ABSTRACT
@#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).
ABSTRACT
Objective: To summarize the research progress of surgical procedures in osteochondral lesions of the talus (OLT). Methods: By consulting the related literature of OLT in recent years, the advantages and disadvantages of various surgical treatment schemes were analyzed and summarized. Results: There are many surgical treatments for OLT, including bone marrow stimulation, osteochondral transplantation, autologous chondrocyte transplantation, and biologically assisted therapy. Various schemes have different indications and limitations. With the continuous development of various technologies, the effectiveness of OLT treatment will gradually improve. Conclusion: There are still many difficulties and controversies in the treatment of OLT, and there is no unified treatment plan. It is suggested that individualized operation plan should be formulated according to the specific conditions of patients.
ABSTRACT
El tratamiento de las lesiones osteocondrales de gran tamaño y profundidad resultan un desafío debido a que las técnicas habituales (microfractura o transplante osteocondral autólogo), son insuficientes para cubrir el defecto; eso es particularmente importante en pacientes jóvenes, pues se debe intentar técnicas que generen la menor comorbilidad posible. Presentamos un caso de un paciente de 18 años con una lesión osteocondral de 6 cm2 por 14 mm de profundidad, tratado mediante autoinjerto óseo, concentrado de médula ósea y matriz colágena, con resultados satisfactorios tanto en lo funcional como en lo imagenológico. Esa técnica presenta la ventaja de realizarse en un tiempo y con una fuente de células troncales mesenquimáticas (Médula ósea), validada en la literatura y altamente reproducible.
The treatment of large osteochondral defects represent a challenge, because the common techniques used (micro fracture or osteochondral autologous transplantation) are insufficient to cover the defect; this is particularly important in young patients where we expect the least comorbidity. We report a case of an 18-year-old patient with an ostechondral injury of 6 cm2 and 14 mm deep, treated with bone autograft, bone marrow concentrate and a matrix of collagen with satisfactory functional and images results. This technique has the advantage to be performed in one single time and with a source of mesenchymal stem cells (bone marrow) validated in the literature.
Subject(s)
Humans , Male , Adolescent , Bone Transplantation , Mesenchymal Stem Cell Transplantation/methods , Osteochondritis/surgery , Collagen/therapeutic use , Transplantation, Autologous , Treatment OutcomeABSTRACT
La cirugía artroscópica del tobillo es un procedimiento relativamente nuevo y forma parte del arsenal terapéutico actual del cirujano ortopedista. Se considera un procedimiento demandante desde el punto de vista técnico y requiere de gran pericia para trabajar en un espacio reducido. Sin embargo, con el perfeccionamiento de la técnica se ha convertido en el gold standard para el tratamiento de ciertas patologías como el síndrome de fricción anterior y las lesiones osteocondrales. Consideramos de mucha importancia, el conocimiento de la anatomía para evitar lesiones de elementos vasculares en la realización de los portales y el conocimiento de los sectores pasibles de exploración en cada una de las puertas de entrada, como así también las distintas técnicas que permiten una visualización más extensa de la articulación. En esta nota técnica describiremos los puntos más sobresalientes en cuanto a la topografía periarticular y la técnica per se para la correcta realización de este procedimiento y para evitar, en la medida de lo posible, potenciales complicaciones.
Arthroscopic surgery of the ankle is a relatively new procedure and is part of the current orthopedic surgeon arsenal. It is considered technically demanding and requires a skilled surgeon in order to be able to work in a restricted space. However, with the improvement of the technique, it has become the gold standard for the treatment of certain pathologies such as anterior impingiment syndrome and osteochondral lesions . To avoid injury, portal placement must be based on a thorough understanding of the ankle and foot extra-articular anatomy. The risk of injury to neurovascular structures is the greatest concern, as well as the different techniques that allow a wider visualization of the articular surface. This technical note will describe the most important points regarding the periarticular topography and the technique itself for the successful completion of this procedure and to avoid potential complications as far as possible.
Subject(s)
Humans , Ankle Joint/anatomy & histology , Ankle Joint/surgery , Arthroscopy/methods , Patient Positioning , Minimally Invasive Surgical ProceduresABSTRACT
Osteochondral lesions of the talus are isolated cartilage and/or bone lesions that are known cause of chronic ankle pain. They can occur as the result of a single acute ankle injury or from repetitive loading of the talus. Technical development in radiologic imaging and ankle arthroscopy have improved diagnostic capabilities for detecting osteochondral lesions. Characteristics which are important in assessing an osteochondral lesions include: the size, the type (chondral, subchondral, cystic), the stability, the displacement, the location, and the containment of lesion. Nonoperative treatment involving period of casting and non-weight-bearing is recommended for acute, non-displaced osteochondral lesions in select pediatric and adolescent patients. Operative treatment is recommended for unstable lesions or failed conservative management. Marrow stimulation techniques (abrasion chondroplasty, multiple drilling, microfracture), osteochondral autograft or allograft, autologous chondrocyte implantation, are frequently employed. The purpose of this article is to review the historical background, etiology, classification systems, diagnostic strategies, and to describe a systematic approach to management of osteochondral lesions of the talus.
Subject(s)
Adolescent , Animals , Humans , Ankle , Ankle Injuries , Arthroscopy , Bone Marrow , Cartilage , Chondrocytes , Containment of Biohazards , Displacement, Psychological , Mandrillus , Talus , Transplantation, HomologousABSTRACT
PURPOSE: We compared the clinical results between arthroscopic multiple drilling and autologous osteochondral grafting for osteochondral lesions of the talus. MATERIALS AND METHODS: Twelve patients underwent arthroscopic multiple drilling that left the remaining cartilage at the lesions, and ten patients underwent autologous osteochondral grafting for detached cartilage lesions. We performed a modified Brostrom procedure for 9 of the cases with combined lateral ankle instability in both groups. The average follow-up period was 12.4 months. The mean ages were 31 and 28 years old, respectively. The results were compared between the two groups by assessing the AOFAS scores and patient satisfaction, based on subjective symptoms. RESULTS: The mean pre-operative AOFAS scores were 70 in the arthroscopic multiple drilling group and 70.3 in the autologous osteochondral grafting group. The post-operative AOFAS scores were 78.8 in the arthroscopic multiple drilling group and 93.5 in the autologous osteochondral grafting group (p<0.05). Patient satisfaction after multiple drilling was good in 3 cases, fair in 4 cases, poor in 5 cases, and pre-operative symptoms were not improved at all in 4 cases. After autologous osteochondral grafting, 7 cases were good and 3 were fair. CONCLUSION: The study demonstrated that in the treatment of osteochondral lesions of the talar dome, the results of autologous osteochondral grafting were superior to those of arthroscopic multiple drilling.