Current management of talar osteochondral lesions

Abstract

Osteochondral lesions of the talus (OLT) occur in up to 70% of acute ankle sprains and fractures. OLT have become increasingly recognized with the advancements in cartilage-sensitive diagnostic imaging modalities. Although OLT may be treated nonoperatively, a number of surgical techniques have been described for patients whom surgery is indicated. Traditionally, treatment of symptomatic OLT have included either reparative procedures, such as bone marrow stimulation (BMS), or replacement procedures, such as autologous osteochondral transplantation (AOT). Reparative procedures are generally indicated for OLT < 150 mm2 in area. Replacement strategies are used for large lesions or after failed primary repair procedures. Although short- and medium-term results have been reported, long-term studies on OLT treatment strategies are lacking. Biological augmentation including platelet-rich plasma and concentrated bone marrow aspirate is becoming increasingly popular for the treatment of OLT to enhance the biological environment during healing. In this review, we describe the most up-to-date clinical evidence of surgical outcomes, as well as both the mechanical and biological concerns associated with BMS and AOT. In addition, we will review the recent evidence for biological adjunct therapies that aim to improve outcomes and longevity of both BMS and AOT procedures.

Post-traumatic ankle osteoarthritis: quality of life, frequency and associated factors

“…This is the principal difference for increased cartilage degeneration and the high rate of primary OA in the knee. Moreover the cartilage of the ankle is thinner with respect to knee or hip, but owns a higher compressive stiffness, proteoglycan density, lower matrix degradation, and less response to catabolic stimulations (25)(26)(27). (18).…”

Geles y membranas

“…La EMO subcondral sigue siendo la primera opción y el método más utilizado para el tratamiento de LOA pequeñas (4,5,(11)(12)(13)27) . En lesiones más grandes, parece que la evidencia existente recomienda técnicas de implante de condrocitos (ACI/MACI) o autoinjerto osteocondral (OATS).…”

“…Estas técnicas de estimulación de condrogénesis autóloga mediante membranas (AMIC) o geles (ACIC), asociadas a perforaciones (micro-o nanofracturas), podrían denominarse de forma general "EMO aumentada" (10,29) . La matriz de base colágena tiene la doble función de andamiaje sobre el que "anidan" las células mesenquimales y, por otro, "contener" y estabilizar el hematoma en la lesión, logrando así un ambiente biológicamente propicio para la proliferación y diferenciación celular (2,4,16,19,24,28) .…”

“…Por otro lado, en la última década, grupos de investigación relacionados con la bioingeniería y la biología molecular han promocionado la utilidad de coadyuvantes biológicos como el ácido hialurónico (17) , el plasma rico en plaquetas (PRP) (2,4,12) , el aspirado de médula ósea con concentración de células mesenquimales pluripotenciales (15,16) , el implante de cartílago juvenil particulado o el uso de "andamiajes" mediante geles o membranas de colágeno, para implementar los procesos reparativos naturales, favoreciendo la proliferación y diferenciación celular, garantizando así mejores y más duraderos resultados sin aumentar la complejidad o potenciales complicaciones.…”

Large Osteochondral Lesions of the Talus Treated With Autologous Bone Graft and Periosteum Transfer

“…On one hand, the injured articular cartilage shows poor intrinsic reparative ability, and on the other hand, current techniques do not offer high success rates at long-term follow-up. 4,13,14,18,24 We have developed a technique for treating large contained OLTs that takes advantage of the intrinsic chondral regenerative abilities of the periosteum and cancellous autograft. The purpose of this study was to evaluate the radiographic and clinical outcomes of autologous cancellous tibial bone and periosteum transfer for the treatment of large OLTs.…”