Scaffold-Based Therapies: Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle

Rothrauff, Benjamin B.; Murawski, Christopher D.; Angthong, Chayanin; Becher, Christoph; Nehrer, Stefan; Niemeyer, Philipp; Sullivan, Martin; Valderrábano, Víctor; Walther, Markus; Ferkel, Richard D.; Ackermann, Jakob; Adams, Samuel B.; Andrews, Carol L.; Batista, Jorge; Baur, O; Bayer, Steve; Berlet, Gregory C.; Boakye, Lorraine; Brown, Alexandra J.; Buda, Roberto; Calder, James; Canata, Gian Luigi; Carreira, Dominic S.; Clanton, Thomas O.; Dahmen, Jari; D’Hooghe, Pieter; DiGiovanni, Christopher W.; Dombrowski, Malcolm E.; Drakos, Mark C.; Ferrao, Paulo N. F.; 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.; Kerkhoffs, Gino M. M. J.; Kim, Soo Hyun; Kong, Siu Wah; Labib, Sameh A.; Lambers, Kaj T. A.; Lee, Jin Woo; Lee, Keun Bae; Ling, Jeffrey S.; Longo, Umile Giuseppe; Marangon, Alberto; McCollum, Graham; Mitchell, Adam; Mittwede, Peter N.; 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.; Reilingh, Mikel L.; Schon, Lew C.; Shimozono, Yoshiharu; Simpson, Helene; Smyth, Niall A.; Sofka, Carolyn M.; Spennacchio, Pietro; Stone, James W.; Takao, Masato; Tanaka, Yasuhito; Thordarson, David B.; Tuan, Rocky S.; Bergen, Christiaan J. A. van; Dijk, C. Niek van; Dijk, Pim A. D. van; Vannini, Francesca; Vaseenon, Tanawat; Wiewiorski, Martin; Xu, Xiangyang; Yasui, Youichi; Hua, Yinghui; Yoshimura, Ichiro; Younger, Alastair; Zhang, Zijun

doi:10.1177/1071100718781864

Cited by 47 publications

(23 citation statements)

References 43 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…4 A preoperative CT scan is used to measure the bony dimensions of the osteochondral defect (anteroposterior diameter, mediolateral diameter and depth) 4 The last part of the distal tibial osteotomy is done with a chisel to prevent thermal damage to the osteochondral unit 4 Both the distal tibial osteotomy and iliac crest autograft transplantation can be customized for every patient 4 In case a larger distal tibial osteotomy is indicated, an extra antiglide plate can be used to prevent rotation and proximal translation 4 Press-fit autograft transplantation allows for quick rehabilitation without need for intra-articular screw removal 4 Theoretically, an optimal graft to replace an osteochondral unit has the following characteristics: natural scaffold, good quality cells, and growth factors [36,41,42,48,53] Postoperative management…”

Section: Special Surgical Considerationsmentioning

confidence: 99%

Talar OsteoPeriostic grafting from the Iliac Crest (TOPIC) for large medial talar osteochondral defects

Kerkhoffs

Altink

Stufkens

et al. 2020

Oper Orthop Traumatol

View full text Add to dashboard Cite

Objective Provision of a natural scaffold, good quality cells, and growth factors in order to facilitate the replacement of the complete osteochondral unit with matching talar curvature for large medial primary and secondary osteochondral defects of the talus. Indications Symptomatic primary and secondary medial osteochondral defects of the talus not responding to conservative treatment; anterior–posterior or medial–lateral diameter >10 mm on computed tomography (CT); closed distal tibial physis in young patients. Contraindications Tibiotalar osteoarthritis grade III; multiple osteochondral defects on the medial, central, and lateral talar dome; malignancy; active infectious ankle joint pathology. Surgical technique A medial distal tibial osteotomy is performed, after which the osteochondral defect is excised in toto from the talar dome. The recipient site is microdrilled in order to disrupt subchondral bone vessels. Then, the autograft is harvested from the ipsilateral iliac crest with an oscillating saw, after which the graft is adjusted to an exact fitting shape to match the extracted osteochondral defect and the talar morphology as well as curvature. The graft is implanted with a press-fit technique after which the osteotomy is reduced with two 3.5 mm lag screws and the incision layers are closed. In cases of a large osteotomy, an additional third tubular buttress plate is added, or a third screw at the apex of the osteotomy. Postoperative management Non-weight bearing cast for 6 weeks, followed by another 6 weeks with a walking boot. After 12 weeks, a CT scan is performed to assess consolidation of the osteotomy and the inserted autograft. The patient is referred to a physiotherapist. Results Ten cases underwent the TOPIC procedure, and at 1 year follow-up all clinical scores improved. Radiological outcomes showed consolidation of all osteotomies and all inserted grafts showed consolidation. Complications included one spina iliaca anterior avulsion and one hypaesthesia of the saphenous nerve; in two patients the fixation screws of the medial malleolar osteotomy were removed.

show abstract

Section: Special Surgical Considerationsmentioning

confidence: 99%

Talar OsteoPeriostic grafting from the Iliac Crest (TOPIC) for large medial talar osteochondral defects

Kerkhoffs

Altink

Stufkens

et al. 2020

Oper Orthop Traumatol

View full text Add to dashboard Cite

show abstract

“…95 The literature reports a wide variety of surgical treatment strategies, with surgical options ranging from regenerative to replacement therapies. 33,73,79,80,83 In general, all of the different surgical treatment strategies for talar OCDs have shown good results, and there is no clear evidence regarding a superior treatment strategy for either primary or secondary defects. 10,45…”

mentioning

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

Self Cite

View full text Add to dashboard Cite

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.

show abstract

“…Beside patient characteristics influencing the final outcome, this series explored also surgical-related aspects. The importance and attention for the scaffold used in the regenerative therapy of ankle OA has been growing in recent years, as documented by the numerous articles in the literature [26,27,33,40,46,47]. To this regard, it is interesting to notice that the different types of scaffolds used in this study did not have any bearing on the final outcome.…”

Section: Discussionmentioning

confidence: 82%

Bone marrow aspirate concentrate and scaffold for osteochondral lesions of the talus in ankle osteoarthritis: satisfactory clinical outcome at 10 years

Vannini

Filardo

Altamura

et al. 2021

Knee Surg Sports Traumatol Arthrosc

Self Cite

View full text Add to dashboard Cite

Purpose To evaluate at long-term follow-up patients undergoing a one-step procedure of debridement and BMAC seeded in situ onto a scaffold for the treatment of osteochondral lesions of the talus (OLT) in ankles affected by osteoarthritis (OA), documenting the duration of the clinical benefit and its efficacy in postponing end-stage procedures. Methods This series included 56 consecutive patients. Patients were evaluated preoperatively and up to a mean of 10 years of follow-up with the AOFAS score and the AOS scale, including pain and disability subscales. Furthermore, patients were asked to rate the satisfaction and failures were documented as well. Results The AOFAS score improved from 52.3 ± 14.3 to 73.5 ± 23.1 at 10 years (p < 0.0005); the AOS pain and disability subscales decreased from 70.9 ± 14.1 to 37.2 ± 32.7 and from 69.0 ± 14.8 to 34.2 ± 29.3, respectively (both p < 0.0005). The overall rate of satisfaction was 61.8 ± 41.2 and 68.6% of patients would undergo again the surgical procedure. A total of 17 failures was documented, for a failure rate of 33.3%. Older patients and those with more complex cases requiring previous or combined surgeries had lower outcomes, as well as those affected by grade 3 OA, who experienced a high failure rate of 71.4%. Conclusions This one-step technique for the treatment of OLT in OA ankles showed to be safe and to provide a satisfactory outcome, even if patients with end stage OA presented a high revision rate at 10 years. Moreover, this procedure was effective over time, with overall good results maintained up to a long-term follow-up. However, older age, more complex cases requiring previous or combined surgeries, and advanced OA led to an overall worst outcome and a significantly higher failure rate.

show abstract

Scaffold-Based Therapies: Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle

Abstract: Level V, expert opinion.

Cited by 47 publications

References 43 publications

Talar OsteoPeriostic grafting from the Iliac Crest (TOPIC) for large medial talar osteochondral defects

Talar OsteoPeriostic grafting from the Iliac Crest (TOPIC) for large medial talar osteochondral defects

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

Bone marrow aspirate concentrate and scaffold for osteochondral lesions of the talus in ankle osteoarthritis: satisfactory clinical outcome at 10 years

Contact Info

Product

Resources

About