Interventions for treating osteochondral defects of the talus in adults

Loveday, David; Clifton, R.; Robinson, A. H. N.

doi:10.1002/14651858.cd008104.pub2

Cited by 28 publications

(25 citation statements)

References 19 publications

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“…In addition, some studies had a shorter followup (range, 1-56 days) [7,8,42], which is less analogous to the clinical situation. Clinical studies of the ankle use a followup period that generally ranges from several months to years [5,9,11,14,22,23,25,39,50]. Concerning our first hypothesis, the differences we observed in terms of the O'Driscoll score for cartilage repair were on the border of statistical significance favoring 2-mm deep holes over 4-mm deep holes, but did not reach the threshold of 15% defined elsewhere as clinically significant [38,42].…”

Section: Discussionmentioning

confidence: 87%

“…This changes the physical properties of the cartilage and its response to cyclic loading. Further clinical research is needed to investigate whether the biomechanical differences also might influence the healing response, clinical outcome, and controversial prognostic factors in the two most predominantly used joints for bone marrow stimulation [25,41]. This should be taken into account when applying our results to the knee, especially because we used an animal model to answer our research question.…”

Section: Discussionmentioning

confidence: 99%

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No Effect of Hole Geometry in Microfracture for Talar Osteochondral Defects

Kok

Tuijthof

Dunnen

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Débridement and bone marrow stimulation is an effective treatment option for patients with talar osteochondral defects. However, whether surgical factors affect the success of microfracture treatment of talar osteochondral defects is not well characterized. Questions/purposes We hypothesized (1) holes that reach deeper into the bone marrow-filled trabecular bone allow for more hyaline-like repair; and (2) a larger number of holes with a smaller diameter result in more solid integration of the repair tissue, less need for new bone formation, and higher fill of the defect. Methods Talar osteochondral defects that were 6 mm in diameter were drilled bilaterally in 16 goats (32 samples). In eight goats, one defect was treated by drilling six 0.45-mm diameter holes in the defect 2 mm deep; in the remaining eight goats, six 0.45-mm diameter holes were punctured to a depth of 4 mm. All contralateral defects were treated with three 1.1-mm diameter holes 3 mm deep, mimicking the clinical situation, as internal controls. After 24 weeks, histologic analyses were performed using Masson-Goldner/Safranin-O sections scored using a modified O'Driscoll histologic score (scale, 0-22) and analyzed for osteoid deposition. Before histology, repair tissue quality and defect fill were assessed by calculating the Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request. The authors certify that the animal protocol for this investigation was approved by the Academic Medical Center and VU University, Amsterdam, and that all investigations were conducted in conformity with ethical principles of research. The design and creation of surgical templates was performed at TU Delft, Delft, The Netherlands. Animal operations were performed at VU University, Amsterdam, The Netherlands. Histology was performed at ACTA, Amsterdam, The Netherlands. Micro-CT acquisition and analyses were performed at Erasmus MC, Rotterdam, The Netherlands. Analyses were performed at Academic Medical Center, Amsterdam, The Netherlands. Conclusions The results indicate that the geometry of microfracture holes does not influence cartilage healing in the caprine talus. Clinical Relevance Bone marrow stimulation technique does not appear to be improved by changing the depth or diameter of the holes.

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Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

No Effect of Hole Geometry in Microfracture for Talar Osteochondral Defects

Kok

Tuijthof

Dunnen

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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“…There have been no randomized-controlled trials comparing these methods and the treatment algorithm for OLT is controversial. 21,22 Multiple factors including defect size, location, patient age, and prior surgeries must be considered.…”

Section: Osteochondral Lesion Of the Talusmentioning

confidence: 99%

Osteochondral allograft transplantation in the ankle: a review of current practice

Fuchs¹,

Kadakia²

2015

ORR

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Abstract:Osteochondral allograft transplantation is a technique that was first developed to treat cartilage pathology in the knee. Over the past 15 years, this technology has been translated to the treatment of osteochondral lesions and end-stage arthritis of the ankle. For osteochondral lesions of the talus or the tibia, a fresh osteochondral allograft transplant can be fashioned to match a specific defect and is useful for large, cystic or uncontained lesions. For a young patient with end-stage arthritis, bipolar fresh osteochondral allograft transplantation is a treatment alternative to ankle arthrodesis. Evidence for these operations is limited and consists primarily of case series, which have reported variable rates of success and in some cases high rates of complications and reoperations. Nevertheless, these techniques continue to evolve and should be considered as options for patients with certain conditions that are particularly challenging to treat.

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“…Through the perforated subchondral bone plate progenitor cells, mesenchymal stem cells, growth factors, and other healing proteins are released into the defect area and form a superclot that provides an enriched environment for fibrous cartilage formation [10]. MFx provides the highest level of evidence for its good clinical outcome compared to all other cartilage repair techniques [11]. However, the good initial clinical results are reported to start to worsen after 5 years [12,13].…”

Section: Surgical Treatment Optionsmentioning

confidence: 99%

Scaffold Based Reconstruction of Focal Full Thickness Talar Cartilage Defects

Walther¹,

Martin²

2013

Clin Res Foot Ankle

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Most talar cartilage injuries have a traumatic pathogenesis. They occur as a result of a single or repeated traumatic event. Initially only the cartilage may be damaged by shear stress and may heal, remaining asymptomatic. Often the trauma causes microfractures in the subchondral plate and bone and upon loading, water is forced into the damaged subchondral area by the compressed cartilage, leading to a localized increased flow and fluid pressure. This can cause osteolysis and lead to the formation of subchondral cysts. Deep ankle pain on weight bearing, most probably caused by repetitive high fluid pressure will limit the patients mobility and hence quality of life and needs to be treated.We describe an emerging and especially cost-effective scaffold-based reconstruction technique for osteochondral defects of the talus-Autologous Matrix-Induced Chondrogenesis (AMIC ® )-a promising alternative to Matrix-induced Autologous Chondrocyte Implantation (MACI) and other techniques.

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Interventions for treating osteochondral defects of the talus in adults

Cited by 28 publications

References 19 publications

No Effect of Hole Geometry in Microfracture for Talar Osteochondral Defects

No Effect of Hole Geometry in Microfracture for Talar Osteochondral Defects

Osteochondral allograft transplantation in the ankle: a review of current practice

Scaffold Based Reconstruction of Focal Full Thickness Talar Cartilage Defects

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