Treatment of extended osteochondral lesions of the talus with a free vascularised bone graft from the medial condyle of the femur

Hintermann, Beat; Wagener, Joe; Knupp, Markus; Schweizer, Christine; Schaefer, Dirk J.

doi:10.1302/0301-620x.97b9.35292

Cited by 27 publications

(22 citation statements)

References 33 publications

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“…11,26 In their series of MFC flaps for talus OCLs, however, Hintermann et al demonstrated complete incorporation of the bone flap within 8-13 weeks. 13 Similar to their higher AOFAS scores, the longer time to union observed in our cohort likely reflects more severe baseline pathology among our patients. Their mean flap volume was 3.36 cm 3 compared with 10.4 cm 3 in our patients indicating significantly larger defect size; however, flap volume was not found to correlate with time to union in our cohort.…”

Section: Discussionsupporting

confidence: 55%

Medial Femoral Condyle Free Flap Reconstruction of Complex Foot and Ankle Pathology

Stranix

Piper

Azoury

et al. 2019

Foot & Ankle Orthopaedics

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Background: Complex hindfoot pathology may benefit from vascularized bone flap reconstruction rather than traditional bone grafting techniques. Medial femoral condyle (MFC) flaps provide vascularized periosteum, skin, and corticocancellous bone. Methods: A retrospective, single-institution cohort study of consecutive MFC flaps performed for complicated hindfoot reconstruction between 2013 and 2019 was reviewed. Radiologic follow-up assessed osseous union and clinical outcomes were evaluated with the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score. Thirty MFC flaps were performed in 28 patients for complex hindfoot pathology. Twenty-seven flaps had adequate clinical and radiographic follow-up (mean 15.8 months). Results: The majority presented with avascular necrosis (83%) and failed prior operations (67%, mean 3.1). Most hindfoot procedures involved arthrodesis (n = 24, 80%); tibiotalocalcaneal (n = 11) and talonavicular (n = 7) most frequently. Mean osseous flap volume was 10.3 cm3 (range 1.7-18.4 cm3); one flap required takeback for venous congestion but no total flap losses occurred. Primary osseous union was initially achieved in 20 patients (74%, mean 217 days). Six flaps developed interface nonunion; 5 underwent revision arthrodesis and ultimately achieved union in 24/27 flaps (89%, mean 271 days). Risk factors for nonunion were body mass index (BMI) >30 ( P = .017) and prior arthrodesis ( P = .042). Mean AOFAS hindfoot scores increased significantly from 52.3 preoperatively to 70.7 postoperatively ( P < .001). Subscore analysis demonstrated significant improvement in postoperative pain scores from 14.2 to 27.3 out of 40 ( P < .001). Conclusion: The MFC free flap provided vascularized bone for complicated foot and ankle reconstruction with relatively low donor site morbidity, promising osseous union results, and improved functional outcomes. Level of Evidence: Level IV, retrospective case series.

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Section: Discussionsupporting

confidence: 55%

Medial Femoral Condyle Free Flap Reconstruction of Complex Foot and Ankle Pathology

Stranix

Piper

Azoury

et al. 2019

Foot & Ankle Orthopaedics

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“… a RTS, return to sports. b References 1, 13, 17, 21, 22, 27, 28, 31, 32, 36, 39, 46, 48, 61, 63 –65, 76, 85, 86, 98. c Range of means of original data.…”

Section: Resultsmentioning

confidence: 99%

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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“…Of the nineteen patients, fourteen were successfully treated according to the AOFAS, resulting in a success percentage of 74% [CI 51–88%]. The second study included in this group was a transplantation method using a bone graft [ 24 ]. As the bone graft was vascularized, the authors decided not to include this study in the previously described osteochondral transplantation group.…”

Section: Resultsmentioning

confidence: 99%

No superior surgical treatment for secondary osteochondral defects of the talus

Lambers

Dahmen

Reilingh

et al. 2017

Knee Surg Sports Traumatol Arthrosc

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Purpose The purpose of this systematic review was to identify the most effective surgical treatment for talar osteochondral defects after failed primary surgery.Methods A literature search was conducted to find studies published from January 1996 till July 2016 using PubMed (MEDLINE), EMBASE, CDSR, DARE and CENTRAL. Two authors screened the search results separately and conducted quality assessment independently using the Newcastle–Ottawa scale. Weighted success rates were calculated. Studies eligible for pooling were combined.ResultsTwenty-one studies with a total of 299 patients with 301 talar OCDs that failed primary surgery were investigated. Eight studies were retrospective case series, twelve were prospective case series and there was one randomized controlled trial. Calculated success percentages varied widely and ranged from 17 to 100%. Because of the low level of evidence and the scarce number of patients, no methodologically proper meta-analysis could be performed. A simplified pooling method resulted in a calculated mean success rate of 90% [CI 82–95%] for the osteochondral autograft transfer procedure, 65% [CI 46–81%] for mosaicplasty and 55% [CI 40–70%] for the osteochondral allograft transfer procedure. There was no significant difference between classic autologous chondrocyte implantation (success rate of 59% [CI 39–77%]) and matrix-associated chondrocyte implantation (success rate of 73% [CI 56–85%]).Conclusions Multiple surgical treatments are used for talar OCDs after primary surgical failure. More invasive methods are administered in comparison with primary treatment. No methodologically proper meta-analysis could be performed because of the low level of evidence and the limited number of patients. It is therefore inappropriate to draw firm conclusions from the collected results. Besides an expected difference in outcome between the autograft transfer procedure and the more extensive procedures of mosaicplasty and the use of an allograft, neither a clear nor a significant difference between treatment options could be demonstrated. The need for sufficiently powered prospective investigations in a randomized comparative clinical setting remains high. This present systematic review can be used in order to inform patients about expected outcome of the different treatment methods used after failed primary surgery.Level of evidenceIV.

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Treatment of extended osteochondral lesions of the talus with a free vascularised bone graft from the medial condyle of the femur

Cited by 27 publications

References 33 publications

Medial Femoral Condyle Free Flap Reconstruction of Complex Foot and Ankle Pathology

Medial Femoral Condyle Free Flap Reconstruction of Complex Foot and Ankle Pathology

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

No superior surgical treatment for secondary osteochondral defects of the talus

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