The Impact of Weight on Arthroscopic Osteochondral Talar Reconstruction

Usuelli, Federico Giuseppe; Maccario, Camilla; Ursino, Chiara; Serra, Nicola; D’Ambrosi, Riccardo

doi:10.1177/1071100717695349

Cited by 17 publications

(9 citation statements)

References 43 publications

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“…In accordance with our results, most studies about AMIC-treated OLTs could not show any significant influence of these demographical factors. 11,24,47 D’Ambrosi et al 11 performed arthroscopic AMIC in 31 OLTs and did not find any age-related differences. However, the preoperative and final functional results were inferior in the subgroup aged >33 years, which may indicate that the preoperative ankle status is a negatively influencing factor.…”

Section: Discussionmentioning

confidence: 94%

Autologous Matrix-Induced Chondrogenesis for Osteochondral Lesions of the Talus: A Clinical and Radiological 2- to 8-Year Follow-up Study

et al. 2019

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Background: Autologous matrix-induced chondrogenesis (AMIC) has become an interesting treatment option for osteochondral lesions of the talus (OLTs) with promising clinical short- to midterm results. Purpose: To investigate the clinical and radiological outcome of the AMIC procedure for OLTs, extending the follow-up to 8 years. Study Design: Case series; Level of evidence, 4. Methods: Thirty-three patients (mean age, 35.1 years; body mass index, 26.8) with osteochondral lesions of the medial talar dome were retrospectively evaluated after open AMIC repair at a mean follow-up of 4.7 years (range, 2.3-8.0 years). Patients requiring additional surgical procedures were excluded. All OLTs (mean size, 0.9 cm2; range, 0.4-2.3 cm2) were approached through a medial malleolar osteotomy, and 28 patients received subchondral autologous bone grafting. Data analysis included the visual analog scale for pain, the American Orthopaedic Foot and Ankle Society score for ankle function, the Tegner score for sports activity, and the MOCART (magnetic resonance observation of cartilage repair tissue) scoring system for repair cartilage and subchondral bone evaluation. Results: Mean ± SD visual analog scale score improved significantly from 6.4 ± 1.9 preoperatively to 1.4 ± 2.0 at latest follow-up ( P < .001). The mean American Orthopaedic Foot and Ankle Society score was 93.0 ± 7.5 (range, 75-100). The Tegner score improved significantly from 3.5 ± 1.8 preoperatively to 5.2 ± 1.7 at latest follow-up ( P < .001), and 79% returned to their previous sports levels. The MOCART score averaged 60.6 ± 21.2 (range, 0-100). Complete filling of the defect was seen in 88% of cases, but 52% showed hypertrophy of the cartilage layer. All but 1 patient showed persistent subchondral bone edema. The patient’s age and body mass index, the size of the osteochondral lesion, and the MOCART score did not show significant correlation with the clinical outcome. There were no cases of revision surgery for failed AMIC. Fifty-eight percent underwent reoperation, mainly for symptomatic hardware after malleolar osteotomy. Conclusion: AMIC for osteochondral talar lesions led to significant pain reduction, recovery of ankle function, and successful return to sport. The MOCART score did not correlate with the good clinical results; the interpretation of postoperative imaging remains therefore challenging.

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Section: Discussionmentioning

confidence: 94%

Autologous Matrix-Induced Chondrogenesis for Osteochondral Lesions of the Talus: A Clinical and Radiological 2- to 8-Year Follow-up Study

et al. 2019

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“…The average BMI of the present study was 28.7 ± 5.4 kg/m 2 , hence displaying a greater range than the study published by Usuelli et al . 35 (24.3 ± 3.4 kg/m 2 ), which might have contributed to the effect seen in the current study. Consequently, it can be theorized that, in fact, an increased BMI negatively influences clinical outcome after AMIC for OLTs.…”

Section: Discussionmentioning

confidence: 67%

“…Usuelli et al . 35 prospectively studied 37 patients undergoing arthroscopic AMIC for OLTs and stratified them based on their preoperative BMI, resulting in mean BMIs of 21.90 ± 1.94 and 27.41 ± 1.98 kg/m 2 for each group. The clinical assessment comprised magnetic resonance imaging, computed tomography, visual analogue scale, Short-Form Health Survey (SF-12) and AOFAS.…”

Section: Discussionmentioning

confidence: 99%

“…Interestingly, increased BMI was associated with larger preoperative lesion size and postoperative bone marrow edema, yet clinical outcome seemed to not be influenced by patient’s BMI as both groups exhibited significantly improved AOFAS at 6, 12, and 24 months postoperatively. 35 However, the authors did not perform a direct comparison between both groups. In fact, patients with an increased BMI showed a smaller improvement of AOFAS scores from pre- to postoperatively (24.8 and 32.3 points at 1 and 2 years compared with 36.8 and 41.2, respectively).…”

Section: Discussionmentioning

confidence: 99%

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Smoking Is Associated with Anterior Ankle Impingement After Isolated Autologous Matrix-Induced Chondrogenesis for Osteochondral Lesions of the Talus

et al. 2020

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Objective To determine potential predictive associations between patient-/lesion-specific factors, clinical outcome and anterior ankle impingement in patients that underwent isolated autologous matrix-induced chondrogenesis (AMIC) for an osteochondral lesion of the talus (OLT). Design Thirty-five patients with a mean age of 34.7 ± 15 years who underwent isolated cartilage repair with AMIC for OLTs were evaluated at a mean follow-up of 4.5 ± 1.9 years. Patients completed AOFAS (American Orthopaedic Foot and Ankle Society) scores at final follow-up, as well as Tegner scores at final follow-up and retrospectively for preinjury and presurgery time points. Pearson correlation and multivariate regression models were used to distinguish associations between patient-/lesion-specific factors, the need for subsequent surgery due to anterior ankle impingement and patient-reported outcomes. Results At final follow-up, AOFAS and Tegner scores averaged 92.6 ± 8.3 and 5.1 ± 1.8, respectively. Both body mass index (BMI) and duration of symptoms were independent predictors for postoperative AOFAS and Δ preinjury to postsurgery Tegner with positive smoking status showing a trend toward worse AOFAS scores, but this did not reach statistical significance ( P = 0.054). Nine patients (25.7%) required subsequent surgery due to anterior ankle impingement. Smoking was the only factor that showed significant correlation with postoperative anterior ankle impingement with an odds ratio of 10.61 when adjusted for BMI and duration of symptoms (95% CI, 1.04-108.57; P = 0.047). Conclusion In particular, patients with normal BMI and chronic symptoms benefit from AMIC for the treatment of OLTs. Conversely, smoking cessation should be considered before AMIC due to the increased risk of subsequent surgery and possibly worse clinical outcome seen in active smokers.

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“…25 However, even heavy patients with larger lesions did show a significant improvement in symptoms. 26 Körner et al . 27 reported a correlation between the Berndt, Harty, and Loomer classification in regard of the relevance for predication of patients complaints.…”

Section: Discussionmentioning

confidence: 99%

Influence of the Medial Malleolus Osteotomy on the Clinical Outcome of M-BMS + I/III Collagen Scaffold in Medial Talar Osteochondral Lesion (German Cartilage Register/Knorpelregister DGOU)

et al. 2020

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Objective Osteochondral lesions of the talus are common injuries, with one of the leading treatment options being the M-BMS (matrix-augmented bone marrow stimulation) + I/III collagen scaffold. Osteotomy of the medial malleolus is not unusual but presents the risk of malunion or irritation by hardware. The aim of the study was to analyze data from the German Cartilage Society (Knorpelregister DGOU) to evaluate the influence of medial malleolar osteotomy on clinical results of M-BMS + I/III collagen scaffold. Design The ankle module of the Cartilage Register includes a total of 718 patients, while 45 patients met the inclusion criteria. Patients were treated with an M-BMS + I/III collagen scaffold of the medial talus, 30 without and 15 with an osteotomy of the medial malleolus. The follow-up evaluations included FAAM (Foot and Ankle Ability Measure), FAOS (Foot and Ankle Outcome Score), and VAS (visual analogue scale). Results Forty-five patients (22 male, 23 female) aged between 18 and 69 years (mean: 34 years) were included in this study. Between preoperative and 12 months postoperative, we noted a significant improvement in FAAM-ADL (Activity of Daily Living) ( P = 0.004) as well as FAOS-Pain ( P = 0.001), FAOS-Stiffness ( P = 0.047), FAOS-ADL ( P = 0.002), FAOS-Sport ( P = 0.001), and FAOS Quality of Life ( P = 0.009). There was no significant difference between patients who underwent an osteotomy or not. Conclusion The results show a significant improvement in patients’ outcome scores following a M-BMS + I/III collagen scaffold. No statistical difference was noted among those undergoing medial malleolar osteotomy.

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The Impact of Weight on Arthroscopic Osteochondral Talar Reconstruction

Abstract: Level III, comparative study.

Cited by 17 publications

References 43 publications

Autologous Matrix-Induced Chondrogenesis for Osteochondral Lesions of the Talus: A Clinical and Radiological 2- to 8-Year Follow-up Study

Autologous Matrix-Induced Chondrogenesis for Osteochondral Lesions of the Talus: A Clinical and Radiological 2- to 8-Year Follow-up Study

Smoking Is Associated with Anterior Ankle Impingement After Isolated Autologous Matrix-Induced Chondrogenesis for Osteochondral Lesions of the Talus

Influence of the Medial Malleolus Osteotomy on the Clinical Outcome of M-BMS + I/III Collagen Scaffold in Medial Talar Osteochondral Lesion (German Cartilage Register/Knorpelregister DGOU)

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