Clinical and MRI results after microfracture of osteochondral lesions of the talus

Kuni, Benita; Schmitt, Holger; Chloridis, Dimitrios; Ludwig, Karl

doi:10.1007/s00402-012-1595-3

Cited by 35 publications

(58 citation statements)

References 32 publications

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“…Twenty-two studies describing the results of BMS for 747 ankles were identified [8, 11, 24, 27, 31, 33, 45, 55, 61, 65, 77, 78, 93, 96, 100, 104, 105, 108, 114, 115, 123, 133]. There were two RCTs, two prospective cohort studies and one retrospective cohort study, three prospective case series, three retrospective comparative studies and eleven retrospective case series.…”

Section: Resultsmentioning

confidence: 99%

No superior treatment for primary osteochondral defects of the talus

Dahmen

Lambers

Reilingh

et al. 2017

Knee Surg Sports Traumatol Arthrosc

141

131

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PurposeThe purpose of this systematic literature review is to detect the most effective treatment option for primary talar osteochondral defects in adults.MethodsA literature search was performed to identify studies published from January 1996 to February 2017 using PubMed (MEDLINE), EMBASE, CDSR, DARE, and CENTRAL. Two authors separately and independently screened the search results and conducted the quality assessment using the Newcastle–Ottawa Scale. Subsequently, success rates per separate study were calculated. Studies methodologically eligible for a simplified pooling method were combined.ResultsFifty-two studies with 1236 primary talar osteochondral defects were included of which forty-one studies were retrospective and eleven prospective. Two randomised controlled trials (RCTs) were identified. Heterogeneity concerning methodological nature was observed, and there was variety in reported success rates. A simplified pooling method performed for eleven retrospective case series including 317 ankles in the bone marrow stimulation group yielded a success rate of 82% [CI 78–86%]. For seven retrospective case series investigating an osteochondral autograft transfer system or an osteoperiosteal cylinder graft insertion with in total 78 included ankles the pooled success rate was calculated to be 77% [CI 66–85%].ConclusionsFor primary talar osteochondral defects, none of the treatment options showed any superiority over others.Level of evidenceIV.

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Section: Resultsmentioning

confidence: 99%

No superior treatment for primary osteochondral defects of the talus

Dahmen

Lambers

Reilingh

et al. 2017

Knee Surg Sports Traumatol Arthrosc

141

131

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“…Microfracturing has been described as a treatment option for chondral defects in various studies. The procedure for microfracture in the knee was first published in 1999 [ 3 , 16 – 18 ], with promising long-term results observed in the knee and talus [ 6 , 10 , 12 ]. However, to the best of our knowledge, only a few studies deal with this procedure in the shoulder, with a notable lack of studies investigating the long-term effects of microfracture in this joint.…”

Section: Discussionmentioning

confidence: 99%

Chondral defects of the glenohumeral joint

Hünnebeck

Magosch²,

Habermeyer³

et al. 2017

Obere Extremität

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IntroductionAn increasing number of young patients are diagnosed with chondral lesions. Minimally invasive surgical techniques are important in order to delay progression of the early stages of osteoarthritis and the need for total joint replacement.Materials and methodsPatients (n = 32) who had received microfracturing of the shoulder were retrospectively enrolled, of whom 5 had received shoulder replacements after a mean time of 47 months. Of these patients, 23 completed the Disabilities of the Arm, Shoulder and Hand (DASH) and Constant–Murley Scores in addition to an additional subjective questionnaire. Patients were then clinically examined and received x‑ray analysis of the operated shoulder. Data from an additional 4 patients were acquired by telephone interview.ResultsMean follow-up was 105 months. Of the included patients, 13/27 patients reported no pain, 12/27 patients moderate pain. Of these 12, 6/27 reported pain only at night and 3/27 only during rest. Concerning the outcome of surgery, 19/27 patients were “satisfied” or “very satisfied”. There was a statistically significant increase in internal rotation, but no further differences in the range of motion pre- and postoperatively. Patients without any signs of osteoarthritis before surgery showed statistically significantly better outcomes. There was a statistically significant increase in radiological signs of osteoarthrosis in pre- versus postoperative patients. Patients with bipolar lesions showed statistically significantly poorer Subjective Shoulder Value (SSV) results.ConclusionEven though microfracturing does not prevent radiographic progression, microfracture of the glenohumeral joint might be worth considering as part of a treatment regimen for younger patients who may not yet be treated with arthroplasty.

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“…The success of treatment of OLT with microfracture techniques has been reported in the literature [ 50 , 61 , 78 , 79 , 82 , 83 ]. Beacher et al studied in 45 patients with arthroscopic debridement and microfracture with improvement of functional outcomes (31 of 39 patients had excellent/good Hannover scoring system) and pain relief (mean pre-operative VAS 6.5/10 improved to 2.4/10 post-operatively) at an average follow-up of 5.8 years [ 78 ].…”

Section: Surgical Strategiesmentioning

confidence: 99%

“…They also reported the improvement of functional outcomes in patients who had failed primary microfracture and underwent repeated microfracture in 17 patients (mean improvement of AOFAS scores was 17.2 points) [ 50 ]. Moreover, MRI was used to evaluate OLT after arthroscopic microfracture in 22 patients by Kuni et al They demonstrated significant reduction of the defect size and significant improvement of the functional outcomes (mean AOFAS score was 87.5 points post-operatively) [ 83 ].…”

Section: Surgical Strategiesmentioning

confidence: 99%

Management of Osteochondral Lesions of the Talar Dome

Rungprai¹,

Tennant²,

Gentry³

et al. 2017

TOORTHJ

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Osteochondral lesion of the talus (OLT) is a common condition associated with ankle injury that brings challenges in the diagnosis and treatment. Symptoms related to this condition are nonspecific including pain, swelling, stiffness, and mechanical symptoms of locking and catching. While the natural history of the OLTs is not well understood, surgical treatment is often required especially in chronic cases and acute cases with displaced articular fragments. Arthroscopic treatment of the OLTs aims to restore ankle joint function and pain relief by the removal of the chondral or osteochondral fragment, debridement and stabilization of cartilage rim and subchondral bone, and stimulate healing of the bone and damaged cartilage. In patients with a large lesion or after a failure of previous bone marrow stimulation, biologic restoration techniques including the use of particulate juvenile cartilage techniques, autogenous chondrocyte implantation, and osteochondral autograft or allograft transplantation may have role. This article summarizes the contemporary concepts in the clinical evaluation and treatment of OLTs with particular emphasis on surgical strategies.

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Clinical and MRI results after microfracture of osteochondral lesions of the talus

Abstract: After AM of osteochondral lesions of the talus, 18 of 22 patients had no or mild, occasional pain at 2 years follow-up. On MRI, the lesion volume had been reduced and filling with repair tissue was found.

Cited by 35 publications

References 32 publications

No superior treatment for primary osteochondral defects of the talus

No superior treatment for primary osteochondral defects of the talus

Chondral defects of the glenohumeral joint

Management of Osteochondral Lesions of the Talar Dome

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