Osteochondral Lesions Of Talus Research Articles

Osteochondral Lesion of Talus: Role of Bone Marrow Aspirate Concentrate and Microfracture—What Does the Current Literature Say?

Osteochondral Lesion of Talus: Role of Bone Marrow Aspirate Concentrate and Microfracture—What Does the Current Literature Say?

Comparative clinical and functional results of microfracture and mosaicoplasty in medial talus osteochondral lesions

Introduction: This study aimed to compare the early clinical and functional outcomes of two surgical interventions, microfracture and mosaicplasty, for the treatment of medial talus osteochondral lesions (OCLs). Materials and Methods: This retrospective study included patients treated at the Medical Faculty Orthopedics and Traumatology Department of XXX University from January 2016 to January 2022. Patients were divided into two groups: those who underwent microfracture (Group 1, n=20) and those who underwent mosaicplasty (Group 2, n=17). Preoperative and postoperative follow-up data at baseline, 6 months, and 12 months included visual analog scale (VAS) and American Orthopedic Foot and Ankle Society (AOFAS) scores. Statistical analysis was conducted using NCSS software, with a significance level set at p

In vivo analysis of ankle joint kinematics and ligament deformation of chronic ankle instability patients during level walking.

Introduction: Chronic ankle instability (CAI) carries a high risk of progression to talar osteochondral lesions and post-traumatic osteoarthritis. It has been clinically hypothesized the progression is associated with abnormal joint motion and ligament elongation, but there is a lack of scientific evidence. Methods: A total of 12 patients with CAI were assessed during level walking with the use of dynamic biplane radiography (DBR) which can reproduce the in vivo positions of each bone. We evaluated the uninjured and CAI side of the tibiotalar and subtalar joint for three-dimensional kinematics differences. Elongation of the anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL), and posterior talofibular ligament (PTFL) were also calculated bilaterally. Results: For patients with CAI, the dorsiflexion of the tibiotalar joint had reduced (21.73° ± 3.90° to 17.21° ± 4.35°), displacement of the talus increased (2.54 ± 0.64mm to 3.12 ± 0.55mm), and the inversion of subtalar joint increased (8.09° ± 2.21° to 11.80° ± 3.41°). Mean ATFL elongation was inversely related to mean dorsiflexion angle (CAI: rho = -0.82, P < 0.001; Control: rho = -0.92, P < 0.001), mean ATFL elongation was related to mean anterior translation (CAI: rho = 0.82, P < 0.001; Control: rho = 0.92, P < 0.001), mean CFL elongation was related to mean dorsiflexion angle (CAI: rho = 0.84, P < 0.001; Control: rho = 0.70, P < 0.001), and mean CFL elongation was inversely related to mean anterior translation (CAI: rho = -0.83, P < 0.001; Control: rho = -0.71, P < 0.001). Furthermore, ATFL elongation was significantly (CAI: rho = -0.82, P < 0.001; Control: rho = -0.78, P < 0.001) inversely correlated with CFL elongation. Discussion: Patients with CAI have significant changes in joint kinematics relative to the contralateral side. Throughout the stance phase of walking, ATFL increases in length during plantarflexion and talar anterior translation whereas the elongation trend of CFL was the opposite. This understanding can inform the development of targeted therapeutic exercises aimed at balancing ligament tension during different phases of gait. The interrelationship between two ligaments is that when one ligament shortens, the other lengthens. The occurrence of CAI didn't change this trend. Surgeons might consider positioning the ankle in a neutral sagittal plane to ensure optimal outcomes during ATFL and CFL repair.

T1ρ relaxation mapping in osteochondral lesions of the talus: a non-invasive biomarker for altered biomechanical properties of hyaline cartilage?

BackgroundTo evaluate T1ρ relaxation mapping in patients with symptomatic talar osteochondral lesions (OLT) and healthy controls (HC) at rest, with axial loading and traction.MethodsParticipants underwent 3-T ankle magnetic resonance imaging at rest and with 500 N loading and 120 N traction, without axial traction for a subcohort of 17/29 HC. We used a fast low-angle shot sequence with variable spin-lock intervals for monoexponential T1ρ fitting. Cartilage was manually segmented to extract T1ρ values.ResultsWe studied 29 OLT patients (age 31.7 ± 7.5 years, 15 females, body mass index [BMI] 25.0 ± 3.4 kg/m2) and 29 HC (age 25.2 ± 4.3 years, 17 females, BMI 22.5 ± 2.3 kg/m2. T1ρ values of OLT (50.4 ± 3.4 ms) were higher than those of intact cartilage regions of OLT patients (47.2 ± 3.4 ms; p = 0.003) and matched HC cartilage (48.1 ± 3.3 ms; p = 0.030). Axial loading and traction induced significant T1ρ changes in the intact cartilage regions of patients (loading, mean difference -1.1 ms; traction, mean difference 1.4 ms; p = 0.030 for both) and matched HC cartilage (-2.2 ms, p = 0.003; 2.3 ms, p = 0.030; respectively), but not in the OLT itself (-1.3 ms; p = 0.150; +1.9 ms; p = 0.150; respectively).ConclusionIncreased T1ρ values may serve as a biomarker of cartilage degeneration in OLT. The absence of load- and traction-induced T1ρ changes in OLT compared to intact cartilage suggests that T1ρ may reflect altered biomechanical properties of hyaline cartilage.Trial registrationDRKS, DRKS00024010. Registered 11 January 2021, https://drks.de/search/de/trial/DRKS00024010.Relevance statementT1ρ mapping has the potential to evaluate compositional and biomechanical properties of the talar cartilage and may improve therapeutic decision-making in patients with osteochondral lesions.Key PointsT1ρ values in osteochondral lesions increased compared to intact cartilage.Significant load- and traction-induced T1ρ changes were observed in visually intact regions and in healthy controls but not in osteochondral lesions.T1ρ may serve as an imaging biomarker for biomechanical properties of cartilage.Graphical

The Comparison of the Results of Microfracture and Mosaicplasty in Talus Osteochondral Lesions.

This study aims to compare the mid-term functional outcomes of microfracture and mosaicplasty techniques in talus osteochondral lesions. This study consists of 47 patients with talus osteochondral lesions who underwent arthroscopic surgery. These patients were divided into two groups: microfracture (28 patients) and mosaicplasty (19 patients). The American Orthopedic Foot and Ankle Society (AOFAS) scoring system was used to evaluate ankle function, and the Visual Analog Scale (VAS) score was used for pain assessment. The mean follow-up period was 26 months (range 10-36 months). It was determined that the mean preoperative AOFAS score of individuals in the mosaicplasty group was 38.84±2.83, and the postoperative AOFAS score was 78.79±3.91. A statistically significant difference was found between the two measurements of AOFAS scores (preoperative and postoperative) in the mosaicplasty group (*t=33.756; p<0.001). The effect size for this difference observed in the mosaicplasty group was determined to be r=0.992 (large). Similarly, a statistically significant difference was found between the two measurements of AOFAS scores (preoperative and postoperative) in the microfracture group (*t=28.152; p<0.001). The effect size for this difference observed in the microfracture group was determined to be r=0.983 (large). We believe that both treatment methods have similar positive effects on pain and ankle function. However, larger controlled studies with longer follow-up periods are needed to reach a definitive conclusion.

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.

Comparison of two versus three-screw fixation for biplanar chevron medial malleolar osteotomy.

This study was designed to compare the clinical outcomes and complications of using two versus three screws to fix the biplanar chevron medial malleolar osteotomy (MMO). A retrospective review was conducted on 43 patients (46 ankles) who underwent biplanar chevron MMO to treat talus osteochondral lesions. Of these, MMO was fixed with two parallel screws placed perpendicular to the osteotomy plane in 16 ankles, while in the remaining 30 ankles, MMO was secured with two parallel screws plus an additional third screw inserted parallel to the tibial plafond. Patients were divided into two groups based on the fixation method and clinical outcomes, union and malunion rates, and complications were compared. Demographic and clinical characteristics such as age (p: 0.411), gender distribution (p: 0.119), affected side (p: 0.126), lesion grades (p: 0.056), and lesion sizes (p: 0.310), immobilization (p: 0.119) and weight-bearing periods (p: 0.252) were statistically similar across both groups. Initial malreduction were observed in five cases within the three-screw group and one case in the two-screw group (p: 0.307). However, neither group exhibited any progressive step-off or gap in the follow-up radiographs, and osteotomy union was achieved in all patients. Delayed union was observed in one patient from the three-screw group. Significant improvements in American Orthopedic Foot and Ankle Society scores were observed in both groups, with no functional discrepancies evident at the final follow-up (p: 0.488). The study found no significant differences in union rates, complications, or clinical outcomes between two and three-screw fixation methods for medial malleolar osteotomies (MMO). Both methods allowed for effective MMO fixation without loss or displacement post-surgery, suggesting their safety and efficacy. Level III, retrospective comparison.

Comparison of Arthroscopic Microfracture and Retrograde Subchondral Drilling in the Treatment of Osteochondral Lesions of Talus.

In our study, it was aimed to evaluate the efficacy of microfracture and retrograde subchondral drilling on clinical outcomes in patients who underwent ankle arthroscopy due to osteochondral lesion of medial talus. Twenty eight patients with osteochondral lesion of talus less than 1.5 cm2 treated with ankle arthroscopy were evaluated retrospectively. Microfracture was performed in 16 patients and retrograde subchondral drilling was performed in 12 patients that there was no loss of integrity in the cartilage layer or cartilage layer is partially preserved during ankle arthroscopy. Postoperative evaluations of the patients were done with Foot and Ankle Ability Measure (FAAM) and results of both group were compared statistically. The mean activities of daily living scale was 93.4±3.2 and sportive activity scale was 90.1±5.7 in the retrograde drilling group. In the micro-fracture group, mean activities of daily living scale was 93.8±4.1 and mean sportive activity scale was 88.9±9.5. No significant difference was found as a result of statistical comparisons of both groups results. It has been determined that the size and preservation of the integrity of talar osteochondral lesions are important factors on clinical results. Results of arthroscopic debridement, microfracture and drilization are not good in lesions larger than 1.5 cm2 and lesions with impaired integrity. In our study, depending on the general literature, osteochondral lesions in talus were less than 1.5 cm2 in patients who underwent arthroscopic micro fracture and retrograde drilling. Both microfracture and retrograde subchondral drilling are effective treatment methods with good clinical results for talar osteochondral lesions less than 1,5cm2 . Retrograde subchondral drilling can be an alternative treatment method with the reliability of clinical results in patients with no loss of the integrity of the cartilage layer or cartilage layer is partially preserved. talus, osteochondral lesion, microfracture, subchondral drilling.

Biomaterials augmented with filtered bone marrow aspirate for the treatment of talar osteochondral lesions. A comparison of clinical and cellular parameters.

Biomaterials augmented with Bone Marrow Aspirate Concentrate (BMAC) are becoming increasingly utilized in the cartilage treatment. However, the potential role of cellular parameters in the intraoperatively applied BMAC have yet to be elucidated. (A) To evaluate clinical outcomes and safety of a combined single-step approach with scaffolds (fibrin glues, collagen gels, collagen-hydroxyapatite membrane) and filtered Bone Marrow Aspirate (fBMA) for the treatment of osteochondral lesions of the talus (OLTs). (B) To identify significant factors for postoperative improvements, considering cellular parameters as potential predictors. All the patients operated on due to OLTs by the combination above were selected from the hospital registry database (35 pts, years 16-55, and minimally 1year follow-up). Treatment outcomes were followed clinically with Patient-reported outcome measures (PROMs), and by pursuing serious adverse events (SAE) and graft failures (GF). Cellular parameters of the injected fBMA were determined. Pre- and postoperative PROMs values were compared to evaluate postoperative improvements. Multivariable regression models were applied to identify potential factors (demographics, medical history, joint and lesion characteristics, scaffold type, surgical and cellular parameters) that predict the treatment outcomes. At the mean follow-up of 32.2 (12.5) months, all Foot and Ankle Outcome Score (FAOS) and European Quality of Life in Five Dimensions Three-Level (EQ-5D-3L) values improved significantly. 4 (11%) SAE (3 arthrofibrosis, one hardware removal), and 3 (9%) GF occurred. Female gender and concomitant procedures were the main negative predictors for postoperative outcomes. The number of fibroblast colony forming units (CFU-F) or their proportion among total nucleated cells (CFU-F/TNC) were positively correlated with the improvements of some PROMs. Scaffolds augmented with fBMA proved as an adequate and safe approach for OLTs treatment. Cellular parameters seem to influence the treatment outcomes, thus further attention should be given to the intraoperatively applied products. Level IV.

Medial malleolar fixation with bioabsorbable magnesium screws; a retrospective study with a mean follow-up of 5 years

BackgroundThis retrospective study aimed to investigate the mid-term clinical and radiological results of medial malleolar fixation with bioabsorbable magnesium screws. Methods44 patients who underwent a medial malleolar fixation for either fracture or osteotomy with magnesium bioabsorbable compression screws between 2015 and 2020 were retrospectively reviewed. Medial malleolar osteotomy was used for cartilage restorative procedures of talus osteochondral lesions (TOL), and biplanar chevron osteotomy was performed in all of them. Clinical results were evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) scale during the final follow-up. Bone healing, loss of reduction, gas formation, implant failure, and resorption were examined through available serial radiographs. All complications were also documented and reported. ResultsPatients were followed with a mean of 61.3 ± 20.2 months (range 27–94). The mean AOFAS score at the final clinical follow-up was 91.6 ± 10.3 points (range 52–100). The postoperative AOFAS score significantly improved in TOL cases compared to preoperative scores (p: 0.001, 46.4 ± 15.0, and 89.1 ± 11.2, respectively). The final radiographic examination showed no signs of ankle osteoarthritis in 36 patients (Grade 0) and Grade I ankle osteoarthritis in eight. Only one patient had a nonunion and was revised with titanium screws. Another patient had early screw breakage but recovered without intervention. ConclusionsThis is the first study that reports the mid-term results of Mg bioabsorbable screws in the current literature. The findings in the present study indicate that Mg bioabsorbable screw fixation might be a good alternative for medial malleolar fracture or osteotomy fixation with a high rate of union and low rate of complications. Besides, it eliminates the need for implant removal.Level of evidence: Level IV, therapeutic, retrospective case series.

Validity of Hepple Classification Used in the Diagnosis of Talus Osteochondral Lesions.

It was aimed to investigate the intra-observer and inter-observer validity of the Hepple classification used in talus osteochondral lesions. This study included 32 patients with osteochondral lesions in the talus after exclusion criteria. A PowerPoint presentation was prepared from the MRI views of the patients. Six observers, divided into two groups according to their experience, were asked to categorize the cases according to Hepple classification. The slides were shuffled and the observers were asked to reevaluate after 6 weeks. Fleiss kappa (κ) coefficient was used for the inter-observer validity and Cohen's kappa (κ) coefficient for the intra-observer validity. In the overall inter-observer reliability was at a moderate level of agreement (set one κ=0.511, set two κ=0.406). In the intra-observer evaluation, one observer from the experienced group showed almost perfect agreement (κ=0.809), one observer from the less experienced group had moderate agreement (κ=0.556), and all other observers had substantial agreement (κ=0.556 - 0.730). When all observers were examined, it was seen that there was a substantial agreement in the mean intra-observer evaluation (κ=0.661). While the intra-observer results showed substantial agreement, the inter-observer results showed moderate agreement. Although the Hepple classification system is frequently used, the need for a more reliable classification system for osteochondral lesions of the talus remains.

Mid-term results of autologous matrix-induced chondrogenesis surgery with or without scaffolds for arthroscopic treatment of deep talus osteochondral lesions: A comparative study.

This study aims to investigate the effectiveness of arthroscopic autologous matrix-induced chondrogenesis (AMIC) procedure with or without polyglycolic acid-hyaluronic acid (PGA-HA)-based cell-free scaffold (CFS) in Bristol Stage 4 and Stage 5 osteochondral lesion of the talus (OLT) ranging between 1.5 and 3 cm2 . Between March 2018 and March 2021, a total of 47 patients with OLTs (29 males, 18 females; mean age: 22.8±2.3 years; range, 18 to 65 years) were retrospectively analyzed. The patients were divided into two groups based on the procedures applied. Patients in the first group (Group 1, n=23) underwent the AMIC procedure alone (curettage, microfracture, and grafting), while patients in the second group (Group 2, n=24) underwent AMIC procedure with PGA-HA-based CFS. The localization of the lesions was evaluated. All OLTs were diagnosed with preoperative radiography and magnetic resonance imaging (MRI). During the preoperative period, lesion stages were evaluated based on the Bristol staging system, and the postoperative results were evaluated based on the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) scoring system. The mean follow-up was 36.2±5.6 months. In the early period, the three-month functional scores were comparable between the groups. While a significant increase was observed in the American Orthopaedic Foot and Ankle Society (AOFAS) scores from the mean preoperative of 62.71±4.44 points to the postoperative of 86.00±6.58 points in Group 1, a significant increase in the AOFAS score was observed from 65.28±7.91 points to 95.42±4.41 points in Group 2 at 12-month follow-up (p=0.016, p=0.011, respectively). The functional scores tended to progress after 12 months. Radiologically, a complete defect filling was observed in a mean of 10.5±2.7 months. No graft hypertrophy was recorded in any patients. The AOFAS and MOCART scores in Group 2 were found to be statistically significantly higher than that in Group 1 (p=0.034 for AOFAS 1/AOFAS 2 and p=0.006 for MOCART 1/MOCART 2). Overall, there was a positive, but weak, significant correlation between the final AOFAS scores and MOCART scores (r=0.347, p<0.001). Arthroscopic AMIC procedure in deep OLTs between 1.5 cm2 and 3 cm2 can yield a statistically significant improvement both clinically and radiologically; however, the use of a PGA-HA-based CFS in addition to this procedure can improve the clinical and radiological recovery.

Clinical Outcomes After Arthroscopic Microfracture Treatment of Coexisting Talar and Tibial Osteochondral Lesions.

Despite increased recognition of coexisting tibial and talar osteochondral lesions (OCLs), the risk factors influencing clinical outcomes remain unclear. To report clinical follow-up results after arthroscopic microfracture surgery in patients with OCLs of the distal tibial plafond and talus and assess possible factors affecting these clinical outcomes. Case series; Level of evidence, 4. A total of 40 patients with coexisting talar and tibial OCLs who underwent arthroscopic microfracture surgery were included. For analysis, the study used the American Orthopaedic Foot & Ankle Society (AOFAS) scale, Karlsson-Peterson scale, and visual analog scale (VAS) for pain for clinical evaluations on the day before surgery, 12 months after surgery, and at the last follow-up. A stepwise regression model and Spearman rank correlation were used to assess possible factors affecting these clinical outcomes. The median follow-up time was 34.5 months (interquartile range [IQR], 26.5-54 months). At the final follow-up, the cohort included 40 patients (26 men and 14 women) with a mean age of 38.8 years (range, 19-60 years). The median AOFAS score increased from 57.5 (IQR, 47-65) before surgery to 88 (IQR, 83-92.5) at the final follow-up, the median Karlsson-Peterson score increased from 48 (IQR, 38.5-67) to 82 (IQR, 76-92), and the median VAS score improved from 5 (IQR, 4-6) to 1 (IQR, 0-2). All scale scores showed significant differences between the preoperative and final follow-up evaluations (P < .001). In the stepwise regression model and Spearman rank correlation analysis, the grade of tibial OCL had a significant independent effect on the final postoperative AOFAS scores of the patients (β = -0.502, P = .001; r = -0.456, P = .003). The size of the tibial lesion also had a significant independent effect on the final postoperative Karlsson-Peterson scores of the patients (β = -0.444, P = .004; r = -0.357, P = .024). Arthroscopic microfracture treatment for coexisting talar and tibial OCLs can achieve good short- to midterm clinical outcomes. The grade and size of tibial OCLs are the main risk factors affecting the prognostic functional scores of such patients.

Effect of Bone Morphogenetic Protein–2 Combined With Microfracture for Osteochondral Defect of the Talus in a Rabbit Model

Background: Osteochondral defects of the talus can be effectively treated using microfracture, which is technically safe, accessible, and affordable. However, fibrous tissue and fibrocartilage comprise the majority of tissue repairs resulting from these procedures. These tissue types lack the mechanical characteristics of native hyaline cartilage and might significantly contribute to the decline in long-term outcomes. Recombinant human-bone morphogenetic protein–2 (rhBMP-2) has been shown to promote matrix synthesis and increase cartilage formation, thus enhancing chondrogenesis in vitro. Purpose: This study aimed to evaluate the treatment ability of combining rhBMP-2 with microfracture in rabbit talus osteochondral defect. Study Design: Controlled laboratory study. Methods: A full-thickness chondral defect (3 × 3 × 2 mm) was constructed in the center talar dome of 24 New Zealand White male rabbits, which were then divided into 4 groups of 6. Each group received the appropriate treatment: group 1 (control; no treatment of defect), group 2 (microfracture treatment), group 3 (rhBMP-2/hydroxyapatite treatment), and group 4 (microfracture combined with rhBMP-2/hydroxyapatite treatment). Animals were sacrificed at 2, 4, and 6 weeks postoperatively. The International Cartilage Regeneration & Joint Preservation Society macroscopic score, which considers the degree of defect repair, the integration to the border zone, and the macroscopic appearance, was used to assess the repaired tissue’s macroscopic appearance. Subchondral bone regeneration in defects was analyzed using micro–computed tomography, and the histological findings were graded using a modified version of the Wakitani scoring system for osteochondral repair. Results: At 2, 4, and 6 weeks, micro-computed tomography analysis revealed that groups 3 and 4 exhibited subchondral bone healing that was more significantly improved compared with groups 1. No sample showed excessive bone growth from the subchondral bone area. According to macroscopic and histological results, group 4 showed higher-quality cartilage and more accelerated cartilage regeneration than the other groups over time. Conclusion: These findings show that osteochondral defect repair in a rabbit talus model could be effectively accelerated and improved by combining rhBMP-2 with microfracture. Clinical Relevance: Using rhBMP-2 in combination with microfracture may enhance the repair of talar osteochondral lesions.

YouTube provides low-quality videos about talus osteochondral lesions and their arthroscopic treatment

BackgroundMedical professionals and patients commonly use the YouTubeTM platform in their research on health information. The quality of videos about talus osteochondral defect (OCD) and arthroscopic surgery has not been evaluated previously. The aim of this study was to interpret the quality and sufficiency of YouTubeTM videos about talus OCD and arthroscopic surgery. MethodsThe present study is a quality control study of videos on OCD and their arthroscopic treatment. The videos were interpreted in terms of Journal of the American Medical Association (JAMA), DISCERN (Quality Criteria for Consumer Health Information), The Global Quality Score (GQS) and Talus OCD - Specific Score (TOCDSS) by two blinded observers to assess the accuracy of these methods. ResultsInter-observer agreement was "very high" for JAMA, DISCERN, and TOCDSS, while "high" for GQS. There was a statistical relationship and a positive correlation between the scoring systems. ConclusionThe content and quality of YouTubeTM videos about talus OCD and arthroscopic treatment are insufficient.

Factors affecting the healing of arthroscopic microfracture and the role of MRI in follow-up: Talus osteochondral lesions

Factors affecting the healing of arthroscopic microfracture and the role of MRI in follow-up: Talus osteochondral lesions

Talar Dome Osteochondral Lesions: Pre- and Postoperative Imaging.

We suggest a similar approach to evaluating osteochondral lesions of the talar dome both pre- and postoperatively. This review addresses the etiology, natural history, and treatment of talar dome osteochondral lesions with an emphasis on imaging appearances. High-resolution magnetic resonance imaging, ideally combining a small field-of-view surface coil with ankle traction, optimizes visibility of most of the clinically relevant features both pre- and postoperatively.

Autologous Matrix-Induced Chondrogenesis (AMIC) for Osteochondral Defects of the Talus: A Systematic Review.

Autologous matrix-induced chondrogenesis (AMIC) has been advocated for the management of talar osteochondral lesions (OCLs). This systematic review, which was conducted according to the PRISMA 2020 guidelines, investigated the clinical and imaging efficacy and safety of the AMIC technique in the management of OCLs of the talus. Only studies investigating AMIC for talar chondral defects that were published in peer-reviewed journals were considered. In September 2022, the following databases were accessed: PubMed, Web of Science, Google Scholar, and Embase. Data on the visual analogue scale (VAS), American Orthopaedic Foot and Ankle Score (AOFAS), Tegner activity scale, and Foot Function Index (FFI) were retrieved. To evaluate the morphological MRI findings, data obtained from the magnetic resonance observation of cartilage repair tissue (MOCART) scores were evaluated. Data on hypertrophy, failures, and revision surgeries were also collected. Data from 778 patients (39% women, 61% men) were collected. The mean length of the follow-up was 37.4 ± 16.1 months. The mean age of the patients was 36.4 ± 5.1 years, and the mean BMI was 26.1 ± 1.6 kg/m2. The mean defect size was 2.1 ± 1.9 cm2. Following the AMIC technique, patients demonstrated an improved VAS (p &lt; 0.001), AOFAS (p &lt; 0.001), and FFI (p = 0.02) score. The MOCART score also improved from the baseline (p = 0.03). No difference was observed in the Tegner score (p = 0.08). No graft delamination and hypertrophy were reported in 353 patients. 7.8% (44 of 564) of patients required revision surgeries, and 6.2% (32 of 515) of patients were considered failures. The AMIC technique could be effective in improving symptoms and the function of chondral defects of the talus.

Arthroscopic-Assisted Minimal Invasive Surgery for Weber C Ankle Fractures: Comparation to Open Reduction Internal Fixation

Category: Trauma; Arthroscopy Introduction/Purpose: After acceptable reduction and internal fixation for ankle fractures, some patients regularly suffer from residual symptoms, presumably due to occult intra-articular injuries. Recently, arthroscopic-assisted technique for ankle fractures was introduced. However, there was no previous study that investigate the outcomes of arthroscopic-assisted minimal invasive surgery (MIS) for pronation type ankle fractures. The aim of this study was to compare the clinical outcomes after arthroscopic- assisted MIS surgery to conventional open reduction internal fixation (ORIF) for Weber C ankle fractures. Methods: Between 2016 and 2019, 86 patients with Weber C type ankle fractures with minimum 2 years follow up were included. Patients were sorted to 2 groups according to operation technique (MIS group (n=34): arthroscopic-assisted MIS, ORIF group (n=52): conventional ORIF). In MIS group, fibula fractures were fixed using fibula nail. Medial and posterior malleolus fractures were fixed using cannulated screw arthroscopically assisted with pin point wound. Syndesmosis injury was treated with arthroscopic reduction and screw fixation. Intraarticular lesions such as loose body or osteochondral lesion of talus were removed or debrided arthroscopically. Clinical outcomes were compared using a visual analog scale (VAS), Foot and Ankle Outcome Score (FAOS). In addition, postoperative complications including posttraumatic arthritis were evaluated. Results: There were no significant differences between 2 groups in VAS, FAOS. There were 2 cases of postoperative infections and 4 cases of wound problems in ORIF group, but there was no complication in MIS group. There were 1 cases of obvious advanced posttraumatic arthritis in MIS group and 3 cases in ORIF group. Conclusion: Arthroscopic-assisted minimal invasive surgery was effective treatment option with low rate of wound problem in for Weber C ankle fractures.

Treatment of Pediatric and Adolescent Talus Osteochondral Lesions

Category: Ankle Introduction/Purpose: Osteochondral lesions of the Talus are defined as any damage involving both articular cartilage and subchondral bone of the talar dome, and this condition is associated with persistent ankle pain and disability. The incidence of osteochondral lesions of the talus is increasing in the pediatric and adolescent population. There are a few studies regarding surgical treatment. The aim of this study is to report that need for surgical treatment is higher than expected in aforementioned lesions. Methods: Osteochondral lesions of the Talus are defined as any damage involving both articular cartilage and subchondral bone of the talar dome, and this condition is associated with persistent ankle pain and disability. The incidence of osteochondral lesions of the talus is increasing in the pediatric and adolescent population. There are a few studies regarding surgical treatment. The aim of this study is to report that need for surgical treatment is higher than expected in aforementioned lesions. Results: Average age was 14,5 (10-18) at beginning of the treatment. 69,2% of our patients were female. Foundation of conservative treatment was activity modification. 9 of our 13 patients were treated surgically. Arthroscopic debridement and microfracture surgery as well as various techniques were applied to all operated patients. In 7 of the operated patients (n=9), the lesion was on the right side and there was a history of trauma before the complaints started. While the mean AOFAS scores of the operated patients were 47 (24-75) before the operation, it was 83.8 in the last follow-up. While the mean AOFAS scores of our conservatively treated patients were 38.2 (21-74) before treatment, the mean AOFAS scores at the last follow-up after treatment (mean follow-up 2 years) were 70 (17-100). There were no minor and major postoperative complications and no need of reoperation. At the final follow up there was significant improvement in clinical results in all patients treated surgically and conservatively. Conclusion: Talus osteochondral lesions at younger ages is an increasing problem. Conservative management with close follow up is the mainstay of the treatment. However, need of surgical treatment may be higher than expected and the short-term results of surgical with various techniques are successful.