Current Concepts Review Update

Kraeutler, Matthew J.; Chahla, Jorge; Dean, Chase S.; Mitchell, Justin J.; Araujo, Maria Gala Santini; Pinney, Stephen J.; Pascual‐Garrido, Cecilia

doi:10.1177/1071100716677746

Cited by 45 publications

(23 citation statements)

References 91 publications

(149 reference statements)

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“… 6 , 18 However, in patients with full-thickness cartilage lesions and large subchondral cysts, the optimal treatment remains to be determined. 7 , 16 , 24 The large cavity of the debrided cyst may compromise the structural support of the articulation, and the subchondral bone defect may hinder cartilage regeneration. Recent studies 7 , 18 , 24 , 28 have shown that in patients with OLTs associated with large subchondral cysts, structural bone grafting, such as osteochondral autografts/allografts and autologous chondrocyte implantation, may provide good results.…”

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confidence: 99%

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

Bai

Guan

Liu

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: Osteochondral lesions of the talus (OLTs) with large subchondral cysts are challenging to treat. Purpose: To determine the safety and efficacy of autologous chondral grafting and malleolus osteotomy for treating OLTs associated with large subchondral cysts. Study Design: Case series; Level of evidence, 4. Methods: A total of 19 patients underwent autologous chondral grafting and malleolus osteotomy. We obtained the visual analog scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot, and magnetic resonance observation of cartilage repair tissue (MOCART) scores at 1 and 2 years postoperatively. The International Cartilage Repair Society (ICRS) score was collected 2 years postoperatively during second-look arthroscopic surgery. Results: In all patients, the osteotomy site healed without nonunion or malunion. Only 1 patient developed joint space narrowing. No donor site complications occurred. The mean AOFAS score significantly improved at 1 year (from 72.8 ± 4.8 preoperatively to 93.7 ± 4.6; t = –13.708; P < .0001). The 1- and 2-year AOFAS scores were similar ( t = –0.755; P = .455), indicating stable improvement. The mean VAS score significantly decreased at 1 year (from 4.68 ± 0.67 preoperatively to 0.47 ± 0.69; t = 18.974; P < .0001). The 1- and 2-year VAS scores were similar ( t = –0.705; P = .455), as were the 1- and 2-year MOCART scores (64.2 ± 7.5 vs 67.4 ± 7.3, respectively; t = –1.312; P = .198). The ICRS scores were as follows: 7 points (abnormal) in 1 (5.2%) patient, 8 to 11 points (nearly normal) in 9 (47.4%) patients, and 12 points (normal) in 9 (47.4%) patients. Conclusion: Osteotomy combined with autologous osteochondral transplantation provided good functional outcomes in patients with OLTs and large subchondral cysts. Second-look arthroscopic surgery showed healthy cartilage healing.

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confidence: 99%

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

Bai

Guan

Liu

et al. 2020

Orthopaedic Journal of Sports Medicine

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“… 3 However, transplantations involving an autograft may lead to significant donor-site morbidity that has the potential to significantly interfere with daily activity. 1 …”

Section: Discussionmentioning

confidence: 99%

“… 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 Most OLTs are associated with acute trauma to the ankle, such as sprains or fractures, with up to 73% to 81% of ankle fractures resulting in chondral defects. 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 Nontraumatic causes of OLTs include localized ischemia, microtrauma, necrosis, and iatrogenic steroid treatment. 1 , 2 For smaller, asymptomatic lesions, a nonoperative approach with limited physical activity and nonsteroidal anti-inflammatory drugs can be used.…”

mentioning

confidence: 99%

“… 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 Nontraumatic causes of OLTs include localized ischemia, microtrauma, necrosis, and iatrogenic steroid treatment. 1 , 2 For smaller, asymptomatic lesions, a nonoperative approach with limited physical activity and nonsteroidal anti-inflammatory drugs can be used. 2 , 3 However, nonoperative treatment may only temporarily or partially alleviate symptoms because natural cartilage repair is limited owing to the avascular nature of the articular cartilage.…”

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confidence: 99%

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Arthroscopic-Assisted Osteochondral Allograft Transplantation for Posterolateral Lesions of the Talus Without Fibular Osteotomy

Youn¹,

Rosinski²,

Gwosdz³

et al. 2019

Arthroscopy Techniques

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Osteochondral lesions of the talus are chondral defects often caused by acute trauma to the ankle such as sprains and fractures. If operative treatment is necessary, microfracture, cartilage replacement, and autologous chondrocyte implantation can be used. We describe a single-step osteochondral allograft transfer to access the posterolateral talar dome that avoids the need for a fibular osteotomy and therefore eliminates morbidity while reducing operative time.

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“…Podem ocorrer em até 50% dos entorses e fraturas agudas do tornozelo, particularmente em associação com lesões esportivas (1) . Vários procedimentos cirúrgicos têm sido usados para tratar as LOT, como o desbridamento e microfraturas ósseas subcondrais, transferência de autoenxerto osteocondral (OATS) e implantação autóloga de condrócitos (ACI), entre outros (2) . Embora vários estudos relatem resultados pós-operatórios positivos para essas técnicas, elas estão associadas a várias desvantagens (3)(4)(5) .…”

Section: Introductionunclassified

All-arthroscopic AMIC® (AT-AMIC) in the treatment of osteochondral talar lesions

Baumfeld

Prado

et al. 2018

Sci J Foot Ankle

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Objective: The objective of this study was to report the postoperative clinical outcomes of patients undergoing the all-arthroscopic AMIC® technique (AT-AMIC®) combined with autologous bone graft placement as necessary. Methods: This was a case series of 17 consecutive patients who underwent AT-AMIC® between January 2016 and April 2017. Nine men and eight women between 15 and 67 years of age were diagnosed with an osteochondral talar lesion (OTL) and underwent surgery only after failure ofconservative treatment of at least 3 months. Patients answered the AOFAS scale before surgery and at the final follow-up session, which ranged from 8 to 20 months. Results: The mean size of the OTLs was 1.16cm2, and “Raikin-4” was the most common site of lesions (71%). Calcaneal osteotomy was the mostcommonly associated procedure (18%). The mean follow-up period was 12.3 months. The mean AOFAS score before surgery was 46.4 points, rising to 89.5 points at the last follow-up, and this difference was statistically significant (p<0.001). No complications were observed in any of the treated patients. Conclusion: AT-AMIC® is a reliable and reproducible treatment method for OTLs and achieves high postoperative clinical scores with very low complication rates. Level of Evidence IV; Therapeutic Studies; Case Series.

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Current Concepts Review Update

Cited by 45 publications

References 91 publications

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

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

Arthroscopic-Assisted Osteochondral Allograft Transplantation for Posterolateral Lesions of the Talus Without Fibular Osteotomy

All-arthroscopic AMIC® (AT-AMIC) in the treatment of osteochondral talar lesions

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