Effects of Early Weightbearing on Microfracture Treatment of Osteochondral Lesions of Talus with Subchondral Bone Defects

Wei, Min; Wang, Yu; Yang, Licong

doi:10.1007/s11596-019-2004-8

Cited by 9 publications

(4 citation statements)

References 25 publications

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“… 28 , 30 However, studies also show that early weightbearing and delayed weightbearing lead to similar healing outcomes after OLT repair. 20 , 34 …”

Section: Discussionmentioning

confidence: 99%

“…28,30 However, studies also show that early weightbearing and delayed weightbearing lead to similar healing outcomes after OLT repair. 20,34 In the current study, the rehabilitation program was based on consensus recommendations, with some modifications. Compared with other studies, 16,23 our rehabilitation training program was designed for earlier exercise and rehabilitation starting from the first day after surgery, including passive ROM exercises and isometric exercises.…”

Section: The Orthopaedic Journal Of Sports Medicinementioning

confidence: 99%

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Outcomes of Single-Stage Versus Staged Treatment of Osteochondral Lesions in Patients With Chronic Lateral Ankle Instability: A Prospective Randomized Study

Wang

Song

Yun

et al. 2022

Orthopaedic Journal of Sports Medicine

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Background: There is controversy about whether treatment of chronic lateral ankle instability (CLAI) with osteochondral lesions of the talus (OLT) can be performed concurrently. Purpose: To investigate the midterm results of arthroscopic treatment of CLAI combined with OLT in different surgical settings. It was hypothesized that the outcomes of treating both injuries at the same time would not be inferior to those of staged surgery. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Included were 103 patients with both CLAI and OLT who underwent arthroscopic microfracture surgery and an open, modified Broström-Gould procedure for ligament repair from January 2015 to December 2016. The patients were assigned randomly to a staged group (51 patients) and a single-stage group (52 patients). The staged group underwent arthroscopic debridement of the OLT and microfracture, then rehabilitation for 4 to 6 months before undergoing modified Broström-Gould ligament repair. The single-stage group underwent both procedures simultaneously. Clinical evaluations were performed on the day before surgery and at 12-month, 24-month, and final follow-up periods using the Karlsson-Peterson score, American Orthopaedic Foot & Ankle Society (AOFAS) score, and pain visual analog scale. The Karlsson-Peterson score at 24 months postoperatively was considered the primary outcome. The predefined noninferiority margin for the primary outcome was −5 points. Results: At the final follow-up, 50 patients in the single-stage group and 48 patients in the staged group completed the study. The median lesion size was 0.72 cm2 (interquartile range [IQR], 0.5-1.12 cm2) in the single-stage group and 0.84 cm2 (IQR, 0.7-1.05 cm2) in the staged group. At 12-month follow-up, the single-stage group had a significantly higher median Karlsson-Peterson score (79 [IQR, 70-85] vs 75 [IQR 65-80] for staged; P = .024) and median AOFAS score (85 [IQR, 76-89] vs 79.5 [IQR, 70-87] for staged; P = .045). At 24-month follow-up, the median difference in the Karlsson-Peterson score for single-stage versus staged surgery was 2 points (95% CI, −2 to 5 points), and the confidence interval was greater than the predefined value. Conclusion: At midterm follow-up, there was no clinical difference between single-stage versus staged surgery to treat CLAI with OLT. Single-stage surgery achieved better clinical outcomes than staged surgery at short-term follow-up.

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“… 28 , 30 However, studies also show that early weightbearing and delayed weightbearing lead to similar healing outcomes after OLT repair. 20 , 34 …”

Section: Discussionmentioning

confidence: 99%

Section: The Orthopaedic Journal Of Sports Medicinementioning

confidence: 99%

Outcomes of Single-Stage Versus Staged Treatment of Osteochondral Lesions in Patients With Chronic Lateral Ankle Instability: A Prospective Randomized Study

Wang

Song

Yun

et al. 2022

Orthopaedic Journal of Sports Medicine

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“…They found through long-term follow-up that immediate postoperative weight bearing has not been shown to result in loss of reduction, hardware failure, or revision surgery for osteolysis. Conversely, maintaining some micromovement of the fracture fragment with firm internal fixation may facilitate the healing process ( 27 ). Controlled axial loading of the fracture site usually results in a larger volume of healing tissue and a faster healing time compared to no loading or excessive early loading.…”

Section: Discussionmentioning

confidence: 99%

When is the optimum time for the initiation of early rehabilitative exercise on the postoperative functional recovery of peri-ankle fractures? A network meta-analysis

2022

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ObjectiveThe purpose of this study was to explore the safe and most effective initiation time for the functional recovery of patients with peri-ankle fractures after surgery.MethodWe searched electronic databases, including the Cochrane Library, Embase, PubMed and the reference lists of relevant articles published from inception to October 30, 2021. Two researchers independently performed literature screening and data extraction and evaluated the quality of the included literature using the Newcastle–Ottawa Scale. Network meta-analysis, including consistency testing, publication bias, and graphical plotting, was performed using Stata (v16.0).ResultsA total of 25 articles involving 1756 patients were included in this study. The results of the meta-analysis showed that functional exercise within 2 days after surgery may result in lower VAS scores compared to other techniques (P < 0.05). Functional exercise within 12 months may lead to higher AOFAS scores than that of other techniques (P < 0.05). The total postoperative complication rate, including deep vein thrombosis, showed no statistically significant differences between any two interventions (P > 0.05). The results of the surface under the cumulative ranking (SUCRA) showed that functional exercise within two days postoperatively may have the lowest VAS scores (SUCRA = 82.8%), functional exercise within 1 week postoperatively may have the lowest deep vein thrombosis rate (SUCRA = 66.8%), functional exercise within 10 days postoperatively may have the fewest total postoperative complication rate (SUCRA = 73.3%) and functional exercise within 12 months postoperatively may contribute to the highest AOFAS scores (SUCRA = 85.5%).ConclusionThe results of this study suggest that initiation of rehabilitation within two days after surgery may be the best time to reduce postoperative pain; rehabilitation interventions within 10 days after surgery may be the optimal time for reducing the total postoperative complication rate, including deep vein thrombosis; and continued functional exercise within 12 months after surgery may steadily and ideally improve the function of the ankle joint.Systematic Review Registration: doi: 10.37766/inplasy2021.12.0030, identifier: INPLASY2021120030

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“…Recent clinical studies have shown that accelerated weightbearing program after a cartilage repair procedure allow for an earlier return to sports without hampering the repair result. 8,9…”

Section: Introductionmentioning

confidence: 99%

Cartilage Repair Capacity within a Single Full-Thickness Chondral Defect in a Porcine Autologous Matrix-Induced Chondrogenesis Model Is Affected by the Location within the Defect

et al. 2021

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Objective Large articular cartilage defects are a challenge to regenerative surgery. Biomaterial scaffolds might provide valuable support for restoration of articulating surface. The performance of a composite biomaterial scaffold was evaluated in a large porcine cartilage defect. Design Cartilage repair capacity of a biomaterial combining recombinant human type III collagen (rhCo) and poly-(l/d)-lactide (PLA) was tested in a porcine model. A full-thickness chondral defect covering the majority of the weightbearing area was inflicted to the medial femoral condyle of the right knee. Spontaneous cartilage repair and nonoperated healthy animals served as controls. The animals were sacrificed after a 4-month follow-up. The repair tissue was evaluated with the International Cartilage Repair Society (ICRS) macroscopic score, ICRS II histological score, and with micro-computed tomography. Additionally, histopathological evaluation of lymph nodes and synovial samples were done for toxicological analyses. Results The lateral half of the cartilage defect in the operated groups showed better filling than the medial half. The mean overall macroscopic score for the rhCo-PLA, spontaneous, and nonoperated groups were 5.96 ± 0.33, 4.63 ± 0.42, and 10.98 ± 0.35, respectively. The overall histological appearance of the specimens was predominantly hyaline cartilage in 3 of 9 samples of the rhCo-PLA group, 2 of 8 of the spontaneous group, and 9 of 9 of the nonoperated group. Conclusions The use of rhCo-PLA scaffold did not differ from spontaneous healing. The repair was affected by the spatial properties within the defect, as the lateral part of the defect showed better repair than the medial part, probably due to different weightbearing conditions.

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Effects of Early Weightbearing on Microfracture Treatment of Osteochondral Lesions of Talus with Subchondral Bone Defects

Cited by 9 publications

References 25 publications

Outcomes of Single-Stage Versus Staged Treatment of Osteochondral Lesions in Patients With Chronic Lateral Ankle Instability: A Prospective Randomized Study

Outcomes of Single-Stage Versus Staged Treatment of Osteochondral Lesions in Patients With Chronic Lateral Ankle Instability: A Prospective Randomized Study

When is the optimum time for the initiation of early rehabilitative exercise on the postoperative functional recovery of peri-ankle fractures? A network meta-analysis

Cartilage Repair Capacity within a Single Full-Thickness Chondral Defect in a Porcine Autologous Matrix-Induced Chondrogenesis Model Is Affected by the Location within the Defect

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