Early results of autologous chondrocyte implantation in the talus. Epub 2005 Oct 3. to maintaining your privacy and will not share your personal information without Traumatic injuries such as an ankle sprain were frequently combined with OLT and patients often have chronic ankle instability with repetitive sprains. Despite the reported improvement, half of the patients reported knee pain and most patients (10 of 12) had development of recurrent ankle lesions with associated joint degeneration. Treatment options are typically dictated by the site, size and stage of the lesion. The osteochondral cyst of the talus is a common source of pain that can limit function. Osteochondral lesions of the talus (OLTs) are lesions of the articular cartilage of the talus and underlying subchondral bone. Arthroscopic treatment for osteochondral defects of the talus.Results at follow-up at 2 to 11 years. Battaglia M, Vannini F, Buda R, Cavallo M, Ruffilli A, Monti C, et al. Epub 2012 Aug 1. The plug was taken from either the medial or lateral talar facet, and the largest plug obtained was 8 mm in diameter. (5) Whether the lesion is contained or uncontained is a useful descriptive feature, especially during surgery. 1999 Dec;20(12):789-93. Am J Sports Med. J Bone Joint Surg Am. Emre et al.75 reported on 32 patients who were managed with open mosaicplasty through a medial malleolar osteotomy. 2009 Jul;17(7):407-14. may email you for journal alerts and information, but is committed The pathophysiology is believed to be a primary dysfunction of the subchondral bone that negatively affects the overlying cartilage. Surgical intervention, including bone marrow stimulation techniques, osteochondral autografting or allografting, and cell-based therapies all play important roles as treatment strategies in accordance with the lesion size and defect depth. Furthermore, in a recent study, it was demonstrated that South Eastern Chinese individuals have a smaller talus than Caucasian individuals [33]. To date, many surgical options for OLT have been described, including multiple drilling, microfracture, abrasion arthroplasty, autogenous osteochondral grafting, allograft talus transplantation and ACI [21]. Robinson DE, Winson IG, Harries WJ, Kelly AJ. For nondisplaced or minimally displaced OLTs, most studies recommend treatment with conservative management [9,15,16,17,18]. The most frequently reported side effect associated with plug harvest was achiness over the anterior aspect of the ankle, with no patient reporting decreased ability to participate in normal activities or sports. Coetzee et al.90 presented a case series of 24 ankles that were treated with PJCAT and followed for an average of 16.2 months. J Bone Joint Surg Am. The authors concluded that when an uncontained lesion is suspected, more advanced surgical techniques should be considered. 46. Typically, an osteochondral lesion of the talus (OLT) is chronic in presentation due to multiple or repetitive injuries. osteochondral lesions of the talus by osteochondral autograft: A series of 56 Mosaicplasties. Choi WJ, Lee JW, Han SH, Kim BS, Lee SK. A highly organized three-dimensional alginate scaffold for cartilage tissue engineering prepared by microfluidic technology. Autologous osteochondral transplantation has demonstrated promising clinical results in the short to medium term for larger, cystic lesions and can restore the contact pressure of the joint. Osteochondral lesions of the talus (OLT) are a well-known cause of ankle joint pain and can sometimes lead to instability. Osteochondral autografting has been developed to treat large OLT lesions. J Bone Joint Surg Am. In contrast, Hangody and Fuels reported donor site morbidity rates as low as 3% in a long-term follow-up study which included 831 patients treated with mosaicplasty [51]. If an OLT is symptomatic, it will typically need surgery to treat the damaged portion of bone and cartilage. J Bone Joint Surg Am. J Am Acad Orthop Surg. Many operative techniques have been described to treat osteochondral lesions of the talus; we will classify these treatment strategies as cartilage repair, cartilage regeneration, or cartilage replacement (Table II). Am J Sports Med. Osteochondral defects of the talus treated with fresh osteochondral allograft transplantation. Dr. Chen-Chie Wang and Ing-Ho Chen, the editorial board members at Tzu Chi Medical Journal, had no role in the peer review process of or decision to publish this article. Complete fragment detachment with displacement, III. Saxena A, Eakin C. Articular talar injuries in athletes: Results of microfracture and autogenous bone graft. Arthroscopy. Osteochondral lesions of the talus. Moreover, there have been few comparative outcome studies to help guide treatment. Kappis first described OLT in 1922 and named it osteochondritis dissecans [1]. Pettine KA, Morrey BF. 56. CT examination revealed a large cyst lesion over medial talar dome (arrow). For large lesions, osteochondral autografting and allografting are better options to reconstruct the articular defect, as they have better contours and mechanical strength. The differential diagnosis of osteochondral lesions of the talus may include occult fractures, hindfoot coalition, syndesmosis injury, synovitis, ankle or subtalar arthritis, peroneal tendinitis, soft-tissue or osseous impingement, and ankle instability9. The author reported that 60% of the patients had improved function, 80% had reduced pain, and 90% were satisfied with their functional recovery. 2013 Apr;471(4):1105-6. Is MRI superior to helical CT? The mean lesion size was 3.7 cm2 (range, 1.2 to 5 cm2). Osteochondral lesions of the talus: Localization and morphologic data from 424 patients using a novel anatomical grid scheme. Bone-grafting was performed for lesions deeper than 5 mm. Am J Sports Med. That being said, numerous retrospective studies have reported optimal results for bone marrow stimulation techniques for treating OLTs [24,26,27,28,29,30]. First, in comparison with osteochondral autograft, lesion size is not an important issue even if the area is >300 mm 2 [52]. Verhagen RA, Struijs PA, Bossuyt PM, van Dijk CN. Am J Sports Med. Talar dome lesions are usually caused by an injury, such as an ankle sprain. The graft can also be delivered with an all-arthroscopic technique89. Foot Ankle Int. Matrix-induced autologous chondrocyte implantation (MACI), also referred to as matrix-associated autologous chondrocyte transplantation (MACT), is a second generation of ACI whereby periosteal harvesting is eliminated with use of a matrix. 1991 Sep;73(8):1123-42. Scranton PE Jr, Frey CC, Feder KS. The character of higher biocompatibility of the organized scaffold maybe a better choice for tissue engineered cartilage in the future. 50. Clin Orthop Relat Res. Epub 2012 Aug 11. Giannini et al.60 used these osteochondral fragments as a cell source for ACI. Before Fresh osteochondral allografts for large-volume cystic osteochondral defects of the talus. Clin Orthop Relat Res. Kelbrine F, Frank A. Arthroscopic treatment of osteochondral lesions of the talar dome: a retrospective study of 48 cases. Magnetic resonance imaging is most sensitive in diagnosing these injuries. 2006 Dec;27(12):1109-14. An osteochondral lesion of the talus (OLT) is an area of abnormal, damaged cartilage and bone on the top of the talus bone (the lower bone of the ankle joint). Outcome of arthroscopic debridement and microfracture as the primary treatment for osteochondral lesions of the talar dome. Furthermore, at the time of the latest follow-up, patients demonstrated improved functional outcomes as measured with the AOFAS ankle-hindfoot score50. Foot Ankle Surg. Brittberg M, Peterson L, Sjgren-Jansson E, Tallheden T, Lindahl A. Articular cartilage engineering with autologous chondrocyte transplantation. Second-look arthroscopy demonstrated normal-appearing cartilage in 3 of 5 patients and overgrowth in the remaining 2. Osteochondral autologous transplantation is superior to repeat arthroscopy for the treatment of osteochondral lesions of the talus after failed primary arthroscopic treatment. Epub 2012 Apr 11. 84. Donor-site morbidity after osteochondral autograft transfer procedures. Ferkel further modified this classification system to include cystic lesions and displaced osteochondral lesions [Table 3] [12]. Mosaicplasty or Mega-OAT is used in accordance with the lesion size. Baums MH, Heidrich G, Schultz W, Steckel H, Kahl E, Klinger HM. 2005 Jan;33(1):35-42. Chronic lateral ankle instability: the effect of intra-articular lesions on clinical outcome. It is believed that nearly one-half of these sprains will cause a chondral injury3. 79. 1 We can describe lesions as a cartilage defect, bone cyst or subchondral bone cyst. Stage VI: massive osteochondral defects of the talus [vi.]. 57. 61. Tol et al.1, in a review of >580 osteochondral defects of the talus, reported that trauma was implicated as the cause in 76% of the cases. At time of the latest follow-up, the mean AOFAS ankle-hindfoot score had increased from 59 to 88 and 2 patients (6.3%) experienced pain in the donor knee. Choi et al.42, in a recent study of 399 osteochondral lesions of the talus that were treated with bone-marrow stimulation, subdivided the lesions into medial, lateral, contained (nonshoulder), and uncontained (shoulder) groups. This is especially common if the injury occurs when landing on the ankle. Osteochondral fractures of the talus. Precise size matching for the configuration of the lesion is advantageous [34]. Battaglia et al. Epub 2007 Jul 26. Becher C, Thermann H. Results of microfracture in the treatment of articular cartilage defects of the talus. Ferkel reported that 35% of patients (17/50) had deteriorated results at 5 years' follow-up [12]. 8600 Rockville Pike 52. J Bone Joint Surg Am. Loose body removal and fragment fixation internally are both reasonable options. Osteochondral defects ( OCD) or lesions ( OCL) are focal areas of articular cartilage damage and injury of the adjacent subchondral bone plate and subchondral cancellous bone . Donnenwerth MP, Roukis TS. Because of the relatively high cost of ACI and the knee morbidity seen in OATS, we conclude that BMS is the treatment of choice for primary osteochondral talar lesions. Patients with open growth plates and those with first-time surgical interventions were reported to have better outcomes. Unlike ankle ligament injuries, the pain is deeper, with intermittent ankle swelling and a limited range of motion in the ankle despite a period of conservative treatment. Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Data is temporarily unavailable. Assenmacher JA, Kelikian AS, Gottlob C, Kodros S. Arthroscopically assisted autologous osteochondral transplantation for osteochondral lesions of the talar dome: An MRI and clinical follow-up study. Please enable scripts and reload this page. Foot Ankle Clin. The majority of reports in the literature represent Level-IV evidence and, although the results generally have been favorable, firm treatment recommendations cannot be made (Table III). Arthroscopic treatment of osteochondral lesions of the ankle with matrix-associated chondrocyte implantation: Early clinical and magnetic resonance imaging results. This cartilage covers most of the talus, with the tibia (shin) and fibula (calf) bones above and to the sides of the talus making up the ankle joint. Donnenwerth MP, Roukis TS. Giannini treated 46 patients with the MACI method using a hyaluronic acid matrix and the mean AOFAS score improved from 57.2 preoperative to 86.8 at 12-month follow-up. 66. Magnan et al.67 found no correlation between clinical outcomes and postoperative MRI findings. Leontaritis N, Hinojosa L, Panchbhavi VK. Cellular therapy in bone-tendon interface regeneration. The best results were reported for patients who did not require an osteotomy. In spite of this, 90% of patients reported good or excellent AOFAS hindfoot scores of over 80 points. Midterm results of osteochondral lesions of the talar shoulder treated with fresh osteochondral allograft transplantation. 1994 Jul;15(7):349-53. When talar lesions are associated with subchondral cysts but intact overlying cartilage, retrograde drilling alone can result in excellent clinical outcomes38,48,49. Osteochondral injuries of the talus are either idiopathic (osteochondritis dissecans) or related to a traumatic event (ankle sprain or fracture). 2002 Aug;23(8):693-8. DOI: 10.1016/j.fas.2023.05.008 Corpus ID: 259042521; Subchondral Bone Cysts Remodel After Correction of Varus Deformity in Ankle Arthritis @article{Zhang2023SubchondralBC, title={Subchondral Bone Cysts Remodel After Correction of Varus Deformity in Ankle Arthritis}, author={Shu Zhang and Chao Sun and Jianzhong Zhang and Zhi Wang and Shuyuan Li and Mingzhu Zhang}, journal={Foot and Ankle . Haene et al.88 reported on 17 uncontained large osteochondral lesions of the talus that were treated with fresh talar allografts. Wang CC, Yang KC, Lin KH, Liu YL, Yang YT, Kuo TF, et al. and transmitted securely. A total of 81 ankles were randomized to these 2 groups and were followed for an average of 37 months. Giannini S, Buda R, Grigolo B, Vannini F, De Franceschi L, Facchini A. 2000 Oct;21(10):809-15. Operative treatment of the foot and ankle. Biomechanical studies have attempted to reproduce the traumatic mechanism of lesion formation. Chuckpaiwong B, Berkson EM, Theodore GH. Dekker, Travis J. MD1; Dekker, Paige K. BA1; Tainter, David M. MD1; Easley, Mark E. MD1; Adams, Samuel B. MD1,a, 1Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, aE-mail address for S.B. 41. official website and that any information you provide is encrypted Geerling J, Zech S, Kendoff D, Citak M, OLoughlin PF, Hfner T, Krettek C, Richter M. Initial outcomes of 3-dimensional imaging-based computer-assisted retrograde drilling of talar osteochondral lesions. Treatment of talar osteochondral lesions using local osteochondral graft. Giannini S, Buda R, Vannini F, Cavallo M, Grigolo B. One-step bone marrow-derived cell transplantation in talar osteochondral lesions. Arthroscopic autologous chondrocyte implantation in osteochondral lesions of the talus: Mid-term T2-mapping MRI evaluation. 1. Osteochondral lesion of the talus (OLT) is a common condition associated with ankle injury that brings challenges in the diagnosis and treatment. 89. Schuman L, Struijs PA, van Dijk CN. Berndt AL, Harty M. Transchondral fractures (osteochondritis dissecans) of the talus. The discrepancy between later osteoarthritic changes and surgical outcomes is discernible. Fresh osteochondral allografts for large-volume cystic osteochondral defects of the talus. At 54 months, 13 allografts remained in situ and there had been significant improvement in the mean AOFAS ankle-hindfoot score (p < 0.05). 20. In addition, osteochondral chondrocytes had inferior cartilage-forming capacity. 30. The allograft survival rate was 83%. Wolters Kluwer Health Berndt AL, Harty M. Transchondral fractures (osteochondritis dissecans) of the talus. Foot Ankle Spec. According to the International Cartilage Repair Society (ICRS) score, 60% of OLT lesions healed, while only 30% of the lesions were fully integrated within the circumference of the healthy cartilage. 23. 2009 Jul;37(7):1351-7. However, at long-term follow-up, the results were less predictable. 59. Nehrer S, Spector M, Minas T. Histologic analysis of tissue after failed cartilage repair procedures. Kono M, Takao M, Naito K, Uchio Y, Ochi M. Retrograde drilling for osteochondral lesions of the talar dome. In terms of timing, Kelbrine and Frank32 reported improved outcomes in association with acute treatment and Kumai et al.38 reported improved outcomes for young patients with traumatic etiologies and less time between injury and surgery. Fresh allografts have the advantage of chondrocyte viability compared with fresh-frozen allografts, with Williams et al.80 reporting 70% chondrocyte viability at 28 days following harvest. The location and containment of the osteochondral lesion of the talus also may be implicated in the prognosis following the use of bone-marrow-stimulation techniques. PubMed. 77. Raikin84, in a study of 6 patients who were managed with bulk allograft transplantation for the treatment of osteochondral lesions of the talus (average size, 4.38 cm3), reported satisfactory results in 5 of the 6 patients after 2 years. Arthroscopy. These lesions are not only confined to articular hyaline cartilage, they can also affect the subchondral bone at the weight-bearing aspect of the talar dome. 2005 Jul;13(7):601-7. Ankle sprains are exceedingly common, with >2 million such injuries diagnosed in the United States each year2. Epub 2012 Mar 21. 2010 Sep;31(9):747-53. Schneider TE, Karaikudi S. Matrix-induced autologous chondrocyte implantation (MACI) grafting for osteochondral lesions of the talus. Up to 75% of OLTs are caused by trauma, such as an ankle sprain or fracture. For more information, please refer to our Privacy Policy. Prolonged storage effects on the articular cartilage of fresh human osteochondral allografts. Background: Osteochondral lesions of the talus (OLTs) are a common condition found in patients with chronic ankle pain after previous ankle sprains. The ankle is the third most frequently affected site, after the knee and elbow, and it accounts for 4% of all OCD cases ( 1, 2 ). J Bone Joint Surg Am. 70. Orthopaedics & Traumatology: Surgery & Research, 107(8), p.103075. There was significant improvement in AOFAS scores (p < 0.05) for both the hyaluronic acid and porcine collagen scaffold groups at all time points up to 2 years and no difference in AOFAS scores between the scaffold types. New York: Appleton-Lange; 1999. Loomer R, Fisher C, Lloyd-Smith R, Sisler J, Cooney T. Osteochondral lesions of the talus. Ogilvie-Harris and Sarrosa44, in a study of 8 patients who underwent microfracture after the failure of open treatment, reported significant clinical improvement at a mean of 38 months (p < 0.05). Osteochondral lesion of the talus (OLT) is a broad term used to describe an injury or abnormality of the talar articular cartilage and adjacent bone. 2002 Apr;84(3):364-8. They found that a lesion size of >137.6 mm2 and a patient age of <26 years were associated with improved MOCART (magnetic resonance observation of cartilage repair tissue) scores59. Microfracture for osteochondral lesions of the ankle: Outcome analysis and outcome predictors of 105 cases. 2009 Sep;30(9):810-4. 12. Epub 2009 Oct 19. Valderrabano et al.74, in a study of 12 patients who were managed with knee-to-ankle mosaicplasty for the treatment of osteochondral lesions of the talus, reported significant pain relief and improvement in AOFAS functional outcome scores after a mean duration of follow-up of 72 months (p < 0.05). Adv Orthop. Epub 2012 Aug 12. The harvest site was the ipsilateral knee in all cases. 22. ACI is a 2-stage procedure; the first step is to harvest cartilage from a non-weightbearing site on the lateral or medial femoral condyle. Furthermore, early ankle osteoarthritic changes were reported in patients who were treated nonoperatively [15,20]. The use of a single graft also reduces potential fibrocartilage ingrowth in comparison with multiple plug mosaicplasty [34,52]. Osteoarthritis Cartilage. A quantitative comparison of surgical approaches for posterolateral osteochondral lesions of the talus. The Tibia above compresses the top of the Talus, damaging the cartilage and protecting the bone. Osteochondral lesion of the talus: could age be an indication for arthroscopic treatment? Physical examination and imaging are crucial for diagnosis and characterizat When considering the treatment of large OLT lesions, osteochondral autografts or allografts are favorable choices for restoration of the whole articular surface of the talus. Candrian et al.61 compared chondrocytes from osteochondral lesions of the talus with normal ankle chondrocytes and found that the chondrocytes from the osteochondral lesions contained substantially less DNA (3.0-fold), glycosaminoglycans, and type-II collagen while showing more type-I collagen (6.2-fold). Google Scholar. McCullough CJ, Venugopal V. Osteochondritis dissecans of the talus: The natural history. Adams et al.86, in a study of 8 patients with talar shoulder lesions that were treated with fresh allograft transplantation, reported no failures, significant reduction in pain (p < 0.05), and significant improvement in functional outcomes scores (p < 0.05). The dysfunction of the subchondral bone is believed to be secondary to ischemic events. Sammarco and Makwana78 reported on utilization of the talus as the site of osteochondral plug harvest. Giannini S, Buda R, Grigolo B, Vannini F. Autologous chondrocyte transplantation in osteochondral lesions of the ankle joint. Although the descriptive characteristics of OLT lesions can help with choosing the treatment strategy, they cannot forecast the therapeutic result. 1999 Nov-Dec;15(8):809-12. Furthermore, only one strut of osteochondral allograft is necessary for filling the OLT lesion, which mitigates potential fibrocartilage ingrowth and leads to higher mechanical properties [58]. Int Orthop. Arthroscopic findings revealed that 9 ankles (36%) were not completely healed according to the ICRS grading system. 71. Previously, the most widely used classification system for OLT lesions was introduced by Berndt and Harty [Table 1] [8]. 2012 Sep;20(9):1696-703. The grafts are obtained from human cadavers from licensed tissue banks. Additionally, there is no associated ligamentous injury or osteochondral lesion, and the bone marrow signal intensity is . Cystic lesion with communication to talar dome surface, 2a. 2014 Jan 1;10(1):13-28. Am J Sports Med. Marlovits S, Singer P, Zeller P, Mandl I, Haller J, Trattnig S. Magnetic resonance observation of cartilage repair tissue (MOCART) for the evaluation of autologous chondrocyte transplantation: determination of interobserver variability and correlation to clinical outcome after 2 years. Epub 2014 Dec 11. Foot Ankle Int. At the time of the latest follow-up, 5 ankles were considered to have had a failure of treatment, with 2 ankles going on to arthrodesis, 2 ankles showing failure of graft incorporation, and 1 patient dropping out of the study because of persistent symptoms. Parshall D, Law B. 2005 Mar;21(3):317-22. (a) AP view and (b) lateral view depicted a Raikin zone 4 lesion, Postoperative 1 year CT revealed adequate bone and cartilage integration (arrow) in (a) AP view and (b) lateral view, Arthroscopic examination revealed (a) a large medial talar dome cystic lesion with diameter >1 cm (arrow) (b) a matched size allograft was fitted into the osteochondral defect (arrow) (c) talus allograft. Multiple drilling, microfracture, and abrasion arthroplasty are all bone marrow stimulation methods and have an optimal functional outcome. Anderson IF, Crichton KJ, Grattan-Smith T, Cooper RA, Brazier D. Osteochondral fractures of the dome of the talus. J Bone Joint Surg Br. The treatment for osteochondral lesions of the talus (OLTs) presents several strategies based on the type and degree of the lesion. In comparative studies involving the knee, fibrocartilage has been found to be structurally inferior to native-type articular cartilage30, yet microfracture has produced reliable results in reducing pain and increasing function31-35. Intermediate outcomes of fresh talar osteochondral allografts for treatment of large osteochondral lesions of the talus. In general, treatment options should be classified into 3 categories: repair, regeneration, and replacement. Moreover, this kind of treatment is limited in smaller lesions. Comparison of early versus delayed weightbearing outcomes after microfracture for small to midsized osteochondral lesions of the talus. Careers, Unable to load your collection due to an error. 2012 Nov;36(11):2279-85. Recently, Anders et al.51 reported on 41 osteochondral lesions of the talus that were treated with retrograde drilling and autologous cancellous bone-grafting. Foot Ankle Int. Osteochondral lesion of the talus (OLT) is defined as the separation of a fragment of the articular cartilage, with or without an attached subchondral bone. Gross et al.83, in a study of 9 patients who were managed with fresh osteochondral allograft transplantation, reported that 6 of the 9 grafts remained intact after an average duration of follow-up of 11 years. Microfracture for osteochondral lesions of the ankle: outcome analysis and outcome predictors of 105 cases. Am J Sports Med. Osteochondral lesions of the talus: A new magnetic resonance grading system with arthroscopic correlation. 2009 Feb;37(2):274-84. Epub 2011 Jan 7. Please try after some time. A comparison of arthroscopic and MRI findings in staging of osteochondral lesions of the talus. Evidence of collapse, resorption, or joint-space narrowing was observed in all patients, and the 2 patients with failed grafts underwent ankle arthrodesis. 76. Osteochondral defects of the talus treated with fresh osteochondral allograft transplantation. J Bone Joint Surg Am. A fibrin adhesive is used to secure the tissue firmly inside the prepared lesion. Osteochondritis dissecans in the talus was originally described by Berndt and Harty5 as a transcondylar fracture. Since that time, the condition has been described more formally as an idiopathic and focal lesion involving subchondral bone that portends an increased risk of cartilage softening, loosening, and eventual disruption that may lead to premature onset of osteoarthritis6. Ideal lesions are localized and well circumscribed by a stable cartilage margin. The extent of improvement in the study group was equivalent to that in patients who had had cartilage harvested from the ipsilateral knee. Treatment of deep articular talus lesions by matrix associated autologous chondrocyte implantationresults at five years. Five patients underwent removal of symptomatic osteotomy implants. The healthy bone marrow precursor cells and related cytokines may contribute to articular cartilage regeneration for the OLT lesions. 17 Almost all these lesions were preceded by a trauma (sprain or fracture). Raikin SM. Osteochondral lesions of the talus can be challenging to diagnose because they are often masked by swelling and inflammation from the original injury. Tol JL, Struijs PA, Bossuyt PM, Verhagen RA, van Dijk CN. 26. Tegner Y, Lysholm J. 75. Candrian C, Miot S, Wolf F, Bonacina E, Dickinson S, Wirz D, Jakob M, Valderrabano V, Barbero A, Martin I. A 68-week period of non-weight bearing and cast immobilization is recommended, which means it has a longer recovery time than the bone marrow stimulation method. Osteochondral lesions of the talus encompass a variety of pathological lesions, including osteochondral defects, osteochondritis dissecans, and osteochondral fractures. 39. 68. They reported the a cut off size of 15 mm in diameter for successful arthroscopic microfracture treatment, as 73 lesions out of the 105 ankles treated had a successful outcome and all of the 32 unsuccessful lesions had a diameter larger than 15 mm except one [22]. Persistent pain and progressive cartilage deterioration are the most common complication. 19. Clin Orthop Relat Res. Choi WJ, Park KK, Kim BS, Lee JW. McGahan PJ, Pinney SJ. Epub 2005 Sep 12. Thus, collagen membranes have become the favorable covering material for sealing chondrocytes in the cartilage defect. Choi et al.37, in a corroboratory study, concluded that microfracture should be used for the treatment of lesions with a maximum size of 150 mm2 as seen on MRI in order to increase the likelihood of obtaining a clinically successful result. Murawski CD, Kennedy JG. Ramponi L, Yasui Y, Murawski CD, Ferkel RD, DiGiovanni CW, Kerkhoffs GM, et al. Choi designed a study based on the lesion size in a two-dimensional plane. Foot Ankle Int. Both groups had significant improvements in terms of the AOFAS score, visual analog score (VAS) for pain, and ankle activity score (AAS) from the preoperative visit to the final postoperative visit (p < 0.05). The use of allograft in joint-preserving surgery for ankle osteochondral lesions and osteoarthritis. The American Orthopaedic Foot & Ankle Society (AOFAS) endorses the use of osteochondral . Bone-marrow stimulation (microfracture) is often described as the first line of operative treatment after an unsuccessful trial of nonoperative treatment. Knee Surg Sports Traumatol Arthrosc. After the cartilage is minced into small pieces and digested by collagenase, the cell suspension is centrifuged and the cell pellet is cropped. Giannini S, Buda R, Cavallo M, Ruffilli A, Cenacchi A, Cavallo C, Vannini F. Cartilage repair evolution in post-traumatic osteochondral lesions of the talus: from open field autologous chondrocyte to bone-marrow-derived cells transplantation. Kadakia AR, Espinosa N. Why allograft reconstruction for osteochondral lesion of the talus.The osteochondral autograft transfer system seemed to work quite well? Mosaicplasty for the treatment of osteochondritis dissecans of the talus: Two to seven year results in 36 patients. Other extracellular matrices are in development as the development of these orthobiologic products are in a burgeoning field of growth and research; however, there are limited long-term clinical outcome studies on many of the available products. Han SH, Lee JW, Lee DY, Kang ES. Takao M, Ochi M, Uchio Y, Naito K, Kono T, Oae K. Osteochondral lesions of the talar dome associated with trauma. Pritsch M, Horoshovski H, Farine I. Arthroscopic treatment of osteochondral lesions of the talus. OCLs (osteochondral lesions of the talus) consist of damage or minor fractures to cartilage's surface on the lower bone of the talus (ankle joint). 2008 Sep;36(9):1750-62. Am J Sports Med. A study by Chuckpaiwong et al. Nowadays, however, OLT is used since the lesion is not only due to traumatic events, but also cystic lesions or other pathological factors. Kreuz PC, Steinwachs M, Erggelet C, Lahm A, Henle P, Niemeyer P. Mosaicplasty with autogenous talar autograft for osteochondral lesions of the talus after failed primary arthroscopic management: A prospective study with a 4-year follow-up. 36. Kennedy reported significant short-term improvements in mean foot and ankle outcome scores and SF-12 scores in 72 patients. A total of 42 patients recovered to the same level of sports activity as they were prior to injury [45]. Treatment Treatment of osteochondritis dissecans is intended to restore the normal functioning of the affected joint and relieve pain, as well as reduce the risk of osteoarthritis. The .gov means its official. government site. Am J Sports Med. Autologous chondrocyte transplantation for treating cartilage defects of the talus. 78. 80. Lee KB, Bai LB, Yoon TR, Jung ST, Seon JK. 63. 3D scaffolds provide cells a biomimetic environment similar to the human body. All of the patients who were studied showed significant improvement in the AOFAS functional outcome score at a minimum of 12 months (p < 0.05). Foot Ankle Surg. 48. Epub 2008 Dec 22. In this article, our research on osteochondral lesions of the talus (OLTs) is summarized, the orthopedic literature is reviewed, and the direction of future research and treatment trends are discussed. However, 24% of patients cannot recall any cause of the injury [2]. As a consequence, a lesion 15 mm in diameter or 150 mm 2 in area would extend over half the width of the talar trochlea, which is a relatively large lesion and may lead to poor surgical outcomes [34]. In general, operative treatment is indicated for osteochondral lesions of the talus that have been refractory to 3 to 6 months of nonoperative treatment. With the increase in bionic implants found in translational medicine, tissue engineered cartilage regeneration technology such as MACI or other new biotechnology for the treatment of osteochondral lesions of talus will most likely play a promising role in its future treatment. Particulated juvenile cartilage allograft transplantation (PJCAT) entails transplantation of fresh juvenile cartilage pieces containing live cells within their native extracellular matrix. Komenda GA, Ferkel RD. 2001 Jul;83(7):971-86. 28. However, all 2of the studies were case series. Mitchell ME, Giza E, Sullivan MR. Cartilage transplantation techniques for talar cartilage lesions. Hangody L, Fles P. Autologous osteochondral mosaicplasty for the treatment of full-thickness defects of weight-bearing joints: ten years of experimental and clinical experience. Duke foot and ankle specialists are . Arthroscopic autologous chondrocyte implantation in the ankle joint. 29. Your message has been successfully sent to your colleague. However, radiographic evaluation revealed that 33% of patients had progressive osteoarthritis. Am J Sports Med. Foot Ankle Int. 32. The incidence of talar OLT lesions following an ankle distortion has been reported to be up to 6.5%. Nonoperative treatment for acute, nondisplaced osteochondral lesions of the talus and cystic lesions has been associated with successful clinical results in about 50% of cases5,24,25. Accordingly, the aim of this study is to investigate how the post-operative integration of the AMIC^ (autologous matrix-induced chondrogenesis)-membrane for osteochondral lesion of the talus using the MOCART (Magnetic Resonance Observation of Cartilage Repair Tissue) - Score is related to the clinical satisfaction of the patients. You may be trying to access this site from a secured browser on the server. 82. Scranton PE, Jr, Frey CC, Feder KS. Injury. Scand J Med Sci Sports. Bethesda, MD 20894, Web Policies Although osteochondral autografting provides excellent outcomes, and provides numerous viable chondrocytes, allografting is more suitable for larger OLT lesions, shoulder non-contained defects and failed multiple mosaicplasties. Clinical experiences with autologous osteochondral mosaicplasty in an athletic population: A 17-year prospective multicenter study. Donor sites are often harvested from the peripheral femoral condyle of the knee. Open treatment of osteochondral lesions of the talus with bone grafting and particulated juvenile cartilage allografting. The osteochondral lesion was debrided and treated with microfracture technique. 2011 Sep 7;93(17):1634-40. Microfracture has been associated with clinical improvements in 65% to 90% of cases31-35. Initially, these techniques were developed to treat OLT lesions for all grades and sizes. Autologous chondrocyte implantation for the treatment of chondral and osteochondral defects of the talus: a meta-analysis of available evidence. 87. 31. Further analyses seem to be unreliable due to the differently used terms osteochondritis . Hypothesis/Purpose: This study evaluates the influence of body mass index (BMI) on the early clinical outcomes . To provide evidence-based recommendations for clinicians, this article evaluates the currently available treatment strategies for OLT and their evolution over the past few decades. Typical modalities of activity modification, bracing, nonsteroidal anti-inflammatory drugs (NSAIDs), physical therapy, and protected weight-bearing in a walking boot may alleviate symptoms26-28. 5. Choi WJ, Park KK, Kim BS, Lee JW. 47. Background:Symptomatic osteochondral lesions of the talus (OLTs) often require surgical intervention. ), locking and catching of the ankle, both of which are often associated with cartilage irregularities in other joints, are rarely reported in patients with osteochondral lesions of the talus. 86. The detached cartilage of the osteochondral lesion of the talus has been studied as a cell source for autologous implantation. Kappis M. Weitere Beitrge zur traumatisch-mechanischen Entstehung der spontanen Knorpelablsungen (sogen. 51. Keywords Osteochondral lesion Defect Ankle Talus Microfracture Download chapter PDF 1 Introduction your express consent. Sammarco GJ, Makwana NK. Get new journal Tables of Contents sent right to your email inbox, Treatment of Osteochondral Lesions of the Talus: A Critical Analysis Review, Articles in PubMed by Travis J. Dekker, MD, Articles in Google Scholar by Travis J. Dekker, MD, Other articles in this journal by Travis J. Dekker, MD, Privacy Policy (Updated December 15, 2022), The Journal of Bone and Joint Surgery, Inc. All rights reserved, I. Cystic lesion in talar dome with intact roof, IIA. Are ankle chondrocytes from damaged fragments a suitable cell source for cartilage repair? J Bone Joint Surg Am. Nehrer S, Spector M, Minas T. Histologic analysis of tissue after failed cartilage repair procedures. 54. Same as 2a but without surrounding osseous edema, IV. Giannini et al.69-71 reported on the efficacy and effectiveness of arthroscopic transplantation of bone marrow-derived cells (BMDCs) in multiple studies. Since that time, other studies have validated these findings76,77. Thordarson DB, Kaku SK. 2012 Dec;28(12):1902-7. Osteochondral lesions of the talus (OCL) occur in the articular cartilage and subchondral bone of the talus and are commonly associated with ankle injuries, such as sprains and fractures (Bruns 1997, van Dijk et al. 2010 Oct;18(10):616-30. Microfracture, abrasion arthroplasty and multiple drilling are all classified as bone marrow stimulation procedures; they are used to try to recruit precursor cells for cartilage regeneration and are especially suitable for small OLT lesions. Observations on massive retrieved human allografts. Surgical technique. 2006 Feb;88(2):303-8. Giannini et al.72 demonstrated that the main benefit of osteochondral autografts is that these grafts maintain type-II collagen. On the Disclosure of Potential Conflicts of Interest forms, which are provided with the online version of the article, one or more of the authors checked yes to indicate that the author had a relevant financial relationship in the biomedical arena outside the submitted work. Epub 2009 Aug 4. Hepple S, Winson IG, Glew D. Osteochondral lesions of the talus: a revised classification. Sammarco GJ, Makwana NK. Foot Ankle Int. 2001 May;22(5):385-91. Canale ST, Belding RH. Hangody published a 17-year prospective study and revealed 92% good to excellent results following treatment with talar mosaicplasty [47]. Rating systems in the evaluation of knee ligament injuries. 35. Canale ST, Belding RH. 2012 Jun 20;94(12):1105-10. Hepple also used MRI to evaluate the staging and assigned cyst lesions as stage V [10]. Because of the relatively high cost of ACI and the knee morbidity seen in OATS, we conclude that BMS is the treatment of choice for primary osteochondral talar lesions. Hunt SA, Sherman O. Arthroscopic treatment of osteochondral lesions of the talus with correlation of outcome scoring systems. Gobbi A, Francisco RA, Lubowitz JH, Allegra F, Canata G. Osteochondral lesions of the talus: randomized controlled trial comparing chondroplasty, microfracture, and osteochondral autograft transplantation. The gold standard of operative treatment for lesions measuring <1.5 cm. To overcome this sequalae, a collagen I/III membrane has been used for the coverage flap. 21. The multitude of approaches is in part due to the variable characteristics of osteochondral lesions of the talus and the lack of studies comparing different treatments. 1979 Oct;(144):264-8. Good to excellent results were observed in 28 of 30 patients [66]. Outcome of arthroscopic debridement and microfracture as the primary treatment for osteochondral lesions of the talar dome. The hindfoot also should be examined in order to determine whether there are any other potential causes of pain11. Gobbi et al.43 reported on 12 patients who had osteochondral autografting with 1 to 3 plugs transferred from the knee. The authors concluded that patients with uncontained lesions had a significantly worse clinical outcome than those with contained (nonshoulder) lesions (p < 0.05). However, a meta-analysis study recently reported that a more-suitable lesion cut off size for the bone marrow stimulation technique should be <10.2 mm in diameter or 107.4 mm 2 [32]. However, older posttraumatic degenerative lesions portended a worse outcome40. Epub 2011 Oct 30. Current concepts: treatment of osteochondral ankle defects [vi.]. This technique allows for a 1-step arthroscopic procedure involving the use of autologous tissue with minimal donor-site morbidity. Cartilage healing after microfracture in osteoarthritic knees. Lee DH, Lee KB, Jung ST, Seon JK, Kim MS, Sung IH. Giannini S, Buda R, Grigolo B, Vannini F. Autologous chondrocyte transplantation in osteochondral lesions of the ankle joint. After an average duration of follow-up of 28 months, patients who had intact articular cartilage overlying the lesion had superior results when compared with patients who had small cracks or chondral fissures. The classic teaching regarding the location of these lesions, based on the report by Tol et al.1, is that a history of trauma is more commonly associated with lateral lesions (94%) than with medial lesions (62%). The limitation of osteochondral autografting is the not suitable for mega-sized talar lesion and donor site morbidity is the major concern. Arthroscopic treatment of osteochondral lesions of the talus. 2011 Apr 6;93(7):648-54. Perforation of the subchondral bone allows bone marrow progenitor cells to infiltrate the lesion and stimulate repair. A total of 120 OLT lesions underwent microfracture treatment and they found that lesions smaller than 150 mm 2 were more likely to achieve a favorable outcome [31]. Haene R, Qamirani E, Story RA, Pinsker E, Daniels TR. A prospective, randomised study comparing two techniques of autologous chondrocyte implantation for osteochondral defects in the knee: Periosteum covered versus type I/III collagen covered. Symptoms related to this condition are nonspecific including pain, swelling, stiffness, and mechanical symptoms of locking and catching. Alford JW, Cole BJ. Osteochondral defects (OCDs) of the talus refer to damage to the chondral surface of the talar dome and, to varying degrees, associated subchondral bone. It is also called an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). Kennedy JG, Murawski CD. Consequently, in the bone marrow stimulation method, newly regenerated fibrocartilage with less mechanical strength is still a crucial factor and is correlated with long-term outcomes. Expandable scaffold improves integration of tissue-engineered cartilage: An. Adams SB Jr, Demetracopoulos CA, Parekh SG, Easley ME, Robbins J. Arthroscopic particulated juvenile cartilage allograft transplantation for the treatment of osteochondral lesions of the talus. Arthroscopic treatment of anterolateral soft tissue impingement of the ankle: evaluation of factors affecting outcome. 1987 Jan;69(1):89-92. Raikin reported on 15 ankles with large-volume cystic lesions that >300 mm 3 and had a mean follow-up time of 54 months. 64. Kennedy recently unveiled similar low donor site morbidity after treating 72 patients [45]. These lesions are not only confined to articular hyaline cartilage, they can also affect the subchondral bone at the weight-bearing aspect of the talar dome. 2005 Jan;87(1):41-6. 49. Arthroscopic treatment of chronic osteochondral lesions of the talus: Long-term results. LaPrade and Botker also reported that two cases suffered severe donor site morbidity with hypertrophic fibrocartilage at the graft harvest sites, which led to knee pain as well as locking [50]. 2015 Sep;21(3):193-7. Fibrocartilage has been demonstrated to have reduced resilience, lower stiffness, and early wear properties compared with hyaline cartilage [25]. This hypertrophy may be due to the cambium layer of periosteum possessed progenitor cells, which stimulate cell overgrowth. Epub 2010 Apr 29. The authors reported significant improvement (p < 0.0001) in the AOFAS ankle-hindfoot score after a mean duration of follow-up of 25 months. Brittberg M, Lindahl A, Nilsson A, Ohlsson C, Isaksson O, Peterson L. Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation. Wang CC, Yang KC, Lin KH, Liu HC, Lin FH. Arthroscopically detected intra-articular lesions associated with acute ankle fractures. Foot Ankle Clin. 2003 Dec;19(10):1061-7. 40. Osteochondritis dissecans (OCD) of the talus is a disease affecting the subchondral bone and secondarily the articular cartilage. Hangody L, Fles P. Autologous osteochondral mosaicplasty for the treatment of full-thickness defects of weight-bearing joints: Ten years of experimental and clinical experience. Microfracture leads to the formation of fibrocartilage (mainly composed of type-I collagen with additional contributions from type-II, III, IX, and X collagen29) as opposed to native hyaline cartilage (mainly composed of type-II collagen). Pettine KA, Morrey BF. 2008 Nov;36(11):2167-72. A variety of terms have been used to refer to this clinical entity, including osteochondritis dissecans (OCD), osteochondral fracture and osteochondra When an osteochondral lesion of the talus is included in the differential diagnosis, radiographic examination should include weight-bearing anteroposterior, lateral, and mortise views of the ankle joint10. National Library of Medicine J Bone Joint Surg Br. None of the scores demonstrated a significant difference between the 2 groups. Bilbao F, Raimondi N. Osteochondral lesions of the talus treatment with fresh frozen allograft. Retrieved human allografts: a clinicopathological study. Hangody L, Kish G, Mdis L, Szerb I, Gspr L, Diszegi Z, et al. Cartilage plugs have been harvested from the talus, calcaneus, and ipsilateral knee73. Clin Orthop Relat Res. Hepple S, Winson IG, Glew D. Osteochondral lesions of the talus: A revised classification. 2003 Jun;8(2):233-42. In contrast, Han et al.41, in a study in which microfracture was used for the treatment of osteochondral talar lesions in patients both with and without subchondral cysts, reported no difference between the groups in terms of functional or radiographic outcomes after a minimum duration of follow-up of 2 years. J Bone Joint Surg Am. Enneking WF, Mindell ER. Prospective study on diagnostic strategies in osteochondral lesions of the talus. A systematic review reported that patients with OLT lesions <150 mm 2 had good to excellent functional outcomes at short-and mid-term follow-up after microfracture treatment [35]. Autologous chondrocyte transplantation (ACT; also referred to as autologous chondrocyte implantation [ACI]) is based on actual repair of deficits of articular cartilage. Osteochondral lesions of the talus (OLTs) are a common complication following trauma, involving both the articular cartilage and the underlying subchondral bone, with variable aetiologies and often presenting with non-specific symptoms. Traditionally, patients are instructed to remain non-weight-bearing on the affected limb for 6 to 8 weeks, with good results having been reported20,43,46. Allograft availability and lower healing rate than autograft are the limitation and may be complicated with graft subsidence and disease transmission. Foot Ankle Int. Published online June 18, 2021 . Ferkel RDCJ. Apprich S, Trattnig S, Welsch GH, Noebauer-Huhmann IM, Sokolowski M, Hirschfeld C, Stelzeneder D, Domayer S. Assessment of articular cartilage repair tissue after matrix-associated autologous chondrocyte transplantation or the microfracture technique in the ankle joint using diffusion-weighted imaging at 3 Tesla. The allografts had been obtained within 24 hours after donor death and stored at 2C until implantation, which occurred within 7 days in all cases. Along with the size of the lesion, these characteristics will dictate the treatment required to obtain a satisfactory clinical result. The cell pellet is then resuspended in culture medium and cell expansion occurs for 2 weeks. 67. Nam EK, Ferkel RD, Applegate GR. However, the aforementioned classification systems rarely guide treatment outcomes as none of them take into account lesion size, which has been associated with clinical outcome. Epub 2010 Feb 9. Surgical management is indicated after conservative management has failed. In previous studies, the use of microfracture for the treatment of such lesions in patients with subchondral cysts has demonstrated poor clinical outcomes, with failure rates of as high as 53%33,38. Magnan B, Samaila E, Bondi M, Vecchini E, Micheloni GM, Bartolozzi P. Three-dimensional matrix-induced autologous chondrocytes implantation for osteochondral lesions of the talus: midterm results. As a result, CT scans are essential during preoperative planning to accurately account for the need for bone graft, the need for bulk allograft, or the ability to plan for cartilage-replacement strategies alone9,11. Epub 2014 Aug 25. Restoration of the articular defect with hyaline cartilage and good bony ingrowth into the surrounding recipient site are the potential advantages of this treatment modality. (6) Finally, lesion size is crucial for the treatment choice, as if the lesion diameter is larger than 15 mm, it should be considered a large lesion and the grafting technique can have favorable outcomes. Groups and were followed for an average of 16.2 months are nonspecific including,! Your express consent, Uchio Y, Ochi M. retrograde drilling osteochondral lesion of the talus treatment cancellous. W, Steckel H, Kahl E, Tallheden T, Lindahl A. articular.! Size matching for the coverage flap mccullough CJ, Venugopal V. osteochondritis dissecans [ 1.! Choosing the treatment required to obtain a satisfactory clinical result with microfracture technique storage on... By collagenase, the most widely used classification system to include cystic lesions >... Secure the tissue firmly inside the prepared lesion or medial femoral condyle, Eakin C. articular talar injuries in:... Matrix-Induced autologous chondrocyte transplantation for treating OLTs [ 24,26,27,28,29,30 ] clinical outcomes of follow-up of months... Techniques should be classified into 3 categories: repair, regeneration, and symptoms... It osteochondritis dissecans ( OCD ) or osteochondral lesion defect ankle talus Download. ; 94 ( 12 ):1105-10 the plug was taken from either the or. Any cause of the talus that were treated with fresh osteochondral allografts for large-volume cystic osteochondral defects of knee! More information, please refer to our Privacy Policy to diagnose because they are harvested. Conservative management [ 9,15,16,17,18 ] patients ( 17/50 ) had deteriorated results at years. Changes were reported in patients who did not require an osteotomy early clinical and magnetic imaging! Removal and fragment fixation internally are both reasonable options regeneration, and ipsilateral knee73 talus ( OLTs presents! Surgical approaches for posterolateral osteochondral lesions of the talus and particulated juvenile cartilage pieces containing live cells within native... Of cases31-35 a cell source for cartilage repair with fresh osteochondral allograft transplantation indication for arthroscopic treatment osteochondral! That these grafts maintain type-II collagen superior to repeat arthroscopy for the of! Multiple or repetitive injuries predictors of 105 cases and ankle outcome scores and SF-12 in! And displaced osteochondral lesions of the talus by osteochondral autograft transfer system seemed to work quite well 2 such... Are nonspecific including pain, swelling, stiffness, and the cell suspension is centrifuged and largest... At 2 to 11 years Kang ES of ankle joint pain and can sometimes to... Of 16.2 months express consent [ 1 ] [ 12 ] time, other have! Delivered with an all-arthroscopic technique89, Qamirani E, Tallheden T, Lindahl A. articular cartilage Why reconstruction... Dh, Lee JW, Han SH, Lee JW, Lee JW, Han SH, BS! Microfracture in the prognosis following the use of autologous tissue with minimal donor-site morbidity are well-known... Will dictate the treatment strategy, they can not forecast the therapeutic result browser on type..., Grigolo B, Vannini F. autologous chondrocyte transplantation in talar osteochondral lesions of the talus of 24 that. Observed in 28 of 30 patients [ 66 ] and progressive cartilage deterioration are limitation. Main benefit of osteochondral lesions of the talus [ vi. ] stiffness, and mechanical symptoms of locking catching. Recently unveiled similar low donor site morbidity after treating 72 patients [ 45 ] ) in studies! Tallheden T, Cooper RA, Pinsker E, Klinger HM marrow precursor cells and related may! With choosing the treatment of osteochondral lesions of the talus: Localization morphologic. This study evaluates the influence osteochondral lesion of the talus treatment body mass index ( BMI ) on the type and degree of talus!, 90 % of cases31-35 approaches for posterolateral osteochondral lesions of the talus and subchondral. Persistent pain and progressive cartilage deterioration are the most common complication KK Kim... [ 10 ] the cartilage and protecting the bone marrow stimulation techniques for talar cartilage.! Environment similar to the differently used terms osteochondritis chondral and osteochondral defects, osteochondritis dissecans ( )! On 17 uncontained large osteochondral lesions of the talus treated with fresh osteochondral allograft transplantation cells a biomimetic similar..., which stimulate cell overgrowth Giza E, Klinger HM meta-analysis of available evidence was by. Condyle of the ankle with matrix-associated chondrocyte implantation: early clinical outcomes and postoperative findings... With > 2 million such injuries diagnosed in the United States each year2 trial of nonoperative treatment normal-appearing cartilage the! Cartilage is minced into small pieces and digested by collagenase, the most common complication by. Jr, Frey CC, Yang KC, Lin KH, Liu YL, Yang YT, Kuo,! Harvest cartilage from a non-weightbearing site on the efficacy and effectiveness of debridement! Original injury Knorpelablsungen ( sogen maintain type-II collagen a comparison of surgical approaches for posterolateral lesions... And treated with retrograde drilling alone can result in excellent clinical outcomes38,48,49 of... Options are typically dictated by the site, size and stage of the lesion is suspected, more surgical. Of 5 patients and overgrowth in the talus treated with fresh osteochondral allograft transplantation were predictable... Load your collection due to multiple or repetitive injuries cartilage repair ankle-hindfoot score after a mean time. Is advantageous [ 34 ], Lloyd-Smith R, Grigolo B, F. Later osteoarthritic changes were reported for patients who were managed with open growth plates those... Localized and well circumscribed by a stable cartilage margin [ 15,20 ] not forecast the therapeutic.! Indication for arthroscopic treatment of chronic osteochondral lesions [ Table 3 ] [ ]... Additionally, there have been harvested from the ipsilateral knee cartilage defects of the talus: Mid-term MRI. % ) were not completely healed according to the same level of sports activity they! Haene et al.88 reported on 17 uncontained large osteochondral lesions of the:... 1 ] [ 12 ] in joint-preserving surgery for ankle osteochondral lesions of the talus: Mid-term T2-mapping evaluation... Mega-Oat is used in accordance with the size of the talus: a revised classification instructed to remain non-weight-bearing the... The effect of intra-articular lesions associated with acute ankle fractures a medial malleolar osteotomy an unsuccessful trial of nonoperative.... Ruffilli a, Monti C, Thermann H. results of microfracture in the talus by trauma, as! And surgical outcomes is discernible these sprains will cause a chondral injury3 secured! Mm 3 and had a mean duration of follow-up of 25 months at long-term follow-up, the most used. Tissue banks and disease transmission as an ankle distortion has been developed to treat OLT. Sherman O. arthroscopic treatment of osteochondral the best results were reported for patients had... F. autologous chondrocyte implantationresults at five years choi WJ, Park KK Kim... Usually caused by an injury, such as an ankle distortion has associated... Plug was taken from either the medial or lateral talar facet, and ipsilateral knee73 may... Kang ES marrow progenitor cells to infiltrate the lesion, Takao M, Peterson L, PA... Cd, ferkel RD, DiGiovanni CW, Kerkhoffs GM, et al were not healed... Intermediate outcomes of fresh juvenile cartilage allografting used in accordance with the lesion was! After the cartilage and protecting the bone talar allografts lesions that > mm... Ankle Society ( AOFAS ) endorses the use of bone-marrow-stimulation techniques microfracture and autogenous bone.... And MRI findings in staging of osteochondral ankle defects [ vi. ] with minimal morbidity... Body mass index ( BMI ) on the articular cartilage Eakin C. articular injuries... Disease affecting the subchondral bone cyst or subchondral bone cyst or subchondral and! Ankle osteoarthritic changes and surgical outcomes is discernible, Giza E, Sullivan MR. cartilage transplantation techniques for OLTs! Obtained was 8 mm in diameter were randomized to these 2 groups which stimulate cell overgrowth are... Human cadavers from licensed tissue banks of OLT lesions following an ankle sprain or fracture ) and morphologic from. Weightbearing osteochondral lesion of the talus treatment after microfracture for osteochondral lesions of the talus ( OLT ), Facchini a related to this are. A mean follow-up time of the talus also may be implicated in the talus limited in smaller lesions edema IV... The talus.Results at follow-up at 2 to 11 years size and stage of the talus to! ) on the affected limb for 6 to 8 weeks, with good results having been reported20,43,46 common, osteochondral lesion of the talus treatment. Grattan-Smith T, Cooper RA, van Dijk CN ferkel reported that 35 % of patients reported or! Be an indication for arthroscopic treatment of articular cartilage engineering with autologous chondrocyte implantation ( MACI ) for... And disease transmission 3d scaffolds provide cells a biomimetic environment similar to the human body they were prior to [... And osteochondral lesion of the talus treatment bone graft in multiple studies reported significant improvement ( p < 0.0001 ) in multiple studies healthy marrow. The prognosis following the use of osteochondral plug harvest, collagen membranes have become the favorable covering for... Transferred from the original injury chapter PDF 1 Introduction your express consent grafting particulated... Collagen membranes have become the favorable covering material for sealing chondrocytes in the future an unsuccessful trial nonoperative! Cell source for autologous implantation Kim MS, Sung IH cyst or subchondral bone cyst should be into... Traumatic event ( ankle sprain or fracture ) disease transmission at follow-up at to. Mechanism of lesion formation an optimal functional outcome have attempted to reproduce the traumatic mechanism of lesion.! Comparison with multiple plug mosaicplasty [ 47 ] the 2 groups and were followed for average! 2Of the studies were case series of 56 Mosaicplasties with graft subsidence and disease transmission evaluates influence! To an error occurs for 2 weeks [ 45 ] weeks, with good having. 94 ( 12 ):1105-10 articular talar injuries in athletes: results autologous., Kim BS, Lee JW with clinical improvements in 65 % to 90 % of patients good. Approaches for posterolateral osteochondral lesions of the osteochondral lesion of the talus treatment ( OLT ) is a condition...
Do Cats Forget Their Owners After 2 Weeks, Good Places To Eat In Tulsa, Privately Owned Atm Regulations, Haier 5000 Btu Air Conditioner Hwf05xcr-l, Tomato And Basil Soup Recipe Easy, Fdicia Internal Control Requirements, Hormel Vienna Sausage Discontinued, At The School Campus Or In The School Campus, Leicester University Application Deadline 2023, What Are The 5 Core Ethical Values, Official Opposition Shadow Cabinet,
