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.

Fractura osteocondral traumática de rodilla en edad pediátrica: reporte de un caso / Traumatic osteochondral knee fracture in pediatric age: report of a case / Fratura osteocondral traumática do joelho em idade pediátrica: relato de um caso

Las fracturas osteocondrales (FOC) traumáticas de rodilla en la edad pediátrica, son lesiones que acompañan hasta un 30% de las luxaciones agudas de rótula (LAR). Si no se mantiene una elevada sospecha clínica, es frecuente su retraso diagnóstico, pudiendo generar potenciales complicaciones. A propósito, presentamos el caso de una paciente de 12 años con una FOC post LAR que pasó inadvertida en la primera consulta, requiriendo la fijación del fragmento osteocondral con tornillos HCS a los 5 meses, logrando un excelente resultado funcional a los 54 meses de seguimiento.

Traumatic osteochondral fractures (OCF) of the knee in pediatric age are injuries that accompany up to 30% of acute patellar dislocations (APD). If high clinical suspicion is not maintained, its diagnostic delay is frequent, and may generate potential complications. Incidentally, we present the case of a 12-year-old patient with a post-APD OCF that went unnoticed in the first consultation, requiring fixation of the osteochondral fragment with HCS screws at 5 months. Achieving an excellent functional result at 54 months follow-up.

As fraturas osteocondrais traumáticas (FOC) do joelho em idade pediátrica são lesões que acompanham até 30% das luxações agudas da patela (LAP). Se uma alta suspeita clínica não for mantida, seu atraso no diagnóstico é frequente e pode gerar complicações potenciais. A propósito, apresentamos o caso de um paciente de 12 anos com FOC pós-LAP que passou despercebido na primeira consulta, exigindo fixação do fragmento osteocondral com parafusos HCS em 5 meses. Obtendo um excelente resultado funcional aos 54 de acompanhamento.

Tratamiento artroscópico en lesión osteocondral subtalar / Arthroscopic treatment of subtalar osteochondral lesion

Las lesiones osteocondrales de la articulación subtalar es una patología infrecuente y de incidencia variable, dado su reporte principalmente como hallazgo en el estudio de dolor crónico de tobillo y ya con cambios degenerativos articulares. La sospecha clínica y el estudio imagenológico dirigido, permiten investigar esas lesiones en estadios iniciales, evitando así el uso de técnicas que no preservan la articulación para su manejo. La artroscopía subtalar es una excelente herramienta tanto diagnóstica como terapéutica para la resolución de dichas lesiones. Dadas las características anatómicas y biomecánicas de la articulación, en estadios iniciales, el manejo mediante sinovectomía y microfracturas es una alternativa con excelentes resultados funcionales. Este trabajo incluye dos casos de lesiones osteocondrales de la faceta posterior de la articulación subtalar manejadas vía artroscópica mediante sinovectomía y microfracturas y su posterior evolución.

Osteochondral lesions in the subtalar joint are an uncommon pathology with a variable incidence, being mainly reported as a finding in chronic ankle pain studies and with already visible degenerative joint changes at time of diagnosis. Clinical suspicion and directed imaging study, allows to investigate these lesions during early stages, thus avoiding the use of invasive techniques with scarce joint preservation. Subtalar arthroscopy is an excellent diagnostic and therapeutic tool for the resolution of these lesions. Given the anatomical and biomechanical characteristics of the joint, in the early stages the management by synovectomy and microfractures is an alternative with excellent functional results. This study includes two cases of osteochondral lesions of the posterior facet of the subtalar joint managed through arthroscopically synovectomy and microfractures and their subsequent evolution.

Protocol for Harvest, Transport and Storage of Human Osteochondral Tissue / Protocolo para captação, transporte e preservação de tecido osteocondral humano

Abstract Objective To elaborate a protocol for the harvest, transport, and preservation of human osteochondral tissue for use in tissue banks (TBs). Methods Osteochondral fragments measuring 2 cm3 of 5 corpse donors aged between 15 and 45 years old were analyzed. The samples were stored in cell preservation medium containing: human albumin, Iscove's and vancomycin preserved at 4ºC. The concentration of proteoglycans in the extracellular medium was quantified by the use of Safranin-O, while tissue structural analysis was assessed by histological study with hematoxylin-eosin stained slides. The images obtained were analyzed according to the histological scores of Mankin and the score proposed by the OsteoArthritis Research Society International. The samples were analyzed with 0, 15, 30 and 45 days of preservation. Results The osteochondral fragments studied showed a progressive decrease in proteoglycan concentration with increased preservation time. After 30 days of preservation, structural changes were identified with discontinuity of the cartilage surface layer. According to the results obtained by the Mankin score, there was a statistically significant difference between 15 and 30 days of tissue preservation. Conclusion The protocol described defined knee transport immersed in Lactated Ringer at a controlled temperature of 10º C until its arrival at the TB. After processing, the preservation solution was composed of Iscove's serum-free cell culture medium supplemented with 10% human albumin and 100 µg/ml vancomycin. The tissue was preserved at a temperature of 4ºC until the moment of transplantation characterizing the fresh preservation.

Resumo Objetivo Elaborar um protocolo para a captação, transporte e preservação de tecido osteocondral humano para utilização em banco de tecidos (BT). Métodos Foram analisados fragmentos osteocondrais com dimensão de 2 cm3 de 5 doadores cadáveres com idades entre 15 e 45 anos. As amostras foram armazenadas em meio de preservação celular contendo: albumina humana, Iscove's e vancomicina preservados à temperatura de 4ºC. A concentração de proteoglicanos no meio extracelular foi quantificada pelo uso de Safranina-O, enquanto a análise estrutural do tecido foi avaliada através de estudo histológico com lâminas coradas em hematoxilina-eosina. As imagens obtidas foram analisadas segundo os escore histológicos de Mankin e o escore proposto pela OsteoArthritis Research Society International. As amostras foram analisadas com 0, 15, 30 e 45 dias de preservação. Resultados Os fragmentos osteocondrais estudados apresentaram diminuição progressiva na concentração de proteoglicanos com o aumento do tempo de preservação. Após 30 dias de preservação, foram identificadas alterações estruturais com descontinuidade da camada superficial da cartilagem. Segundo os resultados obtidos pelo escore de Mankin, houve diferença com significância estatística entre 15 e 30 dias de preservação do tecido. Conclusão O protocolo descrito definiu o transporte de joelho em bloco imerso em Ringer Lactato em temperatura controlada a 10ºC até sua chegada ao BT. Após o processamento, a solução de preservação foi composta por meio de cultura celular sem soro Iscove's suplementado com albumina humana a 10% e vancomicina 100 µg/mL. O tecido foi preservado à temperatura de 4ºC até o momento do transplante caracterizando a preservação a fresco.

Resultados a mediano plazo del trasplante osteocondral autólogo en las lesiones del cartílago patelar / Medium-term results of autologous osteochondral transplantation in patellar cartilage injuries

Resumen: Introducción: El cartílago rotuliano está sometido a altas demandas mecánicas y es una localización muy frecuente de lesiones. No existe consenso en cuanto a su tratamiento. El trasplante osteocondral autólogo puede ser una alternativa para los defectos condrales de pequeño o mediano tamaño con resultados variables en la bibliografía. Nuestro objetivo es analizar los resultados funcionales a mediano plazo de los pacientes con lesiones del cartílago patelar grado III-IV de la International Cartilage Repair Society (ICRS) tratados en nuestro centro. Material y métodos: Estudio retrospectivo con pacientes menores de 55 años, con un defecto condral patelar sintomático, diámetro menor de 2 cm, grado III-IV de la ICRS tratados mediante trasplante osteocondral autólogo entre los años 2012 y 2018. Se evalúan las siguientes variables: edad, sexo, tamaño de la lesión, faceta afectada, número de cilindros trasplantados, escala de Kujala pre y postoperatoria y escala visual analógica del dolor (EVA) pre y postoperatoria. Resultados: Integramos en nuestro estudio 11 pacientes. La mediana de edad fue de 47 años. La mediana del diámetro del defecto condral 1.3 cm. La mediana de seguimiento 3.9 años (1.84-5.58 años). La mediana del cuestionario Kujala preoperatoria es 33 y asciende a 89 al final del seguimiento (p = 0.003). La mediana de la puntuación EVA preoperatoria es nueve y dos al final del seguimiento (p = 0.003). Conclusión: El trasplante osteocondral autólogo generó una importante mejora subjetiva de la función y del dolor.

Abstract: Introduction: Patellar cartilage is subject to high mechanical requests and is a very frequent location of injuries. There is no consensus on their treatment. Autologous osteochondral transplantation may be an alternative to small to medium-sized condral defects with varying results in the literature. Our goal is to analyze the medium-term functional outcomes of patients with grade III-IV patellar cartilage injuries from the International Cartilage Repair Society (ICRS) treated at our facility. Material and methods: Retrospective study in patients under 55 years of age, with a symptomatic patellar condral defect, diameter less than 2 cm, grade III-IV of ICRS treated by autologous osteochondral transplant between 2012 and 2018. The following variables are evaluated: age, sex, injury size, affected facet, number of transplanted cylinders, pre- and postoperative Kujala score, and pre- and postoperative analog visual pain scale (EVA). Results: Eleven patients integrated into our study. The median age was 47 years. The median diameter of the condral defect 1.3 cm. Median follow-up 3.9 years (1.84-5.58 years). The median of the preoperative Kujala questionnaire is 33 and is 89 at the end of the follow-up (p = 0.003). The median of the preoperative EVA score is 9 and 2 at the end of the follow-up (p = 0.003). Conclusion: Autologous osteochondral transplantation generated a significant subjective improvement in function and pain.

Tratamiento de lesiones osteocondrales de patela con trasplante autólogo: resultados funcionales e imagenológicos / Treatment of patellar osteochondral lesions with autologous grafts: functional and imaging results

Introducción El trasplante osteocondral autólogo es una técnica reproducible y con pocas complicaciones para el manejo de lesiones traumáticas grado III y IV de Outerbridge en patela. Con este estudio se busca evaluar los resultados funcionales e imagenológicos en pacientes manejados con esta técnica. Materiales y métodos Estudio descriptivo tipo serie de casos. Se incluyeron pacientes con lesiones traumáticas grado III y IV de Outerbridge (OB) en patela, menores de 25mm de diámetro, sin otras lesiones agregadas, operados con trasplante osteocondral autólogo entre marzo de 2013 y diciembre de 2016. Se evaluaron la escala visual análoga (EVA) y la escala funcional Kujala prequirúrgicas, y se compararon con los controles a los 3 y 6 meses. Se usó el score MOCART por resonancia magnética nuclear a los 6 meses postquirúrgicos para evaluar el porcentaje de osteointegración del injerto. Resultados El estudio incluyó 13 pacientes, 8 hombres (62%) con una edad promedio de 30 años. La lesión más frecuente fue la tipo IV de OB con un 86.6%. El EVA prequirúrgico promedio fue de 7.8 (±0.83), con controles a los 3 y 6 meses de 3.3 (±1.67) y 2.9 (±2.1) respectivamente, ambos con un valor de p <0.05. La escala funcional Kujala tuvo un promedio prequirúrgico de 33.3 (±10.1), con controles a los 3 y 6 meses de 56.1 (±21.1) y 74 (±17.6) respectivamente, ambos con un valor de p <0.05. El score MOCART promedio a los 6 meses fue de 70.5 (±12.1); 7 pacientes (53.8%) presentaron un valor mayor a 80. Discusión El Trasplante Osteocondral Autólogo en patela es una técnica con buenos resultados en pacientes con lesiones grado III y IV de OB, con mejoría significativa a los 3 y 6 meses del postoperatorio en la escala funcional de Kujala y reducción de la EVA. La tasa de integración del injerto medido por MOCART a los 6 meses fue 53%.

Background Autologous osteochondral grafting is a reproducible technique with few complications for the management of grade III and IV Outerbridge patellar injuries. This study aims to evaluate the functional and imaging results in patients managed with this technique. Methods A Case Series study was performed. The study included patients with grade III and IV Outerbridge (OB) traumatic patellar injuries of less than 25mm in diameter, with no other aggregate lesions, and operated on using autologous osteochondral grafts between March 2013 and December 2016. A pre-surgical assessment was made using a visual analogue scale (VAS) and the Kujala functional scale, and was compared with controls at 3 and 6 months. The MOCART score was used by nuclear magnetic resonance at 6 months post-operatively to evaluate the percentage of osteointegration of the graft. Results The study included 13 patients, 8 men (62%) with a mean age of 30 years. The most frequent lesion was type IV OB, with 86.6%. The mean pre-surgical VAS was 7.8 (± 0.83), with controls at 3 and 6 months of 3.3 (± 1.67) and 2.9 (± 2.1), respectively, both with a value of P<.05. The Kujala functional scale had a pre-surgical mean of 33.3 (± 10.1), with controls at 3 and 6 months of 56.1 (± 21.1) and 74 (± 17.6), respectively, both with a value of P<.05. The mean (magnetic resonance observation of cartilage repair tissue) MOCART score at 6 months was 70.5 (± 12.1), and 7 patients (53.8%) had a value greater than 80. Discussion Autologous osteochondral graft in the patella is a technique that obtained good results in patients with grade III and IV OB lesions. There is a significant improvement 3 and 6 months after surgery in the Kujala functional scale and a reduction of the VAS. The graft integration rate measured by MOCART at 6 months was 53%.

Lesión osteocondral extensa de cóndilo femoral; tratamiento en un tiempo con matriz colágena y concentrado de médula ósea: reporte de un caso / Big osteochondral lesion; treatment with collagen scaffold and bone marrow concentrate: case report

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.

Ressonância magnética na avaliação de enxerto osteocondral autógeno na cartilagem articular de coelhos / Magnetic resonance in the evaluation of autogenous osteochondral graft in articular cartilage of rabbits

Este trabalho teve o objetivo de determinar as características e a aplicabilidade do exame de ressonância magnética na avaliação de enxerto ostecondral autógeno, em formato íntegro ou macerado, associado ou não ao fator de crescimento semelhante à insulina tipo 1 (IGF-1), utilizado no reparo de lesões induzidas na cartilagem articular de coelhos. Foram utilizados 9 coelhos da linhagem Nova Zelândia, em que as 18 articulações fêmoro-tíbio-patelares foram submetidas à enxertia osteocondral autógena no sulco troclear femoral. Estas foram divididas em quatro grupos, denominados como enxerto osteocondral íntegro + IGF-1 (n=5), enxerto osteocondral íntegro + solução fisiológica (n=4), enxerto osteocondral macerado + IGF-1 (n=5) e enxerto osteocondral macerado + solução fisiológica (n=4). Os animais foram eutanasiados em 12 semanas após a cirurgia e as articulações foram submetidas ao exame de ressonância magnética utilizando um aparelho scanner de 1,5 Tesla de alto campo magnético. Além disso, amostras dos locais de enxertia foram submetidas aos exames anatomopatológicos. O exame de ressonância magnética mostrou-se eficaz como um método não invasivo para avaliação do tecido de reparação em enxertos osteocondrais na cartilagem articular do fêmur de coelhos, fornecendo dados complementares aos exames macroscópicos e histológicos. Por meio destas imagens e dos exames anatomopatológicos, foram observados resultados satisfatórios em relação ao processo de reparação dos enxertos osteocondrais autógenos na cartilagem de coelhos, independentemente de seu formato ou da adição de IGF-1.(AU)

This study aimed to determine the characteristics and applicability of magnetic resonance imaging (MRI) in the evaluation of autogenous osteochondral graft in intact or macerated format, with or without insulin-like growth factor type 1 (IGF-1) used in repair of cartilage lesions induced in rabbits. Nine New Zealand rabbits were used, in which 18 stifle joints underwent grafting procedure in the femoral trochlear groove. These were divided into four groups, referred as intact osteochondral graft + IGF-1 (n=5), intact osteochondral graft + saline solution (n=4), macerated osteochondral graft + IGF-1 (n=5) and macerated osteochondral graft + saline solution (n=4). Animals were euthanized 12 weeks after surgery and the joints were subjected to MRI using a high magnetic field scanner of 1.5 Tesla. In addition, samples of grafting sites were subjected to anatomopathological examination. The MRI was effective as a noninvasive method to evaluate the repair tissue in osteochondral grafts in articular cartilage of the femur of rabbits by providing complementary data to macroscopic and histological examinations. Through these images and anatomopathological examinations satisfactory results were observed in relation to the repair process of autogenous osteochondral grafts in cartilage of rabbits, regardless of its format or the addition of IGF-1.(AU)

Tratamiento de lesión osteocondral del astrágalo con microfractura / Injury treatment with microfracturetalar osteochondral

Se han descrito diversas opciones de tratamiento de la lesión osteocondral del domo del Astrágalo de acuerdo al tamaño y ubicación de la misma, el propósito de este trabajo es evaluar los resultados del tratamiento de esta lesión, con microfractura, vía artroscópica, sin importar el tamaño ó ubicación de la misma. Se realiza un análisis retrospectivo de los pacientes con lesión osteocondral del domo astragalino, tratados con microfractura vía artroscópica, realizadas entre agosto 2005 y enero 2014. Se evaluó escala de dolor (VAS), satisfacción del paciente y tamaño de la lesión, dividiéndose en 2 grupos: pacientes con lesiones menores a 20 mm y pacientes con lesiones igual ó mayores a 20 mm. Se intervinieron 46 pacientes, con edad promedio 37 años (19-49), el tiempo promedio de seguimiento,17,6 meses (6-32 meses). La escala de dolor (VAS) en el preoperatorio en los pacientes con lesiones menores a 20 mm, fue 7,8 (4 a 9) y el postoperatorio 1,6 (0 a 4);2 ameritaron nueva microfractura. 11 pacientes presentaron lesiones igual ó mayores a 20 mm, el VAS preoperatorio fue 8,2 (6 a 9) y 2,6 (1 a 6) el postoperatorio, 3 ameritaron otro procedimiento, 1 nueva microfractura y 2 mosaicoplastia. Si bien es cierto que la evidencia científica ha demostrado que la microfractura es el tratamiento más efectivo y menos invasivo en lesiones pequeñas, en nuestro estudio evidenciamos, que un alto porcentaje de pacientes con lesiones iguales ó mayores a 20 mm, también pueden beneficiarse de este tratamiento, evitando la realización de procedimientos más invasivos y las potenciales complicaciones asociados a estos; por lo tanto, la microfractura artroscópica, es nuestra primera opción de tratamiento en esta lesión(AU)

There has been a described diverse option of treatment for talar dome dome osteocondral lesions, depending on the lesion size and placement. The purpose of this study, is to evaluate the results of microfracture of this lesion, despite the size and lesion placement. Retrospective analysis was performed of patients with talar dome osteochondral lesion, treated with arthroscopic microfracture by the same surgeon, at Hospital de Clínicas Caracas between august 2005 and January 2014. Visual analog scale (VAS), patient satisfaction and lesion size was evaluated, dividing it in 2 groups, lesion size smaller than 20 mm and lesion size equal or bigger than 20 mm.46 patients with talar dome ostreochondral lesion had surgery in the perios of time studied, with an average age of 37 years (19-46), 39 patients Could be followed up one year postop, the mean following time was 17,6 months (6-32). The VAS preop in the 28 patients with lesions smaller than 20 mm was 7,8 (4 to 9) and postop 1,6 (0 to 4), 2 patients needed new microfracture. 11 patients had lesion equal or bigger than 20 mm, preop VAS was 8,2 (6 to 9) and postop 2,6 (1 to 6). 3 needed a new procedure, 1 microfracture and 2 mosaicplasty. Talar dome ostechondral lesions treatment is a great Challenger. Although scientific evidence has shown that microfracture is the less invasive and most effective treatment for small lesions, in our study we showed that a high percent of patients with lesions equal or bigger than 20 mm may Benedit from this treatment, avoiding more invasive procederes and its potencial complications, so microfracture is the first treatment option for the lesion, despite the size and lesion location(AU)

Defecto osteocondral de cóndilo femoral. Estudio experimental en ratas / Osteochondral defect of femoral condyle. Experimental study in rats

Objetivo: Determinar si hay reparación de defectos osteocondrales en cóndilos femorales usando cartílago costal e injerto de cresta iliaca autólogos en ratas blancas. Material y métodos: Se experimentó con 60 ratas blancas de entre 110 y 120 gr. Se formaron dos grupos de 30 especímenes cada uno (control y experimental). Al control solo se le hizo la exceresis del cóndilo femoral medial y al grupo experimental, además, se colocó cartílago costal sobre el defecto con injerto de cresta iliaca interpuesto, ambos autólogos. Los especímenes fueron sacrificados a los 60 días y evaluados microscópicamente. Resultados: Se usó el test de t-student. Hubo diferencia significativa entre los grupos control y experimental, considerando el puntaje total de las cinco variables estudiadas. Así mismo se encontró diferencia significativa con la variable morfología celular; con las variables metacromasia, regularidad de superficie, grosor del cartílago e integración con el cartílago adyacente, no se encontró diferencia significativa. Conclusiones: No hubo reparación de los defectos osteocondrales amplios de los cóndilos femorales.

Objetive: Determine if osteochondral femoral defect will be repaired using costal cartilage and autologous iliac crest graft in rats. Material: We experimented with 60 white rats of 110 and 120 gr. Two groups of 30 specimens (control and experimental). By controlling onIy the exeresis him the medial femoral condyle and the experimental group, in addition, costal cartilage was placed over the defect with iliac crest graft interposed, both autologous. Specimens were sacrificed at 60 days and evaluated microscopically. Results: It was used student's-t test. There was significant difference between the control and experimental groups, considering the total score of the five variables. Also significant differences were found with variable cell morphology, with metachromasia variables, surface regularity, thickness of cartilage and integration with adjacent cartilage, no significant difference was found. Conclusions: There was no repair of large osteochondral defects of the femoral condyles.

Tratamento das lesões osteocondrais do talo através da técnica de microperfurações assistidas por artroscopia / Treatment of osteochondral lesions of the talus by means of thearthroscopy-assisted microperforation technique

OBJETIVO: Analisar pacientes acometidos por fratura osteocondral do talo tratados cirurgicamente através de microperfurações assistidas por artroscopia. MÉTODOS: Foi realizado um estudo retrospectivo de 24 pacientes com lesão osteocondral do talo submetidos à microperfurações assistidas por videoartroscopia do tornozelo. Todos os pacientes foram submetidos ao sistema de avaliação da American Orthopaedic Foot & Ankle Society (AOFAS) no pré e pós-operatório. RESULTADOS: Foram observados 19 homens e cinco mulheres, com idade média de 35,3 anos (mínima de 17 anos e máxima de 54 anos). O tempo mínimo de seguimento foi de dois anos (máximo de 39 meses). Todos os pacientes apresentaram melhora do escore da AOFAS após o procedimento cirúrgico, com média de elevação do escore em torno de 22,5 pontos. CONCLUSÃO: A técnica de microperfurações assistidas por videoartroscopia consiste em boa opção para o tratamento das lesões osteocondrais do talo e fornece bons resultados funcionais.

OBJECTIVE: To evaluate patients affected by osteochondral fractures of the talus who were treated surgically by means of arthroscopy-assisted microperforation. METHODS: A retrospective study was carried out on 24 patients with osteochondral lesions of the talus who underwent microperforation assisted by videoarthroscopy of the ankle. They were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) score system before and after the operation. RESULTS: There were 19 men and 5 women, with a mean age of 35.3 years (minimum of 17 years and maximum of 54 years). The minimum follow-up was two years (maximum of 39 months). All the patients showed an improvement in AOFAS score after surgery, with an average improvement of around 22.5 points. CONCLUSION: Videoarthroscopy-assisted microperforation is a good option for treating osteochondral lesions of the talus and provides good functional results.

Mosaicoplastia revestida com periósseo no tratamento de perda osteocondral do joelho / Mosaicplasty with periosteal gratf for resurfacing local full-thickness chondral defects of the knee

Introdução e Objetivos: Existem várias formas de tratamento das perdas extensas de substância osteocondral (OC), entre elas, a mosaicoplastia recoberta com periósseo (mosaicambium). Neste trabalho pretende-se avaliar os resultados clínicos a médio dos doentes com defeito osteocondral tratados por esse método. Métodos: Vinte joelhos com defeito osteocondral superior a 2cm2 foram operados entre 1999 e 2005, com recurso a duas técnicas cirúrgicas (mosaicoplastia/mosaicambium). Todos os doentes foram avaliados em pré-operatório clinicamente (escalas ICRS,VAS), radiograficamente e com RM. No ano de 2008 todos foram revistos e avaliados seguindo os mesmos critérios. Os casos foram distribuídos em dois grupos consoante o tipo de tratamento.A avaliação estatística recorreu ao programa informático EPI2000. Utilizou-se o teste do qui-quadrado para variáveis categoriais e o teste t de Student para variáveis contínuas. Aceitou-se como erro alfa um valor de 0,05. Tipo de estudo: Estudo clínico, retrospectivo, nível de evidência 4. Resultados: Antes, todos os doentes estavam nos grupos ICRS C e D. Em 2008, 18 doentes estavam nos grupos A e B (12 no grupo A). Comparando os resultados entre grupos (mosaicoplastia/mosaicambium), não houve diferenças significativas entre os grupos. Radiograficamente, não existiam alterações em 55% dos casos. Discussão: Sem diferenças clínicas, por que a opção mosaicambium? A morbilidade nas zonas dadoras não é desprezível. A opção mosaicambium recorreu a menos cilindros OC, reduzindo a morbilidade resultante. Conclusão: A técnica mosaicambium é uma boa opção alternativa para perdas de substância OC com mais de 2 cm2.

Introduction and Objectives: Clinical and functional assessment comparing cases of full-thickness chondral defects (OC) treated with mosaicplasty or mosaicplasty covered with periosteum (mosaicambium). Methods: 20 knees with chondral defect, (10 mosaicplasty/10 mosaicambium) were operated between 1999 and 2005. All patients were clinically assessed preoperatively using the ICRS scale, VAS scale, X-ray and MRI. During 2008, we reviewed patients using the sameprotocol. For statistical purposes, the patients were divided into two groups, according to the surgical technique. Statistical analysis was performed with EPI2000 program, using chi-squared test and Student's t test, with a significance level of 0.05. Results: Preoperatively, all patients were in group C /D (ICRS scale). In 2008, 18 cases were in groups A and B according to the ICRS scale (12 in A). Between groups, there were no statistical differences. The X-ray study revealed nochanges in 55% of cases. Discussion: With no differences, why mosaicambium option? Morbidity on graft donor zones is not negligible. Mosaicambium uses less chondral grafts, reducing the potential for morbidity at graft donor zones. Conclusion: The mosaicambium technique is an excellent alternative forchondral defects greater than 2 cm2.