Exploring the Bilateral Comparisons of Articular Surfaces of Talus: An Observational Study at Tertiary Health Care Center in Pune City

Background: The existing conclusive data show variations in the subtalar joint regarding its morphological features and articulation of bones. Inadequate studies exist on the morphometry of articular surfaces of the talus which may help in surgical interventions and development of implants and prostheses in diverse populations. Purpose: The current study was undertaken to conduct a bilateral comparison of parameters of articulating surfaces of talus. Material and Methods: An observational study design was carried out at one of the private medical colleges in the Pune district of Maharashtra. A total of 100 (fifty-one from right side and forty-nine left-sided tali) dry human talar bones were collected and various dimensions of articular surfaces of bones were measured by Digital Vernier Caliper and Ruler. The data analysis was performed and results were tabulated and presented graphically. Results: There was a statistically significant difference (p<0.05) in bilateral measurements of lateral articular surface height (LASH) of talar bones. The difference was not significant (p>0.05) for all other parameters. Conclusions: The study inferences can be applied as a guide and baseline information for surgical measures, inflammatory disease management, and forensic anthropologists.

Squatting Facets and Trochlear Extensions of Talus Bone in Indian Population

Introduction:The talus is a tarsal bone articulated with the tibia, fibula, navicular, and calcaneus bones to form supratalar, pretalar, and subtalar joints, respectively. A squatting facet is a kind of anomaly that forms on the surfaces where the tibia and talus articulate. The squatting facet states the daily activities and living style of society. Squatting is described as the hyperflexion of the hip and the knee and the movement of hyperdorsiflexion between the leg and the ankle. Materials and Methods: In the present cross‑sectional study, 600 dry adult human tali were taken from the osteology laboratory in the Department of Anatomy, King George’s Medical University, UP, Lucknow. Each talus was examined for the presence of various patterns of articular facets on the neck of the talus and extensions of its trochlear surface. Ethical clearance was obtained from the Institutional Ethics Committee, King George’s Medical University, Lucknow, as reference code: 121 ECMIIA/P3. Results: In our study, we observed that the lateral, medial, and combined squatting faces are 282 (47.64%), 49 (8.28%), and 22 (3.72%), respectively. Lateral, medial, and continuous trochlear extensions are 126 (21.12%), 120 (20.58%), and 31 (5.36%), respectively, in the Indian population. Conclusion: Modifications of the neck of the talus (squatting facets and trochlear extensions) are the result of prolonged squatting positions, which is a common habit of the Indian population, and incidences of these variations can be used as an anthropological marker for racial and regional differentiation of unidentified bones.

A comparison of effectiveness of sex estimation from the calcaneus and talus in a Thai population / Comparación de la efectividad de la estimación del sexo a partir del calcáneo y el talus en una población tailandesa

SUMMARY: Sex estimation is an important aspect of skeletal identification. In addition, previous studies have found that the sex estimation of each race is different. Thus, it is necessary to develop discriminant function equations for the estimation of sex for the Thai population. This study aims to investigate the relationship between width, length and height of the calcaneus and talus with regards to sex and compare the effectiveness of sex estimation between the calcaneus alone, the talus alone, and between both the calcaneus and talus. A total of 200 individuals (100 males and 100 females) were used in this study; ages ranged from 19 to 94 years. Thirteen variables of calcaneus and ten variables of talus were measured. The authors created discriminant function equations for the estimation of sex and tested the efficiency of the equations obtained by using a test group of 40 individuals (20 males and 20 females). By analyzing the mean values of the variables in the calcaneus and the talus, it was shown that males were significantly different from females (p0.05). A stepwise method was used to create 6 equations for sex estimation. The equations were categorized from between the calcaneus alone, the talus alone, and between both the calcaneus and the talus, providing a sex estimation accuracy of between 88.5 and 93.0 %. Using the test group, it was shown that discriminant function equations from the calcaneus alone, the talus alone, and the calcaneus and the talus together, can estimate sex at a high level of accuracy. Sex estimation accuracy was greater than 85 % in all equations. Therefore, the discriminant function equations from the calcaneus alone, the talus alone, and between both the calcaneus and the talus, from this study can be applied to the Thai population.

La estimación del sexo es un aspecto importante de la identificación esquelética. Estudios previos han encontrado que la estimación del sexo de cada raza es diferente. Por lo tanto, es necesario desarrollar ecuaciones de funciones discriminantes para la estimación del sexo de la población tailandesa. Este estudio tuvo como objetivo investigar la relación entre el ancho, el largo y la altura de los huesos calcáneo y talus con respecto al sexo y comparar la efectividad de la estimación del sexo entre el calcáneo solo, el talus solo y entre el calcáneo y el talus. Se utilizaron un total de 200 huesos de individuos adultos (100 hombres y 100 mujeres), cuyas edades oscilaron entre 19 y 94 años. Se midieron trece variables del calcáneo y diez variables del talus. Los autores crearon ecuaciones de funciones discriminantes para la estimación del sexo y probaron la eficiencia de ellas usando un grupo de prueba de huesos de 40 individuos (20 hombres y 20 mujeres). Al analizar los valores medios de las variables en el calcáneo y el talus, se demostró que los huesos de los hombres eran significativamente diferentes al de las mujeres (p0.05). Se utilizó un método paso a paso para crear 6 ecuaciones para la estimación del sexo. Las ecuaciones se clasificaron entre el calcáneo solo, el talus solo y entre el calcáneo y el talus, lo que proporcionó una precisión de estimación del sexo de entre 88,5 y 93,0 %. Usando el grupo de prueba, se demostró que las ecuaciones de funciones discriminantes del calcáneo solo, el talus solo y el calcáneo y el talus juntos pueden estimar el sexo con un alto nivel de precisión. La precisión de la estimación del sexo fue superior al 85 % en todas las ecuaciones. Por lo tanto, las ecuaciones de la función discriminante del calcáneo solo, el talus solo y entre el calcáneo y el talus de este estudio se pueden aplicar a la población tailandesa.

Fractura de astrágalo asociado a fractura del cuboides en un niño de 9 años: reporte de caso / Talar fracture associated with cuboid fracture in a 9-year-old boy: case report / Fratura do tálus associada à fratura do cubóide em menino de 9 anos: relato de caso

Introducción: El astrágalo tiene una anatomía única y juega un papel fundamental en la función del tobillo y pie. Las fracturas de astrágalo se consideran una urgencia ortopédica especialmente las fracturas de cuello desplazadas, debido al alto riesgo de necrosis avascular. Sin embargo, estas son raras en los niños con una prevalencia estimada del 0,008% de todas las fracturas pediátricas. Las fracturas del cuello del astrágalo se asocian con una alta tasa de complicaciones, entre las más importantes se destacan la artrosis postraumática y la necrosis avascular. Éstas están relacionadas principalmente con el grado de desplazamiento inicial del cuello del astrágalo y la incidencia puede ser del 100%. Objetivos: Los objetivos del presente trabajo son demostrar la evolución de un paciente con una patología poco frecuente, con una asociación lesional no reportada hasta el momento y realizar una revisión bibliográfica del tema. Material y métodos: Se evaluó de forma retrospectiva un paciente de sexo masculino de 9 años con una luxo-fractura de cuello de astrágalo de pie izquierdo asociado a una fractura de cuboides. Se evaluaron los resultados clínicos radiológicos y funcionales luego de 3 años de evolución. Resultados: En nuestro caso se realizó reducción abierta y fijación percutánea. Se logró una excelente consolidación ósea sin complicaciones y con buena funcionalidad del tobillo luego de 3 años de seguimiento. Se realizó la escala AOFAS obteniendo una puntuación de 93/100. No presentó limitaciones en cuanto al dolor, con un total de 40 puntos, no mostró limitaciones en cuanto a la función, con un total de 45 puntos. Observamos una leve desaxación en valgo del retropie, asintomático, con un total de 8 puntos. Conclusiones: Las fracturas del astrágalo son raras en la población pediátrica pero pueden ocasionar complicaciones graves. En nuestro caso observamos una fractura grave, con una asociación lesional no descrita hasta el momento, que presentó muy buena evolución, con una consolidación ósea, sin complicaciones y con buen resultado funcional a los 3 años de la cirugía. Al tratarse de una patología muy poco frecuente y rara, la bibliografía revisada es en general de baja evidencia científica y se basa en su mayoría en reporte de casos clínicos, excepto una revisión sistemática con bajo numero de pacientes.

Introduction: The talus has a unique anatomy and plays a fundamental role in the function of the ankle and foot. Talar fractures are considered an orthopedic emergency, especially displaced neck fractures, due to the high risk of avascular necrosis. However, these are rare in children with an estimated prevalence of 0.008% of all pediatric fractures. Talar neck fractures are associated with a high rate of complications, the most important of which include post-traumatic osteoarthritis and avascular necrosis. These are mainly related to the degree of initial displacement of the talar neck and the incidence can be 100%. Objectives: The objectives of this work are to demonstrate the evolution of a patient with a rare pathology, with an injury association not reported so far and to carry out a bibliographic review of the topic. Material and methods: A 9-year-old male patient with a talar neck fracture dislocation of the left foot associated with a cuboid fracture was retrospectively evaluated. Clinical, radiological and functional results were evaluated after 3 years of evolution. Results: In our case, open reduction and percutaneous fixation were performed. Excellent bone union was achieved without complications and with good ankle functionality after 3 years of follow-up. The AOFAS scale was performed, obtaining a score of 93/100. It did not present limitations in terms of pain, with a total of 40 points, it did not show limitations in terms of function, with a total of 45 points. We observed a slight valgus dexation of the hindfoot, asymptomatic, with a total of 8 points. Conclusions: Talar fractures are rare in the pediatric population but can cause serious complications. In our case we observed a serious fracture, with an injury association not described until now, which presented a very good evolution, with bone consolidation, without complications and with good functional result 3 years after surgery. As it is a very infrequent and rare pathology, the literature reviewed is generally of low scientific evidence and is based mostly on clinical case reports, except for a systematic review with a low number of patients.

Introdução: O tálus possui anatomia única e desempenha papel fundamental na função do tornozelo e do pé. As fraturas do tálus são consideradas uma emergência ortopédica, principalmente as fraturas deslocadas do colo, devido ao alto risco de necrose avascular. No entanto, estas são raras em crianças, com uma prevalência estimada de 0,008% de todas as fraturas pediátricas. As fraturas do colo do tálus estão associadas a uma alta taxa de complicações, sendo as mais importantes a osteoartrite pós-traumática e a necrose avascular. Estas estão relacionadas principalmente ao grau de deslocamento inicial do colo do tálus e a incidência pode ser de 100%. Objetivos: Os objetivos deste trabalho são demonstrar a evolução de um paciente com patologia rara, com associação de lesão até o momento não relatada e realizar uma revisão bibliográfica sobre o tema. Material e métodos: Foi avaliado retrospectivamente um paciente do sexo masculino, 9 anos de idade, com fratura luxação do colo do tálus do pé esquerdo associada a fratura do cuboide. Os resultados clínicos, radiológicos e funcionais foram avaliados após 3 anos de evolução. Resultados: No nosso caso foi realizada redução aberta e fixação percutânea. Excelente consolidação óssea foi alcançada sem complicações e com boa funcionalidade do tornozelo após 3 anos de acompanhamento. Foi realizada a escala AOFAS, obtendo pontuação de 93/100. Não apresentou limitações em termos de dor, com um total de 40 pontos, não apresentou limitações em termos de função, com um total de 45 pontos. Observamos leve dexação em valgo do retropé, assintomática, com total de 8 pontos. Conclusões: As fraturas do tálus são raras na população pediátrica, mas podem causar complicações graves. No nosso caso observamos uma fratura grave, com associação de lesão até então não descrita, que apresentou evolução muito boa, com consolidação óssea, sem complicações e com bom resultado funcional 3 anos após a cirurgia. Por se tratar de uma patologia muito pouco frequente e rara, a literatura revista é geralmente de baixa evidência científica e baseia-se maioritariamente em relatos de casos clínicos, exceto uma revisão sistemática com um número reduzido de doentes.

Arthroscopic minimally invasive reduction for talus posterior process fractures / 中华创伤骨科杂志

Objective:To evaluate the efficacy of arthroscopic minimally invasive reduction in the treatment of talus posterior process fractures.Methods:The clinical data were retrospectively studied of the 42 patients with talus posterior process fracture who had been admitted to Department of Orthopedics, The Fourth Hospital of Wuhan from January 2010 to June 2021. There were 25 males and 17 females, aged from 21 to 60 years (average, 40.5 years). They were assigned into 2 groups according to their different treatments. In the arthroscopic group of 15 cases, arthroscopic reduction and internal fixation (ARIF) were conducted via the posteromedial and posterolateral approaches; in the open reduction group of 27 cases, open reduction and internal fixation (ORIF) were conducted via the posteromedial para-Achilles approach. The 2 groups were compared in terms of operation time, blood loss, hospital stay, fracture clinical healing time, postoperative complications, and the American Society for Foot and Ankle Surgery (AOFAS) ankle-hindfoot score at one year postoperation.Results:There was no significant difference in the preoperative general data between the 2 groups, showing comparability ( P> 0.05). The arthroscopic group incurred significantly less blood loss [(32.0±11.5) mL], hospital stay [(5.3±1.8) d], and fracture clinical healing time [(4.6±1.0) months], and a significantly lower incidence of postoperative complications [20.0% (3/15)] than the open reduction group did [(80.0±15.2) mL, (8.4±2.4) d, (6.3±2.2) months, and 29.6% (8/27)], but significantly longer operation time [(74.0±8.9) min] than the open reduction group [(62.9±5.1) min] ( P<0.05). The AOFAS ankle-hindfoot scores at one year postoperation in both groups were higher than those before operation. The AOFAS ankle-hindfoot scores in the arthroscopic group [(83.0±13.0) points] were significantly higher than those in the open reduction group [(72.3±16.0) points] ( P<0.05). Conclusion:ARIF is a preferred minimally invasive treatment for talus posterior process fractures, because it leads to a smaller incision, less blood loss, shorter hospital stay, quicker clinical healing, a lower incidence of postoperative complications, and better functional improvement of the ankle and hindfoot than ORIF.

Research progress of cell transplantation in the treatment of osteochondral lesions of the talus / 中华创伤杂志

Osteochondral lesions of the talus (OLT) frequently manifest following ankle joint trauma, causing ankle pain, swelling and impaired mobility, thereby significantly impeding daily activities of the patients. Presently, clinical treatment approaches encompass both conservative management and surgical intervention. Conservative management endeavors to alleviate symptoms, while patients experiencing persistent symptoms resort to surgical intervention. Commonly employed surgical treatments encompass bone marrow stimulation, autologous osteochondral transplantation, and allogeneic osteochondral transplantation. Bone marrow stimulation is employed as a therapeutic approach for the management of smaller OLT, demonstrating favorable short-term effectiveness; however, the long-term prognosis remains uncertain. Autologous osteochondral transplantation is a viable option for larger OLT lesions, albeit it carries the potential of complications at the donor site. Conversely, allogenic osteochondral transplantation exhibits a diminished success rate. In recent times, the utilization of cell transplantation techniques has garnered escalating interest in the treatment of OLT due to their capacity to regenerate cartilage resembling hyaline and their diverse range of cellular origins. The authors reviewed the progress of cell transplantation in the treatment of OLT, providing a reference for the clinical treatment.

Expert consensus on platelet-rich plasma treatment for osteochondral lesion of talus (version 2023) / 中华创伤杂志

Osteochondral lesion of talus (OLT) is a foot and ankle disease characterized by ankle pain, which may impact the joint function and life quality. If managed improperly, it may lead to a further ankle arthritis, severely compromising the prognosis. The therapeutic effect of conservative treatment for OLT is still uncertain. Surgery is still the main treatment modality for OLT with various techniques. However, the optimized surgical technique is still inconclusive, furthermore, regeneration and repair of cartilage after debridement is also a great challenge for the treatment of OLT. Platelet-rich plasma (PRP) with good repair effect on cartilage injury is gradually applied in the treatment of OLT. However, there still lacks the unified understanding of the technique and specification of PRP for the treatment of OLT. Therefore, National Orthopedics Center of Shanghai Sixth People′s Hospital allied Foot Ankle Basic Research & Orthopedics Group, Chinese Association of Orthopedic Surgeons; Foot and Ankle Committee of Chinese Association of Sports Medicine Physicians; and Foot and Ankle Group of Orthopedic Specialized Branch of Shanghai Medical Association to organize related experts to formulate the Expert consensus on platelet- rich plasma treatment for osteochondral lesion of talus ( version2023). Fifteen recommendations were put forward upon PRP preparation, indications, contraindications and treatment methods of PRP for OLT, so as to standardize the PRP treatment for OLT.

Efficacy of osteochondral fragment fixation using bioabsorbable pins for Hepple Ⅱ osteochondral lesions of the talus in adolescents / 国际外科学杂志

Objective:To investigate the efficacy of osteochondral fragment fixation using bioabsorbable pins for Hepple Ⅱ osteochondral lesions of the talus (OLT) in adolescents.Methods:Retrospective case analysis was used. The clinical data and follow-up results of 13 adolescent patients (13 feet) with Hepple Ⅱ OLT were all treated with osteochondral fragment fixation using bioabsorbable pins admitted to Shanghai Sixth People′s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2017 to December 2021 were retrospectively analyzed. There were 7 males and 6 females, with 13 right feet. The age was (14.85±2.23) years old, ranged from 12 to 18 years old. According to the American orthopedic foot and ankle society (AOFAS) ankle-hindfoot score, visual analogue scale (VAS) and SF-36 score before operation and at the last follow-up were used to evaluate the efficacy and function of the patients. Measurement data with normal distribution were represented as mean ± standard deviation( ± s), and the comparison between groups was conducted using the t-test; The mearsurement data with skewness distribution were expressed by M( Q1, Q3), and rank-sum test was used for inter-group comparison. Results:Thirteen adolescent patients (13 feet) with Hepple Ⅱ OLT underwent surgery successfully and were followed up for (25.54±9.95) months. All wounds healed by first intention, and no complications such as wound infection and delayed healing occurred. Preoperative AOFAS ankle-posterior foot score, VAS and SF-36 score were 58.62±3.55, 7.00 (6.50, 8.00) and 68.38±4.81, respectively. At the last follow-up, the scores were 97.38±2.73, 1.00 (0.00, 1.00), 91.15±4.28, respectively, and the results were significantly improved at the last follow-up, with the difference between the two groups statistically significant( P<0.05). Conclusion:Osteochondral fragment fixation using bioabsorbable pins which can promote cartilage repair, significantly improve symptoms, and achieve better clinical satisfaction with fewer complications, is a safe and effective surgical treatment option for Hepple Ⅱ OLT in adolescents with satisfactory short-term clinical outcomes.

Evaluation and management of osteochondral lesions of the talus in skeletally immature patients / Evaluación y tratamiento de las lesiones osteocondrales del astrágalo en pacientes esqueléticamente inmaduros

Abstract: Osteochondral lesions of the talus (OLTs) are defined as damage to the talar cartilage, with pathological changes in the underlying bone. They include a group of injuries that involve juvenile osteochondritis dissecans (JOCD) and osteochondral fractures of the talus. The etiology of OLT remains not fully clarified but is more common in young and active patients. Treatment strategies for OLTs in skeletally immature populations depend on the magnitude of symptoms, lesion morphology (stability and overlying cartilage integrity), size, nature of the lesion (traumatic versus JOCD), ankle stability, lower extremity alignment, and previous treatment. The aim of this review is to provide an overview of the current evidence for the diagnosis and treatment of OLTs in skeletally immature patients.

Resumen: Las lesiones osteocondrales del astrágalo (OLT) se definen como lesiones del cartílago talar, con cambios patológicos en el hueso subyacente. Incluyen un grupo de lesiones que implican osteocondritis disecante juvenil (JOCD) y fracturas osteocondrales del astrágalo. La etiología de las OLT aún no está totalmente aclarada, pero son más frecuentes en pacientes jóvenes y activos. Las estrategias de tratamiento de las OLT en poblaciones esqueléticamente inmaduras dependen de la magnitud de los síntomas, la morfología de la lesión (estabilidad e integridad del cartílago suprayacente), el tamaño, la naturaleza de la lesión (traumática frente a JOCD), la estabilidad del tobillo, la alineación de la extremidad inferior y el tratamiento previo. El objetivo de esta revisión es proporcionar una visión general de las pruebas actuales para el diagnóstico y el tratamiento de los OLT en pacientes esqueléticamente inmaduros.

Investigation of the relationship between foot deformities and radiographic measurements of the talus and calcaneus / Investigación de la relación entre las deformidades del pie y las mediciones radiográficas del talo y del calcáneo

SUMMARY: The weight of the body is transmitted to the foot through the subtalar joint and talus. Considering the important location of the talus and calcaneus, the morphological structures of these bones may affect the biomechanics of the subtalar joint. At the same time, the morphological structure of these bones is important in some common foot deformities. We aimed to investigate whether the various measurements of the talus and calcaneus are associated with different foot deformities in this study. In this study, radiography images of 158 (72 male and 86 female) patients within the mean age of 44 years were retrospectively examined. Eleven different measurements of the talus and calcaneus were obtained from the lateral and antero-posterior radiographs of the patients. A total of 158 patient's routine clinic radiographs were retrospectively assessed, which have calcaneal spur (n=63), hallux valgus (n=32) and control group (n=63). We determined that the body height of the calcaneus, maximum width of the head of the talus, minimum anterior width of the calcaneus were significantly different between calcaneal spur group and control group. Maximum length fibular malleolar facet of the talus was significantly different between age groups. And we determined that the calcaneal index was significantly different between hallux valgus group and control groups. Also all measurements were significantly different between males and females. As a result, some measurements that significantly determine the morphology of the talus and calcaneus were found to be significant between deformity groups and control groups. We think that our study will contribute to the literature as it is the first study in which the measurements obtained from the radiographic images of the talus and calcaneus are associated with foot deformities.

El peso del cuerpo se transmite al pie a través de la articulación subtalar y el talo. Teniendo en cuenta la importante ubicación del talo y el calcáneo, las estructuras morfológicas de estos huesos pueden afectar la biomecánica de la articulación subtalar. Al mismo tiempo, la estructura morfológica de estos huesos es importante en algunas deformidades comunes del pie. Nuestro objetivo fue investigar si las diversas medidas del talo y el calcáneo están asociadas con diferentes deformidades del pie en este estudio. Se examinaron retrospectivamente imágenes radiográficas de 158 pacientes (72 hombres y 86 mujeres) con una edad promedio de 44 años. Se obtuvieron once medidas diferentes del talo y el calcáneo a partir de las radiografías lateral y anteroposterior de los pacientes. Se evaluaron retrospectivamente un total de 158 radiografías clínicas de rutina de los pacientes, los cuales tenían espolón de calcáneo (n=63), hallux valgus (n=32) y grupo control (n=63). Determinamos que la altura del cuerpo del calcáneo, el ancho máximo de la cabeza del talo, el ancho anterior mínimo del calcáneo fueron significativamente diferentes entre el grupo con espolón calcáneo y el grupo control. La longitud máxima de la faceta maleolar fíbular del talo era significativamente diferente entre los grupos de edad. También determinamos que el índice calcáneo fue significativamente diferente entre el grupo de hallux valgus y los grupos controles. Además, todas las medidas fueron significativamente diferentes entre hombres y mujeres. Como resultado, algunas medidas que determinan la morfología del talo y el calcáneo resultaron significativas entre los grupos de deformidad y los grupos controles. Estimamos que nuestro estudio contribuirá a la literatura debido a que es el primer reporte en el que las medidas obtenidas de las imágenes radiográficas del talo y el calcáneo se asocian con deformidades del pie.

iSMART Contoura laser-assisted in situ keratomileusis: A new planning software

Background: Topography guided laser-assisted in situ keratomileusis (LASIK) has always been some sort of an enigma in terms of its understanding and interpretation. Contoura LASIK is one such form of FDA approved topography guided LASIK on the Wavelight platform for virgin eyes. Inspite of promising so much, its complete application has not yet been fully understood and cannot be applied for all cases. Purpose: The iSMART Contoura LASIK is a software designed by the author, aimed to specifically to plan and treat eyes with Contoura LASIK. Synopsis: This is computer based software which studies the higher order aberrations being treated by the machine, and applies geometry and vector mathematics to appropriately modify the final treatment refraction so as to completely correct the refractive error. The software guides almost everything related to LASIK planning including safety parameters like percent tissue altered and residual stromal bed, the ring and stop size for microkeratome needed, femto flap diamter and Contoura planning. This software will be a useful tool for all Wavelight EX500 Contoura LASIK users. Highlights: This video demonstrates briefly the overview, working and utility of the iSMART LASIK software along with a quick understanding of how Contoura LASIK planning is done using it.

Posterior ankle arthroscopic microfracture with platelet-rich plasma injection for the treatment of osteochondral lesions of the talus / 中华创伤杂志

Objective:To investigate the efficacy of posterior ankle arthroscopic microfracture with platelet-rich plasma (PRP) injection for the treatment of posterior osteochondral lesions of the talus (OLT).Methods:A retrospective case series study was conducted on clinical data of 13 patients with posterior OLT admitted to Shanghai Sixth People′s Hospital Affiliated to Shanghai Jiao Tong University from September 2019 to October 2020. There were 10 males and 3 females, aged 10-65 years [(38.2±15.9)years]. According to Hepple′s classification, four patients were with type II, three with type IV, and six with type V. According to Elias′ grid scheme, nine patients were in zone 7 and four patients in zone 9. The disease duration was 13-51 months [(26.2±11.4)months]. All patients underwent posterior ankle arthroscopic microfracture with PRP injection. The operation time was recorded. The visual analogue scale (VAS), American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, and ankle range of motion (ROM) were compared before operation and at 3 months and 1 year after operation. The magnetic resonance observation of cartilage repair tissue (MOCART) score was used to evaluate the repair of cartilage injury at 1 year after operation. Complications were recorded.Results:All patients were followed up for 12-25 months [(15.7±3.7)months]. The operation time ranged from 50 to 90 minutes [(63.8±13.3)minutes]. The VAS improved from 3.0(3.0, 4.0)points before operation to 1.0(0, 2.0)points at 3 months after operation and 1.0(0,1.5)points at 1 year after operation; the AOFAS ankle-hindfoot score was improved from (66.1±11.8)points before operation to (84.8±9.5)points at 3 months after operation and (92.9±8.6)points at 1 year after operation; the ankle ROM was improved from (48.5±7.5)° before operation to (61.9±10.3)° at 3 months after operation and (65.4±11.8)° at 1 year after operation (all P<0.05). There was no significant difference in VAS at 3 months and 1 year after operation ( P>0.05). There were significant differences in AOFAS ankle-hindfoot score and ankle ROM at 3 months and 1 year after operation (all P<0.05). According to AOFAS ankle-hindfoot score, the results were excellent in 11 patients, good in one, and fair in one, with the excellent and good rate of 92%. The MOCART score was 40-85 points [(70.4±14.2)points] at 1 year after operation. There was no postoperative necrosis, infection or neurovascular injury. Two patients had slight transient pain during rehabilitation training and were improved after non-surgical treatment. Conclusion:For posterior OLT, posterior ankle arthroscopic microfracture with PRP injection can effectively alleviate pain, improve ankle function and repair cartilage damage, with satisfactory short-term efficacy.

Osteochondrogenesis with Autologous Peripheral Blood Stem Cells for Osteochondral Lesions of the Talus: Report of Five Cases

@#Osteochondral lesions of the talus (OLTs) may progress to ankle arthritis needing ankle arthroplasty or arthrodesis. We report five cases of OLTs treated along the principles developed for chondrogenesis of the knee joint with autologous peripheral blood stem cells (PBSCs), resulting in repair and regeneration of the bone and cartilage components. Improvement in Ankle Osteoarthritis Scale (AOS) scores with minimum two years follow-up showed statistical significance (p < 0.05).

Clinical outcomes of robotic arthroscopy for Hawkins type Ⅱ talus neck fracture / 中华创伤骨科杂志

Objective:To investigate the efficacy of TiRobot navigation combined with ankle arthroscopy in the reduction and internal fixation of Hawkins type Ⅱ talus neck fracture.Methods:From January 2019 to September 2020, a total of 13 patients with Hawkins type Ⅱ talus neck fracture were admitted to Department of Foot and Ankle Surgery, Xuzhou Renci Hospital. They were 8 males and 5 females, with a mean age of 35.8 years (from 22 to 61 years). All fractures were reduced and fixated using TiRobot navigation combined with ankle arthroscopy. Time for fracture reduction assisted by intraoperative arthroscopy, time for internal fixation assisted by TiRobotic navigation, fracture union time and complications were recorded. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score was used at the last follow-up to evaluate the functional outcomes.Results:All the operations were finished within 2 hour. The primary screw placement succeeded in all. The time for fracture reduction assisted by intraoperative arthroscopy averaged 52.8 min (from 43 to 66 min) and the time for internal fixation assisted by TiRobotic navigation 43.6 min (from 33 to 55 min). All the patients were followed up for an average 13.3 months(from 12 to 15 monhs). They obtained bony union within 3 months. One patient developed traumatic subtalar arthritis with mild pain and was treated conservatively. None of the patients had complications like incision infection or talus necrosis. The average AOFAS ankle-hindfoot score was 91.0 points (from 83 to 94 points) at the last follow-up.Conclusion:In the reduction and internal fixation of Hawkins type Ⅱ talus neck fracture, TiRobot navigation combined with ankle arthroscopy shows advantages of minimal invasion, accurate reduction and screw placement, and limited complications, leading to fine short-term functional outcomes.

Arthroscopic medullary decompression combined with platelet-rich plasma therapy for bone marrow edema of the talus / 中华创伤杂志

Objective:To report the efficacy of arthroscopic medullary decompression combined with platelet-rich plasma (PRP) in the treatment of bone marrow edema of the talus.Methods:A retrospective case series study was used to analyze the clinical data of 17 patients with bone marrow edema of the talus admitted to Union Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 2018 to July 2020. There were 11 males and 6 females, with the age range of 15-56 years [(45.7±4.3)years]. All patients were subjected to arthroscopic medullary decompression combined with the administration of PRP. Operation time and wound healing were recorded. Maximum area of bone marrow edema was measured by MRI preoperatively and at 6 and 12 months postoperatively. Ankle range of motion (ROM), visual analog score (VAS) and American Association of Foot and Ankle Surgery (AOFAS) ankle-hindfoot score were measured preoperatively and at 6 and 12 months postoperatively. Complications were also detected.Results:All patients were followed up for 12-41 months [(16.7±2.1)months]. Operation time was 45.2-68.5 minutes [(53.4±12.4)minutes]. All wounds were healed at stage I. The maximum area of bone marrow edema decreased from (28.2±6.9)mm 2 preoperatively to (16.3±5.7)mm 2 at 6 months postoperatively and to (7.1±1.7)mm 2 at 12 months postoperatively (all P<0.01). Ankle ROM increased from (52.2±8.9)° preoperatively to (72.3±3.1)° at 6 months postoperatively and to (83.1±2.8)° at 12 months postoperatively (all P<0.01). VAS decreased from (8.2±0.6)points preoperatively to (6.5±0.4)points at 6 months postoperatively and to (3.1±0.8)points at 12 months postoperatively (all P<0.01). AOFAS ankle-hindfoot score increased from (32.4±4.8)points preoperatively to (54.4±6.5)points at 6 months postoperatively and to (88.7±4.3)points at 12 months postoperatively (all P<0.01). There were significant differences in maximum area of bone marrow edema of the talus, ankle ROM, VAS and AOFAS ankle-hindfoot score at 12 months postoperatively when compared with those at 6 months postoperatively (all P<0.01). One patient showed the symptom of localized skin numbness postoperatively, and improved with nerve nutrition therapy. Conclusion:Arthroscopic medullary decompression combined with PRP therapy for bone marrow edema of the talus presents good short-term clinical benefits in terms of reduced extent of bone marrow edema, improved ankle ROM, attenuated pain, improved ankle joint function and few postoperative complications.

Morphology and distribution characteristics of subchondral bone cysts in the talus based on CT three-dimensional reconstruction / 中华创伤杂志

Objective:To analyze the morphology and distribution characteristics of subchondral bone cysts of the talus by CT three-dimensional reconstruction.Methods:A total of 176 patients diagnosed with subchondral bone cyst of the talus after CT scan of the ankle or foot from 2015 to 2020 were retrieved from the imaging report database of Tianjin Hospital, including 77 males and 99 females, aged 14-84 years［(56.1±14.0)years］. After three-dimensional reconstruction of the talus and cyst area by Mimics 20.0 software, an equal 2×2 grid configuration was constructed to divide the domed articular surface into four regions: anteromedial, anterolateral, posteromedial and posterolateral. For subchondral cyst of the talus, area involved under grid localization, gender, age and side of the onset were recorded. The anteroposterior diameter, transverse diameter, depth, surface area and volume of the subchondral bone cyst of the talus were measured.Results:Subchondral cyst of the talus was anteromedial in 131 patients (74.4%), anterolateral in 5(2.8%), posteromedial in 34(19.3%), and posterolateral in 6(3.4%). Subchondral cyst of the talus occurred in the older aged (≥60 years) for 78 patients (44.3%), in the middle aged (45-59 years) for 62(35.2%), in young adults for 32(18.2%), and in preadolescents for 4(2.3%). The age composition of the subchondral cyst of the talus involving the anteromedial, anterolateral, posteromedial and posterolateral regions was 59(49, 64)years, 44(39, 45)years, 61(54, 68)years and 40(22, 58) years, respectively (all P<0.01). There were no statistically significant differences in gender and side of the onset (all P>0.05). The anteroposterior diameter of the subchondral bone cysts located anteromedially, anterolaterally, posteromedially and posterolaterally was (9.7±4.4)mm, (3.5±1.1)mm, (10.3±4.4)mm and (2.1±0.8)mm, respectively; the transverse diameter was (5.4±1.7)mm, (3.9±1.8)mm, (5.9±2.2)mm and (3.4±1.1)mm, respectively; the depth was (7.1±2.4)mm, (3.2±2.2)mm, (8.2±3.0)mm and (3.9±1.9)mm, respectively; the surface area was 156.1(82.6, 198.2)mm 2, 23.0(21.4, 28.9)mm 2, 180.0(75.1, 230.4)mm 2 and 28.0(20.3, 36.7)mm 2, respectively; the volume was 77.1(37.1, 129.1)mm 3, 23.9(14.2, 37.8)mm 3, 104.6(37.7, 157.4)mm 3 and 13.0(10.4, 16.0)mm 3, respectively. When comparing the anteroposterior diameter, transverse diameter, depth, surface area and volume of the subchondral bone cysts in the anteromedial and posteromedial regions with the anterolateral and posterolateral regions, the differences were statistically significant (all P<0.01) except for the transverse diameter of the subchondral bone cysts in the anteromedial region and the anterolateral region ( P>0.05). In addition, the depth of subchondral bone cysts in the anteromedial region was significantly greater than that in the posteromedial region ( P<0.05). Conclusions:Subchondral bone cysts of the talar are commonly found in the middle- and old-aged population. Anteromedial lesions of the talar dome are the most commonly seen, with large and deeply involved cysts, followed by posteromedial lesions of the dome, while anterolateral and posterolateral lesions of the dome are less common and have smaller cyst sizes. An equal 2×2 grid configuration for talar cysts is useful in positioning and characterizing bone cysts, and can assist clinicians in accurately diagnosing and treating bone cysts.

Which clinical outcome scores are more frequently used in the literature on osteochondral lesions of the talus? a systematic review / Quais escores de desfechos clínicos são usados com mais frequência na literatura lesões osteocondrais do tálus? uma revisão sistemática

ABSTRACT Objective: This study aimed to identify the most used scales in the assessment of the clinical outcomes for the treatment of osteochondral lesions of the talus. Methods: We performed a systematic review of the PubMed/MEDLINE databases from September 1999 to September 2019, based on the guidelines established by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The research strategy was: osteochondral [All Fields], AND ("talus" [MeSH Terms] OR "talus" [All Fields]) AND lesion [All Fields]. Of the 364 articles found in the literature, 166 (45%) were included in the study and 198 (55%) excluded. In total, 23 clinical assessment tools were used in the studies. Results: We found 49.4% of the studies to use the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS Ankle-Hindfoot Scale) and 29.5% the Visual Analogue Scale (VAS). Conclusion: The use of AOFAS increased in relation to VAS in the last 6 years (p = 0.046), and these two scales, either alone or combined, were the most used for studying osteochondral lesions of the talus. Level of Evidence III, Systematic Review of Level II studies.

RESUMO Objetivo: Este estudo propõe revisar sistematicamente a literatura para identificar as escalas mais utilizadas da avaliação clínica de resultados do tratamento das LOTs. Métodos: Foi realizada revisão sistemática das bases de dados do PubMed/MEDLINE, desde setembro de 1999 a setembro 2019 baseado nas diretrizes PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses). A estratégia de pesquisa foi: osteochondral [All Fields], AND ("talus" [MeSH Terms] OR "talus" [All Fields]) AND lesion [All Fields]. De 364 artigos, foram incluídos no estudo 166 (45%) e excluídos 198 (55%). Foram observadas 23 escalas de avaliação clínica utilizadas. Resultados: A escala AOFAS e EVA de dor foram as mais utilizadas, ocorrendo em 49,4% e 29,5% dos artigos, respectivamente. Foi observado aumento de uso de AOFAS e diminuição EVA nos últimos 6 anos (p = 0,046). Conclusão: As ferramentas Escala AOFAS e EVA para dor demonstraram ser as mais usadas na literatura para avaliação de resultados do tratamento da lesão osteocondral de tálus, tanto isoladamente, quanto combinadas. Nível de Evidência III, Revisão Sistemática de Estudos de Nível II.

A comprehensive study of the anatomical variations of the posterolateral tubercle of talus / Un estudio integral de las variaciones anatómicas del tubérculo posterolateral del talo

SUMMARY: The aim of our study was to determine the prevalence and the anatomical variations of the posterolateral tubercle of talus in relation to sex on CT imaging. A total of 1478 ankle CT scans was retrospectively reviewed for the different anatomical variants of the posterolateral tubercle of talus, the type and size of os trigonum. Normal sized lateral tubercle was found in 46.1 %, an enlarged posterolateral tubercle (Stieda's process) in 26.1 %, os trigonum in 20.5 % and almost absent tubercle in 7.3 %. A statistically higher prevalence of Stieda's process was found in males while os trigonum was higher in females (p0.05). The posterolateral tubercle of talus and its accessory ossicle, the os trigonum, could vary morphologically. The data of this study could be helpful in understanding the clinical problems that could be associated with some of these variants.

RESUMEN: El objetivo de nuestro estudio fue determinar la prevalencia y las variaciones anatómicas del tubérculo posterolateral del talo en relación con el sexo en la imagen de TC. Se revisaron retrospectivamente un total de 1478 TC de tobillo para las diferentes variantes anatómicas del tubérculo posterolateral del talo, el tipo y tamaño del os trigonum. Se encontró tubérculo lateral de tamaño normal en 46,1 %, tubérculo posterolateral (proceso de Stieda) en 26,1 %, os trigonum en 20,5% y tubérculo casi ausente en 7,3 %. Se encontró una prevalencia estadísticamente más alta del proceso de Stieda en los hombres, mientras que el os trigonum fue mayor en las mujeres (p 0,05) no se observaron diferencias significativas. El tubérculo posterolateral del talo y su osículo accesorio, el os trigonum, podrían originar problemas clínicos que podrían estar asociados con algunas de estas variantes.

Outcome of Arthroscopic Bone Marrow Stimulation in Osteochondritis Dissecans of the Talus in a Tertiary Care Hospital

Introduction: Osteochondritis dissecans of the talus is a rarecondition that can create challenges for both the patient andthe treating surgeon. Arthroscopic bone marrow stimulation(i.e. microfracture, drilling) is a well-accepted and proventechnique to allow fibrocartilage differentiation and therebyprovide infill at the site of a cartilage defect in several joints,including the ankle. The aim of our study was to examine therole of arthroscopic bone marrow stimulation techniques as ameans of treatment for osteochondral lesions of the talus.Material and methods: Thirty two ankles were identifiedbetween January 2012 and January 2020 with talus OCD thatunderwent arthroscopic bone marrow stimulation. Each lesionwas classified according to the Berndt and Harty classification.Study patients were evaluated at 6 weeks, 3 months, 6 months,12 months, and annually after surgery. Assessments via avisual analogue scale (VAS) for pain during daily activitiesand sport activity and the American Orthopaedic Foot & AnkleSociety (AOFAS) scoring system were obtained at each visit.Result: There were 25 men and 4 women of average age 35years (range 17–50) and mean body mass index (BMI) 22 kg/m2 (range 20–34) at the time of surgery. Quantitative MRImeasurements on 3D FSPGR Sequence showed that meanarea of the lesions were 0.801 ± 0.505 cm2. Mean AOFASscores improved from 66 points (range 53–77) preoperativelyto 90 points (range 83–100) at final follow-up (p<0.05) andmean Visual Analogue Scale (VAS) scores from 6 points(range 5–8) to 2 points (range 0–5) with p value <0.05 whichis statistically significant.Conclusion: Arthroscopic management of osteochondrallesions of the talus has the advantages of better cosmeticresults, less pain, and less surgical trauma. This techniqueis technically demanding and should be reserved for theexperienced foot and ankle arthroscopist.

Fractura del tubérculo medial de la apófisis posterior del astrágalo / Medial tubercle's fracture of posterior process of talus

OBJETIVO Mostrar una fractura infrecuente del tubérculo posteromedial del astrágalo diagnosticado y tratado de manera aguda mediante osteosíntesis con tornillo Acutrak® (2014 Acumed® LLC). MATERIAL Y MÉTODOS Varón de 28 años, que acude a Urgencias tras torcedura de tobillo con dolor al mover tobillo y hallux y tumefacción en cara interna. En Urgencias pasó desapercibida. En consulta a la semana refería sensación de que se le engancha el primer dedo con la flexoextensión. Se observa fractura del tubérculo medial de la apófisis posterior del astrágalo con desplazamiento >3mm y clínica de posible interposición del flexor hallucis longus. Se decidió tratamiento quirúrgico con tornillo Acutrak®. Se inmovilizó con férula 3 semanas y descarga 6 semanas. RESULTADOS A los 8 meses balance articular completo, sin dolor ni limitación para las ABVD y sin clínica de atrapamiento del flexor del hallux. Como complicación aguda, se verificó infección de herida quirúrgica que se trató con antibióticos. DISCUSIÓN Ese tipo de fracturas son infrecuentes. El mecanismo lesional suele ser dorsiflexión-pronación. Es importante un diagnóstico temprano y para ello es necesario una alta sospecha diagnóstica. Para su diagnóstico, son necesarias radiografías anteroposterior y lateral y si no se visualiza la lesión, proyección oblicua con 30°- 40° de rotación externa. En casos agudos resulta de utilidad la TAC y en casos crónicos la RM. CONCLUSIÓN Aunque generalmente el tratamiento es conservador, en ocasiones puede ser necesario la cirugía mediante osteosíntesis o exéresis del fragmento cuando la fractura provoca impingement.

OBJECTIVE Show an infrequent fracture of the posteromedial tubercle of the talus diagnosed and treated acutely by Acutrak® screw (2014 Acumed® LLC) osteosynthesis. MATERIAL AND METHODS A 28-year-old man attended the Emergency Department after spraining his ankle with pain when moving his ankle and hallux and swelling on the internal face. In the ER it went unnoticed. A week later in the clinic, he refered to the sensation that the first finger is hooked with the flexion extension. A fracture of the medial tubercle of the posterior process of the talus is observed with a displacement of > 3 mm and clinical signs of possible interposition of the hallucis longus . Surgical treatment with Acutrak® screw was made. He was immobilized with a splint for 3 weeks and discharge for 6 weeks. RESULTS At 8 months complete joint balance, without pain or limitations for BADL and without hallux flexor entrapment symptoms. As an acute complication, surgical wound infection that was treated with antibiotics. DISCUSSION These types of fractures are rare. The injury mechanism is usually dorsiflexion-pronation. Early diagnosis is important and a high diagnostic suspicion is required. Anteroposterior and lateral radiographs are necessary for its diagnosis and if the lesion is not visualized, oblique projection with 30°- 40° external rotation. CT is useful in acute cases and MRI in chronic cases. CONCLUSION Although the treatment is conservative, surgery may sometimes be necessary by means of osteosynthesis or excision of the fragment when the fracture causes impingement.