No superior treatment for primary osteochondral defects of the talus

Dahmen, Jari; Lambers, Kaj T. A.; Reilingh, Mikel L.; Bergen, Christiaan J. A. van; Stufkens, Sjoerd A. S.; Kerkhoffs, Gino M. M. J.

doi:10.1007/s00167-017-4616-5

Cited by 144 publications

(144 citation statements)

References 139 publications

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“…1,26,69,85 This was demonstrated by the scores given for methodological quality according to the MINORS criteria (Appendix Table A3). These findings are in accordance with those of prior systematic reviews 10,45,95,97 and underline the clear need for more high-quality randomized studies. Future research should be more focused on conducting randomized comparative clinical trials with extensive follow-up times and uniformity in methodology and outcome assessments.…”

Section: Discussionsupporting

confidence: 91%

Return to Sports After Surgical Treatment of Osteochondral Defects of the Talus: A Systematic Review of 2347 Cases

Steman

Dahmen

Lambers

et al. 2019

Orthopaedic Journal of Sports Medicine

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Background: Osteochondral defects (OCDs) of the talus are found subsequent to ankle sprains and ankle fractures. With many surgical treatment strategies available, there is no clear evidence on return-to-sport (RTS) times and rates. Purpose: To summarize RTS times and rates for talar OCDs treated by different surgical techniques. Study Design: Systematic review; Level of evidence, 4. Methods: The literature from January 1996 to November 2018 was screened, and identified studies were divided into 7 different surgical treatment groups. The RTS rate, with and without associated levels of activity, and the mean time to RTS were calculated per study. When methodologically possible, a simplified pooling method was used to combine studies within 1 treatment group. Study bias was assessed using the MINORS (Methodological Index for Non-Randomized Studies) scoring system. Results: A total of 61 studies including 2347 talar OCDs were included. The methodological quality of the studies was poor. There were 10 retrospective case series (RCSs) that investigated bone marrow stimulation in 339 patients, with a pooled mean rate of RTS at any level of 88% (95% CI, 84%-91%); 2 RCSs investigating internal fixation in 47 patients found a pooled RTS rate of 97% (95% CI, 85%-99%), 5 RCSs in which autograft transplantation was performed in 194 patients found a pooled RTS rate of 90% (95% CI, 86%-94%), and 3 prospective case series on autologous chondrocyte implantation in 39 patients found a pooled RTS rate of 87% (95% CI, 73%-94%). The rate of return to preinjury level of sports was 79% (95% CI, 70%-85%) for 120 patients after bone marrow stimulation, 72% (95% CI, 60%-83%) for 67 patients after autograft transplantation, and 69% (95% CI, 54%-81%) for 39 patients after autologous chondrocyte implantation. The mean time to RTS ranged from 13 to 26 weeks, although no pooling was possible for this outcome measure. Conclusion: Different surgical treatment options for talar OCDs allow for adequate RTS times and rates. RTS rates decreased when considering patients’ return to preinjury levels versus return at any level.

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Section: Discussionsupporting

confidence: 91%

Return to Sports After Surgical Treatment of Osteochondral Defects of the Talus: A Systematic Review of 2347 Cases

Steman

Dahmen

Lambers

et al. 2019

Orthopaedic Journal of Sports Medicine

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“…Any first episode of a symptomatic lesion without acute trauma should be treated conservatively, including rest, immobilization, NSAIDs and restriction of activity. In case of persistent pain, various treatment strategies have been proposed, with osteochondral autograft transfer system (OATS) and autologous matrix-induced chondrogenesis (AMIC) representing the most promising [59,61,62]. Bone stress injuries occur after repetitive high forces or atypical forces due to joint instability.…”

Section: Mechanical/degenerativementioning

confidence: 99%

How We Manage Bone Marrow Edema—An Interdisciplinary Approach

Baumbach

Pfahler

Pozza

et al. 2020

JCM

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Bone marrow edema (BME) is a descriptive term for a common finding in magnetic resonance imaging (MRI). Although pain is the major symptom, BME differs in terms of its causal mechanisms, underlying disease, as well as treatment and prognosis. This complexity together with the lack of evidence-based guidelines, frequently makes the identification of underlying conditions and its management a major challenge. Unnecessary multiple consultations and delays in diagnosis as well as therapy indicate a need for interdisciplinary clinical recommendations. Therefore, an interdisciplinary task force was set up within our large osteology center consisting of specialists from internal medicine, endocrinology/diabetology, hematology/oncology, orthopedics, pediatrics, physical medicine, radiology, rheumatology, and trauma surgery to develop a consenus paper. After review of literature, review of practical experiences (expert opinion), and determination of consensus findings, an overview and an algorithm were developed with concise summaries of relevant aspects of the respective underlying disease including diagnostic measures, clinical features, differential diagnosis and treatment of BME. Together, our single-center consensus review on the management of BME may help improve the quality of care for these patients.

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“…With time, blood clot shows metaplastic changes and promote formation of fibrous cartilage repair tissue. Although formed fibrous cartilage has less resistance to compression and shear forces than the normal articular cartilage tissue; it is shown that approximately 78–86% of patients achieve good to excellent results after MFx 18, 19, 20, 21…”

Section: Discussionmentioning

confidence: 99%

One step treatment of talus osteochondral lesions with microfracture and cell free hyaluronic acid based scaffold combination

Yontar¹,

Aslan²,

Can³

et al. 2019

Acta Orthopaedica et Traumatologica Turcica

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ObjectiveThe aim of this study was to assess the effectiveness of microfracture and cell free hyaluronic acid (HA) based scaffold combination in the treatment of talus osteochondral defects (OCD).MethodsThis study retrospectively evaluated the clinical results of the 20 patients (14 males and 6 females, mean age at the time of surgery: 32.9 years (range: 16–52 years)) who were treated with MFx and cell-free HA-based scaffold combination for talus OCD smaller than 1.5 cm2 and deeper than 7 mm. Results were evaluated with AOFAS and VAS scores. Also, patients' satisfaction was questioned.ResultsPatients were evaluated after an average follow-up of 20.3 months. Intraoperative measurements showed that mean depth of the lesions were 10.4 ± 1.9 mm after debridement. The mean preoperative AOFAS score was 57.45 ± 9.37, which increased to 92.45 ± 8.4 postoperatively (p < 0.05). VAS score was improved from 7.05 ± 2.45 to 1.65 ± 2.20 postoperatively (p < 0.05).ConclusionMFx and cell-free HA-based scaffold combination appear to be a safe and efficient technique that provide good clinical outcomes for lesions deeper than 7 mm.Level of evidenceLevel IV, Therapeutic Study.

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No superior treatment for primary osteochondral defects of the talus

Cited by 144 publications

References 139 publications

Return to Sports After Surgical Treatment of Osteochondral Defects of the Talus: A Systematic Review of 2347 Cases

Return to Sports After Surgical Treatment of Osteochondral Defects of the Talus: A Systematic Review of 2347 Cases

How We Manage Bone Marrow Edema—An Interdisciplinary Approach

One step treatment of talus osteochondral lesions with microfracture and cell free hyaluronic acid based scaffold combination

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