Better knowledge of the characteristics of patients with OLT should make it possible to optimize the surgical indications and anticipate the associated lesions, which should not be overlooked. Article 2013;95:104554. First recognized by Konig in 1888 [1]; an osteochondral defect is loosely defined as an insult to both the articular cartilage and subchondral bone of the talus. They may lead to deep ankle pain on weight-bearing, prolonged swelling, diminished range of motion and synovitis. An osteochondral lesion of the talus or osteochondritis dissecans occurs when the talus's bone and/or cartilage is damaged. These injuries range from mild bruising to more severe damage such as blistering of the cartilage layers, cyst-like lesions within the bone, or fracture of the cartilage and bone layers. Osteochondral lesions of the distal tibial plafond: a systematic review of lesion locations and treatment outcomes. Concomitant injuries in chronic ankle instability. Clinical Research on Foot and Ankle 6.3 (2018): 7. The best method to enhance surgical procedures addressing chondral defect is still unknown. Although biomechanically inferior to hyaline cartilage, fibrocartilage formation appears to be sufficient for smaller lesions. Our goal is to help generate a community that fosters original ideas and content for medical students, residents, fellows and attendings interested in or involved in sports medicine. Few studies reported data with regard to the location of the lesion: medial 73% (99 of 135), lateral 27% (36 of 135), central 0% (0 of 135). Hollander AP. Management depends primarily on displacement. Surgical management of focal chondral defects of the talus: a bayesian network meta-analysis. Shepherd et al |(1999) found a thickness of 0.7 to 1.2 mm in the ankle compared to 1.5 to 2.6 mm in the knee, which may reduce the ability of the local cartilage to resist shear and impact loads. Platelet-rich plasma for the management of Hip and Knee osteoarthritis. Osteochondral Lesions of the Talus are focal injuries to the talar dome with variable involvement of the subchondral bone and cartilage which may be caused by a traumatic event or repetitive microtrauma. The deeper, sometimes cystic nature of the medial talar lesions could be interpreted as lending support the theory that a pathophysiology other than trauma may contribute to the development of these lesions. Teaching Points. For binary data (rate of failure, revision surgery, graft hypertrophy and delamination), the number of observations and the number of patients for each study were collected. 2019;14:441. The most common sites are the posteromedial (53%) ( Fig. Elksnins-Finogejevs A, Vidal L, Peredistijs A. Intra-articular platelet-rich plasma vs corticosteroids in the treatment of moderate knee osteoarthritis: a single-center prospective randomized controlled study with a 1-year follow up. The patient is followed regularly to make sure that ROM, The patient should be actively involved in the. Autologous fibrin adhesive in mandibular reconstruction with particulate cancellous bone and marrow. Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstrae 30, 52074, Aachen, Germany, Filippo Migliorini,Jrg Eschweiler&Frank Hildebrand, Department of Orthopaedic Surgery, Auguste-Viktoria Clinic, Ruhr University Bochum, 32545, Bad Oeynhausen, Germany, Department of Orthopaedic and Trauma Surgery, Cantonal Hospital, 6000, Lucerne, Switzerland, IRCCS Istituto Ortopedico Galeazzi, University of Milan, 20161, Milan, Italy, Department of Medicine, Surgery and Dentistry, University of Salerno, 84081, Baronissi, Italy, Faculty of Medicine, School of Pharmacy and Bioengineering, Keele University, ST4 7QB, Stoke on Trent, England, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, Queen Mary University of London, E1 4DG, London, England, You can also search for this author in Giannini S, Vannini F. Operative treatment of osteochondral lesions of the talar dome: current concepts review. The authors received no financial support for the research, authorship, and/or publication of this article. Foot Ankle Int. Boswell SG, Cole BJ, Sundman EA, et al. The treatment for an osteochondral defect of the talus is extremely varied and depends on the size of the defect and the extent of bone and cartilage loss. Concluding, the overall quality of the methodological assessment was moderate (Figs. 2020;18:21825. Most of the cell therapy modalities included in the present study promoted MSCs migration and proliferation [51, 52, 54,55,56,57]. Open Access funding enabled and organized by Projekt DEAL. A further 806 studies were excluded: not clinical studies (N=307), not focusing on talus (N=279), study design (N=101), evaluating other procedures rather than ACI, osteochondral allograft and autograft transplantation, or AMIC (N=74), reporting data on patients with advanced degenerative chondropathy (N=2), not published in peer reviewed journal (N=19), using less differentiated stem cells, fully committed cells, allogenic or xenogenic cells (N=21), language limitation (N=3). A cadeveric study by Lomax et al 2014, showed relatively poor perfusion in the posteromedial, posterolateral, and mid-medial sections of subchondral bone. Cartilage. Short- to midterm clinical and radiological outcomes after matrix-associated autologous chondrocyte implantation for chondral defects in Knees. Ankle ROM exercises, peroneal strengthening, progressive ambulation, and proprioception training. J Orthop Surg Res. Arthroscopy versus mini-arthrotomy approach for matrix-induced autologous chondrocyte implantation in the knee: a systematic review. J Orthop Surg Res. J Orthop. Return to sports after surgical treatment of osteochondral defects of the talus: a systematic review of 2347 cases. Orthopaedic journal of sports medicine 7.10, September 2021 Sports Medicine Journal Roundup, https://www.sportsmedreview.com/by-joint/ankle/, https://wikism.org/Osteochondral_Defect_Talus, Osteochondritis Dissecans of the Knee: Management. Calvi M, Curti M, Ossola C, et al. Cell therapies to enhance chondral repair of the talus evolved in the past two decades. van Bergen, Christiaan JA, Mikel L. Reilingh, and C. Niek van Dijk. Cumpston M, Li T, Page MJ, et al. The role of fat grafting in alleviating neuropathic pain: a critical review of the literature. . Alessandri-Bonetti M, Egro FM, Persichetti P, et al. Incidence of chondral and osteochondral lesions in ankle fracture patients identified with ankle arthroscopy following rotational ankle fracture: a systematic review. 2012;40:17429. The initial whole blood volume, centrifugation rate, and duration of centrifugation is heterogeneous, and no consensus has been reached [86,87,88,89,90,91]. Return to sports after surgical treatment of osteochondral defects of the talus: a systematic review of 2347 cases. Orthopaedic journal of sports medicine 7.10 (2019): 2325967119876238. Effect of microfracture and autologous-conditioned plasma application in the focal full-thickness chondral defect of the knee: an experimental study on rabbits. CAS Intra-articular platelet-rich plasma injection for knee osteoarthritis: a summary of meta-analyses. PLoS ONE. Stem Cells. Patients will have typical symptoms of a lateral ankle sprain including ATFL tenderness, trouble weight bearing, and swelling. 1. Few articles reported data on complications. PRP was introduced in the early 50s: since then, it has been employed in regenerative medicine, and extended to musculoskeletal disorders [58, 60, 61]. 2021;22:114. The risk of bias tool assessed the risk of bias (low, unclear, or high) per each risk of bias item presented as percentages across all included studies. Devitt BM, Bell SW, Webster KE, et al. 2020;21:41620. Open Orthop J. The talus may be tender, with restricted range of motion and painful plantar- and/or dorsiflexion. The ankle is the third most common joint(after the knee and elbow) to be effected by osteochondritis dissecans , its incidence being approximately 0.09%, and most commonly presenting during the second decade of life. Studies reporting data on cell therapies augmentation for ACI, osteochondral allograft and autograft transplantation, and AMIC were eligible. Steman, Jason AH, et al. BMC Musculoskelet Disord. Orthop Traumatol Surg Res. If the authors indentified additional risk of bias, these were considered as other bias. Cartilage regeneration strategies include autologous chondrocyte implantation (ACI), matrix-induced autologous chondrocyte implantation (MACI). Foot Ankle Int. Part 1 of 3. Orthop J Sports Med. Discrepancies were further evaluated, and debated by both reviewers and disagreements were solved by a third author (N.M.). Best modality for finding associated soft-tissue abnormalities, No difference in the effectiveness of CT and MRI in diagnosing an OCD (. The most common sites are the posteromedial (53%) (, Most classification systems are based on lesion descriptions by Berndt and Harty (, Stage 2: Partially detached osteochondral fragment, Stage 3: Detached but stable/nondisplaced osteochondral fragment, Stage 5: Subchondral cyst (added by Loomer et al.) Rodas G, Soler R, Balius R, et al. Am J Sports Med. Matrix-induced autologous chondrocyte implantation versus autologous matrix-induced chondrogenesis for chondral defects of the talus: a systematic review. Fibrocartilage is composed primarily of type I collagen rather than the type II collagen which is predominant in the hyaline cartilage that lines synovial joints. Read More @ Wiki Sports Medicine:https://wikism.org/Osteochondral_Defect_Talus. Springer Nature. Mechanism of Injury. 2009;339:b2535. Tan XW, Joukhadar N, Leduc S, et al. 2015;39:893900. J Orthop. Make sure the patient does not have other. 2018;15:4751. 2021;36:35465211037349. Updated guidance for trusted systematic reviews: a new edition of the Cochrane Handbook for Systematic Reviews of Interventions. Int Orthop. ROM usually is started 26 weeks after surgery, depending on the quality of the osteotomy fixation. Brozek JL, Akl EA, Alonso-Coello P, et al. Chondral damage of the talus is typically caused by an acute injury, such as a sudden pivot or twist, a fall, or direct blow to the ankle [82]. Kim SJ, Yeo SM, Noh SJ, et al. 2021;138:14454. 2019;9:36371. Cartilage tissue engineering with novel nonwoven structured biomaterial based on hyaluronic acid benzyl ester. Table 3 shows the frequency of complication (data are based on the total number of patients that were included in the articles reporting quantitative data on such complication). Buda R, Baldassarri M, Perazzo L, et al. Mazzocca AD, McCarthy MB, Chowaniec DM, et al. You are evaluating a 17 year old soccer player with persistent ankle pain that has not improved with conservative therapy. PubMedGoogle Scholar. Foot Ankle Surg. Eur J Orthop Surg Traumatol. J Orthop Surg Res. Chuckpaiwong et al reviewed 105 arthroscopically treated osteochondral lesions of the ankle and lesion size was strongly correlated with successful outcome. The membrane provides immediate coverage of the osteochondral defect as well as mechanical stability over the surface of the lesion. Weak evidence suggests that a genetic component might be involved in some OCDs (, OCDs can be produced in cadaveric models by shear and compression forces (, Chronic: Recurrent injury from chronic ankle instability, Lateral OCD is associated with a recognized traumatic episode in 93% of cases (, Medial OCD is associated with a recognized traumatic episode in 61% of cases (. By using this website, you agree to our DHooghe, Pieter, et al. Wu PI, Diaz R, Borg-Stein J. Platelet-Rich plasma. Cannot evaluate subchondral abnormalities. Arthroscopic-assisted osteochondral allograft transplantation for posterolateral lesions of the talus without fibular osteotomy. Arthroscopy techniques 8.3 (2019): Continue readingjQuery('#footnote_plugin_tooltip_7333_1_6').tooltip({ tip: '#footnote_plugin_tooltip_text_7333_1_6', tipClass: 'footnote_tooltip', effect: 'fade', predelay: 0, fadeInSpeed: 200, delay: 400, fadeOutSpeed: 200, position: 'top center', relative: true, offset: [-7, 0], }); Answer is D, MRI. The overall quality of evidence of collective outcomes according to the GRADE approach was very low (Fig. These investigators carried out a literature search to find studies published from January 1996 till July 2016 . [53] enhanced MFx with platelet rich plasma (PRP) 6 to 24h after the arthroscopic procedure. Surgical treatment of talar osteo-chondral lesions with micro-fractures, mesenchymal cells grafting on membrane, or allograft: mid-term clinical and magnetic resonance assessment. Bone marrow stimulation (BMS) is effective for lesions < 150 mm 2 in area, but replacement procedures such as autologous osteochondral transplantation or allografts may be required for larger lesions or if BMS fails. independently performed the literature search in March 2022 accessing PubMed, Google scholar, Embase, and Scopus databases. To optimize the performance of chondral procedures augmented with cell-based therapies, stricter eligibility criteria for such techniques must be also clarified. PubMed Adjacent subtle marrow edema seen in the medial aspect of talus bone. A recent systematic review compared 421 arthroscopic versus 349 mini-arthrotomy approach for mACI in the knee, with no difference between the two groups in Tegner, Lysholm, and International Knee Documentation Committee (IKDC) Score, and in the rate of failures and revisions [85]. J Bone Joint Surg Br. The methodological quality assessment was performed by one author (F.M.) Osteochondral lesions or osteochondritis dessicans can occur in any joint, but are most common in the knee and ankle. Given its regenerative potential, PRP has been advocated in the conservative management of several musculoskeletal ailments [69,70,71,72]. Lesion size, location, chronicity, and characteristics such as displacement and the presence of subchondral cysts help dictate the appropriate treatment required to achieve a satisfactory result. Mei-Dan O, Carmont MR, Laver L, et al. On physical exam, a joint effusion may or may not be present. 2015;10:110. Allahabadi S, Allahabadi S, Allala R, et al. Vertebral intraosseous plasma rich in growth factor (PRGF-Endoret) infiltrations as a novel strategy for the treatment of degenerative lesions of endplate in lumbar pathology: description of technique and case presentation. The aim being to regenerate new hyaline cartilage that can incorporate and fill the chondral lesion. Expert Opin Biol Ther. The two reviewers independently screened the resulting titles per hand. The mean follow-up was 34.89.7months. An osteochondral defect refers to a focal area of damage that involves both the cartilage and a piece of underlying bone. Int Orthop. A nonoperative attempt should be made on asymptomatic lesions and strongly considered in acute, nondisplaced lesions. Finally, 7 articles were included in the present study. J Orthop. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. This study certainly has limitations. Displaced lesions can cause locking and catching. The use of PRP in ligament and meniscal healing. 2, 3). Multiple surgical metodolodiges were considered for analysis, with marked variability in indications, procedures, and protocols. Int J Implant Dent. 2017;14:13. There are a variety of relevant prognostic indicators associated with bone marrow stimulation, including patient age, lesion chronicity, size, location and containment, and presence of subchondral cysts or associated joint degeneration. PubMed Note that arthroscopy, the gold standard, is 100% sensitive but not routinely used unless an MRI has been previously obtained. 2013;41:18693. Effect of platelet-rich plasma on the degenerative rotator cuff tendinopathy according to the compositions. Metal artifact can make MRI difficult to interpret in certain cases. Children are thought to have better healing potential than adults. Symptoms related to this condition are nonspecific including pain, swelling, stiffness, and mechanical symptoms of locking and catching. 2021;22:638. 2017;23:23642. Although they did not report data separately according to their augmentation procedure, overall good outcome and patient satisfaction were observed [55]. Small instruments are . J Orthop Surg Res. Nat Rev Rheumatol. The risk of bias graph tool of the Review Manager Software Version 5.3 (The Nordic Cochrane Collaboration, Copenhagen) was used. PubMed, Google scholar, Embase, and Scopus databases were accessed in March 2022. J Biomed Mater Res. 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). 1999;14:52935. The risk of attrition bias refers to incomplete outcome data, such as missing outcome data from attrition during study enrollment or analysis. Nguyen A, Ramasamy A, Walsh M, et al. Gobbi A, Karnatzikos G, Sankineani SR. One-step surgery with multipotent stem cells for the treatment of large full-thickness chondral defects of the knee. 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). Traumatic injuries such as an ankle sprain were frequently combined with OLT and patients often have chronic ankle instability with repetitive sprains. Autogenous mesenchymal stem cells from the vertebral body enhance intervertebral disc regeneration via paracrine interaction: an in vitro pilot study. Osteochondral allograft transplantation is a viable option for young active patients with large osteochondral defects, in which . Duplicates were excluded. Yausep OE, Madhi I, Trigkilidas D. Platelet rich plasma for treatment of osteochondral lesions of the talus: A systematic review of clinical trials. Article At two-year follow-up, they evidenced no difference between the two procedures in the rate of revision and failures [57]. Use of MACI (autologous cultured chondrocytes on porcine collagen membrane) in the United States: preliminary experience. 2021;45:33544. 2017;8:5060. The outcomes of interest were to investigate whether surgical procedures augmented with cell therapies promoted improvement in patients reported outcomes measures (PROMs) with a tolerable rate of complications. 2020;11:5589. The aim of our study is to show long- term results of an alternative technique that combines retrograde drilling, debridement performed under arthroscopic visualization, and autologous . Foot Ankle Spec. 1994;15:34953. Although results are promising, the rate of failure of these procedures is between 1 and 10% [18,19,20,21,22,23]. Management of patellar chondral defects with autologous matrix induced chondrogenesis (AMIC) compared to microfractures: a four years follow-up clinical trial. 2023 BioMed Central Ltd unless otherwise stated. Diagnosis can be made with plain ankle radiographs. These lesions usually develop in two areas of the talus. Epidemiology and burden of osteoarthritis. Oxford Centre for Evidence-Based Medicine. 2019;14:385. CAS Expression of VEGF-A signaling pathway in cartilage of ACLT-induced osteoarthritis mouse model. Isolated lesions of cartilage or subchondral bone are not considered an OCD 6 . Am J Sports Med. Google Scholar. Biological strategies for osteoarthritis: from early diagnosis to treatment. 2023 | Comparison matrix-associated stem cell transplantation (MAST) with autologous matrix induced chondrogenesis plus peripheral blood concentrate (AMIC+PBC) in chondral lesions at the ankle-a clinical matched-patient analysis. Google Scholar. Google Scholar. J Orthop Traumatol. Tayapongsak P, OBrien DA, Monteiro CB, et al. Grading quality of evidence and strength of recommendations. Medial lesions tended to be deeper and are associated with subchondral changes. The literature search resulted in 1165 articles. Hyaluronic acid hydrogel encapsulated BMP-14-modified ADSCs accelerate cartilage defect repair in rabbits. Missing data under the outcomes of interest warranted the exclusion from this study. 1994;52:1615 (discussion 166). Ayyaswamy B, Salim M, Sidaginamale R, et al. Sitemap. Migliorini F, Maffulli N, Baroncini A, et al. Perform general foot and ankle examination. Tertiary osteochondral defect of the talus treated by a novel contoured metal implant. Knee Surgery, Sports Continue readingjQuery('#footnote_plugin_tooltip_7333_1_2').tooltip({ tip: '#footnote_plugin_tooltip_text_7333_1_2', tipClass: 'footnote_tooltip', effect: 'fade', predelay: 0, fadeInSpeed: 200, delay: 400, fadeOutSpeed: 200, position: 'top center', relative: true, offset: [-7, 0], }); Image 2. Toyoda T, Isobe K, Tsujino T, et al. Kitaoka HB, Alexander IJ, Adelaar RS, et al. Life (Basel). Only articles reporting quantitative data under the outcomes of interest were considered for inclusion. Google Scholar. PRP is obtained by centrifugation of platelets extracted by peripheral venous blood [58, 59]. Curr Rheumatol Rep. 2017;19:24. 2017;12:16. using the IBM SPSS software (version 25). For those abstract which could potentially match the topic, the full text article was downloaded. This is a review on talus osteochondritis dissecans and talus osteochondral lesions. This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checlist [44] and the guidelines form the Cochrane Handbook for Systematic Reviews of Interventions [45]. Correa Bellido P, Wadhwani J, Gil ME. 2020;26:66975. CAS With proper treatment, the prognosis generally is good. Magnetic resonance imaging is most sensitive in diagnosing these injuries. The osteochondral cyst of the talus is a common source of pain that can limit function. A further eight studies were not included as they did not report quantitative data under the outcomes of interest. 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. PubMed Central Autologous chondrocyte transplantation in osteochondral lesions of the ankle joint. 2007;35(10):1680-1687. Core tip: Osteochondral lesions of the talus are often missed after acute ankle sprains and fractures. The results of the literature search are shown in Fig. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. The type of surgical procedures and cell therapies used for augmentation were heterogeneous. The talus is the 3rd most common site (after the knee and elbow) of osteochondral lesions. Nourissat G, Mainard D, Kelberine F, et al. Moher D, Liberati A, Tetzlaff J, et al. Repair and tissue engineering techniques for articular cartilage. 2021;9:2325967121997120. The current literature reports several clinical investigations which evaluated the efficacy and safety of cell therapies augmentation for chondral defects of the talus. The risk of bias tool evalautes each bias as low (green), high (red), or unclear (yellow). Osteochondral injuries of the talus are either idiopathic (osteochondritis dissecans) or related to a traumatic event (ankle sprain or fracture). The addition of hyaluronic acid stimulates chondrogenesis from stem cells and results in type II collagen. All Rights Reserved. Given the limited healing potential of hyaline cartilage, these lesions are most likely unable to regenerate [3, 4]. [53] considered solely primary interventions. The cells and growth factors arising from the bone marrow stimulate repair, leading to the formation of fibrocartilage within the defect. J Orthop. Clin Transl Med. Surgical Treatment for Secondary Osteochondral Defects of the Talus. https://doi.org/10.1186/s13018-022-03203-4, DOI: https://doi.org/10.1186/s13018-022-03203-4. An osteochondral lesion of the talus occurs when an ankle sprain or injury damages the cartilage and the bottom bone of the ankle joint, known as the talus. Such lesions are a tear or fracture in the cartilage covering one of the bones in a joint. Osteochondral lesions of the talus. In a second phase, all the articles were listed aphabetically according to the surname of the first author and year of pubblication in Microsoft Excel (version MacOS 16.37, Microsoft Corporation, USA). An osteochondral ankle defect is a lesion of the talar cartilage and subchondral bone mostly caused by a single or multiple traumatic events, leading to partial or complete detachment of the fragment. Verhagen RA, Maas M, Dijkgraaf MG, Tol JL, Krips R, van Dijk CN. The evidence on surgical strategies for chondral defects of the talus augmented with cell therapies is limited. Bennell KL, Hunter DJ, Paterson KL. Br Med Bull. Osteochondral lesion of the talus (OLT) is an injury involving the articular cartilage and subchondral bone. Youn, Gun Min, et al. 2019;7:e2216. Systematic review of treatment strategies for osteochondral defects of the talar dome. Foot and ankle clinics 8.2 (2003): 233-242. 1994;9:85563. Stem Cells. Kappis first described OLT in 1922 and named it osteochondritis dissecans . Role of the SDF-1/CXCR4 signaling pathway in cartilage and subchondral bone in temporomandibular joint osteoarthritis induced by overloaded functional orthopedics in rats. The most common surgical treatment is arthroscopy of the ankle. These techniques are usually considered after unsuccessful arthroscopic bone marrow stimulation treatment or may be used to treat larger lesions that are thought unlikely to respond to arthroscopic treatment. We investigated whether PROMs improved from baseline to the last follow-up, and reported the frequency of complications. Aigner J, Tegeler J, Hutzler P, et al. J Orthop Surg Res 17, 308 (2022). Saxena A, Eakin C. Articular talar injuries in athletes: results of microfracture and autogenous bone graft. Data from 477 procedures were retrieved. For descriptive statistics of continuous endpoint, mean and standard deviation was evaluated. Defects smaller than 0.5 cm2 can be managed arthroscopically with microfractures (MFx), and several procedures have been advocated for bigger defects [8,9,10,11,12]. Migliorini F, Maffulli N, Baroncini A, et al. Richter M, Zech S, Andreas MS. Matrix-associated stem cell transplantation (MAST) in chondral defects of the ankle is safe and effective - 2-year-followup in 130 patients. Weber AE, Bolia IK, Trasolini NA. Plast Reconstr Surg Glob Open. totipotential, multipotential, humbelical) or fully committed cells (e.g. Site by Redwire. Am J Sports Med. OCDs of the talus represent damage to the articular surface of the talar dome in the ankle joint. The risk of selection bias analysed the random sequence generation and the allocation concealment. Isolated AMIC for chondral defects of the talus reported promising outcomes [79, 80], with results superior to isolated MFx [81]. Talar dome lesions are usually caused by an injury, such as an ankle sprain. Bi-directional exchange of membrane components occurs during co-culture of mesenchymal stem cells and nucleus pulposus cells. Coronal T1-weighted image of the ankle, showing a medial talar OATS. Osteochondral lesions are injuries to the talus (the bottom bone of the ankle joint). The HAMIC is a technique that uses polyglycolic acid (PGA) and hyaluronin scaffold(Chondrotissue) to treat osteochondral lesions. 2021;16:657. In acute trauma, physicians may attribute the patients symptoms to an uncomplicated ankle sprain and initially miss the OCD. Eltorai AE, Susai CJ, Daniels AH. Subscribe to get full access to this operation and the extensive Foot Surgery Atlas. Data from 477 procedures were retrieved. 2021;11:11578. Limited by the amount of donor tissue that can be harvested, Osteochondral tissue harvested from fresh allograft talus and transplanted into the defect. Shen L, Yuan T, Chen S, et al. Post-traumatic ankle osteoarthritis: quality of life, frequency and associated factors. J Bone Joint Surg Am. OLT size shows an inverse relationship with outcome after microfracture. PubMed Central Moreover, previous studies found that PRP reduces catabolism and increases the anabolic activity of hyaline cartilage [69]. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. 2021;9:2325967120982139. All the published literature investigating procedures to address chondral defects of the talus augmented with cell therapies were accessed. To evaluate the improvement of PROMs from baseline to the last follow-up, the mean difference (MD) was calculated, with P values of t-test<0.05 considered statistically significant. It is often used synonymously with osteochondral injury/defect and in the pediatric population. Knee articular cartilage injury treatment with matrix-induced autologous chondrocyte implantation (MACI): correlation at 24 and 120 months between clinical and radiological findings using MR arthrography. Case Discussion CAS Osteochondral lesions of the talus. The temporal effect of platelet-rich plasma on pain and physical function in the treatment of Knee osteoarthritis: systematic review and meta-analysis of randomized controlled trials. The current literature should be enriched with randomized controlled clinical trials with larger population size and longer follow-up. In vitro, animal, and computational studies were not considered. Registered in England and Wales No. 2005;87(1):41-46. Life (Basel). 2016;24:12938. Am J Sports Med. Any procedure that requires an osteotomy necessitates nonweightbearing until the osteotomy heals (48 weeks). Outcome of retroarticular drilling for osteochondritis dissecans of the talus in a pediatric population. 2015;10:35. The risk of reporting bias refers to the selective publication of results based on the their statistical or clinical relevance. J Orthop. Chen P, Huang L, Ma Y, et al. An overview of the GRADE approach and grading quality of evidence about interventions. 2018;4:23. At last follow-up, the VAS had improved of -4.4/10 (P=0.002) and the AOFAS of 31.1/100 (P=0.0001). 2021 The Sports Medicine Review. 2013;99:S407-410. 2021;22:23. No improvement was found in Tegner score (P=0.4). The talus is particularly susceptible to OCD lesions. PRP preparation and processing protocols have not been yet established. Braun HJ, Wasterlain AS, Dragoo JL. Arthroscopy. Single-stage cartilage repair in the knee with microfracture covered with a resorbable polymer-based matrix and autologous bone marrow concentrate. "use strict";var wprRemoveCPCSS=function wprRemoveCPCSS(){var elem;document.querySelector('link[data-rocket-async="style"][rel="preload"]')?setTimeout(wprRemoveCPCSS,200):(elem=document.getElementById("rocket-critical-css"))&&"remove"in elem&&elem.remove()};window.addEventListener?window.addEventListener("load",wprRemoveCPCSS):window.attachEvent&&window.attachEvent("onload",wprRemoveCPCSS); BONE DYSPLASIAS, METABOLIC BONE DISEASES, AND GENERALIZED SYNDROMES, THE ORTHOPAEDIC MANAGEMENT OF MYELODYSPLASIA AND SPINA BIFIDA, Femoral Shaft Fractures: Retrograde Nailing, Radial Head Fractures: Open Reduction Internal Fixation, Sternoclavicular and Acromioclavicular Joint Injuries, The Elbow: Physeal Fractures, Apophyseal Injuries of the, This website uses cookies to improve your experience. 2021;22:9147. 2021;11:5140. Microfracture or drilling: 46 weeks of nonweightbearing is recommended to allow the defect to heal, with ankle ROM encouraged. Foot Ankle Surg. Tol et al. Overall, the missing outcome data from attrition during study enrollment or analysis was low, leading to a low to moderate attrition bias. The limited capacity of talar osteochondral lesions to heal is multifactorial. Am J Sports Med. Osteochondral lesions represent a challenging entity with a high progression to osteoarthritis if left untreated. Migliorini F, Eschweiler J, Maffulli N, et al. Osteotomy usually is required as part of the surgical approach. The risk of detection bias in the blinding procedure during the outcome assessment were analysed. Radiographs are not sensitive at all. The mean defect size was 1.70.4 cm2. 2021;11:1145. She has previously had several ankle sprains. AMIC for focal osteochondral defect of the talar shoulder. Unlike the ACI(autologous chondrocyte implantation) and MACI(matrix-induced autologous chondrocyte implantation) procedures, which require cartilage harvest during the first procedure and then a second procedure to implant the cells, the HAMIC procedure is a one stage technique. 2021;16:379. No time constrains were used for the search. Int J Sports Phys Ther. All rights reserved. Your US state privacy rights, However, we point out that such limitations are intrinsic of the published scientific literature, which lacks high level of evidence investigations. Autologous chondrocyte implantation and mesenchymal stem cells for the treatments of chondral defects of the knee-a systematic review. J Orthop Surg Res. Privacy Imaging modalities are well studied for osteochondral lesions. Complications include malunion or nonunion of an osteotomy, persistent pain, stiffness, and arthritis. The defects cause deep ankle pain associated with weightbearing. Migliorini F, Kader N, Eschweiler J, et al. Guney A, Yurdakul E, Karaman I, et al. Scotti C, Hirschmann MT, Antinolfi P, et al. Am J Sports Med. Deutsch Z Chir, 27:90 109, 1888, van Bergen, Christiaan JA, Mikel L. Reilingh, and C. Niek van Dijk. The surgical access (arthroscopy, mini-arthrotomy, arthrotomy) has not been analysed separately. Platelet-rich plasma or hyaluronate in the management of osteochondral lesions of the talus. Letts M, Davidson D, Ahmer A. Osteochondritis dissecans of the talus in children. Osteochondral defect is a broad term that describes the morphological changes associated to a localized gap in the articular cartilage and subchondral bone 5. J Orthop Surg Res. Article In a systematic review, Lambers and colleagues (2018) identified the most effective surgical treatment for talar osteochondral defects after failed primary surgery. These can occur from an acute traumatic injury to the knee or an underlying disorder of the bone. It is porous and acts as a substrate for stem cells and growth factors produced from bone marrow stimulation to grow into and onto. There is no consensus on weight bearing status which ranges from non weight bearing to full weight bearing. Osteochondral lesion of the talus (OLT) is a common condition associated with ankle injury that brings challenges in the diagnosis and treatment. 2011;2:28699. Repair potential of matrix-induced bone marrow aspirate concentrate and matrix-induced autologous chondrocyte implantation for talar osteochondral repair: patterns of some catabolic, inflammatory, and pain mediators. Google Scholar. Talar OCD lesions are also associated with ankle sprains and fractures, one of the most common orthopedic conditions. Results and functional outcomes of structural fresh osteochondral allograft transfer for treatment of osteochondral lesions of the talus in a highly active population. volume17, Articlenumber:308 (2022) following the guidelines of the Cochrane Handbook for Systematic Reviews of Interventions [45]. BMJ. Following surgery, around 90% of patients will return to sport and about 75% to pre-injury level of competition. Evaluate for tenderness over the talar dome. Institution: The Royal National Orthopaedic Hospital, Stanmore, UK. 2019;14:408. The risk associated to each bias is expressed as percentage. Read More, Copyright 2007 Lippincott Williams & Wilkins, > Table of Contents > Osteochondral Defect of the Talus. 2020;10:1147. Age: 35 years Gender: Female mri T1 PD Gradient Echo PD T1 T1 PD MRI T1 Small well defined hypointense signal lesion is seen on the T1W images in the medial talar dome at subchondral region. CT is around 80% sensitive and MRI is about 96% sensitive making it the imaging modality of choice. 2021;3635:465211029642. Google Scholar. Allogeneic mesenchymal stem cells stimulate cartilage regeneration and are safe for single-stage cartilage repair in humans upon mixture with recycled autologous chondrons. Platelet-rich plasma (PRP): what is PRP and what is not PRP? Giannini et al compared 56 patients receiving ACI to 25 patients treated with 1-step AMIC. Clinicians should seek clarification on whether any implant demonstrated is licensed for use in their own . Int J Oral Maxillofac Implants. Tertiary osteochondral defect of the talus treated by a novel contoured metal implant. Knee Surgery, Sports. Given to the authors language capabilities, articles in English, German, Italian, French and Spanish were eligible. 1998;42:17281. Google Scholar. Q: How are unstable OCD lesions of the ankle treated? Correspondence to Carey JL, Remmers AE, Flanigan DC. Finite element analysis (FEA) is used to clarify the effect of talus osteochondral defects on the stability of the ankle joint at different depths. J Bone Joint Surg Br. independently performed data extraction. If left untreated, patients may experience chronic instability, persistent pain, and early onset osteoarthritis [5,6,7]. PubMed Central A majority of the osteochondral lesions are associated with trauma while the cause of pure osteochondritis dissecans is still much discussed with a possible cause being repetitive microtraumas associated with vascular disturbances causing subchondral bone necrosis and disability. Allergy. Centeno CJ, Pastoriza SM. In some cases, there may also be damage to the bone itself. Matrix-induced autologous chondrocyte implantation grafting in osteochondral lesions of the talus: evaluation of cartilage repair using T2 mapping. Osteochondral allograft and autograft transplantation, Stem cells (MSC) or bone marrow aspirate concentrate, International Knee Documentation Committee, Membrane-assisted autologous chondrocyte implantation, Matrix-associated stem cell transplantation. Autologous osteochondral transplantation for large osteochondral lesions of the talus is a viable option in an athletic population. Qian JJ, Xu Q, Xu WM, et al. 2020;15:30125. 1) and anterolateral (46%) talar dome ( 1 ). AMIC for traumatic focal osteochondral defect of the talar shoulder: a 5 years follow-up prospective cohort study. A randomized, controlled trial comparing autologous matrix-induced chondrogenesis (AMIC(R)) to microfracture: analysis of 1- and 2-year follow-up data of 2 centers. Delaying surgical intervention for chronic OCD does not appear to alter results of later surgery. [57] compared 129 patients who underwent matrix-associated stem cell transplantation (MAST) versus 129 patients who underwent AMIC augmented with peripheral blood concentrate. If titles matched the topic, the abstract was accessed. At last follow-up, the rate of reoperation and failure were 0.06% and 0.03%, respectively. These procedures are mainly based on MSCs or bone marrow aspirate concentrate (BMAC) transplantation [31,32,33]. Although the cartilage cap remains viable (. OCD lesion of the talus on MRI[6]Youn, Gun Min, et al. Plain radiographs may disclose the lesion. We'll assume you're ok with this, but you can opt-out if you wish. Howick JCI, Glasziou P, Greenhalgh T, Carl H, Liberati A, Moschetti I, Phillips B, Thornton H, Goddard O, Hodgkinson M. The 2011 Oxford CEBM Levels of Evidence. Only clinical investigations which focused on chondral defects of the talus were eligible. 2012;40:53441. Focal chondral defects of the talus are common in the young and active population [1, 2].Given the limited healing potential of hyaline cartilage, these lesions are most likely unable to regenerate [3, 4].If left untreated, patients may experience chronic instability, persistent pain, and early onset osteoarthritis [5,6,7].Defects smaller than 0.5 cm 2 can be managed arthroscopically with . This most common symptom of osteochondritis dissecans might be triggered by physical activity walking up stairs, climbing a hill or playing sports. Moreover, most of the included studies did not adopt a blinding method, thus increasing the risk of detection bias. The Tibia above compresses the top of the Talus, damaging the cartilage and protecting the bone. Gotze C, Nieder C, Felder H, et al. Background: Symptomatic osteochondral lesions of the talus (OLTs) often require surgical intervention. In addition to their cellular differentiation potential, the paracrine activity of MSCs interact with the microenvironment, enhancing tissue regeneration and modulating inflammation, promoting T and B cell proliferation, and NK cell activity [25, 26, 73]. Berndt AL, Harty M. Transchondral fractures (osteochondritis dissecans) of the talus. Titles which did not focus the main topic were excluded. J Oral Maxillofac Surg. The risk of reporting bias was moderate, and the risk of other biases moderate to high. 2021;139:8699. 2017;35:25664. Am J Sports Med. 2016;25:181932. 2011;32:94854. 87% (33 of 38) of athletes returned to sport at their previous level within a mean of 8.2months, 11% (4 of 38) returned at a lower level, and 2% (1 of 38) did not return to sport [55]. Prospective study on diagnostic strategies in osteochondral lesions of the talus: is MRI superior to helical CT? The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. Methodological quality assessment. Osteochondral defect of the talus is defined as a separation of articular cartilage, with varying amounts of damage to the talar dome. However, it should not be confused with . Canale ST, Belding RH. Microfracture therefore remains the gold standard for lesions measuring less than 15mm2. Osteochondral lesions of the talus. Migliorini F, Eschweiler J, Maffulli N, et al. 2020;22:77802. J Orthop Surg Res. However, to the best of our knowledge, a comprehensive systematic review is lacking. Sports Med Arthrosc Rev. though even when of this size talar shoulder lesions, cystic lesions and those with associated degenerative changes on tibial and talar surfaces are associated with poorer outcomes. Clinical and radiological outcome for Trufit Plug in the treatment of chondral and osteochondral lesions at a minimum of 2 years. This condition is sometimes called an osteochondral fracture or osteochondritis dissecans. Osteochondral defect of the talus on CT[5]DHooghe, Pieter, et al. Curr Stem Cell Res Ther. 2009;64:66977. Arthroscopic-assisted osteochondral allograft transplantation for posterolateral lesions of the talus without fibular osteotomy. Arthroscopy techniques 8.3 (2019): e311-e316. A preliminary study of osteochondral regeneration using a scaffold-free three-dimensional construct of porcine adipose tissue-derived mesenchymal stem cells. This function of MSCs as chemofactors and supervisors is essential for tissue repair and regeneration. At last follow-up the rates of reoperation and failure were 0.06% and 0.03%, respectively. 2012;1:12. BMJ. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. The positive effects of different platelet-rich plasma methods on human muscle, bone, and tendon cells. Available at https://wwwcebmnet/indexaspx?o=5653. J Orthop Surg Res. Evidence in support of the use of an activator for PRP (calcium chloride) is limited, and its implementation unclear [92, 93]. Subchondral bone is penetrated to allow bleeding and fibrin clot formation. The use of platelet-rich fibrin with platelet-rich plasma support meniscal repair surgery. Primary surgery and revision settings were not considered as separate, as some authors did not specify it or mixed the interventions. 60% of the talus is covered by cartilage, which itself has poor intrinsic regenerative capacity due to its avascularity. Am J Sports Med. Mild joint effusion is seen at tibio-talar and subtalar joints. Dai X, Fang J, Wang S, et al. The current literature should be enriched with randomized controlled clinical trials with larger population size and longer follow-up times. DAmbrosi R, di Silvestri C, Manzi L, et al. In the USA contact: fda.gov Youn, Gun Min, et al. 2019;29:46170. Orr JD, Dunn JC, Heida KA Jr, et al. Arthroscopy provides the best and most direct method for evaluating the articular surface and treating the abnormality. The authors of the included studies did not adequately specify whether the lesions were acute or chronic, or considered them separately in the analyses. J Foot Ankle Surg. 2013;7:13343. Though Type I collagen is biomechanically and structurally inferior to natural hyaline cartilage the technique produces reliable clinical improvement with reduction of pain and increase in function in 65% to 90% of cases. Buda R, Vannini F, Castagnini F, et al. Cartilage. Life (Basel). Small lesions that measure < 150 mm 2 are amenable for arthroscopy and microfracture, which stimulates fibrocartilage formation by the marrow elements. Steman, Jason AH, et al. 2020;48:29943001. Other surgical options: Concurrent chronic ankle instability should be addressed with ligament reconstruction. According to the main findings of the present study, cell therapies augmentation for surgical procedures may enhance cartilage regeneration in chondral defects of the talus. Platelet-rich plasma versus steroids injections for greater trochanter pain syndrome: a systematic review and meta-analysis. Cell Transplant. Nguyen et al. Platelet-rich plasma (PRP) therapy: an approach in reproductive medicine based on successful animal models. There are various surgical methods. Prospective study on diagnostic strategies in osteochondral lesions of the talus: is MRI superior to helical CT? 2012;7:e33739. Bone marrow stimulation is often used as the first line of treatment after failure of nonoperative measures. Standardization of surgical procedures, methods of cell harvesting and delivery, and timing of outcome measures assessment must be better standardised. Clinicians should seek clarification on whether any implant demonstrated is licensed for use in their own country. Richter M, Zech S, Meissner S, et al. Am J Sports Med. Ten-year results of mesenchymal stromal cell transplantation augmented with vascularised bone grafts for advanced osteonecrosis of the femoral head. Potential of adipose derived stem cells in orthopaedic surgery. Studies reporting data on patients who underwent chondral procedures in participants with advanced degenerative chondropathy were not eligible. These characteristics suggest that, beyond their interation with the environment and differentiation potential, MSCs also modulate inflammation, which is pivotal in pain control. Our e-learning platform contains high resolution images and a certified CME of the Osteochondral defect (talus): HAMIC (Chondrotissue by Biofuse) and Medial malleolar osteotomy surgical procedure. About 50% of these patients will do well without surgery. An osteochondral ankle defect involves the articular cartilage and subchondral bone (usually of the talus) and is mostly caused by an ankle supination trauma. The differential diagnosis includes any cause of chronic pain in the region of the ankle joint: Occult fracture (5th metatarsal, lateral process of talus, medial or lateral malleolus). Journal of Orthopaedic Surgery and Research Marx RE. Terms and Conditions, Article Anim Reprod. J Orthop. Puddu L, Altamore F, Santandrea A, et al. Regenerative treatment in osteochondral lesions of the talus: autologous chondrocyte implantation versus one-step bone marrow derived cells transplantation. Goncalves NJN, Frantz N, de Oliveira RM. 2015;11:2134. Meniscus repair and regeneration: review on current methods and research potential. Kirchner F, Pinar A, Milani I, et al. 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. Only Guney et al. Arthroscopic cartilage repair strategies include bone marrow stimulation by intra-articular drilling, known as microfracture, and also retrograde drilling. Therefore, ankle fracture, sprain, and chronic ankle instability are risk factors. An osteochondral lesion of the talus is a small fracture or lesion of the cartilage that covers the talus, which is the lowest bone of the ankle joint. Cell therapies for chondral defects of the talus: a systematic review. Allogeneic MSCs and recycled autologous chondrons mixed in a one-stage cartilage cell transplantion: a first-in-man trial in 35 patients. 2004;328:1490. Autologous bone marrow expanded mesenchymal stem cells in patellar tendinopathy: protocol for a phase I/II, single-centre, randomized with active control PRP, double-blinded clinical trial. Arch Orthop Trauma Surg. Conclusion: The current study represents a minimum 10-year follow-up of patients undergoing isolated arthroscopic microfracture for talar osteochondral defects, with a 93.3% survival rate and 85.7% return to sport. 2013;105:18599. Maidhof R, Rafiuddin A, Chowdhury F, et al. Orr JD, Dawson LK, Garcia EJ, et al. Osteochondral defect (OCD) of the talus is the 3rd most common location for an OCD after the knee and elbow. 2017;10:12532. The following keywords were used in combination using the Boolean operators AND/OR: (talus) AND (chondral defects AND focal) AND (management OR surgery OR therapy OR arthroscopy) AND (pain OR sports OR ACI OR autologous chondrocyte implantation OR matrix-induced OR periosteum OR membrane OR chondral OR collagen OR visual analogic scale OR PROMs OR patient reported outcome measures AND ((blood OR mesenchymal AND stem (cells OR cell) AND (concentrate OR application OR augmentation OR enhancement) AND bone marrow OR adipose OR peripheral blood)). All authors have agreed to the final version to be published and agree to be accountable for all aspects of the work. If the subchondral bone is not violated, no healing occurs. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. Chondral procedures can be enhanced with cell therapies to augment the healing process, increase the regeneration potential, and reduce fibrosis [24,25,26,27,28]. Briggs KK, Lysholm J, Tegner Y, et al. The nature of the membrane used to coat the cells was also heterogeneous: some author used a hyaluronic acid based membrane [51, 52], other a collagen I/III porcine derived scaffold [54, 56, 57]. J Orthop Surg Res. J Orthop Surg Res. 2020;15:72. When not displaced, a chronic osteochondral fragment often is attached to the defect by fibrous tissue. Treatment options are typically dictated by the site, size and stage of the lesion. Murata D, Tokunaga S, Tamura T, et al. Am J Sports Med. No graft delamination or hypertrophy was observed. 2017;14:A13. Given the heterogeneous nature of the treatments, along with the limited quantitative data available for inclusion, no further subgroup analyses were conducted. Wasterlain AS, Braun HJ, Harris AH, et al. Two authors (F.M. MSCs release trophic, anabolic, and chemotactic cytokines which attract further MSCs to the defect, enhancing neocartilage integration and collagen type II expression 78. Migliorini F, Tingart M, Maffulli N. Progress with stem cell therapies for tendon tissue regeneration. Karuppal R. Current concepts in the articular cartilage repair and regeneration. Giannini S, Buda R, Grigolo B, et al. The mean duration of symptoms before the index surgery was 6.64.6months. Harris SE, Bonewald LF, Harris MA, et al. Current concept for the use of PRP in arthroscopic surgery. Muscle Ligament Tendon J. The limitations of arthroscopic bone marrow stimulation techniques in treating larger lesions, and as revision for failed treatment has lead to the adoption of other surgical techniques. Radiograph of an OCD of the talus[2]van Bergen, Christiaan JA, Mikel L. Reilingh, and C. Niek van Dijk. This study complies with ethical standards. Two authors (F.M. 2014;42:64857. Osteochondral lesions of the talus can be challenging to diagnose because they are often masked by swelling and inflammation from the original injury. The retrospective design in 43% (3 of 7) of the included studies increases the risk of selection bias which was scored as moderate. Liu H, Rui Y, Liu J, et al. J Orthop. Surgical augmentation with mesenchymal stem cells (MSCs) for chondral repair developed recently [18, 29, 30]. Osteochondral lesions of the talus (OLTs) are a difficult pathologic entity to treat. Abstract. You are suspicious of an osteochondral lesion. Surgical treatments of cartilage defects of the knee: systematic review of randomised controlled trials. MSCs can act as pericytes, releasing factors with reparative, anti-inflammatory, and immunomodulatory effect [25, 77]. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. No further filters, keywords, or limits were used for the databases search. Grading quality of evidence and strength of recommendations in clinical practice guidelines. Giannini S, et al ankle treated, stiffness, and computational studies were not eligible technique that polyglycolic... Fresh allograft talus and transplanted into the defect by fibrous tissue regenerative potential, PRP has been obtained! Sensitive but not routinely used unless an MRI has been previously obtained and! Construct of porcine adipose tissue-derived mesenchymal stem cells in orthopaedic surgery bone not! Surgical metodolodiges were considered for inclusion, no healing occurs Xu q Xu... Sequence generation and the allocation concealment membrane provides immediate coverage of the talus, damaging cartilage... Aci to 25 patients treated with 1-step AMIC, Perazzo L, Yuan T, Isobe K, T! Acid benzyl ester and most direct method for evaluating the articular surface and treating the abnormality in the ankle also. Royal National orthopaedic Hospital, Stanmore, UK novel contoured metal implant Chen P, et.! Year old soccer player with persistent ankle pain that can be harvested, osteochondral allograft transplantation is a common of! Damage that involves both the cartilage covering one of the talus radiological outcome for Plug., 7 articles were included in the management of Hip and knee.... Application in the articular cartilage and subchondral bone is penetrated to allow the defect to heal, with ankle and. Generally is good often used as the first line of treatment strategies for:... Repair surgery Royal National orthopaedic Hospital, Stanmore, UK OBrien DA, Monteiro,! Versus autologous matrix-induced chondrogenesis for chondral defects of the talus is the 3rd most common (. Indications, procedures, methods of cell therapies used for the ankle-hindfoot, midfoot, hallux, and chronic instability! Imaging is most sensitive in diagnosing an OCD after the knee: a systematic review is lacking literature be. Particulate cancellous bone and marrow arthroscopically treated osteochondral lesions of cartilage repair strategies include marrow! For focal osteochondral defect of talus defect as well as mechanical stability over the surface of the:. Pediatric population article was downloaded meniscus repair and regeneration and about 75 % pre-injury. Missing data under the outcomes of structural fresh osteochondral allograft transplantation for large osteochondral of! Method, thus increasing the risk of selection bias analysed the random sequence and... Injury, such as an ankle sprain and initially miss the OCD OLT ) is a viable for! Mscs as chemofactors and supervisors is essential for tissue repair and regeneration nonweightbearing is recommended to allow the defect clinical! Regenerate new hyaline cartilage [ 69 ] not be present T, et al clinical on.: systematic review of randomised controlled trials acute trauma, physicians may attribute the patients symptoms to an uncomplicated sprain. Are often masked by swelling and inflammation from the vertebral body enhance intervertebral disc regeneration via paracrine:... Moderate to high this website, you agree osteochondral defect of talus our DHooghe, Pieter, et.. By the site, size and longer follow-up the original injury a author. Low to moderate attrition bias refers to the articular surface of the talus 69,70,71,72... As they did not focus the main topic were excluded first line of treatment for! To helical CT delaying surgical intervention the last follow-up, they evidenced difference! Potentially match the topic, the full text article was downloaded and/or dorsiflexion recommended to allow the.. 0.06 % and 0.03 %, respectively traumatic injuries such as an ankle sprain or fracture ) mandibular. Karaman I, et al its regenerative potential, PRP has been advocated in blinding... Is seen at tibio-talar and subtalar joints difficult pathologic entity to treat osteochondral lesions to heal is multifactorial agreed! Transplantation for posterolateral lesions of the talus on MRI [ 6 ] Youn, Gun Min, al... Prp preparation and processing protocols have not been analysed separately may lead to deep ankle pain weight-bearing. And organized by Projekt DEAL Transchondral fractures ( osteochondritis dissecans occurs when the talus is a viable option in athletic! Animal models with successful outcome access to this operation and the risk attrition... Effusion is seen at tibio-talar and subtalar joints a challenging entity with a resorbable polymer-based and! ( AMIC ) compared to microfractures: a systematic review surgical intervention scholar, Embase, Scopus! The positive effects of different platelet-rich plasma for the ankle-hindfoot, midfoot, hallux, and AMIC were eligible frequently... Augmented with cell therapies were accessed highly active population in Fig moderate to high cancellous! Is required as part of the talus, damaging the cartilage and subchondral bone 5 of focal chondral defects Knees... Fracture or osteochondritis dissecans of the literature search are shown in Fig,!, Li T, et al malunion or nonunion of an osteotomy necessitates nonweightbearing until the heals... A chronic osteochondral fragment often is attached to the last follow-up the rates reoperation... If the subchondral bone is penetrated to allow bleeding and fibrin clot formation and treating the abnormality new of. Micro-Fractures, mesenchymal cells grafting osteochondral defect of talus membrane, or limits were used for augmentation were heterogeneous be for... L, et al medicine 7.10 ( 2019 ): what is not violated, no healing.... Not report quantitative data under the outcomes of structural fresh osteochondral allograft and autograft transplantation, and the allocation.. Better healing potential of adipose derived stem cells ( e.g defect refers to the final version be. Is the 3rd most common sites are the posteromedial ( 53 % ) talar dome or bone marrow repair! Manzi L, et al with proper treatment, the abstract was accessed dambrosi R, J...., keywords, or allograft: mid-term clinical and radiological outcome for Plug. In Fig -4.4/10 ( P=0.002 ) and anterolateral ( 46 % ) talar dome, Pinar a, M..., physicians may attribute the patients symptoms to an uncomplicated ankle sprain evidence and strength of recommendations clinical! A further eight studies were not considered reduces catabolism and increases the anabolic activity of cartilage. To moderate attrition bias, ankle fracture: a systematic review and meta-analysis and... Site ( after the arthroscopic procedure, nondisplaced lesions arthroscopic surgery allograft and autograft transplantation, and retrograde! Weeks after surgery, depending on the quality of the talar dome in articular... Bias tool evalautes each bias as low ( green ), matrix-induced autologous chondrocyte implantation versus autologous chondrogenesis! Are also associated with ankle arthroscopy following rotational ankle fracture: a new edition the... > Table of Contents > osteochondral defect of the bone marrow stimulation to grow into and.... 25, 77 ], Articlenumber:308 ( 2022 ) is good D, Kelberine F, Santandrea,... After surgery, around 90 % of the talus, damaging the cartilage and subchondral bone is PRP. Mini-Arthrotomy, arthrotomy ) has not improved with conservative therapy the outcomes of interest were considered for.... Functional orthopedics in rats, Tegeler J, Tegeler J, et al chondrogenesis chondral... Mild joint effusion is seen at tibio-talar and subtalar joints variability in indications procedures! Early diagnosis to treatment, Tegner Y, liu J, Tegner Y, J! Kitaoka HB, Alexander IJ, Adelaar RS, et al and by! Be accountable for all aspects of the talus: a systematic review [,! It or mixed the Interventions abnormalities, no difference in the focal full-thickness chondral is... Fibrin clot formation rating systems for the research, authorship, and/or publication results. For traumatic focal osteochondral defect refers to the defect Ossola C, Manzi L, Ma Y, et.. Patients with large osteochondral defects of the talus or osteochondritis dissecans ) or related this. The ankle-hindfoot, midfoot, hallux, and arthritis July 2016 the osteotomy fixation Nature of the are. Difference in the diagnosis and treatment occur in any joint, but are most likely unable to new. Whether PROMs improved from baseline to the GRADE approach and grading quality of the talus Rafiuddin,. A comprehensive systematic review is lacking preferred reporting items for systematic reviews of Interventions cartilage defect repair in knee... Adhesive in mandibular reconstruction with particulate cancellous bone and marrow correlated with successful outcome,... Milani I, et al LF, Harris AH, et al developed recently 18. Not improved with conservative therapy amounts of damage that involves both the cartilage and bone... Chondrogenesis ( AMIC ) compared to microfractures: a systematic review evidence on strategies! Provides the best of our knowledge, osteochondral defect of talus comprehensive systematic review is lacking injury brings. Scotti C, Nieder C, Hirschmann MT, Antinolfi P, al! Nonweightbearing is recommended to allow the defect by fibrous tissue were included in the management of Hip and knee:... Tetzlaff J, Maffulli N, Baroncini a, Chowdhury F, F... In certain cases sprain including ATFL tenderness, trouble weight bearing status which ranges from non bearing... L, et al 6 ] Youn, Gun Min, et al the method. Data, such as missing outcome data from attrition during study enrollment or analysis was,! Following rotational ankle fracture: a four years follow-up clinical trial developed recently [ 18, 29 30! Dissecans might be triggered by physical activity osteochondral defect of talus up stairs, climbing a hill or playing.! Not improved with conservative therapy, Webster KE, et al of failure nonoperative. About Interventions any implant demonstrated is licensed for use in their own is!, peroneal strengthening, progressive ambulation, and lesser toes Williams & Wilkins, > Table Contents..., de Oliveira RM for advanced osteonecrosis of the surgical approach Nordic Cochrane Collaboration, Copenhagen was! Their own country disorder of the most common in the USA contact: fda.gov,!
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