Gender Differences May Exist in the Presentation, Mechanism of Injury and Outcomes Following Bone Marrow Stimulation for Osteochondral Lesions of the Talus

Gianakos, Arianna L.; Williamson, Emilie; Mercer, Nathaniel P.; Kerkhoffs, Gino M. M. J.; Kennedy, John G.

doi:10.1053/j.jfas.2022.04.010

Cited by 4 publications

(4 citation statements)

References 37 publications

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“…Among the other baseline factors assessed, the associations of long-term survival with the lesion size, a non-primary lesion type, the presence of preoperative cysts, and patient sex did not reach the level of significance. These findings are not in line with previous studies finding a relationship between these baseline characteristics and PROMs 21-28 , which may be because the outcome of survival free from revision incorporates not only PROMs but also mental health, physical functioning, work and sport activities, etc. However, we did observe a nonsignificant trend toward poorer survival for non-primary OLT and for female patients (see Appendix Supplementary Materials 5).…”

Section: Discussioncontrasting

confidence: 98%

“…According to the statistical principles of survival analysis, a 10:1 ratio of the number of failures to the number of predictive baseline factors was considered acceptable 20 . Therefore, before the start of the study, a hierarchy of possible dichotomous predictive factors was defined according to the current evidence-based literature [21][22][23][24][25][26][27][28] in order to determine which factors were to be analyzed. The following hierarchy was established: (1) lesion size (£100 versus >100 mm 2 ), (2) a primary versus non-primary lesion (i.e., following failed primary surgery), (3) the presence versus absence of subchondral cysts on preoperative imaging, (4) a body mass index (BMI) of ‡30 versus <30 kg/m 2 , and (5) sex.…”

Section: Outcome Measuresmentioning

confidence: 99%

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Ten-Year Survival Rate of 82% in 262 Cases of Arthroscopic Bone Marrow Stimulation for Osteochondral Lesions of the Talus

Rikken,

Aalders,

Dahmen

et al. 2024

Journal of Bone and Joint Surgery

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Background: The long-term sustainability of arthroscopic bone marrow stimulation (BMS) for osteochondral lesions of the talus (OLT) remains a matter of debate. The primary aim of the present study was to assess the 10-year survival free from revision in ankles that had undergone arthroscopic BMS for an OLT. The secondary aim was to evaluate the influence of baseline patient and lesion characteristics on survival. Methods: Patients who underwent arthroscopic BMS for a symptomatic OLT and had a minimum follow-up of 10 years were included to assess procedure survival. The primary outcome, the 10-year cumulative survival rate, was analyzed by the Kaplan-Meier survival method. Secondary outcomes were the median time to revision and the effects of baseline factors (lesion size, primary or non-primary lesion type, preoperative cysts, and obesity as defined by a body mass index [BMI] of ≥30 kg/m2) on survival, analyzed with a Cox regression model and reported using hazard ratios (HRs). Results: The 262 included patients had a mean follow-up of 15.3 ± 4.8 years. The 10-year cumulative survival rate of the arthroscopic BMS procedures was 82% (95% confidence interval [CI]: 77% to 87%). At 15 years of follow-up, the cumulative survival rate was 82% (95% CI: 76% to 86%). The median time to revision was 2.4 years (interquartile range: 1.3 to 5.1 years). Of the baseline factors, obesity (HR: 3.0 [95% CI: 1.44 to 6.43], p < 0.01) was associated with decreased survival. Lesion size (HR: 0.9 [95% CI: 0.5 to 1.8], p = 0.8), non-primary lesion type (HR: 1.8 [95% CI: 0.9 to 3.4], p = 0.1), and the presence of preoperative cysts (HR: 1.0 [95% CI: 0.6 to 1.9], p = 0.9) were not significantly associated with survival. Conclusions: At a minimum follow-up of 10 years, the survival rate of arthroscopic BMS for OLT was 82%. At 15 and 20 years of follow-up, survival appeared to remain stable. Obesity (BMI ≥ 30 kg/m2) was associated with a higher likelihood of revision surgery. This risk factor should be incorporated into the treatment algorithm for OLT when counseling patients regarding surgery. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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Section: Discussioncontrasting

confidence: 98%

Section: Outcome Measuresmentioning

confidence: 99%

Ten-Year Survival Rate of 82% in 262 Cases of Arthroscopic Bone Marrow Stimulation for Osteochondral Lesions of the Talus

Rikken,

Aalders,

Dahmen

et al. 2024

Journal of Bone and Joint Surgery

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“… a Significantly different from osteo(chondral) autograft transplantation therapies ( Q = 7.55, P = 0.0060) and metal implants ( Q = 5.27, P = 0.0217). 43,52,59,61 -63,66,81,92,93,109,113,117,121,123,125,131,135,141,143,146,149,150,153,158,164,165,167,168,171,173,176,177,179 -183,187,190,192,195 -200,202,204 -206 b Significantly different from metal implants ( Q = 3.86, P = 0.0493). 11,42,53,56,59,116,118,137,170,…”

Section: Resultsmentioning

confidence: 99%

The Frequency and Severity of Complications in Surgical Treatment of Osteochondral Lesions of the Talus: A Systematic Review and Meta-Analysis of 6,962 Lesions

et al. 2023

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Objective The primary aim was to determine and compare the complication rate of different surgical treatment options for osteochondral lesions of the talus (OLTs). The secondary aim was to analyze and compare the severity and types of complications. Design A literature search was performed in MEDLINE (PubMed), EMBASE (Ovid), and the Cochrane Library. Methodological quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS). Primary outcome was the complication rate per surgical treatment option. Secondary outcomes included the severity (using the Modified Clavien-Dindo-Sink Complication Classification System for Orthopedic Surgery) and types of complications. The primary outcome, the severity, and the sub-analyses were analyzed using a random effects model. A moderator test for subgroup-analysis was used to determine differences. The types of complications were presented as rates. Results In all, 178 articles from the literature search were included for analysis, comprising 6,962 OLTs with a pooled mean age of 35.5 years and follow-up of 46.3 months. Methodological quality was fair. The overall complication rate was 5% (4%-6%; treatment group effect, P = 0.0015). Analysis resulted in rates from 3% (2%-4%) for matrix-assisted bone marrow stimulation to 15% (5%-35%) for metal implants. Nerve injury was the most observed complication. Conclusions In 1 out of 20 patients treated surgically for an OLT, a complication occurs. Metal implants have a significantly higher complication rate compared with other treatment modalities. No life-threatening complications were reported.

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“…In the literature, there is a growing awareness of the difference between gender in talus OCL presentation and in the outcomes from treatments such as autologous osteochondral transplantation or BMS [ 40 , 41 ]. It might be of great interest to differentiate the results obtained from the reported studies based on patient gender to reveal any difference in the clinical presentation or the results or to eventually highlight the comparable effectiveness of RD in the outcomes regardless of gender.…”

Section: Discussionmentioning

confidence: 99%

A Systematic Review of the Retrograde Drilling Approach for Osteochondral Lesion of the Talus: Questioning Surgical Approaches, Outcome Evaluation and Gender-Related Differences

Veronesi

Maglio

Brogini

et al. 2023

JCM

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Background: Retrograde drilling (RD) is a minimally invasive surgical procedure mainly used for non-displaced osteochondral lesions (OCL) of the talus, dealing with subchondral necrotic sclerotic lesions or subchondral cysts without inducing iatrogenic articular cartilage injury, allowing the revascularization of the subchondral bone and new bone formation. Methods: This systematic review collected and analyzed the clinical studies of the last 10 years of literature, focusing not only on the clinical results but also on patients’ related factors (gender, BMI, age and complications). Results: Sixteen clinical studies were retrieved, and differences in the type of study, follow-up, number and age of patients, lesion type, dimensions, grades and comparison groups were observed, making it difficult to draw conclusions. Nevertheless, lesions on which RD showed the best results were those of I–III grades and not exceeding 150 mm2 in size, showing overall positive results, a good rate of patient satisfaction, improvements in clinical scores, pain reduction and return to daily activities and sports. Conclusions: There are still few studies dealing with the issue of post-surgical complications and gender-related responses. Further clinical or preclinical studies are thus mandatory to underline the success of this technique, also in light of gender differences.

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Gender Differences May Exist in the Presentation, Mechanism of Injury and Outcomes Following Bone Marrow Stimulation for Osteochondral Lesions of the Talus

Cited by 4 publications

References 37 publications

Ten-Year Survival Rate of 82% in 262 Cases of Arthroscopic Bone Marrow Stimulation for Osteochondral Lesions of the Talus

Ten-Year Survival Rate of 82% in 262 Cases of Arthroscopic Bone Marrow Stimulation for Osteochondral Lesions of the Talus

The Frequency and Severity of Complications in Surgical Treatment of Osteochondral Lesions of the Talus: A Systematic Review and Meta-Analysis of 6,962 Lesions

A Systematic Review of the Retrograde Drilling Approach for Osteochondral Lesion of the Talus: Questioning Surgical Approaches, Outcome Evaluation and Gender-Related Differences

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