Treatment of Osteochondral Lesions of the Talus in Athletes

Abstract

The definition of osteochondral lesion of the talus (OLT) is any defect involving both the articular surface and the subchondral bone of the talus. Many of these lesions are associated with acute ankle injury. Although many classification schemes for OLT have been proposed, Berndt and Harty's 4-staging classification is most commonly used. Stage 4 lesions and symptomatic lesions under grade 3 are usually recommended to surgical treatment. The treatment approach for athletes should be more elaborate due to the need for an early return to play. Several different types of treatment are described for OLTs in athletes, including bone marrow stimulation, osteochondral autograft transfer system, and autogenous chondrocyte implantation. Osteochondral autograft transfer system shows good clinical outcome and has the advantages that could be applied to large defect and recurred lesions, however, it has some disadvantages in terms of the complications related with the donor site and the difficult approach to the medial lesions. Although autogenous chondrocyte implantation has been extensively applied for treating OLTs with successful clinical outcomes, it has some limitations that apply to athletes in terms of the 2-stage and complicated procedure and the insurance issues. Bone marrow stimulation being a simple and cost-effective procedure associated with a low complication rate and low postoperative pain has faster return to play and is recommended the first-line treatment for the OLTs of athletes.

Enzymatically Cross-Linked Silk Fibroin-Based Hierarchical Scaffolds for Osteochondral Regeneration

“…These properties can closely mimic the mechanical transitions existing at the different segments of the OC tissue. 1 Interestingly, on examination of the mechanical behavior of the bilayered scaffolds, the BdTCP presented a significantly higher compressive strength in comparison to the BTCP. In fact, it has been reported that ion dopants (e.g., Zn and Sr) can positively influence the mechanical properties of scaffolds through the modification of the lattice structure, microstructure, crystallinity and dissolution rate of the biomaterials.…”

“…The compressive modulus (Figure b) and compressive strength (Figure c) of the BdTCP and BTCP scaffolds were significantly higher than those of the monolayered HRP-SF control scaffolds, showing that the bilayered scaffolds possess stratified compressive properties due to the different mechanical properties of the cartilage and subchondral bone-like layers. These properties can closely mimic the mechanical transitions existing at the different segments of the OC tissue . Interestingly, on examination of the mechanical behavior of the bilayered scaffolds, the BdTCP presented a significantly higher compressive strength in comparison to the BTCP.…”

“…Osteochondral (OC) defects are joint injuries that simultaneously affect the articular cartilage and the underlying subchondral bone. 1 The causes associated with these deformities can be of natural degradation or trauma-related injuries. The natural wear of articular cartilage tissue is commonly observed in an aging population and usually leads to degenerative osteoarthritis (OA), the biggest cause of natural OC defects.…”

“…Osteochondral (OC) defects are joint injuries that simultaneously affect the articular cartilage and the underlying subchondral bone . The causes associated with these deformities can be of natural degradation or trauma-related injuries.…”