Proposal of a new CT arthrographic classification system of osteochondral lesions of the talus

Lopes, Ronny; Geffroy, Loïc; Padiolleau, Giovany; Ngbilo, Cédric; Baudrier, Nicolas; Mainard, Didier; Benoist, Jonathan; Wackenheim, Frédéric Leiber; Cordier, Guillaume; Ferrière, Victor Dubois; Freychet, Benjamin; Barbier, Olivier; Amouyel, Thomas

doi:10.1016/j.otsr.2021.102890

Cited by 26 publications

(4 citation statements)

References 56 publications

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“…The most important finding of the present study was that a higher preoperative range of motion and the absence of osteoarthritis are predictive of good results in the multivariate analysis. The use of the Lopes classification to standardize the management of OLT following unsuccessful well‐followed conservative management resulted in a success rate defined by an AOFAS score of more than 80 after at least 1 year of follow‐up in 65% of patients, with a mean AOFAS of 82 ( σ = 19) all techniques combined, and a mean increase of 27 points [18]. These overall results may seem disappointing compared to the results in the literature, as Dahmen et al had a success rate of 82% for microfracture techniques and 77% for mosaicplasties in a meta‐analysis including 11 and 7 studies, respectively [3].…”

Section: Discussionmentioning

confidence: 99%

“…Eighty‐six patients were included with a mean follow‐up of 15 months (12–36), 49 with stage 1 OLT by the Lopes classification [18] who underwent microfracture, 2 with stage 2 who underwent excision of the cartilage defect, and a cancellous graft with screw fixation [15] and 35 with grade 3 who underwent mosaicplasty. The mean age was 37 years (18–62).…”

Section: Methodsmentioning

confidence: 99%

“…A new CT arthrographic classification system of osteochondral lesions of the talus was recently proposed by Lopes et al to help guide the choices of surgical treatment and standardize the indications for microfracture and mosaicplasty [18].…”

Section: Introductionmentioning

confidence: 99%

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Higher preoperative range of motion is predictive of good mid-term results in the surgical management of osteochondral lesions of the talus: a prospective multicentric study

Amouyel

Barbier

l’Escalopier

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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Introduction Osteochondral lesions of the talus (OLT) are a frequent cause of pain in young patients and a new CT arthrographic classiication system of OLT was recently proposed to help guide the choices of and standardize the indications for surgical treatment. The primary hypothesis was that this algorithm would result in a postoperative AOFAS score of ≥ 80/100. The secondary hypothesis was to identify the preoperative factors of successful surgery. Methods This was a prospective observational multicenter study. Eighty-six patients who underwent surgery for OLT after at least 6 months of unsuccessful conservative management were included for a mean follow-up of 15 months (12-36). Fortynine patients with stage 1 OLT underwent microperforation, 2 patients with stage 2 OLT underwent a lift, drill, ill, and ix graft procedure with screw ixation, and 35 patients with stage 3 OLT were treated with mosaicplasty. Results After a follow-up of at least 1 year, 56 patients (65%) had an AOFAS score > 80 and the mean AOFAS score was 82 (16-100). A lower BMI (p = 0.038), a higher preoperative range of motion in the ankle (p = 0.033), higher preoperative AOFAS and FAOS scores (p = 0.001 and p = 0.011), and the presence of a preoperative bone bruise on MRI (p = 0.020) were good prognostic factors on univariate analysis. The presence of grade 1 osteoarthritis on the Van Dijk classiication was predictive of a poor prognosis (p = 0.044). Multivariate analysis showed that a good preoperative range of motion (OR = 1.080 [1.020-1.150] p = 0.01) was predictive of a positive outcome, while grade 1 osteoarthritis was predictive of a poor outcome (OR = 0.147 [0.036-0.603] p = 0.008). The postoperative AOFAS decreased in six patients and 17 patients had at least one complication: six dysthesias of the supericial ibular nerve, two of the sural nerve, and nine stage 1 complex regional pain syndromes. ConclusionThe new algorithm for OLT resulted in a postoperative AOFAS score of ≥ 80/100 in 65% of cases. The positive predictive factors of a successful postoperative outcome were the presence of a good preoperative range of motion and the absence of preoperative osteoarthritis. Level of evidence Level II.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Higher preoperative range of motion is predictive of good mid-term results in the surgical management of osteochondral lesions of the talus: a prospective multicentric study

Amouyel

Barbier

l’Escalopier

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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“…This system resulted in excellent interobserver agreement (Fleiss κ of 0.897 for four observers) and allowed for the correct identification of lesions amenable to bone marrow stimulation techniques (stage 1) from those requiring alternative intervention (stage 2 and stage 3). 48…”

Section: Computed Tomography and Magnetic Resonance Imagingmentioning

confidence: 99%

Osteochondral Lesions of the Ankle and Foot

Haug

Sill

Shrestha

et al. 2023

Semin Musculoskelet Radiol

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Osteochondral lesions (OCLs) in the ankle are more common than OCLs of the foot, but both share a similar imaging appearance. Knowledge of the various imaging modalities, as well as available surgical techniques, is important for radiologists. We discuss radiographs, ultrasonography, computed tomography, single-photon emission computed tomography/computed tomography, and magnetic resonance imaging to evaluate OCLs. In addition, various surgical techniques used to treat OCLs—debridement, retrograde drilling, microfracture, micronized cartilage-augmented microfracture, autografts, and allografts—are described with an emphasis on postoperative appearance following these techniques.

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The too-long anterior process and osteochondral lesion of the talus: Is there an anatomical predisposition? A case-control study on 135 feet

Wartelle

Hocquet

Lucchesi

et al. 2022

Foot and Ankle Surgery

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Proposal of a new CT arthrographic classification system of osteochondral lesions of the talus

Cited by 26 publications

References 56 publications

Higher preoperative range of motion is predictive of good mid-term results in the surgical management of osteochondral lesions of the talus: a prospective multicentric study

Higher preoperative range of motion is predictive of good mid-term results in the surgical management of osteochondral lesions of the talus: a prospective multicentric study

Osteochondral Lesions of the Ankle and Foot

The too-long anterior process and osteochondral lesion of the talus: Is there an anatomical predisposition? A case-control study on 135 feet

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