incidence, whereas changes in the LTCA and pitch angles elevated the risk of OLT. Furthermore, increased age was found to be associated with a higher risk of OLT formation. We also showed that Achilles tendinopathy and EC were significantly higher in patients with OLT.A considerable number of future studies are needed to establish whether this significant relationship is causal.

Collagen Scaffold Application in Arthroscopic Reconstruction of Osteochondral Lesions of the Talus With Autologous Cancellous Bone Grafts.

Single-step all-arthroscopic techniques have gained popularity recently in the treatment of osteochondral lesions of the talus (OLT). Concomitant subchondral bone defects led surgeons to add autologous bone grafting to the surgical procedures. Collagen scaffolds have been used widely for stabilization of the reconstruction and regeneration of the articular surface. To compare single-step all-arthroscopic treatment of OLT consisting of debridement, microfracture, autologous bone grafting, and application of fibrin sealant in 2 patient groups: with versus without collagen scaffold. Cohort study; Level of evidence, 3. Included were 94 patients who underwent single-step all-arthroscopic treatment for OLT. Autologous bone grafting was applied to 48 patients (BG group), while autologous bone grafting plus collagen scaffold was applied to 46 patients (BG+S group). A fibrin sealant was applied to both groups. Clinical outcomes were assessed with the American Orthopaedic Foot & Ankle Society (AOFAS) score and the visual analog scale (VAS) for pain. Radiological outcomes were evaluated with the magnetic resonance observation of cartilage repair tissue score. The mean follow-up time was 69.3 ± 20.7 months. Patients in both groups showed statistically significant improvement in pre- to postoperative AOFAS and VAS scores (P < .001 for all), with no difference between groups in AOFAS and VAS score improvement. Complete healing with or without hypertrophy was achieved in 42 patients in the BG group (87.5%) and 38 patients in the BG+S group (82.6%). The treatment of bone lesions in OLT may be the ultimate goal to obtain successful outcomes, in which case using a collagen scaffold besides grafting may not affect clinical and radiological outcomes.

Typical Complications After Cartilage Repair of the Ankle Using Autologous Matrix-Induced Chondrogenesis (AMIC).

Autologous matrix-induced chondrogenesis (AMIC) for the treatment of osteochondral lesions of the talus (OLT) results in favorable clinical outcomes, yet high reoperation rates. The aim of this study was to report and analyze typical complications and their risk factors after AMIC for OLT. A total of 127 consecutive patients with 130 AMIC procedures for OLT were retrospectively assessed. All AMIC procedures were performed in an open fashion with 106 (81.5%) cases requiring a malleolar osteotomy (OT) to access the OLT. Seventy-one patients (54.6%) underwent subsequent surgery. These cases were evaluated at a mean follow-up of 3.1 years (±2.5) for complications reviewing postoperative imaging and intraoperative findings during revision surgery. Six patients (8.5%) were lost to follow-up. Regression model analysis was conducted to identify factors that were associated with AMIC-related complications. Among the 65 (50%) patients who required revision surgery, 18 patients (28%) demonstrated AMIC-related complications with deep fissuring (83%) and thinning (17%) of the AMIC graft. Conversely, 47 patients (72%) underwent subsequent surgery due to AMIC-unrelated reasons including isolated removal of symptomatic hardware (n = 17) and surgery addressing concomitant pathologies with (n = 25) and without hardware removal (n = 5). Previous prior cartilage repair surgery was significantly associated with AMIC graft-associated complications in patients undergoing revision surgery (P = .0023). Among age, body mass index, defect size, smoking, and bone grafting, smoking was the only factor showing statistical significance with an odds ratio of 3.7 (95% CI 1.24, 10.9; P = .019) to undergo revision surgery due to graft-related complications, when adjusted for previous cartilage repair surgery. The majority of revision surgeries after AMIC for OLT are unrelated to the performed AMIC graft but frequently address symptomatic hardware and concomitant pathologies. Both smoking and previous cartilage repair surgery seem to significantly increase the risk of undergoing revision surgery due to AMIC-related complications. Level IV, case series.

High incidence of osteoarthritic changes in patients with osteochondral lesions of the talus without chronic lateral ankle instability

BackgroundIt is unclear whether osteochondral lesions of the talus (OLTs) without chronic lateral ankle instability (CLAI) progress to osteoarthritis, which affects the therapeutic strategy. Especially, the efficacy of conservative treatment for OLT remains controversial. Since various anatomical abnormalities have been reported, there may be abnormal movement of the talus in the mortise, causing ankle instability. We hypothesized that OLTs have frequent osteoarthritic changes even without CLAI. This study aimed to evaluate the incidence of osteoarthritic changes and stress distribution on the talus in OLT. MethodsFifty-eight ankles with medial OLT without CLAI were retrospectively reviewed. Osteophytes and joint space narrowing on radiographs were scored using Kraus's classification and compared to ankles without OLTs. OA scores were compared between over 18 years and less than 17 years in OLTs. On computed tomography images, the area of OLTs was measured. Besides, Hounsfield Units (HU) of the talus in patients with and without OLTs were measured and compared. ResultsOsteoarthritic changes were observed in 54 of the 58 ankles (94.8%) in the OLT patients. Osteophytes were frequently observed at the medial gutter and anterior tibial plafond. The OA score in patients aged over 18 years was significantly higher than that in patients aged less than 17 years (P < 0.05). HU values in the talus were significantly higher than those in non-OLT patients. OLTs more than 100 mm2 had a significantly higher osteoarthritic score than those less than 100 mm2. ConclusionMedial OLT without CLAI has frequently osteoarthritic changes, especially large lesions. Osteoarthritic changes in OLTs will progress over time, which needs to be considered when deciding whether to perform the surgical or non-surgical treatment.

Ankle bone morphology affects the size of non-trauma related osteochondral lesions of the talus in skeletally immature children

BackgroundThis study aimed to elucidate the relationship between ankle morphology and the size of non-trauma related osteochondral lesions of the talus (OLT), because approximately half the OLT found in children is of unknown origin. Methods34 ankles in 30 skeletally immature children with OLTs who underwent preoperative magnetic resonance imaging (MRI) were evaluated. Parameters measured included area of the OLT, tibial axis-medial malleolus angle (TMM), malleolar width (MalW), and talar surface angle (TSA; defined as the angle between the line perpendicular to the mid-diaphysis of the tibia and the talar joint surface; medial inclination, positive). The ankles were divided into two groups: the trauma group had a history of injury and the idiopathic group had no history of injury. The correlation between lesion area and MRI parameters were evaluated in each group. ResultsThirteen ankles in 13 patients comprised the trauma group, while 21 ankles in 17 patients were in the idiopathic group. Of the 17 patients in the idiopathic group, four had bilateral OLT. In the trauma group, MalW was significantly correlated with the area (r = 0.827, P = 0.0001). In the idiopathic group, TMM and MalW were significantly correlated with the area (r = 0.608, P = 0.003 and r = 0.566, P = 0.008). TSA was positively correlated with area in the idiopathic group (r = 0.516, P = 0.017), but negatively correlated with area in the trauma group (r = −0.609, P = 0.027). The other parameters showed no significant correlation. ConclusionsThe size of non-trauma related OLTs may have been affected by an ankle morphology showing poor bone conformity, such as an open medial malleolus and inclined talar joint surface. In addition, the evaluation of the contralateral ankle joint may be crucial when patients with OLT have no specific history of trauma.