Results of Microfracture in the Treatment of Articular Cartilage Defects of the Talus

Becher, Christoph; Thermann, Hajo

doi:10.1177/107110070502600801

Cited by 182 publications

(154 citation statements)

References 32 publications

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“…Of note, a recent study of 2 nd look arthroscopy at 12 mo postoperatively revealed incomplete healing of osteochondral lesions treated using these techniques in 40% of the patients [25] . Interestingly, good clinical results were achieved, which agrees with most series demonstrating pain relief and optimisation of function [26][27][28] . O'Driscoll [29] summarised that this technique may be best for the treatment of small (< 6 mm), shear-type lesions with minimal subchondral involvement.…”

Section: Marrow Stimulation Techniquessupporting

confidence: 72%

Cartilage repair techniques of the talus: An update

Baums¹

2014

WJO

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Symptomatic chondral or osteochondral defects of the talus reduce the quality of life of many patients. Although their pathomechanism is well understood, it is well known that different aetiologic factors play a role in their origin. Additionally, it is well recognised that the talar articular cartilage strongly differs from that in the knee. Despite this fact, many recommendations for the management of talar cartilage defects are based on approaches that were developed for the knee. Conservative treatment seems to work best in paediatric and adolescent patients with osteochondritis dissecans. However, depending on the size of the lesions, surgical approaches are necessary to treat many of these defects. Bone marrow stimulation techniques may achieve good results in small lesions. Large lesions may be treated by open procedures such as osteochondral autograft transfer or allograft transplantation. Autologous chondrocyte transplantation, as a restorative procedure, is well investigated in the knee and has been applied in the talus with increasing popularity and promising results but the evidence to date is poor. The goals of the current article are to summarise the different options for treating chondral and osteochondral defects of the talus and review the available literature.

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Section: Marrow Stimulation Techniquessupporting

confidence: 72%

Cartilage repair techniques of the talus: An update

Baums¹

2014

WJO

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“…Several authors have reported good results following arthroscopic bone marrow stimulation 28,34,35 . Lee et al 35 reported good to excellent results after microfracture in 89% of thirty-five patients under fifty years of age and with lesions of <1.5 cm 2 .…”

Section: Outcomes Of Arthroscopic Bone-marrow Stimulationmentioning

confidence: 97%

“…Choi et al also evaluated the effect of lesion size on clinical outcome in 117 patients and found the lowest clinical failure rate to be associated with a defect area of <100 mm 2 (5.2% of fifty-eight ankles) 26 . Analyses by several authors have noted that age and a history of trauma have no effect on overall outcome [25][26][27][28][29][30] .…”

Section: Outcomes Of Arthroscopic Bone-marrow Stimulationmentioning

confidence: 99%

Operative Treatment of Osteochondral Lesions of the Talus

Murawski

Kennedy

2013

Journal of Bone and Joint Surgery

235

212

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➤ Osteochondral lesions of the talus are common injuries in recreational and professional athletes, with up to 50% of acute ankle sprains and fractures developing some form of chondral injury. Surgical treatment paradigms aim to restore the articular surface with a repair tissue similar to native cartilage and to provide long-term symptomatic relief.➤ Arthroscopic bone-marrow stimulation techniques, such as microfracture and drilling, perforate the subchondral plate with multiple openings to recruit mesenchymal stem cells from the underlying bone marrow to stimulate the differentiation of fibrocartilaginous repair tissue in the defect site. The ability of fibrocartilage to withstand mechanical loading and protect the subchondral bone over time is a concern.➤ Autologous osteochondral transplantation techniques replace the defect with a tubular unit of viable hyaline cartilage and bone from a donor site in the ipsilateral knee. In rare cases, a graft can also be harvested from the ipsilateral talus or contralateral knee. The limitations of donor site morbidity and the potential need for an osteotomy about the ankle should be considered. Some anterior or far posterior talar lesions can be accessed without arthrotomy or with a plafondplasty.➤ Osteochondral allograft transplantation allows an osteochondral lesion with a large surface area to be replaced with a single unit of viable articular cartilage and subchondral bone from a donor that is matched to size, shape, and surface curvature. The best available evidence suggests that this procedure should be limited to large-volume cystic lesions or salvage procedures.➤ Autologous chondrocyte implantation techniques require a two-stage procedure, the first for chondrocyte harvest and the second for implantation in a periosteum-covered or matrix-induced form after in vivo culture expansion. Theoretically, the transplantation of chondrocyte-like cells into the defect will result in hyaline-like repair tissue.

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“…OCL smaller than 1.5 cm 2 can be treated by microfractures (Becher and Thermann, 2005) or retrograde drilling (Kono et al, 2006); lesions larger than 1.5 cm 2 can be treated by autologous chondrocyte implantation (ACI) (Whittaker et al, 2005) or mosaic-plasty (Hangody, 2003). Patients younger than 50 years can be treated by microfractures, retrograde drilling, mosaicplasty, or ACI and those older than 50 years by microfractures or, in the case of large defects, by ankle joint replacement or fusion (Giannini and Vannini, 2004).…”

Section: Introductionmentioning

confidence: 99%

Radiographic evaluation of frontal talar edge configuration for osteochondral plug transplantation

et al. 2008

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For successful reconstruction of osteochondral lesions of the talus, the anatomic configuration of the talar edge must be respected. This study evaluated the radiographic configuration of the talar edge in the anterior-posterior (AP) view by analyzing medial and lateral talar edge angles and radii in 81 patients with a true AP view and without ankle pathology. The mean lateral talar edge angle was 91.8 degrees , and the mean medial talar edge angle was 110.0 degrees . The medial frontal talar edge radius was 4.8 mm and the lateral 3.5 mm, respectively. No correlation between angle and radius was found. These results revealed a significant difference between the medial and the lateral talar edge configuration. This may be due to the three-dimensional function of the human ankle joint. No study so far has addressed these differences radiologically. These differences should be addressed in the reconstruction of osteochondral lesions and be included in the preoperative planning.

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Results of Microfracture in the Treatment of Articular Cartilage Defects of the Talus

Abstract: At short-term followup, the microfracture technique appeared to repair severe cartilage damage with a good functional outcome. Age was not shown to be a limiting factor.

Cited by 182 publications

References 32 publications

Cartilage repair techniques of the talus: An update

Cartilage repair techniques of the talus: An update

Operative Treatment of Osteochondral Lesions of the Talus

Radiographic evaluation of frontal talar edge configuration for osteochondral plug transplantation

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