Comparison of arthroscopic microfracture and cell-free scaffold implantation techniques in the treatment of talar osteochondral lesions.

OBJECTIVES: This study aims to compare two single-step arthroscopic techniques, microfracture and cell-free scaffold implantation, in the treatment of talar osteochondral lesions (OCLs) clinically and radiologically. PATIENTS AND METHODS: This retrospective study included 62 patients (35 males, 27 females; mean age 41±13 years; range, 15 to 65 years) diagnosed with talar OCLs between March 2007 and January 2015. Patients who were followed-up with a minimum of 24 months with lesions larger than 1 cm2 were included. Pre- and postoperative clinical evaluations were performed according to the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale and radiological evaluations according to the magnetic resonance observation of cartilage repair tissue (MOCART) scale. RESULTS: Patients were divided into microfracture (n=22) and scaffold (n=40) groups. The mean follow-up duration was 36.1±14.9 months. The mean preoperative AOFAS score increased from 60.6±13.9 to 82.1±11.8 in the microfracture group (p<0.001) and from 53.8±13.6 to 89.4±9.9 in the scaffold group (p<0.001). The scaffold group had superior results than the microfracture group clinically (p=0.011). Clinical results were superior in younger patients (<45 years) (p=0.018), male patients (p=0.020), and traumatic lesions (p=0.014). There was no significant difference between the two techniques according to the total MOCART scores (p=0.199). However, the scaffold technique was more successful in terms of lesion border and effusion subgoups of MOCART scale. CONCLUSION: Both single-step arthroscopic techniques are effective and safe in the treatment of talar OCLs. The scaffold technique showed superior clinical results than the microfracture technique in short-term follow-up. Age, trauma history and gender significantly affected the treatment outcomes. The scaffold technique can be considered as a safe and good alternative particularly in the treatment of large lesions.

Endovascular Treatment for Near Occlusion of the Internal Carotid Artery : 30-Day Outcome and Long-Term Follow-Up.

BACKGROUND: The treatment strategy and the correct incidence of near occlusion (NO) of the internal carotid artery (ICA) is still controversial. In routine radiological imaging NO can easily be misdiagnosed as complete occlusion and there is no consensus on the standard treatment strategy. PURPOSE: To present our perioperative and long-term follow-up results of ICA NO patients treated with carotid artery stenting (CAS). MATERIAL AND METHODS: Between 2004-2014 a total of 182 patients with ICA NO were evaluated for CAS. The study included 132 male (72.5 %) and 50 female (27.5 %) patients with a mean age of 70.2 years. Patients underwent a clinical neurological evaluation and radiological imaging of the carotid arteries before the CAS procedure. Of the patients 80 (44 %) were asymptomatic. The median clinical and carotid Doppler ultrasound (DUS) follow-up period was 64 months (range 18-124 months). RESULTS: In 182 patients CAS were performed, 4 patients (2.2 %) developed minor stroke, 2 patients (1.1 %) developed myocardial infarction but no major stroke or death occurred in the following 30-day period. Asymptomatic restenosis was detected in seven patients (3.8 %) in the follow-up period. CONCLUSION: With sufficient neurological evaluation during pretreatment and posttreatment periods and when the procedure is performed with technologically developed products by an experienced interventional team, CAS is beneficial in patients with ICA NO.

Single-Step Arthroscopic Repair With Cell-Free Polymer-Based Scaffold in Osteochondral Lesions of the Talus: Clinical and Radiological Results.

PURPOSE: To report the clinical and radiological results of patients with talar osteochondral lesions who were treated by microfracture and cell-free scaffold implantation in a single-step arthroscopic surgery. METHODS: Forty patients, treated with a single-step arthroscopic surgery, were evaluated in this single-center-based retrospective study. Patients with degenerative arthritis (n = 1), history of ankle fracture (n = 1), kissing lesions (n = 1), lower extremity deformity (n = 1), and lesions <1.5 cm2 (n = 4) were excluded. Oversized (>10 mm depth) bone cysts were additionally treated with bone graft. Patients were evaluated clinically, using the American Orthopedic Foot and Ankle Society (AOFAS) hindfoot score. Radiological assessment was performed with magnetic resonance imaging, using the magnetic resonance observation of cartilage repair tissue (MOCART) score. RESULTS: Thirty-two patients with a mean age of 38 ± 12 years were evaluated. The mean defect size was 2.5 ± 0.8 cm2 and the mean defect volume was 2.4 ± 1.9 cm3. The mean preoperative AOFAS score was 52.8 ± 13.9 and increased to 87.1 ± 11.1 postoperatively at the mean follow-up of 33.8 ± 14.0 months (P = .0001). A total of 84.4% of patients had good to excellent clinical scores. Clinical scores had no significant relation with age, lesion size, depth, or body mass index. The mean MOCART score was 64.2 ± 12.0. There was no significant correlation between the total MOCART and AOFAS scores (P = .123). A significant relation was found between the defect filling (the subgroup of the MOCART score) and the clinical outcomes (P = .0001, rho = 0.731). CONCLUSIONS: The arthroscopic scaffold implantation technique is a single-step, safe, and effective method for the treatment of talar osteochondral lesions with satisfactory clinical and radiological outcomes. LEVEL OF EVIDENCE: Level IV, therapeutic case series.