Osteochondral Allograft transplantation for knee lesions after failure of cartilage repair surgery. of 30 patients comparing intra-articular injection of PRP and HA concluded that both PRP and HA resulted in improved function and decreased pain that maintained for at least 6 months. They reported favorable outcomes with 86% of patients having no pain or only mild pain, no advancement of MRI staging in 84% of patients, and no significant ankle arthritis at final follow-up, though many patients reported minor discomfort on activities of daily living and sporting activities. Methods: The study included 28 patients (17 males, 11 females; mean age 30.3 years; range 22-55 years) who had osteochondral lesions of the talus and were treated by arthroscopic surgery. The mean lesion size for microfracture was 3.4 cm 2, which is larger than the indicated size for this procedure. doi: 10.1136/bmjopen-2019-033850. Despite the advantages, the reported failure rate is 40% with lesions of area >125 mm2 and male sex associated with significantly higher risk of clinical failure. [22], Injection therapy alone with PRP or HA has also been attempted in the treatment of OLT. If structured rehabilitation is unsuccessful, then … [Diagnosis and treatment of osteochondral lesions of the talus]. 2016. [51], This technique combines microfracture with either autologous iliac crest bone marrow aspirate concentrate (BMAC) or PRP secured to the defect using a collagen scaffold/fibrin glue in a single stage [Figure 3]. Chahla et al. They highlighted the heterogeneity of the data and suggested the need for high-quality prospective randomized studies using validated outcome measures for clarity regarding the effective modalities of treatment for OLT.[50]. Initial x-rays are taken to check the alignment of the foot and ankle, as well as look for any bone damage. OCD lesions are also called osteochondritis dissecans or osteochondral fractures. Clinical Outcomes of Osteochondral Lesions of the Talus With Large Subchondral Cysts Treated With Osteotomy and Autologous Chondral Grafts: Minimum 2-Year Follow-up and Second-Look Evaluation. 2002;23:381–389. Osteochondral transplantation of autologous graft for the treatment of osteochondral lesions of talus: 5- to 7-year follow-up. Al-Shaikh RA, Chou LB, Mann JA, et al. After a longer follow-up, some patients showed that the beneficial results were not maintained, indicating the deterioration of the … Among the OLT, up to 94% of the lateral lesions are said to be secondary to trauma while only 62% of medial lesions are post-traumatic. Lesions with large cystic areas, diffuse arthritic changes, ankle malalignment, and prior history of infections are contraindications to this procedure. Foot Ankle Spec. These authors evaluate the effectiveness of procedures such as microfracture and arthroscopy, and recent innovations such as … The knee and the ankle joint are the most commonly involved joints for OCLs in the lower extremity. This is a relatively newer technique that employs transfer of particulated juvenile cartilage pieces with their native extracellular matrix harvested from deceased donors aged from newborns to 13 years. Osteochondral lesions of the talus are injuries to the cartilage in the bone inside the ankle joint. Plain radiography is the initial investigation of choice in a clinically suspected case of OLT. We use cookies to ensure that we give you the best experience on our website. Allograft juvenile articular cartilage transplantation for treatment of talus osteochondral defects. complications: a systematic review. IN) to treat patellar lesion. [46] As cartilage tissue is immune deprived, it is also not associated with immune reactions. doi: 10.12659/MSM.921823. © Copyright 2020 – Journal of Arthroscopic Surgery and Sports Medicine – All rights reserved.Published by Scientific Scholar on behalf of Indian Arthroscopy Society. Berndt and Harty classification is the staging system that is widely employed for describing OLT on plain radiographs. [] This is a broad terminology that encompasses a variety of disorders including osteochondritis dissecans, osteochondral fractures, and osteochondral defects. 2020 Jul;14(2):64-71. doi: 10.5704/MOJ.2007.014. 1,2 Researchers have reported an occurrence of up to an astounding 73 percent in ankle fracture cases … The cost-per-point change in functional outcome score was $200.59 for MFx, $313.84 for OAT, and $536.59 for ACI-1. High-impact activities, such as running and jumping, should be avoided until 6 to 12 months after surgery. Arthroscopic microfracture is the most frequently performed procedure for an osteochondral lesion of the talus (OLT) [1,2,3,4]. Abstract: The objective of this study was to assess the outcome of osteochondral allograft (OCA) transplantation as a salvage procedure after various cartilage repair surgeries. In this video, I discuss the types of surgery and how you might recover from those surgeries. COVID-19 is an emerging, rapidly evolving situation. described the classifications of OLT based on CT and MRI, respectively. All of the bones are a complex group of living organs that are composed of multiple cells, protein fibers and a range of minerals. Cystic lesions require curettage and penetration of the calcified wall of the cyst. reported a reoperation rate of 25% with development of moderate or severe ankle arthritic changes, pain due to hardware-related complications, graft collapse, and non-union/delayed union at osteotomy site as reasons for reoperation with a failure rate of 13.2%. USA.gov. -, Baums MH, Heidrich G, Schultz W, et al. 32 … Awareness of current national guidelines is important in the appropriate consenting of patients undergoing surgery. Foot Ankle Int. [28], The prognostic factors that determine the success of microfracture are listed in [Table 3]. In both studies magnetic resonance imaging (MRI) was performed prior to open reduction and internal fixation (ORIF). [28] Despite these findings, microfracture still seems to be resulting in good functional outcomes. BMJ Open. doi: 10.2106/JBJS.E.00033. This joint permits much of the up (dorsiflexion) and down (plantarflexion) motion of the foot and ankle. [29] Return to sports rate after microfracture is reported to be 76%, though most patients may not be able to achieve the pre-injury level. Surgical treatment of transchondral talar-dome fractures (osteochondritis dissecans). Systematic review of treatment strategies for osteochondral defects of the talar dome. These lesions pose a diagnostic challenge to the attending clinician due to lack of specific clinical signs and lack in consensus regarding treatment makes the management aspect controversial. concluded OATS to be an effective treatment strategy even for large OLT with MOCART scoring showing good structural integrity of the graft at mean follow-up of 24.8 months and good functional outcomes irrespective of a prior microfracture or concomitant procedure. Because MRI may overdiagnose or overestimate the … There is limited understanding of cartilage damage and its repair. 2013 Jun 5;95(11):1045-54. doi: 10.2106/JBJS.L.00773. [17,18] Arthroscopy remains the gold standard as it allows direct visualization, probing of the lesion to assess the stability of the overlying cartilage and also accurately assess the extent of the lesion. Availability of fresh donor allografts and the associated cost is also a concern in developing countries. Foot Ankle Clin. [2,39] Flynn et al. Rationale of conservative treatment is to offload the affected area for resolution of bone marrow edema and to facilitate healing of the detached cartilage. 1999;15:197–202. Guney et al. Seven studies described the results of non-operative treatment, 4 of excision, 13 of excision and curettage, 18 of excision, curettage and bone marrow stimulation (BMS), 4 of an autogenous bone graft, 2 of transmalleolar drilling (TMD), 9 of osteochondral transplantation (OATS), 4 of autologous chondrocyte implantation (ACI), 3 of retrograde drilling and 1 of fixation. Finite Element Analysis of the Effect of Talar Osteochondral Defects of Different Depths on Ankle Joint Stability. J ISAKOS. Osteochondral lesions are caused by trauma, osteochondritis dissecans (OCD), or osteonecrosis. [23] A level-II randomized study conducted by Mei-Dan et al. Anders et al. Commonly, multiple cylinders have to … The diagnosis of cartilage damage (osteochondral lesion, also known as talar dome) is often done with x-rays and/or an MRI. By the mosaicplasly technique, osteochondral grafts are transplanted from areas of little weight bearing at the outer limits of the trochlca to the focal lesion in the same knee. Box 22660, 1100 DD, ... 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. Limited, Coimbatore, Tamil Nadu, Department of Orthopedics and Spine surgery. The etiology of osteochondral lesions of the talus is frequently attributed to ankle trauma but these lesions can also stem from alcohol abuse, chronic steroid use, endocrine abnormalities or genetics. in their study of 165 consecutive ankles with OLT demonstrated good functional outcomes and improved quality of life in patients at 6.7 years of follow-up. Arthroscopic debridement is recommended as the initial intervention, unless primary fixation of a loose osteochondral lesion is required. Osteochondral lesions of the talus (OLT) are those that affect the chondral and subchondral areas of the talus. J Bone Joint Surg Am. that included four studies concluded that PRP used in conjunction with microfracture results in better pain and functional improvement than microfracture alone. Once the piece has broken off, surgery is almost always necessary. transplantation surgery fo r osteochondral lesions. OLT encompass a wide variety of disorders that are both difficult to diagnose and also to treat with varying functional outcomes. In some rare cases, osteochondral lesions can occur for no apparent reason. [16] Ferkel et al. The procedure has a low morbidity and complication rate and low cost and is technically undemanding. Together with the newer techniques OATS and ACI, BMS was identified as an effective treatment strategy for OCD of the talus. The key cost driver is the cost of the graft, but over the lifetime horizon, there are QALYs gained from using OCA, and there are cost savings later due to fewer people needing a TKA in the OCA arm. in 1986. There was a significantly lower cost for return to play in athletes after OAT versus microfracture at 1 year ($11,428 vs $16,953, respectively), 3 years ($12,856 vs $38,000, respectively), and 10 years ($32,141 vs $60,799, respectively). Patient age for all such options is a significant restrictive factor since transplanted cells and marrow cells tend to lose regenerative potential … Knee Surg Sports Traumatol Arthrosc. Les lésions du cartilage articulaire du genou sont fréquentes. 2020 Feb 9;10(2):e033850. MRI is the most sensitive imaging for OLT with a sensitivity of 96%. [19] Commonly used classifications are summarized in [Table 1]. Osteochondral lesions are most common in the knee joint, and the ankle is the next most frequent joint affected. Arthroscopic surgery is sometimes referred to as “keyhole surgery” as it is performed through very small incisions. This may cause complications of the donor site and the ankle. Because MRI may overdiagnose or overestimate the extent of OCLs in an acute trauma setting the aim of this study was … 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. A review was performed of 30 athletes with 31 OLTs that were refractory to marrow stimulation or … [6] Kouvalchouk et al. of the talus but at the cost of a hi gh rate of. [37] Morphological evaluation post-retrograde drilling using second look arthroscopy showed no worsening of overlying cartilage at 1-year follow-up. found PRP as an adjunct to arthroscopic microfracture for the treatment of OLT resulted in improved functional score status at an average follow-up of 16.2 months. 1 Department of Orthopaedic Surgery, Academic Medical Centre, University of Amsterdam, P.O. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms. The aim of this study was to summarize all eligible studies to compare the effectiveness of treatment strategies for osteochondral defects (OCD) of the talus. [48], It is a 2-stage procedure where in hyaline cartilage is harvested either from the neck of the talus or non-weight portion of the knee joint, this cartilage is then cultured to grow chondrocytes which are implanted back to the area of defect and secured using a periosteal flap as a second-stage procedure. 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. Most of the talus is covered by cartilage. in their systematic review of 15 studies with a mean follow-up of 72 months also highlighted surface damage in 76% of patients on follow-up MRI that could be a harbinger for long-term problems. A history of ankle trauma/recurrent instability is to be elicited as OLT are associated with ankle instability. This consists of particles of live cartilage that enable the surgeon to truly lay down the best quality cartilage. Diagram shows the classic four signs of instability in an OCD lesion: 1, high signal intensity rim at the interface between the fragment and the adjacent bone on T2-weighted MR images; 2, fluid-filled cysts beneath the lesion; 3, a high-signal-intensity line extending through the articular cartilage overlying the lesion; and 4, a focal osteochondral defect filled with joint fluid. My question is: For a young man with 13, with the condition that the correct option and including microfracture. [46] This harvested cartilage is then transferred to the area of defect and secured using fibrin glue. Importance Osteochondral autologous transplantation surgery (OATS) is one of many treatment modalities for osteochondral lesions of the talus (OLT). Operative treatment of osteochondral lesions of the talus. 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