Lift, drill, fill and fix (LDFF): a new arthroscopic treatment for talar osteochondral defects

Kerkhoffs, Gino M. M. J.; Reilingh, Mikel L.; Gerards, Rogier M.; Leeuw, Peter A. J. de

doi:10.1007/s00167-014-3057-7

Cited by 68 publications

(62 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A possible future direction for such a promising treatment strategy is the internal fixation surgeries. In small patient series, these have been shown to induce a significant clinical improvement, possibly because these aim at preserving hyaline cartilage [56, 58]. …”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

No superior treatment for primary osteochondral defects of the talus

Dahmen

Lambers

Reilingh

et al. 2017

Knee Surg Sports Traumatol Arthrosc

144

131

View full text Add to dashboard Cite

PurposeThe purpose of this systematic literature review is to detect the most effective treatment option for primary talar osteochondral defects in adults.MethodsA literature search was performed to identify studies published from January 1996 to February 2017 using PubMed (MEDLINE), EMBASE, CDSR, DARE, and CENTRAL. Two authors separately and independently screened the search results and conducted the quality assessment using the Newcastle–Ottawa Scale. Subsequently, success rates per separate study were calculated. Studies methodologically eligible for a simplified pooling method were combined.ResultsFifty-two studies with 1236 primary talar osteochondral defects were included of which forty-one studies were retrospective and eleven prospective. Two randomised controlled trials (RCTs) were identified. Heterogeneity concerning methodological nature was observed, and there was variety in reported success rates. A simplified pooling method performed for eleven retrospective case series including 317 ankles in the bone marrow stimulation group yielded a success rate of 82% [CI 78–86%]. For seven retrospective case series investigating an osteochondral autograft transfer system or an osteoperiosteal cylinder graft insertion with in total 78 included ankles the pooled success rate was calculated to be 77% [CI 66–85%].ConclusionsFor primary talar osteochondral defects, none of the treatment options showed any superiority over others.Level of evidenceIV.

show abstract

Section: Discussionmentioning

confidence: 99%

“…The general consensus is that bone marrow stimulation (BMS) is administered for primary smaller defects. Other surgical options are internal fixation, osteochondral autograft transfer systems (OATS), chondrocyte implantation, retrograde drilling, metal resurfacing, total ankle prostheses or arthrodesis [44, 56, 124]. …”

Section: Introductionmentioning

confidence: 99%

No superior treatment for primary osteochondral defects of the talus

Dahmen

Lambers

Reilingh

et al. 2017

Knee Surg Sports Traumatol Arthrosc

144

131

View full text Add to dashboard Cite

show abstract

“…At 8 weeks postoperatively, the cast was removed. Physical therapy was prescribed to assist in functional recovery and extend to full weight bearing in approximately 2 weeks [7]. …”

Section: Methodsmentioning

confidence: 99%

The subchondral bone healing after fixation of an osteochondral talar defect is superior in comparison with microfracture

Reilingh

Lambers

Dahmen

et al. 2017

Knee Surg Sports Traumatol Arthrosc

View full text Add to dashboard Cite

PurposeArthroscopic bone marrow stimulation (BMS) has been considered the primary surgical treatment for osteochondral defects (OCDs) of the talus. However, fixation has been considered as a good alternative. Recently, a new arthroscopic fixation technique was described: the lift, drill, fill and fix procedure (LDFF). The purpose of this study was to evaluate the clinical and radiological results between arthroscopic LDFF and arthroscopic BMS in primary fixable talar OCDs at 1-year follow-up.MethodsIn a prospective comparative study, 14 patients were treated with arthroscopic BMS and 14 patients with arthroscopic LDFF. Pre- and postoperative clinical assessment included the American Orthopaedic Foot and Ankle Society (AOFAS) score and the numeric rating scales (NRSs) of pain at rest and running. Additionally, the level of the subchondral plate (flush or depressed) was analysed on the 1 year postoperative computed tomography scans.ResultsNo significant differences in the AOFAS and NRS pain at rest and running were found between both groups at 1-year follow-up. After LDFF the level of the subchondral bone plate was flush in 10 patients and after BMS in three patients (p = 0.02).ConclusionNo clinical differences were found between arthroscopic LDFF and arthroscopic BMS in the treatment of talar OCDs at 1-year follow-up. However, the subchondral bone plate restores significantly superior after arthroscopic LDFF compared to arthroscopic BMS. It may therefore give less progression of ankle osteoarthritis in the future with a thus potential better long-term outcome.Level of evidenceIII.

show abstract

“…For small primary defects, common first-line surgical management options consist of (arthroscopic) bone marrow stimulation and retrograde drilling [11-13, 30, 43]. For fixable defects, arthroscopic and open internal fixation procedures are amenable options and have proven to be effective for pediatric and adult patient populations [28,29,31,45,46]. In case of large defects or in case of failure of firstline surgical treatment, more extensive and invasive surgery can be considered a necessary step in the management process [30].…”

Section: Introductory Remarksmentioning

confidence: 99%

Talar OsteoPeriostic grafting from the Iliac Crest (TOPIC) for large medial talar osteochondral defects

Kerkhoffs

Altink

Stufkens

et al. 2020

Oper Orthop Traumatol

Self Cite

View full text Add to dashboard Cite

Objective Provision of a natural scaffold, good quality cells, and growth factors in order to facilitate the replacement of the complete osteochondral unit with matching talar curvature for large medial primary and secondary osteochondral defects of the talus. Indications Symptomatic primary and secondary medial osteochondral defects of the talus not responding to conservative treatment; anterior–posterior or medial–lateral diameter >10 mm on computed tomography (CT); closed distal tibial physis in young patients. Contraindications Tibiotalar osteoarthritis grade III; multiple osteochondral defects on the medial, central, and lateral talar dome; malignancy; active infectious ankle joint pathology. Surgical technique A medial distal tibial osteotomy is performed, after which the osteochondral defect is excised in toto from the talar dome. The recipient site is microdrilled in order to disrupt subchondral bone vessels. Then, the autograft is harvested from the ipsilateral iliac crest with an oscillating saw, after which the graft is adjusted to an exact fitting shape to match the extracted osteochondral defect and the talar morphology as well as curvature. The graft is implanted with a press-fit technique after which the osteotomy is reduced with two 3.5 mm lag screws and the incision layers are closed. In cases of a large osteotomy, an additional third tubular buttress plate is added, or a third screw at the apex of the osteotomy. Postoperative management Non-weight bearing cast for 6 weeks, followed by another 6 weeks with a walking boot. After 12 weeks, a CT scan is performed to assess consolidation of the osteotomy and the inserted autograft. The patient is referred to a physiotherapist. Results Ten cases underwent the TOPIC procedure, and at 1 year follow-up all clinical scores improved. Radiological outcomes showed consolidation of all osteotomies and all inserted grafts showed consolidation. Complications included one spina iliaca anterior avulsion and one hypaesthesia of the saphenous nerve; in two patients the fixation screws of the medial malleolar osteotomy were removed.

show abstract

Lift, drill, fill and fix (LDFF): a new arthroscopic treatment for talar osteochondral defects

Abstract: Prospective case series. Therapeutic, Level IV.

Cited by 68 publications

References 31 publications

No superior treatment for primary osteochondral defects of the talus

No superior treatment for primary osteochondral defects of the talus

The subchondral bone healing after fixation of an osteochondral talar defect is superior in comparison with microfracture

Talar OsteoPeriostic grafting from the Iliac Crest (TOPIC) for large medial talar osteochondral defects

Contact Info

Product

Resources

About