Efficacy of Particulated Juvenile Cartilage Allograft Transplantation for Osteochondral Lesions of the Talus

Dekker, Travis J.; Steele, John R.; Federer, Andrew E.; Easley, Mark E.; Hamid, Kamran S.; Adams, Samuel B.

doi:10.1177/1071100717745502

Cited by 33 publications

(20 citation statements)

References 26 publications

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“…There were 8 studies identified with a total of 171 patients. 3,4,9,12,23,24,51,55 An overview of the study characteristics, patient characteristics, and outcomes within this group is shown in Table 8.…”

Section: Resultsmentioning

confidence: 99%

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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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Section: Resultsmentioning

confidence: 99%

“… a N/A, not available; RTS, return to sports. b References 3, 4, 9, 12, 23, 24, 51, 55. 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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“…Coetzee et al 44 found that the clinical improvements diminished when treating defects larger than 150 mm 2 . Dekker et al 47 found that 6 of 15 patients (40%) were clinical failures. The authors concluded that defects larger than 125 mm 2 were prone to failure.…”

Section: Discussionmentioning

confidence: 99%

“…After 25 months, the authors found a significantly higher AOFAS (American Orthopaedic Foot & Ankle Society) score for the PJAC group (97.02) compared with the bone marrow concentrate group (71.33). 46 In 2018, Dekker et al 47 followed 15 patients for 34 months. There was a 40% failure rate, and the predictors of poor outcome were found to be male gender and lesion size greater than 125 mm 2 .…”

Section: Clinical Studiesmentioning

confidence: 99%

“…There was a 40% failure rate, and the predictors of poor outcome were found to be male gender and lesion size greater than 125 mm 2 . 47 Van Dyke et al 48 used PJAC for first metatarsal osteochondral lesions in 2018. In 9 patients followed for an average of 3.3 years, the authors found a decrease in pain scores and an increase in the AOFAS score.…”

Section: Clinical Studiesmentioning

confidence: 99%

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Particulated Cartilage for Chondral and Osteochondral Repair: A Review

et al. 2020

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Introduction Injuries to articular cartilage have a poor spontaneous repair potential and no gold standard treatment exist. Particulated cartilage, both auto- and allograft, is a promising new treatment method that circumvents the high cost of scaffold- and cell-based treatments. Materials and Methods A comprehensive database search on particulated cartilage was performed. Results Fourteen animal studies have found particulated cartilage to be an effective treatment for cartilage injuries. Many studies suggest that juvenile cartilage has increased regenerative potential compared to adult cartilage. Sixteen clinical studies on 4 different treatment methods have been published. (1) CAIS, particulated autologous cartilage in a scaffold, (2) Denovo NT, juvenile human allograft cartilage embedded in fibrin glue, (3) autologous cartilage chips—with and without concomitant bone grafting, and (4) augmented autologous cartilage chips. Conclusion Implantation of allogeneic and autologous particulated cartilage provides a low cost and effective treatment alternative to microfracture and autologous chondrocyte implantation. The methods are promising, but large randomized controlled studies are needed.

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Particulated juvenile cartilage allograft for the treatment of osteochondral lesions of the talus is associated with a high complication rate and a high failure rate at short‐term follow‐up: A systematic review

Butler,

Rizla,

Egol

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeThe purpose of this systematic review was to evaluate the clinical and radiological outcomes together with the complication rates and failure rates at short‐term follow‐up following particulated juvenile cartilage allograft (PJCA) for the management of osteochondral lesions of the talus (OLT).MethodsDuring October 2023, the PubMed, Embase and Cochrane library databases were systematically reviewed to identify clinical studies examining outcomes following PJCA for the management of OLTs. Data regarding study characteristics, patient demographics, lesion characteristics, subjective clinical outcomes, radiological outcomes, complications and failures were extracted and analysed.ResultsTwelve studies were included. In total, 241 patients underwent PJCA for the treatment of OLT at a weighted mean follow‐up of 29.0 ± 24.9 months. The weighted mean lesion size was 138.3 ± 59.6 mm2. Prior surgical intervention was recorded in seven studies, the most common of which was microfracture (65.9%). The weighted mean American Orthopaedic Foot and Ankle Society score improved from a preoperative score of 58.5 ± 3.2 to a postoperative score of 83.9 ± 5.3. The weighted mean postoperative magnetic resonance observation of cartilage repair tissue (MOCART) score was 48.2 ± 3.3. The complication rate was 25.2%, the most common of which was allograft hypertrophy (13.2%). Thirty failures (12.4%) were observed at a weighted mean time of 9.8 ± 9.6 months following the index procedure.ConclusionThis systematic review demonstrated a moderate improvement in subjective clinical outcomes following PJCA for the treatment of OLT at short term follow‐up. However, postoperative MOCART scores were reported as poor. In addition, a high complication rate (25.2%) and a high failure rate (12.4%) at short‐term follow‐up was observed, calling into question the efficacy of PJCA for the treatment of large OLTs. In light of the available evidence, PJCA for the treatment of large OLTs cannot be currently recommended.Level of EvidenceLevel IV

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Efficacy of Particulated Juvenile Cartilage Allograft Transplantation for Osteochondral Lesions of the Talus

Abstract: Level IV, retrospective case series.

Cited by 33 publications

References 26 publications

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

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

Particulated Cartilage for Chondral and Osteochondral Repair: A Review

Particulated juvenile cartilage allograft for the treatment of osteochondral lesions of the talus is associated with a high complication rate and a high failure rate at short‐term follow‐up: A systematic review

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