Subchondral Bone Degradation After Microfracture for Osteochondral Lesions of the Talus: An MRI Analysis

Shimozono, Yoshiharu; Coale, Max; Yasui, Youichi; O'Halloran, A; Deyer, Timothy; Kennedy, John G.

doi:10.1177/0363546517739606

Cited by 69 publications

(72 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…BMS has been shown to provide favorable short-term clinical outcomes, 9,36,44 but several clinical studies have shown that midterm to long-term outcomes have less satisfactory results, as fibrocartilage repair tissue may deteriorate over time. 13,23,26,38,42 Recently, several studies have shown that subchondral bone is also not fully restored after BMS and may degrade over time. 35,37,38 The deterioration in both cartilage and subchondral bone suggests that BMS may fail in the long term.…”

mentioning

confidence: 99%

Midterm Outcomes of Bone Marrow Stimulation for Primary Osteochondral Lesions of the Talus: A Systematic Review

Toale

Shimozono

Mulvin

et al. 2019

Orthopaedic Journal of Sports Medicine

Self Cite

View full text Add to dashboard Cite

Background:Bone marrow stimulation (BMS) is a common surgical intervention in the treatment of small osteochondral lesions of the talus (OLTs). Evidence has shown good clinical outcomes after BMS in the short term, but several studies have shown less favorable results at midterm and long-term follow-up because of fibrocartilaginous repair tissue degeneration.Purpose:To evaluate the clinical and radiological outcomes of BMS in the treatment of primary OLTs at midterm and long-term follow-up and to investigate reported data in these studies.Study Design:Systematic review; Level of evidence, 4.Methods:A systematic search of the MEDLINE, Embase, and Cochrane Library databases was performed in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Clinical and radiological outcomes as well as reported data were evaluated.Results:A total of 15 studies comprising 853 patients (858 ankles) were included at a weighted mean follow-up time of 71.9 months. There were 9 studies that used the American Orthopaedic Foot & Ankle Society (AOFAS) score, with a weighted mean postoperative score of 89.9. There were 3 studies that measured postoperative magnetic resonance imaging results in the midterm using the MOCART (magnetic resonance observation of cartilage repair tissue) scoring system and showed 48% of patients with complete filling, 74% with complete integration, and 76% with surface damage. There was a complication rate of 3.4% and a reoperation rate of 6.0% after BMS in the midterm.Conclusion:This systematic review found good clinical outcomes after BMS at midterm follow-up for primary OLTs. Radiological outcomes showed repair tissue surface damage in the majority of patients, which may be a harbinger for long-term problems. Data were variable, and numerous data were underreported. Further high-quality studies, a validated outcome scoring system, and further radiological reports at midterm follow-up are required to accurately assess the success of BMS in the midterm.

show abstract

mentioning

confidence: 99%

Midterm Outcomes of Bone Marrow Stimulation for Primary Osteochondral Lesions of the Talus: A Systematic Review

Toale

Shimozono

Mulvin

et al. 2019

Orthopaedic Journal of Sports Medicine

Self Cite

View full text Add to dashboard Cite

show abstract

“…After trauma causing the breakdown of the subchondral bone plate or cartilage over the talus, liquid flows into the subchondral bone, which results in the formation of talar cysts 23. However, the damaged subchondral bone plate and talar cysts allows more liquid to flow into the subchondral bone, which may cause subsequent degeneration of the cartilage over the talus and articular damage, with loss of proteoglycans and glycoprotein 5 24. Hence, in surgical treatment for large cystic OLTs, large cysts need to be filled in order to promote the healing of talar cartilage.…”

Section: Discussionmentioning

confidence: 99%

“…The progression of subchondral cysts formation, associated with deep ankle pain, could cause the deterioration of clinical scores after a surgical procedure, as confirmed by Shimozono et al 5. The consensus statement for the treatment of OLT has been published in 2018 6.…”

Section: Introductionmentioning

confidence: 90%

Comparison of autologous osteoperiosteal cylinder and osteochondral graft transplantation in the treatment of large cystic osteochondral lesions of the talus (OLTs): a protocol for a non-inferiority randomised controlled trial

et al. 2020

View full text Add to dashboard Cite

IntroductionLarge cystic osteochondral lesions of the talus (OLTs) have been shown to have inferior clinical outcomes after reparative techniques such as bone marrow stimulation. Autologous osteochondral transplantation has been viewed as an alternative choice for treating these lesions, but donor-site morbidity has limited its application. Excellent clinical outcomes have been shown in repairing these types of lesions with autologous osteoperiosteal grafts, and these outcomes are achieved at a low cost and without donor-site morbidity in the normal knee joint. This will be the first randomised controlled trial to compare the two surgical techniques, and recommendations for the treatment of patients with large cystic OLTs will be provided.Methods and analysisA non-inferiority randomised controlled trial will be conducted. A total of 70 participants with clinically diagnosed large cystic OLTs will be randomly allocated to either the experimental group or the control group at a ratio of 1:1. The experimental group will be treated with autologous osteoperiosteal cylinder graft transplantation, while the control group will be treated with autologous osteochondral transplantation. The primary outcome measure will be the American Orthopaedic Foot & Ankle Society Ankle-Hindfoot Score and the Short Form 12 (SF-12) questionnaire. Secondary outcome measures will include the secondary arthroscopy International Cartilage Repair Society score, the Magnetic Resonance Observation of Cartilage Repair Tissue score, the Tegner activity level score, the visual analogue scale, routine X-rays, CT and complications. These parameters will be evaluated preoperatively, as well as at 3, 6, 12, 24, 36 and 60 months postoperatively. In this trial, we hypothesised that both procedures offer good results for the treatment of patients with large cystic OLTs, and occurrence of donor-site morbidity in autologous osteoperiosteal cylinder graft transplantation group is less than that in autologous osteochondral transplantation group.Ethics and disseminationThe current study was approved by the board of research ethics of Peking University Third Hospital Medical Science Research Ethics Committee. The results of this study will be presented at national and international conferences and published in peer-reviewed journals.Trial registration numberNCT03347877.

show abstract

“…55 However, upon short- (1 year) and long-term (4–6 years) follow-up, patients treated with microfracture for talar osteochondral lesions showed deteriorating subchondral bone health, with the development of cysts and subchondral bone plate thickening long term. 56,57…”

Section: Methodsmentioning

confidence: 99%

Beyond Cartilage Repair: The Role of the Osteochondral Unit in Joint Health and Disease

Lepage

Robson

Gilmore

et al. 2019

Tissue Engineering Part B: Reviews

View full text Add to dashboard Cite

Once believed to be limited to articular cartilage, osteoarthritis is now considered to be an organ disease of the “whole joint.” Damage to the articular surface can lead to, be caused by, or occur in parallel with, damage to other tissues in the joint. The relationship between cartilage and the underlying subchondral bone has particular importance when assessing joint health and determining treatment strategies. The articular cartilage is anchored to the subchondral bone through an interface of calcified cartilage, which as a whole makes up the osteochondral unit. This unit functions primarily by transferring load-bearing weight over the joint to allow for normal joint articulation and movement. Unfortunately, irreversible damage and degeneration of the osteochondral unit can severely limit joint function. Our understanding of joint pain, the primary complaint of patients, is poorly understood and past efforts toward structural cartilage restoration have often not been associated with a reduction in pain. Continued research focusing on the contribution of subchondral bone and restoration of the entire osteochondral unit are therefore needed, with the hope that this will lead to curative, and not merely palliative, treatment options. The purpose of this narrative review is to investigate the role of the osteochondral unit in joint health and disease. Topics of discussion include the crosstalk between cartilage and bone, the efficacy of diagnostic procedures, the origins of joint pain, current and emerging treatment paradigms, and suitable preclinical animal models for safety and efficacy assessment of novel osteochondral therapies. The goal of the review is to facilitate an appreciation of the important role played by the subchondral bone in joint pain and why the osteochondral unit as a whole should be considered in many cases of joint restoration strategies. Impact Statement In this comprehensive review, we are providing a holistic overview of osteochondral tissue development, disease, pain localization, as well as structural evaluation and current repair strategies. This review is intended to serve as a broad introduction to this multidisciplinary research area. It is a thorough examination of the biological aspects of the osteochondral unit from a tissue engineering perspective, highlighting the importance of the subchondral bone in chondral and osteochondral lesion repair and pain relief.

show abstract

Subchondral Bone Degradation After Microfracture for Osteochondral Lesions of the Talus: An MRI Analysis

Cited by 69 publications

References 30 publications

Midterm Outcomes of Bone Marrow Stimulation for Primary Osteochondral Lesions of the Talus: A Systematic Review

Midterm Outcomes of Bone Marrow Stimulation for Primary Osteochondral Lesions of the Talus: A Systematic Review

Comparison of autologous osteoperiosteal cylinder and osteochondral graft transplantation in the treatment of large cystic osteochondral lesions of the talus (OLTs): a protocol for a non-inferiority randomised controlled trial

Beyond Cartilage Repair: The Role of the Osteochondral Unit in Joint Health and Disease

Contact Info

Product

Resources

About