Effect of the Containment Type on Clinical Outcomes in Osteochondral Lesions of the Talus Treated With Autologous Osteochondral Transplantation

Shimozono, Yoshiharu; Donders, Johanna C. E.; Yasui, Youichi; Hurley, Eoghan T.; Deyer, Timothy; Nguyen, Joseph; Kennedy, John G.

doi:10.1177/0363546518776659

Cited by 21 publications

(14 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Uncontained lesions of the talar shoulder also pose a unique challenge because of the geometrical complexity, tenuous vascular supply, and weightbearing requirement. 33 Thus, osteochondral allograft transplantation was developed to address these challenging lesions. The use of osteochondral allograft transplantation for OLTs was first performed in the early 1980s and reported by Gross et al in 2001.…”

Section: Introductionmentioning

confidence: 99%

Midterm Prospective Evaluation of Structural Allograft Transplantation for Osteochondral Lesions of the Talar Shoulder

et al. 2022

View full text Add to dashboard Cite

Background: In cases of large osteochondral lesions of the talus (OLTs), fresh structural or bulk osteochondral allograft transplantation has yielded favorable outcomes in several retrospective and few prospective case series. The purpose of this study was to prospectively evaluate patients who received fresh structural allograft transplantation of the talar shoulder. Methods: A prospective evaluation of patients who received a fresh structural allograft of an OLT was performed. Preoperative imaging included magnetic resonance imaging (MRI) and/or computed tomography (CT) with plain radiographs. The following patient-reported outcomes questionnaires were administered preoperatively and yearly after surgery: 36-Item Short-Form Health Survey (SF-36), visual analog scale (VAS) for pain, and the Short Musculoskeletal Functional Assessment (SMFA). Preoperative and postoperative imaging were evaluated for allograft assimilation, evidence of arthritic changes, or functional range of motion abnormalities. Results: Thirty-one patients with a mean age of 41.4 years (±14.1, range 18-69) underwent structural fresh osteochondral allograft transplantation to the talar shoulder and were included in this study. The mean follow-up was 56.2 months (±36.1, range 24-142). The majority of patients were female (n=17, 54.8%), reported some history of prior ankle trauma (n=21, 67.7%), and underwent prior ankle surgery (n=23, 74.2%). The mean lesion size on CT scan was 1879 mm3 (n = 27) compared to the mean lesion size of 3877 mm3 (n = 21) on MRI. There was a significant improvement in the mean preoperative VAS score ( P < .0001), SF-36 score ( P < .0005), SMFA bother index ( P < .0015), and the SMFA function index ( P < .0001) at final follow-up. A total of 15 (48.4%) patients underwent an additional surgery following their osteochondral allograft transplant, most commonly arthroscopic debridement or removal of hardware, performed at an average of 25.2 (±13.0) from their index procedure. There was one failure that required a total ankle replacement. The overall graft survival rate was 96.8%. Conclusion: Fresh, structural allograft transplantation resulted in significant improvement in patient-reported postoperative pain and function in patients suffering from OLTs. The graft survival rate was 96.8% at a mean of 56.2 months follow-up, with half of patients requiring a second procedure. Level of Evidence: Level IV, prospective case series.

show abstract

Section: Introductionmentioning

confidence: 99%

Midterm Prospective Evaluation of Structural Allograft Transplantation for Osteochondral Lesions of the Talar Shoulder

et al. 2022

View full text Add to dashboard Cite

show abstract

“…95 The literature reports a wide variety of surgical treatment strategies, with surgical options ranging from regenerative to replacement therapies. 33,73,79,80,83 In general, all of the different surgical treatment strategies for talar OCDs have shown good results, and there is no clear evidence regarding a superior treatment strategy for either primary or secondary defects. 10,45…”

mentioning

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

View full text Add to dashboard Cite

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.

show abstract

“…However, contouring the autograft to fit congruently within the uncontained lesion is technically challenging. Furthermore, patients who undergo OAT for contained OLT have demonstrated better FAOS scores than those who undergo OAT for uncontained OLT around a median followup of 4-years 26 . However, OAT was still associated with a high FAOS score for uncontained OLT.…”

Section: Discussionmentioning

confidence: 98%

“…Conducting future microfracture procedures with this smaller awl may improve long-term outcomes by limiting disruption of the subchondral bone. Alternative surgical therapies including osteochondral autograft transplantation (OAT) have also been explored as a method to improve outcomes in uncontained lesions due to the poor results with microfracture 26 . However, contouring the autograft to fit congruently within the uncontained lesion is technically challenging.…”

Section: Discussionmentioning

confidence: 99%

Predictors of outcomes of microfracture with concentrated bone marrow aspirate for osteochondral lesions of the talus

Shimozono

Dankert

Deyer

et al. 2021

Journal of Cartilage & Joint Preservation

Self Cite

View full text Add to dashboard Cite

Effect of the Containment Type on Clinical Outcomes in Osteochondral Lesions of the Talus Treated With Autologous Osteochondral Transplantation

Abstract: Patients with contained-type OLTs experienced better clinical outcomes than those with uncontained-type OLTs after AOT for the treatment of OLTs. However, the AOT procedure still provided good clinical and MRI outcomes in both contained-type and uncontained-type OLTs at midterm follow-up.

Cited by 21 publications

References 29 publications

Midterm Prospective Evaluation of Structural Allograft Transplantation for Osteochondral Lesions of the Talar Shoulder

Midterm Prospective Evaluation of Structural Allograft Transplantation for Osteochondral Lesions of the Talar Shoulder

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

Predictors of outcomes of microfracture with concentrated bone marrow aspirate for osteochondral lesions of the talus

Contact Info

Product

Resources

About