Advances in Cartilage Repair

Azam, Mohammad T.; Butler, James J.; Duenes, Matthew L.; McAllister, Thomas W.; Walls, Raymond C.; Gianakos, Arianna L.; Kennedy, John G.

doi:10.1016/j.ocl.2022.11.007

Cited by 9 publications

(7 citation statements)

References 56 publications

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“…Lesion size is a critical factor that helps guide management of OLTs [3]. OLTs with an area greater than 100 mm 2 or diameter greater than 10 mm require more extensive replacement procedures due to significant disruption of the osteochondral unit.…”

Section: Discussionmentioning

confidence: 99%

“…OLTs are a difficult to treat pathology primarily due to the limited regenerative capacity of the avascular articular cartilage [3]. This has led to the emergence of innovative treatment strategies that improve the biological milieu at the site of the injured cartilage.…”

Section: Discussionmentioning

confidence: 99%

“…Osteochondral lesions of the talus (OLTs) refers to an injury to the articular talar cartilage and/or underlying subchondral bone, often following a traumatic event [3]. Conservative management often results in poor clinical outcomes, thus, most OLTs require surgical intervention.…”

Section: Introductionmentioning

confidence: 99%

“…Treatment is predicated on numerous factors, the most important of which is lesion size [1,5]. Smaller OLTs (<100 mm 2 or <10 mm in diameter) are treated with reparative procedures such as arthroscopic debridement, bone marrow stimulation (BMS) and augmentation with biological adjuvants such as platelet-rich plasma (PRP) or concentrated bone marrow aspirate (cBMA) [3,20,33,36]. Larger lesions (>100 mm 2 or >10 mm in diameter) entail replacement procedures, including autologous osteochondral transplantation (AOT), osteochondral allograft transplantation, autologous chondrocyte implantation and matrixinduced chondrocyte implantation [13,17,19,23].…”

Section: Introductionmentioning

confidence: 99%

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Particulated juvenile cartilage allograft for the treatment of osteochondral lesions of the talus is associated with a high complication rate and a high failure rate at short‐term follow‐up: A systematic review

Butler,

Rizla,

Egol

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeThe purpose of this systematic review was to evaluate the clinical and radiological outcomes together with the complication rates and failure rates at short‐term follow‐up following particulated juvenile cartilage allograft (PJCA) for the management of osteochondral lesions of the talus (OLT).MethodsDuring October 2023, the PubMed, Embase and Cochrane library databases were systematically reviewed to identify clinical studies examining outcomes following PJCA for the management of OLTs. Data regarding study characteristics, patient demographics, lesion characteristics, subjective clinical outcomes, radiological outcomes, complications and failures were extracted and analysed.ResultsTwelve studies were included. In total, 241 patients underwent PJCA for the treatment of OLT at a weighted mean follow‐up of 29.0 ± 24.9 months. The weighted mean lesion size was 138.3 ± 59.6 mm2. Prior surgical intervention was recorded in seven studies, the most common of which was microfracture (65.9%). The weighted mean American Orthopaedic Foot and Ankle Society score improved from a preoperative score of 58.5 ± 3.2 to a postoperative score of 83.9 ± 5.3. The weighted mean postoperative magnetic resonance observation of cartilage repair tissue (MOCART) score was 48.2 ± 3.3. The complication rate was 25.2%, the most common of which was allograft hypertrophy (13.2%). Thirty failures (12.4%) were observed at a weighted mean time of 9.8 ± 9.6 months following the index procedure.ConclusionThis systematic review demonstrated a moderate improvement in subjective clinical outcomes following PJCA for the treatment of OLT at short term follow‐up. However, postoperative MOCART scores were reported as poor. In addition, a high complication rate (25.2%) and a high failure rate (12.4%) at short‐term follow‐up was observed, calling into question the efficacy of PJCA for the treatment of large OLTs. In light of the available evidence, PJCA for the treatment of large OLTs cannot be currently recommended.Level of EvidenceLevel IV

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Particulated juvenile cartilage allograft for the treatment of osteochondral lesions of the talus is associated with a high complication rate and a high failure rate at short‐term follow‐up: A systematic review

Butler,

Rizla,

Egol

et al. 2024

Knee surg. sports traumatol. arthrosc.

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“…The native articular cartilage lining the talar dome lacks regenerative capacity, primarily due to its avascular nature [4]. In light of the poor regenerative capacity of the native cartilage, novel biological modalities have been developed to augment the biological milieu to provide improved cartilage repair, including plateletrich plasma, concentrated bone marrow aspirate (cBMA), and scaffolds including extracellular matrix cartilage allograft (EMCA) [4].…”

Section: Introductionmentioning

confidence: 99%

Outcomes Following the Use of Extracellular Matrix Cartilage Allograft for the Management of Osteochondral Lesions of the Talus: A Systematic Review

Butler,

Hartman,

Dhilllon

et al. 2024

Cureus

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Extracellular matrix cartilage allograft (EMCA) is a novel biological strategy utilized to augment the repair of osteochondral lesions of the talus (OLTs). However, there is no consensus on the precise role and outcomes following its use in the treatment of OLTs. The purpose of this systematic review was to evaluate the clinical and radiological outcomes following the use of EMCA for the treatment of OLT. During July 2023, the PubMed, Embase, and Cochrane Library databases were systematically reviewed to identify clinical studies examining outcomes following EMCA for the management of OLTs. In total, 162 patients (162 ankles) across five studies received EMCA as part of their surgical procedure at a weighted mean follow-up time of 23.8±4.2 months. Across all five studies, there were improvements in subjective clinical outcomes following the use of EMCA, regardless of the clinical scoring tool utilized. Two studies demonstrated superior postoperative magnetic resonance observation of cartilage repair tissue (MOCART) scores in the EMCA cohort compared to the bone marrow stimulation (BMS) cohort alone. In the EMCA-BMS cohort, there were seven complications (9%) and three failures (4.1%). In the autologous osteochondral transplantation (AOT) cohort, there were 10 complications (38.5%), zero failures, and six secondary surgical procedures (23.1%). In the EMCA alone cohort, there were zero complications and three failures (4.3%), all of which underwent an unspecified revision procedure. This current systematic review demonstrated improvements in both clinical and radiological outcomes following the use of EMCA for the treatment of OLTs. Further prospective comparative studies with longer follow-up times are warranted to determine the precise role of EMCA in the management of OLT.

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