Talonavicular Arthroscopy for Osteochondral Lesions

Ross, Keir A.; Seaworth, Christine M.; Smyth, Niall A.; Ling, Jeffrey S.; Sayres, Stephanie C.; Kennedy, John G.

doi:10.1177/1071100714540887

Cited by 12 publications

(26 citation statements)

References 16 publications

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“…1). 5,6,[10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] Between the first 2 authors, there was overall consensus in all cases included in this review, and final agreement was achieved by the senior author (M.T.). All of them were case reports (level 5).…”

Section: Resultsmentioning

confidence: 99%

Current Lack of Evidence on Treatment Strategies and Clinical Outcomes for Osteochondral Lesions of the Subtalar, Talonavicular, and Calcaneocuboid Joints: A Systematic Review

Shimozono,

Rammelt,

Takao

2023

CARTILAGE

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Objective In contrast to osteochondral lesion (OCL) of the ankle, OCLs in other joints of the foot, such as subtalar joint, talonavicular joint, calcaneocuboid joint, and the midfoot, are rare conditions, but they can also lead to significant morbidity. The objective of this systematic review was to summarize the clinical evidence for the treatment of OCLs of the subtalar, talonavicular, calcaneocuboid, and the other midfoot joints. Design A systematic search of the MEDLINE, EMBASE, and Cochrane Library databases was performed in January 2021 based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines by 2 independent reviewers. Included studies were evaluated with regard to LOE (level of evidence) and QOE (quality of evidence). Variable reporting outcome data, clinical outcomes, and complications were evaluated. Results Seventeen studies with 21 patients were included, all of which were case reports (level 5) without any case series reporting greater than 3 patients. There were 5 patients with OCL in the subtalar joint, 15 patients in the talonavicular joint, and 1 patient in the calcaneocuboid joint. Thirteen case reports (4 subtalar joint, 8 talonavicular joint, and 1 calcaneocuboid joint) reported surgical treatment. Surgical procedures mainly included debridement, bone marrow stimulation, fixation, and bone grafting, through open or arthroscopy, all of which resulted in successful outcomes. Four case reports (1 subtalar joint, 3 talonavicular joint) reported successful conservative treatment. Other 13 case reports reported successful surgery after failed conservative treatment. No complications and reoperations were reported. Conclusions The current systematic review revealed that there is no available evidence to ascertain clinical outcomes of both conservative and surgical treatments for cartilage lesions in the talonavicular joint, subtalar joint, and the midfoot joints, owing to the extreme paucity of literature. Both nonoperative and operative treatments can be considered, but no treatment strategies have been established.

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Section: Resultsmentioning

confidence: 99%

Current Lack of Evidence on Treatment Strategies and Clinical Outcomes for Osteochondral Lesions of the Subtalar, Talonavicular, and Calcaneocuboid Joints: A Systematic Review

Shimozono,

Rammelt,

Takao

2023

CARTILAGE

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“…This could include some talar OCLs, such as small recurrent lesions that have previously failed marrow stimulating methods, or small lesions with cysts, especially when the patient is already undergoing an ankle ligament repair or reconstruction. Furthermore, smaller osteochondral lesions in the talar head, 30 navicular, 40,42 or metatarsal head 22,46 could be treatable with a local autograft. These findings show the feasibility of harvesting cartilage grafts from the lateral side of the talus, which could decrease morbidity by utilizing a local donor site rather than harvesting from another area, such as the knee.…”

Section: Discussionmentioning

confidence: 99%

“…Cartilage lesions in the ankle and foot are a common source of pain following injury or microtrauma. 22,30,33,40,42,46 Cartilage injury has been reported in 50% to 65% of ankle sprains and up to 75% of ankle fractures. 20,21,23,27,33 Cartilage lesions in the foot and ankle may also be the result of other etiologies, such as genetic factors, avascular necrosis, or endocrine pathology.…”

Section: Introductionmentioning

confidence: 99%

“…Little consensus exists on the best methodology for the treatment of osteochondral lesions in the foot and ankle as confirmed by low quality and low levels of evidence. 11,18,22,30,36,37,40,42,46 Microfracture has been considered a common first-line surgical treatment for cartilage lesions due to its low cost, minimally invasive surgical technique, and overall good outcomes, 18 and according to the study by McGahan and Pinney, 31 it has fair evidence constituting a grade B recommendation. However, studies have shown that microfracture surgery may produce inferior outcomes in the face of revision cartilage repair or in lesions beyond a certain size.…”

Section: Introductionmentioning

confidence: 99%

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Accessibility and Thickness of Medial and Lateral Talar Body Cartilage for Treatment of Ankle and Foot Osteochondral Lesions

et al. 2021

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Background: The purposes of this study were to determine (1) if cartilage thicknesses on the talar dome and medial/lateral surfaces of the talus were similar, (2) whether there was sufficient donor cartilage surface area on the medial and lateral talar surfaces to repair talar dome cartilage injuries of the talus, and (3) whether the cartilage surface could be increased following anterior talofibular ligament (ATFL) and sectioning of the tibionavicular and tibiospring portion of the anterior deltoid. Methods: Medial and lateral approaches were utilized in 8 cadaveric ankles to identify the accessible medial, lateral, and talar dome cartilage surfaces in 3 conditions: (1) intact, (2) ATFL release, and (3) superficial anterior deltoid ligament release. The talus was explanted, and the cartilage areas were digitized with a coordinate measuring machine. Cartilage thickness was quantified using a laser scanner. Results: The mean cartilage thickness was 1.0 ± 0.1 mm in all areas tested. In intact ankles, the medial side of the talus showed a larger total area of available cartilage than the lateral side (152 mm2 vs 133 mm2). ATFL release increased the available cartilage area on the medial and lateral sides to 167 mm2 and 194 mm2, respectively. However, only the lateral talar surface had sufficient circular graft donor cartilage available for autologous osteochondral transplantation (AOT) procedures of the talus. After ATFL and deltoid sectioning, there was an increase in available graft donor cartilage available for AOT procedures. Conclusion: The thickness of the medial and lateral talar cartilage surfaces is very similar to that of the talar dome cartilage surface, which provides evidence that the medial and lateral surfaces may serve as acceptable AOT donor cartilage. The surface area available for AOT donor site grafting was sufficient in the intact state; however, sectioning the ATFL and superficial anterior deltoid ligament increased the overall lateral talar surface area available for circular grafting for an AOT procedure that requires a larger graft. These results support the idea that lateral surfaces of the talus may be used as donor cartilage for an AOT procedure since donor and recipient sites are similar in cartilage thickness, and there is sufficient cartilage surface area available for common lesion sizes in the foot and ankle. Clinical Relevance: This anatomical study investigates the feasibility of talar osteochondral autografts from the medial or lateral talar surfaces exposed with standard approaches. It confirms the similar cartilage thickness of the talar dome and the ability to access up to an 8- to 10-mm donor graft from the lateral side of the talus after ligament release. This knowledge may allow better operative planning for use of these surfaces for osteochondral lesions within the foot and ankle, particularly in certain circumstances of a revision microfracture.

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“…Other recent advances include arthroscopy of the midfoot and forefoot. 8 The method was first reported in Brazil in 1994 when Nery et al 9 used it for treating anterior ankle impingement. Although arthroscopy has been increasingly used in recent years, Brazil has no surveys on the use of this technique.…”

Section: Introductionmentioning

confidence: 99%

Arthroscopic Foot and Ankle Surgery: Brazilian Surgeon Profile

et al. 2022

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Objective: To study the profile of the practice of arthroscopy among ankle and foot surgeons in Brazil and its evolution in recent years. Methods: Observational, cross-sectional study, using a survey sent to all members of the Associação Brasileira de Medicina e Cirurgia do Tornozelo e Pé (ABTPé) in 2017 and 2019. Results: In total, 75 surgeons participated in 2017 and 82 in 2019 and most had over 10 years of experience. Of these, 56 participants in 2017 (75%) and 68 in 2019 (82%) used arthroscopy. The number of specialists with no to five years of experience (p = 0.027) and who learned the technique during fellowship (p = 0.007) increased. The use of the 4.0 mm optics and 30° optics (p = 0.040) increased whereas the routine use of traction (p = 0.049) and radiofrequency (p = 0.002) decreased. The main pathology treated with anterior ankle arthroscopy was bone injury. The most frequent complication was neuropraxia. Conclusion: Most of the foot and ankle surgeons who use arthroscopy have more than 10 years of experience, performed anterior access, and are concentrated in the Southeast region of the country. The number of younger surgeons who learned the technique during fellowship increased. Level of Evidence III, Cross-Sectional Comparative Study.

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Talonavicular Arthroscopy for Osteochondral Lesions

Abstract: Level IV, case series.

Cited by 12 publications

References 16 publications

Current Lack of Evidence on Treatment Strategies and Clinical Outcomes for Osteochondral Lesions of the Subtalar, Talonavicular, and Calcaneocuboid Joints: A Systematic Review

Current Lack of Evidence on Treatment Strategies and Clinical Outcomes for Osteochondral Lesions of the Subtalar, Talonavicular, and Calcaneocuboid Joints: A Systematic Review

Accessibility and Thickness of Medial and Lateral Talar Body Cartilage for Treatment of Ankle and Foot Osteochondral Lesions

Arthroscopic Foot and Ankle Surgery: Brazilian Surgeon Profile

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