Fixation Techniques: Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle

Reilingh, Mikel L.; Murawski, Christopher D.; DiGiovanni, Christopher W.; Dahmen, Jari; Ferrao, Paulo N. F.; Lambers, Kaj T. A.; Ling, Jeffrey S.; Tanaka, Yasuhito; Kerkhoffs, Gino M. M. J.; Ackermann, Jakob; Adams, Samuel B.; Andrews, Carol L.; Angthong, Chayanin; Batista, Jorge; Baur, O; Bayer, Steve; Becher, Christoph; Berlet, Gregory C.; Boakye, Lorraine; Brown, Alexandra J.; Buda, Roberto; Calder, James; Canata, Gian Luigi; Carreira, Dominic S.; Clanton, Thomas O.; D’Hooghe, Pieter; Dombrowski, Malcolm E.; Drakos, Mark C.; Ferkel, Richard D.; Fortier, Lisa A.; Glazebrook, Mark; Giza, Eric; Gomaa, Mohamed; Görtz, Simon; Haleem, Amgad M.; Hamid, Kamran S.; Hangody, László; Hannon, Charles P.; Haverkamp, Daniël; Hertel, Jay; Hintermann, Beat; Hogan, MaCalus V.; Hunt, Kenneth J.; Hurley, Eoghan T.; Karlsson, Jón; Kearns, Stephen; Kennedy, John G.; Kim, Soo Hyun; Kong, Siu Wah; Labib, Sameh A.; Lee, Jin Woo; Lee, Keun Bae; Longo, Umile Giuseppe; Marangon, Alberto; McCollum, Graham; Mitchell, Adam; Mittwede, Peter N.; Nehrer, Stefan; Niemeyer, Philipp; Nunley, James A.; O’Malley, Martin J.; Osei-Hwedieh, David O.; Paul, Jochen; Pearce, Christopher J.; Pereira, Hélder; Popchak, Adam; Prado, Marcelo Pires; Raikin, Steven M.; Rothrauff, Benjamin B.; Schon, Lew C.; Shimozono, Yoshiharu; Simpson, Helene; Smyth, Niall A.; Sofka, Carolyn M.; Spennacchio, Pietro; Stone, James W.; Sullivan, Martin; Takao, Masato; Thordarson, David B.; Tuan, Rocky S.; Valderrábano, Víctor; Bergen, Christiaan J. A. van; Dijk, C. Niek van; Dijk, Pim A. D. van; Vannini, Francesca; Vaseenon, Tanawat; Walther, Markus; Wiewiorski, Martin; Xu, Xiangyang; Yasui, Youichi; Hua, Yinghui; Yoshimura, Ichiro; Younger, Alastair; Zhang, Zijun

doi:10.1177/1071100718781096

Cited by 39 publications

(31 citation statements)

References 25 publications

(20 reference statements)

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“…Fixation of the osteochondral fragment was indicated for large lesions with intact or nearly normal articular cartilage. 27 This procedure was performed in 28 ankles (27 patients) using the PLLA pin between January 2004 and December 2018 at our hospital. Among them, 7 ankles were excluded because no tissue was obtained intraoperatively from the osteochondral fragment.…”

Section: Methodsmentioning

confidence: 99%

“…5 Osteochondral fragments should be fixed when the fragment is relatively large, at least 3 mm in thickness and 10 mm in diameter, with a nearly normal articular cartilage surface. 27 Several fixation procedures are available for treating OLT, including cortical bone pegs, 17 biocompression screws, 14 and bioabsorbable pins. 15,21,22 Bioabsorbable bone fixation is advantageous because there is less interference from the articular cartilage because of the small diameter of the device, and it is unnecessary to harvest healthy tissue and remove the implant.…”

mentioning

confidence: 99%

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Histopathological and Radiographic Features of Osteolysis After Fixation of Osteochondral Fragments Using Poly-L-Lactic Acid Pins for Osteochondral Lesions of the Talus

et al. 2021

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Background: Fixation of osteochondral fragments is a potential option for treating an osteochondral lesion of the talus (OLT) involving large lesions in the remaining articular cartilage surface. Bioabsorbable devices, especially those made of poly-L-lactic acid (PLLA), can be used for the fixation of an OLT. Postoperative osteolysis surrounding the PLLA pins is occasionally observed; however, the significance of osteolysis remains unknown. Purpose: To elucidate the association between osteolysis surrounding the PLLA pins, histopathological findings in subchondral bone, and preoperative Hounsfield unit (HU) values at the pin fixation site. Study Design: Case Series; Level of evidence, 4. Methods: This retrospective analysis included 20 patients with OLT (11 men and 9 women; mean age, 20.9 years; 1 bilateral case). Tissue from the osteochondral fragment was collected intraoperatively using a bone biopsy needle for histological evaluation. The fragment was fixed through the biopsy hole using a PLLA pin. Osteolysis surrounding the PLLA pin was assessed at 1 year postoperatively using magnetic resonance imaging (MRI). Histopathological scores were assigned based on trabecular bone loss, empty lacunae, inflammatory granulation tissue, cartilage-like tissue, and the presence of osteoclasts. The HU values around the pin insertion site, detected on the postoperative MRI scans, were measured using the region of interest based on the preoperative coronal and sagittal computed tomography (CT) images. Results: Osteolysis was observed postoperatively in 9 ankles (42.9%). Histopathological evaluation revealed that the osteolysis group had a significantly higher pathological score than the nonosteolysis group (10.2 vs 6.3; P < .001). Lower HU values were identified in the osteolysis group on preoperative coronal and sagittal CT images ( P < .05). The histopathological score negatively correlated with preoperative HU values (Pearson r = −0.46; P = .037). Conclusion: Intraoperative biopsy of the OLT allowed for histopathological evaluation of the same site as that of the PLLA pin fixation. Our findings suggest that preoperative subchondral trabecular deterioration is associated with the incidence of postoperative osteolysis surrounding the PLLA pin. Additionally, low preoperative HU values in subchondral bone under OLT may serve as a predictor of osteolysis surrounding the PLLA pin.

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Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

Histopathological and Radiographic Features of Osteolysis After Fixation of Osteochondral Fragments Using Poly-L-Lactic Acid Pins for Osteochondral Lesions of the Talus

et al. 2021

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“…The advantage of this technique is the restoration of the natural congruency of the joint and the preservation of the hyaline cartilage in the lesion. 29 Several studies have reported good clinical results using this treatment. 8,12,27,31 Generally, indications for the fixation technique include an intact osteochondral fragment larger than 10 mm in diameter with a bony portion of at least 3 mm in thickness.…”

mentioning

confidence: 92%

“…8,12,27,31 Generally, indications for the fixation technique include an intact osteochondral fragment larger than 10 mm in diameter with a bony portion of at least 3 mm in thickness. 29 However, bone in the fragment has various morphologies, especially the subchondral bone plate. 21 Some cases show disruption of the subchondral bone plate or the appearance of a normal subchondral bone plate in the osteochondral fragment.…”

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confidence: 99%

Clinical Results of Bioabsorbable Pin Fixation Relative to the Bone Condition for Osteochondral Lesion of the Talus

et al. 2019

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Background: Fixation of an osteochondral lesion of the talus (OLT) can restore the natural congruency of the joint surface with hyaline cartilage. In this procedure, the bone condition of the osteochondral fragment is important for stabilizing the lesion, and it may affect clinical outcomes. The aim of this study was to explore the influence of the fragment’s bone condition on clinical outcomes. Methods: Eighteen ankles in 17 patients with a mean age of 20.1 years, which had undergone fixation of an OLT using bioabsorbable pins, were included. Based on the fragment’s bone condition on preoperative computed tomography scans, ankles were divided into 3 groups: normal, segmentation, and absorption. The American Orthopaedic Foot & Ankle Society (AOFAS) scale and magnetic resonance imaging (MRI) findings were evaluated both pre- and postoperatively. Second-look arthroscopic findings were evaluated in 15 ankles and were compared with biopsy specimens from the initial surgery. Results: The AOFAS scale significantly improved at the final follow-up in all groups with no significant differences among the 3 groups. MRI at 1 year showed good bone incorporation and a congruent cartilage surface in all groups, but the bone marrow lesion in the absorption group was significantly larger than that in the other groups. In second-look arthroscopy, all ankles showed stable and near-normal cartilage. There was no significant correlation between arthroscopic and histological findings. Conclusion: We found that fixation can be considered when there is a good cartilage surface on a large OLT, even if bone absorption in the fragment exists. Level of Evidence: Level III, comparative study.

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“…8,9,19 However, it is recommended for small lesions of <107.4 mm 2 in area and/or 10.2 mm in diameter. 25,26 For large lesions, replacement surgery such as autologous osteochondral transplantation or osteochondral allografting is required. 1,16,19,23,27 Despite their excellent clinical results, these replacement procedures are not without risks or complications.…”

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confidence: 99%

Internal Fixation of Osteochondral Lesion of the Talus Involving a Large Bone Fragment

Choi

Kim

et al. 2021

Am J Sports Med

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Background: Internal fixation of an osteochondral lesion of the talus (OLT) can restore the congruency of the talus and maintain the subchondral bone and innate hyaline cartilage. However, OLT that is indicated for fixation is rarely encountered; hence, not many studies report on the results after the procedure. Purpose: To evaluate the clinical and radiological outcomes after internal fixation of chronic OLT involving a large bone fragment of at least 10 mm in diameter and 3 mm in depth on computed tomography (CT). Study Design: Case series; Level of evidence, 4. Methods: We retrospectively reviewed the data of 26 patients with OLT treated with internal fixation between August 2014 and April 2018. Of the patients, 15 were male and 11 were female, with a mean age of 16 years (range, 11-29 years). The primary radiological outcome measurement was bone union assessed on the 6-month postoperative CT scan. Clinical outcomes were assessed at a mean of 27.7 months postoperatively. Results: Twenty patients (77%) achieved bone union on postoperative CT scan. The mean 100-mm visual analog scale (VAS) improved from 30.5 ± 8.5 preoperatively to 13.4 ± 9.7 postoperatively ( P < .001). The mean Foot Function Index (FFI) improved from 30.5 ± 6.7 preoperatively to 13.7 ± 9.8 postoperatively ( P < .001). A malleolar osteotomy was not necessary to approach the lesion in 88% of patients. A bone fragment with an irregular margin and low density on the preoperative CT scan was significantly associated with nonunion (odds ratio: 7.67, 95% confidence interval: 2.67 to 22.02, P = .008). The difference in clinical outcomes between patients with skeletally immature ankles and those with skeletally mature ankles was not statistically significant. Patient age did not correlate with postoperative 100-mm VAS (Pearson correlation coefficient, r = −0.07, P = 0.72) or the postoperative FFI (Pearson correlation coefficient, r = –0.05, P = .80). Conclusion: Internal fixation of an OLT involving a large bone fragment resulted in satisfactory clinical and radiologic outcomes. We found that patients with skeletally immature and mature ankles attained healing at comparable rates after the internal fixation of OLT.

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Fixation Techniques: Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle

Abstract: This international consensus derived from leaders in the field will assist clinicians with using fixation techniques in the treatment of osteochondral lesions of the talus.

Cited by 39 publications

References 25 publications

Histopathological and Radiographic Features of Osteolysis After Fixation of Osteochondral Fragments Using Poly-L-Lactic Acid Pins for Osteochondral Lesions of the Talus

Histopathological and Radiographic Features of Osteolysis After Fixation of Osteochondral Fragments Using Poly-L-Lactic Acid Pins for Osteochondral Lesions of the Talus

Clinical Results of Bioabsorbable Pin Fixation Relative to the Bone Condition for Osteochondral Lesion of the Talus

Internal Fixation of Osteochondral Lesion of the Talus Involving a Large Bone Fragment

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