[31] The reported incidence of complication rate varies from 0 to 14% with superficial peroneal neuropathy and portal site pain cited as the most common complications. reported good pain relief and function in a prospective study of 10 patients with a long follow-up of 13 years and concluded that MACI should be considered for osteochondral lesions that fail initial microfracture treatment. -, Alexander AH, Lichtman DM. [25,32-36], In OLT with subchondral cysts and intact overlying cartilage, retrograde drilling is a better modality that penetrates the necrosed subchondral bone without disturbing the overlying cartilage. [2], Microfracture is a technique of perforating the subchondral bone to allow the progenitor cells from the bone marrow to infiltrate into the lesion [Figure 2]. A history of ankle trauma/recurrent instability is to be elicited as OLT are associated with ankle instability. 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. OCD lesions are also called osteochondritis dissecans or osteochondral fractures. doi: 10.12659/MSM.921823. 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. 2008 Mar;37(3):204, 206-11. doi: 10.1007/s00132-008-1219-3. Osteochondral allograft reconstruction (OCA) is highly cost-effective [30, 31] but the procedure is limited by the scarcity of fresh grafts and in some countries use is restricted by law [11, 46]. Although it still remains a 2-staged procedure, using a collagen matrix reduces the operative time and also helps in even distribution of chondrocytes. J Bone Joint Surg Am. [26] Furthermore, the quantity and quality of fibrocartilage formed may vary. [53], In summary, outcomes following surgery are variable and thus treatment strategy has to be tailored to every patient depending on specific factors. -, Baums MH, Heidrich G, Schultz W, et al. BMJ Open. High-impact activities, such as running and jumping, should be avoided until 6 to 12 months after surgery. [25] Useful algorithm describing the indication for each procedure is outlined in [Figure 1].  |  [] This is a broad terminology that encompasses a variety of disorders including osteochondritis dissecans, osteochondral fractures, and osteochondral defects. 1999;15:197–202. In this video, I discuss the types of surgery and how you might recover from those surgeries. [28], The prognostic factors that determine the success of microfracture are listed in [Table 3]. Osteochondral defects of the talus (OCD) are a well-established pathology within the ankle. Furthermore, juvenile cartilage has been shown to possess copious cellular activity that results in formation of abundant extracellular matrix than its adult counterpart. [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. This procedure is a single-stage procedure and as it does not require a press fit or graft contouring due to its particulate nature, it can be carried out arthroscopically. However, due to great diversity in the articles and variability in treatment results, no definitive conclusions can be drawn. Surgical treatment options for the management of focal chondral and osteochondral lesions in the knee include biological solutions and focal metal implants. 2013 Jun 5;95(11):1045-54. doi: 10.2106/JBJS.L.00773. Patient’s consent not required as patients identity is not disclosed or compromised. A systematic review of 52 studies including 1236 primary OLT by Dahmen et al. Osteochondral Allograft transplantation for knee lesions after failure of cartilage repair surgery. Ferkel’s grading is the most commonly employed grading system on arthroscopy. Foot Ankle Int. 1,2 Researchers have reported an occurrence of up to an astounding 73 percent in ankle fracture cases … [3] Conservative treatment mainly consists of rest, avoiding sporting activities, cast immobilization with or without NSAIDs, and intraarticular injection of platelet-rich plasma (PRP) and hyaluronic acid (HA). This may cause complications of the donor site and the ankle. Also read: Should you play sports with an OCD lesion in your knee? [] This is a broad terminology that encompasses a variety of disorders including osteochondritis dissecans, osteochondral fractures, and osteochondral defects. Knee Surg Sports Traumatol Arthrosc. This is possible due to less damage to the surrounding skin, ligaments and tendons. [54] to detect the most effective treatment for OLT concluded that none of the interventions were clinically superior over another. 2005;26:583–589. Both non-operative and operative modalities have been described for the treatment of OLT. [50] Kreulen et al. NLM Patients present with spectrum of non-specific complaints including of pain on weight-bearing, swelling, stiffness, and occasionally locking sensation at the ankle joint. Recommended indications include a symptomatic patient with size of the lesion at least 1.5 cm in one dimension or a patient who had a failed marrow stimulation technique. Osteochondral lesions of the talus (OLT) are those that affect the chondral and subchondral areas of the talus. The mosaicplasty technique for osteochondral lesions of the talus. [38], This technique involves harvesting osteochondral plugs from donor sites such as non-weight-bearing portions of the knee and implantation of these plugs to the areas of osteochondral defects. HHS [14] Provocative tests such as anterior drawer test should be performed and compared to the unaffected side to evaluate the associated instability. Good clinical outcome after osteochondral autologous transplantation surgery for osteochondral lesions of the talus but at the cost of a high rate of complications: a systematic review Carlos Ferreira,1 Gwendolyn Vuurberg,2 Joaquim Miguel Oliveira,3,4,5 João Espregueira-Mendes,3,4 Hélder Pereira,3,4,5,1 Rui Luís Reis,3,4 Pedro L Ripoll5 Scranton Type V Osteochondral Defects of Talus: Does one-stage Arthroscopic Debridement, Microfracture and Plasma Rich in Growth Factor cause the Healing of Cyst and Cessation of Progression to Osteoarthritis? 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%. [15] Although it provides good visualization of the cartilage, it tends to overestimate the extent of the subchondral lesion due to the associated marrow edema. [2] Although majority may be associated with trauma, some may develop insidiously. There are a number of treatment options. 6-8 These treatment methods … 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. Les lésions du cartilage articulaire du genou sont fréquentes. The first description of osteocartilaginous loose bodies in the ankle, attributed to trauma, was given by Monro in 1738. [2] The allografts used are either fresh allografts which have to be used within 28 days or fresh frozen allografts with relatively less chondrocyte viability. Surgical treatment of transchondral talar-dome fractures (osteochondritis dissecans). Arthroscopic debridement is recommended as the initial intervention, unless primary fixation of a loose osteochondral lesion is required. Availability of fresh donor allografts and the associated cost is also a concern in developing countries. 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. 2020 Jul 28;8(7):2325967120937798. doi: 10.1177/2325967120937798. [16] Ferkel et al. Introduction. ISSN (Print): AwaitedISSN (Online): 2582-7332, © 2020 Published by Scientific Scholar on behalf of Journal of Arthroscopic Surgery and Sports Medicine, Department of Arthroscopy & Foot and Ankle, Ganga Medical Centre and Hospital Pvt. J Bone Joint Surg Am. [23] As far as BMAC is concerned, varying degrees of beneficial effects have been reported in different studies when used as an adjunct to surgical procedures. Une lésion localisée ou diffuse est ainsi retrouvée chez deux tiers des patients en cas d’exploration arthroscopique d’un genou douloureux.1–4 Les faibles capacités de cicatrisation du cartilage au-delà d’une certaine taille sont expliquées par sa nature avasculaire et les facultés très limitées de régénération des chondrocytes.5–7 Les lésions cartilagineuses sont des facteurs de risque d’arthrose post-traumatique.8,9 De nombreuses technique… [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. Thus, treatment should be individualized to every patient, with adequate counseling regarding the outcomes and associated complications of that technique. [2] Lee et al. Malays Orthop J. [4] In 1922, Kappis extrapolated the concept of spontaneous necrosis at the hip to the etiopathogenesis of foreign bodies in the ankle joint and used the term osteochondritis dissecans. Commonly, multiple cylinders have to … Arthroscopic microfracture is the most frequently performed procedure for an osteochondral lesion of the talus (OLT) [1,2,3,4]. [12] Second, arterial supply to the talar dome and the overlying cartilage is by a retrograde vascular network that comes from the talar neck with additional watershed areas showing poor perfusion in the posteromedial, posterolateral, and mid-medial segments of the subchondral bone. For each treatment strategy, study size weighted success rates were calculated. of the talus but at the cost of a hi gh rate of. An osteochondral cyst can also be present following surgery. 2002;23:381–389. [46] This harvested cartilage is then transferred to the area of defect and secured using fibrin glue. 32 … The skeleton … Current treatment options include minced bone and cartilage paste, 1 mosaicplasty, 2 allogeneic osteochondral transplantation, 3-5 combined bone and chondrocyte transplantation, the so-called sandwich technique, and synthetic osteochondral implants. This is an US FDA approved allograft technique and was first made available in 2007 by DeNovo NT, Natural Tissue Graft (Zimmer, Inc., Warsaw. Verhagen RA, Struijs PA, Bossuyt PM, van Dijk CN. The talus is the bottom bone of the ankle joint. [3] This review aims to elucidate the historical aspect of the disease, etiopathogenesis, classifications, diagnosis, and treatment to assist in day-to-day clinical practice. Bai L, Guan S, Liu S, You T, Xie X, Chen P, Zhang W. Orthop J Sports Med. There are only a few recent studies that have reported the outcomes following non-operative management. Therapeutic arthroscopy with microfracture leads to fibrocartilaginous repair and is an effective treatment of osteochondral lesions of the talus. The next day did MRI scans and X-rays and there was the release of free bone fragment in the knee joint and with apparent origin in the former osteochondral lesion. [47] A recent systematic review on the role of PJCAT in OLT involving 10 studies and 132 patients showed good postoperative functional outcomes, however, the regenerated cartilage was heterogeneous in nature with relatively unaltered subchondral area which is in contrast to the belief that PJCAT would restore the area of defect to near normal cartilage. First, the talar cartilage is relatively thinner with a thickness of 0.7–1.2 mm compared to that of other joints of the lower extremity. [19] Commonly used classifications are summarized in [Table 1]. In some rare cases, osteochondral lesions can occur for no apparent reason. The tibia and fibula bones sit above and to the sides of the talus, forming the ankle joint. 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. 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. [37] Morphological evaluation post-retrograde drilling using second look arthroscopy showed no worsening of overlying cartilage at 1-year follow-up. They are most commonly … Treating osteochondral lesions of the talus can pose challenges and delayed diagnosis due to late presentation after an ankle sprain. described the classifications of OLT based on CT and MRI, respectively. [2,39] Flynn et al. Series shows the case of a 25-years-old man, a sports and physically active patient, with chronic ankle pain, a lateral talus osteochondral lesion (OCL), and chronic ankle instability. in their review of 82 patients reported increase in arthrosis by one grade radiologically though none of the patients had Grade IV arthritis at a minimum follow-up of 5 years. 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. This commonly occurs after an ankle sprain where the two bones hit against each other, causing a piece of cartilage and bone to chip off inside the ankle. [20] Either fixation or excision is recommended for acutely displaced lesions while conservative treatment is the initial treatment indicated for all acute undisplaced lesions and other symptomatic OLT presenting late. INTRODUCTION. A non-shoulder-type lesion is defined as a chondral defect that has surrounding articular cartilage (a contained cartilage defect), whereas a shoulder-type lesion does not have a peripheral cartilage border on one side with the loss of the medial or lateral articular buttress (uncontained defect). Initial x-rays are taken to check the alignment of the foot and ankle, as well as look for any bone damage. Awareness of current national guidelines is important in the appropriate consenting of patients undergoing surgery. Operative treatment of osteochondral lesions of the talus. FIGURE 71-1 Osteochondral lesion of the talus. Actual surgical treatments for osteochondral lesions and early knee osteoarthritis seem to be promising. 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. [28] Despite these findings, microfracture still seems to be resulting in good functional outcomes. Together with the newer techniques OATS and ACI, BMS was identified as an effective treatment strategy for OCD of the talus. Epub 2014 Oct 19. 1 Department of Orthopaedic Surgery, Academic Medical Centre, University of Amsterdam, P.O. The cost-per-point change in functional outcome score was $200.59 for MFx, $313.84 for OAT, and $536.59 for ACI-1. doi: 10.1136/bmjopen-2019-033850. The blood supply to the talus is not as rich as many other bones in the body, and as a result injuries to the talus sometimes are more difficult to heal than similar injuries in other bones. 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