Arthroscopic treatment of osteochondral lesions of the talus

Parisien, J. Serge

doi:10.1177/036354658601400306

Cited by 160 publications

(51 citation statements)

References 16 publications

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“…A recent systematic literature review showed a large degree of similarity in current surgical techniques for microfracture [19], including use of K-wires [2,22,31] or awls [43], removal of unstable cartilage, hole depth between 2 and 4 mm until bleeding or fat droplets occur, and hole spread with a distance of 3 to 4 mm. These recommendations are similar to the originally presented technique by Steadman et al [43].…”

Section: Introductionmentioning

confidence: 99%

No Effect of Hole Geometry in Microfracture for Talar Osteochondral Defects

Kok

Tuijthof

Dunnen

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Débridement and bone marrow stimulation is an effective treatment option for patients with talar osteochondral defects. However, whether surgical factors affect the success of microfracture treatment of talar osteochondral defects is not well characterized. Questions/purposes We hypothesized (1) holes that reach deeper into the bone marrow-filled trabecular bone allow for more hyaline-like repair; and (2) a larger number of holes with a smaller diameter result in more solid integration of the repair tissue, less need for new bone formation, and higher fill of the defect. Methods Talar osteochondral defects that were 6 mm in diameter were drilled bilaterally in 16 goats (32 samples). In eight goats, one defect was treated by drilling six 0.45-mm diameter holes in the defect 2 mm deep; in the remaining eight goats, six 0.45-mm diameter holes were punctured to a depth of 4 mm. All contralateral defects were treated with three 1.1-mm diameter holes 3 mm deep, mimicking the clinical situation, as internal controls. After 24 weeks, histologic analyses were performed using Masson-Goldner/Safranin-O sections scored using a modified O'Driscoll histologic score (scale, 0-22) and analyzed for osteoid deposition. Before histology, repair tissue quality and defect fill were assessed by calculating the Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request. The authors certify that the animal protocol for this investigation was approved by the Academic Medical Center and VU University, Amsterdam, and that all investigations were conducted in conformity with ethical principles of research. The design and creation of surgical templates was performed at TU Delft, Delft, The Netherlands. Animal operations were performed at VU University, Amsterdam, The Netherlands. Histology was performed at ACTA, Amsterdam, The Netherlands. Micro-CT acquisition and analyses were performed at Erasmus MC, Rotterdam, The Netherlands. Analyses were performed at Academic Medical Center, Amsterdam, The Netherlands. Conclusions The results indicate that the geometry of microfracture holes does not influence cartilage healing in the caprine talus. Clinical Relevance Bone marrow stimulation technique does not appear to be improved by changing the depth or diameter of the holes.

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Section: Introductionmentioning

confidence: 99%

No Effect of Hole Geometry in Microfracture for Talar Osteochondral Defects

Kok

Tuijthof

Dunnen

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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“…Treatment included arthroscopic removal of the involved osteochondral segment, curettage and multiple drilling of the base with a Kirschner wire (1.6 mm). 22,23 The more posteriorly located lesions were treated with the ankle in maximum plantar flexion. Final diagnosis.…”

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confidence: 99%

Prospective study on diagnostic strategies in osteochondral lesions of the talus

Verhagen

Maas²,

Dijkgraaf³

et al. 2005

The Journal of Bone and Joint Surgery. British volume

252

156

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Our aim in this prospective study was to determine the best diagnostic method for discriminating between patients with and without osteochondral lesions of the talus, with special relevance to the value of MRI compared with the new technique of multidetector helical CT. We compared the diagnostic value of history, physical examination and standard radiography, a 4 cm heel-rise view, helical CT, MRI, and diagnostic arthroscopy for simultaneous detection or exclusion of osteochondral lesions of the talus. A consecutive series of 103 patients (104 ankles) with chronic ankle pain was included in this study. Of these, 29 with 35 osteochondral lesions were identified. Twenty-seven lesions were located in the talus.Our findings showed that helical CT, MRI and diagnostic arthroscopy were significantly better than history, physical examination and standard radiography for detecting or excluding an osteochondral lesion. Also, MRI and diagnostic arthroscopy performed better than a mortise view with a 4 cm heel-rise. We did not find a statistically significant difference between helical CT and MRI. Diagnostic arthroscopy did not perform better than helical CT and MRI for detecting or excluding an osteochondral lesion.

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“…The osteochondral lesions occur predominantly in the talus with a ratio of occurrences in the tibial plateau to the talar dome of 1 to 20. Most osteochondral lesions are caused by trauma (94 % of lateral lesions and 62 % of medial OCL) [25,28,29]. The symptoms of OCL are unspecific ankle pain and swelling [25,29], often associated with a limitation of dorsal extension.…”

Section: Classification Of Osteochondral Lesionsmentioning

confidence: 99%

Modern Cartilage Imaging of the Ankle

Weber

Wünnemann

Jungmann

et al. 2017

Fortschr Röntgenstr

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ABSTR AC TBackground Talar osteochondral lesions are an important risk factor for the development of talar osteoarthritis. Furthermore, osteochondral lesions might explain persistent ankle pain. Early diagnosis of accompanying chondral defects is important to establish the optimal therapy strategy and thereby delaying or preventing the onset of osteoarthritis. The purpose of this review is to explain modern cartilage imaging with emphasis of MR imaging as well as the discussion of more sophisticated imaging studies like CT-arthrography or functional MR imaging.Methods Pubmed literature search concerning: osteochondral lesions, cartilage damage, ankle joint, talus, 2 D MR imaging, 3 D MR imaging, cartilage MR imaging, CT-arthrography, cartilage repair, microfracture, OATS, MACT.Results and Conclusion Dedicated MR imaging protocols to delineate talar cartilage and the appearance of acute and chronic osteochondral lesions were discussed. Recent developments of MR imaging, such as isotropic 3 D imaging that has a higher signal-to noise ratio when compared to 2 D imaging, and specialized imaging methods such as CT-arthrography as well as functional MR imaging were introduced. Several classifications schemes and imaging findings of osteochondral lesions that influence the conservative or surgical therapy strategy were discussed. MRI enables after surgery the noninvasive assessment of the repair tissue and the success of implantation. Key points▪ Modern MRI allows for highly resolved visualization of the articular cartilage of the ankle joint and of subchondral pathologies. ▪ Recent advances in MRI include 3 D isotropic ankle joint imaging, which deliver higher signal-to-noise ratios of the cartilage and less partial volume artifacts when compared with standard 2 D sequences. ▪ In case of osteochondral lesions MRI is beneficial for assessing the stability of the osteochondral fragment and for this discontinuity of the cartilage layer is an important factor. ▪ CT-arthrography can be used in case of contraindications of MRI and in unclear MRI findings as further diagnostic approach. Citation Format

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Arthroscopic treatment of osteochondral lesions of the talus

Cited by 160 publications

References 16 publications

No Effect of Hole Geometry in Microfracture for Talar Osteochondral Defects

No Effect of Hole Geometry in Microfracture for Talar Osteochondral Defects

Prospective study on diagnostic strategies in osteochondral lesions of the talus

Modern Cartilage Imaging of the Ankle

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