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Richter A, Altemeier A, Becher C, Güllmann M, Plaass C, Ettinger S. Influence of the BMI (<30 kg/m 2 vs. ≥30 kg/m 2) on the Surgical Outcome of Osteochondral Lesions of the Talus: Prospective Data from the German Cartilage Registry (KnorpelRegister DGOU). Cartilage 2025:19476035241301294. [PMID: 40071546 PMCID: PMC11907501 DOI: 10.1177/19476035241301294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/17/2025] Open
Abstract
ObjectiveAim of this study was to evaluate the 24 months follow-up data of the German Cartilage Registry (KnorpelRegister DGOU, GCR) regarding the influence of body mass index (BMI) on clinical outcomes after surgical osteochondral lesions of the talus (OCT) treatment.DesignA total of 303 patients met the inclusion criteria. Pre- and post-operative Foot and Ankle Outcome Score (FAOS) total scores, subscores, and ΔFAOS were analyzed for most frequent surgical techniques (bone marrow stimulation [BMS], matrix-augmented BMS, matrix-augmented BMS with additional bone grafting) in normal weight group (NW, BMI <30 kg/m2, n = 228) and obese weight group (OW, BMI ≥30 kg/m2, n = 75).ResultsBMI was significantly different in NW and OW (24.6 ± 2.97 [16.9-29.9] kg/m2 vs. 33.7 ± 4.0 [30.0-51.3] kg/m2, P < 0.001). Significant improvement from pre- to post-operative FAOS score and subscales was reached in both groups (NW: 64.2 ± 17.5 vs. 77.7 ± 17.8; OW: 52.3 ± 15.5 vs. 73.5 ± 20.2; P < 0.001) with higher pre- and post-operative scores in NW. No significant difference in ΔFAOS score was detected. Treatment technique did not influence the clinical outcome. OW showed an extended use of bone grafting due to greater defect depth. Age was significantly higher in OW compared to NW (35.7 ± 13.2 [18.0-69.0] years vs. 40.7 ± 13.1 [18.0-77.0] years, P = 0.005).ConclusionsPatients benefit from surgical cartilage therapy regardless of their BMI. OW showed significantly lower pre- and post-operative FAOS scores. In OW, additional bone grafting was required more frequently due to significantly deeper defects.
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Affiliation(s)
- Alena Richter
- Department for Foot and Ankle Surgery, DIAKOVERE Annastift, Orthopedic Clinic of Hanover Medical School, Hannover, Germany
| | - Anna Altemeier
- University Hospital for Orthopaedic and Trauma Surgery, Pius Hospital Oldenburg, Oldenburg, Germany
| | - Christoph Becher
- International Center for Orthopedics at the ATOS Clinic Heidelberg, Heidelberg, Germany
| | | | - Christian Plaass
- Department for Foot and Ankle Surgery, DIAKOVERE Annastift, Orthopedic Clinic of Hanover Medical School, Hannover, Germany
| | - Sarah Ettinger
- University Hospital for Orthopaedic and Trauma Surgery, Pius Hospital Oldenburg, Oldenburg, Germany
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Bergman EM, Mulligan EP, Patel RM, Wells J. Concurrent validity of the Single Assessment Numerical Evaluation and hip-specific patient-reported outcome measures. Bone Jt Open 2024; 5:904-910. [PMID: 39419510 PMCID: PMC11486539 DOI: 10.1302/2633-1462.510.bjo-2024-0094.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2024] Open
Abstract
Aims The Single Assessment Numerical Evalution (SANE) score is a pragmatic alternative to longer patient-reported outcome measures (PROMs). The purpose of this study was to investigate the concurrent validity of the SANE and hip-specific PROMs in a generalized population of patients with hip pain at a single timepoint upon initial visit with an orthopaedic surgeon who is a hip preservation specialist. We hypothesized that SANE would have a strong correlation with the 12-question International Hip Outcome Tool (iHOT)-12, the Hip Outcome Score (HOS), and the Hip disability and Osteoarthritis Outcome Score (HOOS), providing evidence for concurrent validity of the SANE and hip-specific outcome measures in patients with hip pain. Methods This study was a cross-sectional retrospective database analysis at a single timepoint. Data were collected from 2,782 patients at initial evaluation with a hip preservation specialist using the iHOT-12, HOS, HOOS, and SANE. Outcome scores were retrospectively analyzed using Pearson correlation coefficients. Results Mean raw scores were iHOT-12 67.01 (SD 29.52), HOS 58.42 (SD 26.26), HOOS 86.85 (SD 32.94), and SANE 49.60 (SD 27.92). SANE was moderately correlated with the iHOT-12 (r = -0.4; 95% CI -0.35 to -0.44; p < 0.001), HOS (r = 0.57; 95% CI 0.53 to 0.60; p < 0.001), and HOOS (r = -0.55; 95% CI -0.51 to -0.58; p < 0.001). The iHOT-12 and HOOS were recorded as a lower score, indicating better function, which accounts for the negative r values. Conclusion This study was the first to investigate the relationship between the SANE and the iHOT-12, HOS, and HOOS in a population of patients with hip pain at the initial evaluation with an orthopaedic surgeon, and found moderate correlation between SANE and the iHOT-12, HOS, and HOOS. The SANE may be a pragmatic alternative for clinical benchmarking in a general population of patients with hip pain. The construct validity of the SANE should be questioned compared to legacy measures whose content validity has been more rigorously investigated.
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Affiliation(s)
- Elizabeth M. Bergman
- School of Physical Therapy, Texas Woman’s University, Houston, Texas, USA
- Performance Science + Rehab, St. Augustine, Florida, USA
| | - Edward P. Mulligan
- Department of Rehabilitation Sciences, Tufts School of Medicine, Phoenix, Arizona, USA
| | - Rupal M. Patel
- School of Physical Therapy, Texas Woman’s University, Houston, Texas, USA
| | - Joel Wells
- Department of Orthopedic Surgery, Baylor Scott and White Health, McKinney, Texas, USA
- UT Southwestern Medical Center Orthopaedic Surgery Clinic, UT Southwestern, Dallas, Texas, USA
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Rikken QG, Aalders MB, Dahmen J, Sierevelt IN, Stufkens SA, Kerkhoffs GM. Ten-Year Survival Rate of 82% in 262 Cases of Arthroscopic Bone Marrow Stimulation for Osteochondral Lesions of the Talus. J Bone Joint Surg Am 2024; 106:1268-1276. [PMID: 38728384 PMCID: PMC11608585 DOI: 10.2106/jbjs.23.01186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
BACKGROUND The long-term sustainability of arthroscopic bone marrow stimulation (BMS) for osteochondral lesions of the talus (OLT) remains a matter of debate. The primary aim of the present study was to assess the 10-year survival free from revision in ankles that had undergone arthroscopic BMS for an OLT. The secondary aim was to evaluate the influence of baseline patient and lesion characteristics on survival. METHODS Patients who underwent arthroscopic BMS for a symptomatic OLT and had a minimum follow-up of 10 years were included to assess procedure survival. The primary outcome, the 10-year cumulative survival rate, was analyzed by the Kaplan-Meier survival method. Secondary outcomes were the median time to revision and the effects of baseline factors (lesion size, primary or non-primary lesion type, preoperative cysts, and obesity as defined by a body mass index [BMI] of ≥30 kg/m 2 ) on survival, analyzed with a Cox regression model and reported using hazard ratios (HRs). RESULTS The 262 included patients had a mean follow-up of 15.3 ± 4.8 years. The 10-year cumulative survival rate of the arthroscopic BMS procedures was 82% (95% confidence interval [CI]: 77% to 87%). At 15 years of follow-up, the cumulative survival rate was 82% (95% CI: 76% to 86%). The median time to revision was 2.4 years (interquartile range: 1.3 to 5.1 years). Of the baseline factors, obesity (HR: 3.0 [95% CI: 1.44 to 6.43], p < 0.01) was associated with decreased survival. Lesion size (HR: 0.9 [95% CI: 0.5 to 1.8], p = 0.8), non-primary lesion type (HR: 1.8 [95% CI: 0.9 to 3.4], p = 0.1), and the presence of preoperative cysts (HR: 1.0 [95% CI: 0.6 to 1.9], p = 0.9) were not significantly associated with survival. CONCLUSIONS At a minimum follow-up of 10 years, the survival rate of arthroscopic BMS for OLT was 82%. At 15 and 20 years of follow-up, survival appeared to remain stable. Obesity (BMI ≥ 30 kg/m 2 ) was associated with a higher likelihood of revision surgery. This risk factor should be incorporated into the treatment algorithm for OLT when counseling patients regarding surgery. LEVEL OF EVIDENCE Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Quinten G.H. Rikken
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Sports and Musculoskeletal Health Programs, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Centre, Amsterdam UMC, Amsterdam, The Netherlands
| | - Margot B. Aalders
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Sports and Musculoskeletal Health Programs, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Centre, Amsterdam UMC, Amsterdam, The Netherlands
| | - Jari Dahmen
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Sports and Musculoskeletal Health Programs, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Centre, Amsterdam UMC, Amsterdam, The Netherlands
| | - Inger N. Sierevelt
- Orthopedic Department, Spaarne Gasthuis Academy, Hoofddorp, The Netherlands
| | - Sjoerd A.S. Stufkens
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Sports and Musculoskeletal Health Programs, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Centre, Amsterdam UMC, Amsterdam, The Netherlands
| | - Gino M.M.J. Kerkhoffs
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Sports and Musculoskeletal Health Programs, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Centre, Amsterdam UMC, Amsterdam, The Netherlands
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Brulc U, Drobnič M, Kolar M, Stražar K. A prospective, single-center study following operative treatment for osteochondral lesions of the talus. Foot Ankle Surg 2022; 28:714-719. [PMID: 34518042 DOI: 10.1016/j.fas.2021.08.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/22/2021] [Accepted: 08/21/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND (1) To evaluate patient-reported outcomes and revision surgeries after various operative interventions for osteochondral lesions of the talus (OLT) in a prospective single center series over 10 years, and (2) to identify predicting factors related to subjective ankle status and quality of life pre- and postoperatively. METHODS Ninety-nine patients underwent operative treatment due to primary or recurrent OLT, with an average follow up 3.5 (1.8) years. Treatment outcome was followed clinically (FAOS, EQ-5D, Tegner activity scale) and by pursuing any serious adverse events or graft failures. RESULTS There were 80 responding patients (81%) for the study. The mean lesion size was 2.0 (1.1) cm2. All FAOS values increased from preoperative to final follow-up values (Symptoms 60-68, Pain 58-69, ADL 71-80, Sport 36-54, QoL 30-45). EQ-5D increased from 0.49 to 0.62, while Tegner activity scale change from 3.2 to 3.4. There were 19 (24%) serious adverse events recorded; 13 (16%) of them were graft-related. Graft survival rates were 100% at 1 year, 94% (males)/93% (females) at 2 years, and 77% (males)/47% (females) at 5 years. Female gender, higher BMI, and higher Kellgren-Lawrence ankle OA score were negative predictors for preoperative patient-reported ankle joint status. The foremost improvement after operative intervention was observed in patients with large osteochondral lesions without postoperative adverse events. CONCLUSION Various operative interventions for OLT significantly improved patients' ankle status and quality of life. High graft survival rates were demonstrated over first two years, but notable decline was confirmed thereafter, especially in female patients.
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Affiliation(s)
- Urban Brulc
- Chair of Orthopaedics, Faculty of Medicine, University of Ljubljana, Kongresni trg 12, 1000 Ljubljana, Slovenia; Sanatorij MD Medicina, Bohoričeva ulica 5, 1000 Ljubljana, Slovenia.
| | - Matej Drobnič
- Department of Orthopaedic Surgery, University Medical Centre Ljubljana, Zaloška cesta 9, 1000 Ljubljana, Slovenia; Chair of Orthopaedics, Faculty of Medicine, University of Ljubljana, Kongresni trg 12, 1000 Ljubljana, Slovenia
| | - Matic Kolar
- Department of Orthopaedic Surgery, University Medical Centre Ljubljana, Zaloška cesta 9, 1000 Ljubljana, Slovenia; Chair of Orthopaedics, Faculty of Medicine, University of Ljubljana, Kongresni trg 12, 1000 Ljubljana, Slovenia
| | - Klemen Stražar
- Department of Orthopaedic Surgery, University Medical Centre Ljubljana, Zaloška cesta 9, 1000 Ljubljana, Slovenia; Chair of Orthopaedics, Faculty of Medicine, University of Ljubljana, Kongresni trg 12, 1000 Ljubljana, Slovenia
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Marín Fermín T, Macchiarola L, Zampeli F, Maskalo G, Olory B, Papakostas E, Murawski CD, Hogan MV, Kennedy JG, D'Hooghe P. Osteochondral lesions of the talar dome in the athlete: what evidence leads to which treatment. JOURNAL OF CARTILAGE & JOINT PRESERVATION 2022; 2:100065. [DOI: 10.1016/j.jcjp.2022.100065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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Koh DTS, Tan MWP, Zhan X, Li Z, Tay KS, Tan SM, Yeo NEM, Rikhraj Singh I. Association of Elevated Body Mass Index and Outcomes of Arthroscopic Treatment for Osteochondral Lesions of the Talus. FOOT & ANKLE ORTHOPAEDICS 2022; 7:24730114221103263. [PMID: 35722174 PMCID: PMC9201327 DOI: 10.1177/24730114221103263] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Osteochondral lesions of the talus (OLTs) are a common condition found in patients with chronic ankle pain after previous ankle sprains. Surgical management is indicated after conservative management has failed. Hypothesis/Purpose: This study evaluates the influence of body mass index (BMI) on the early clinical outcomes of arthroscopic debridement and microfracture of OLTs. Methods: A total of 252 patients with symptomatic OLTs who failed conservative management underwent arthroscopic debridement and microfracture of OLTs over the affected ankle between 2007 and 2017. Patients from this cohort were divided into 2 groups based on BMI: the normal BMI group (NB Group) (BMI 18.5-25.0) and overweight and obese BMI group (OB Group) (BMI ≥25). Visual analogue scale (VAS), American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score, and the physical and mental component summaries of the 36-Item Short-Form Health Survey (PCS and MCS, respectively) were prospectively collected from the cohort during their standard postoperative outpatient follow-up. Results: The NB Group (n=105) and OB Group (n=147) were well matched demographically. The operative duration was significantly shorter for the NB Group compared to the OB Group. Patients from both groups had significant improvements in VAS, AOFAS, and PCS scores postoperatively at 6 and 24 months after surgery ( P < .05). Between both groups, patients had comparable VAS, AOFAS, and PCS scores at preoperation, 6 months postoperation, and 24 months postoperation ( P > .05). However, MCS in the OB Group was lower at 24 months postoperatively compared with the NB Group ( P < .05). The OB Group reported better satisfaction scores (82.4% vs 72.6%, P < .05), and a greater proportion had their expectations met (88.2% vs 77.9%, P < .05). Conclusion: A BMI ≥25 was not associated with worse postoperative pain and functional outcomes, but rather was found to be associated with greater satisfaction and fulfillment. However, patients with BMI ≥25 required longer procedure duration and had poorer MCS scores at 24 months after surgery. Level of Evidence: Level III, retrospective cohort study.
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Affiliation(s)
| | | | - Xia Zhan
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Zongxian Li
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Kae Sian Tay
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Shi Ming Tan
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
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Abas S, Kuiper JH, Roberts S, McCarthy H, Williams M, Bing A, Tins B, Makwana N. Osteochondral Lesions of the Ankle Treated with Bone Marrow Concentrate with Hyaluronan and Fibrin: A Single-Centre Study. Cells 2022; 11:629. [PMID: 35203279 PMCID: PMC8869915 DOI: 10.3390/cells11040629] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/26/2022] [Accepted: 01/28/2022] [Indexed: 12/10/2022] Open
Abstract
Osteochondral defects of the ankle (OCD) are being increasingly identified as a clinically significant consequence of injury to the ankle, with the potential to lead to osteoarthritis if left untreated. The aim of this retrospective cohort study was to evaluate a single-stage treatment of OCD, based on bone marrow aspirate (BMA) centrifuged to produce bone marrow concentrate (BMC). In a dual syringe, the concentrate was mixed with thrombin in one syringe, whereas hyaluronan and fibrinogen were mixed in a second syringe. The two mixtures were then injected and combined into the prepared defect. Clinical outcome and quality of life scores (MOXFQ and EQ-5D) were collected at baseline and yearly thereafter. Multilevel models were used to analyse the pattern of scores over time. Ninety-four patients were treated between 2015 and 2020. The means of each of the three components of the MOXFQ significantly improved between baseline and 1 year (p < 0.001 for each component), with no further change from year 1 to year 3. The EQ-5D index also improved significantly from baseline to 1 year, with no evidence for further change. Our results strongly indicate that this BMC treatment is safe for, and well tolerated by, patients with OCD of the ankle as both primary treatment and those who have failed primary treatment. This technique provides a safe, efficacious alternative to currently employed cartilage repair techniques, with favourable outcomes and a low complication rate at 36 months.
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Affiliation(s)
- Sameera Abas
- Department of Foot and Ankle Surgery, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry SY10 7AG, UK; (J.H.K.); (S.R.); (H.M.); (M.W.); (A.B.); (B.T.)
| | - Jan Herman Kuiper
- Department of Foot and Ankle Surgery, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry SY10 7AG, UK; (J.H.K.); (S.R.); (H.M.); (M.W.); (A.B.); (B.T.)
- School of Pharmacy and Bioengineering, Keele University, Staffordshire, Newcastle upon Tyne ST5 5BG, UK
| | - Sally Roberts
- Department of Foot and Ankle Surgery, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry SY10 7AG, UK; (J.H.K.); (S.R.); (H.M.); (M.W.); (A.B.); (B.T.)
- School of Pharmacy and Bioengineering, Keele University, Staffordshire, Newcastle upon Tyne ST5 5BG, UK
| | - Helen McCarthy
- Department of Foot and Ankle Surgery, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry SY10 7AG, UK; (J.H.K.); (S.R.); (H.M.); (M.W.); (A.B.); (B.T.)
- School of Pharmacy and Bioengineering, Keele University, Staffordshire, Newcastle upon Tyne ST5 5BG, UK
| | - Mike Williams
- Department of Foot and Ankle Surgery, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry SY10 7AG, UK; (J.H.K.); (S.R.); (H.M.); (M.W.); (A.B.); (B.T.)
- School of Pharmacy and Bioengineering, Keele University, Staffordshire, Newcastle upon Tyne ST5 5BG, UK
| | - Andrew Bing
- Department of Foot and Ankle Surgery, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry SY10 7AG, UK; (J.H.K.); (S.R.); (H.M.); (M.W.); (A.B.); (B.T.)
| | - Bernhard Tins
- Department of Foot and Ankle Surgery, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry SY10 7AG, UK; (J.H.K.); (S.R.); (H.M.); (M.W.); (A.B.); (B.T.)
| | - Nilesh Makwana
- Department of Foot and Ankle Surgery, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry SY10 7AG, UK; (J.H.K.); (S.R.); (H.M.); (M.W.); (A.B.); (B.T.)
- School of Pharmacy and Bioengineering, Keele University, Staffordshire, Newcastle upon Tyne ST5 5BG, UK
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Owens BD. Staying SANE. Am J Sports Med 2021; 49:3780-3782. [PMID: 34855546 DOI: 10.1177/03635465211059123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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de l'Escalopier N, Amouyel T, Mainard D, Lopes R, Cordier G, Baudrier N, Benoist J, Ferrière VD, Leiber F, Morvan A, Maynou C, Padiolleau G, Barbier O. Long-term outcome for repair of osteochondral lesions of the talus by osteochondral autograft: A series of 56 Mosaicplasties®. Orthop Traumatol Surg Res 2021; 107:103075. [PMID: 34563735 DOI: 10.1016/j.otsr.2021.103075] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/24/2021] [Accepted: 07/27/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The present study analyzed results in 56 osteochondral Mosaicplasty® autografts for osteochondral lesion of the talus (OLT) at more than 5 years' follow-up. HYPOTHESIS Mosaicplasty® shows long-term efficacy and low morbidity in the treatment of OLT. PATIENTS AND METHODS A multicenter retrospective study included patients treated by Mosaicplasty® with more than 5 years' follow-up. Preoperative data were collected from medical files, and all patients were reassessed. AOFAS scores and FAOS were calculated at last follow-up. Imaging comprised standard radiographs and MRI or CT arthrography of the ankle. RESULTS Fifty-six patients were included, with a mean age of 34 years (range, 18-60 years). Seventeen involved work accidents. Mean follow-up was 8.5 years (range, 5-20 years). Mean AOFAS score at follow-up was 80.6±19.4 and mean FAOS 77.8±21.5. Work accident, preoperative osteoarthritis and untreated laxity correlated significantly with poorer results. At last follow-up, 22 patients (39%) showed signs of osteoarthritis. There was no morbidity implicating the malleolar osteotomy. There were 11 cases (20%) of persistent patellar syndrome at the donor site. DISCUSSION The present results were comparable to those reported elsewhere, showing that functional results of Mosaicplasty® autograft for OLT do not deteriorate over the long term. Work accidents correlated significantly with poorer functional outcome. Any associated instability must always be treated. Malleolar osteotomy provides good exposure without additional morbidity. LEVEL OF EVIDENCE IV; retrospective study.
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Affiliation(s)
- Nicolas de l'Escalopier
- Service de Chirurgie Orthopédique, Traumatologique et Réparatrice des Membres, HIA Percy, 101, avenue Henri Barbusse, 92140 Clamart, France.
| | - Thomas Amouyel
- Hôpital Salengro, Service de Chirurgie Orthopédique, 2, avenue Oscar Lambret, 59000 Lille, France
| | - Didier Mainard
- Hôpital Central, 29, avenue du Maréchal de Lattre de Tassigny, 54000 Nancy, France
| | - Ronny Lopes
- Centre PCNA, avenue Claude Bernard, 44800 Saint-Herblain, France
| | - Guillaume Cordier
- Centre de Chirurgie Orthopédique et Sportive, 2, rue Georges Negrevergne, 33700 Mérignac, France
| | - Nicolas Baudrier
- Hôpital Ambroise Paré, Service de Chirurgie Orthopédique, 9, avenue Charles de Gaulle, 92100 Boulogne-Billancourt, France
| | - Jonathan Benoist
- Institut Locomoteur de l'Ouest, 7, boulevard de la Boutière, 35760 Saint-Grégoire, France
| | - Victor Dubois Ferrière
- Centre Assal de Médecine et de Chirurgie du Pied, avenue de Beau-Séjour 6, 1206 Geneva, Switzeraland
| | - Fréderic Leiber
- Clinique de l'Orangerie, 29, allée de la Robertsau, 67000 Strasbourg, France
| | - Antoine Morvan
- Hôpital Ambroise Paré, Service de Chirurgie Orthopédique, 9, avenue Charles de Gaulle, 92100 Boulogne-Billancourt, France
| | - Carlos Maynou
- Hôpital Salengro, Service de Chirurgie Orthopédique, 2, avenue Oscar Lambret, 59000 Lille, France
| | | | - Olivier Barbier
- Service de Chirurgie Orthopédique et Traumatologique, HIA Sainte Anne, 2, boulevard Sainte-Anne, 83800 Toulon, France
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- 15, rue Ampère, 92500 Rueil Malmaison, France
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Marín Fermín T, Hovsepian JM, D'Hooghe P, Papakostas ET. Arthroscopic debridement of osteochondral lesions of the talus: A systematic review. Foot (Edinb) 2021; 49:101852. [PMID: 34536818 DOI: 10.1016/j.foot.2021.101852] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 07/07/2021] [Accepted: 07/08/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Arthroscopic debridement (AD) for the osteochondral lesions of the talar dome (OLT) was widely documented in the nineties with satisfactory results. However, in modern treatment algorithms, its role is not described. The present systematic review aims to evaluate the current evidence on the clinical outcomes of AD in the management of OLT. METHODS Two independent reviewers searched PubMed, EMBASE, Scopus, and Virtual Health Library databases evaluating the clinical outcomes of AD of OLT with a minimum 6-month follow-up. The following terms "talus", "chondral", "cartilage", "injury", "lesion", "delamination", "damage", "excision", "curettage", "debridement", "chondrectomy", "chondroplasty", were used alone and in combination with Boolean operators AND and OR. Studies in which surgical technique was not described, an additional procedure was performed after debridement, and/or outcomes were not reported separately when more than one technique was implemented were excluded. The modified Coleman methodology score (mCMS) was used to evaluate the methodological quality of the included studies. A narrative analysis was conducted. Publication bias was assessed using the ROBIS tool. RESULTS AD showed satisfactory short and medium-term outcomes for the primary treatment of OLT irrespectively of size and depth. However, the heterogeneity of the included studies and the level of available evidence hinders its recommendation. CONCLUSIONS There is a paucity of evidence evaluating AD alone for OLT treatment in the last two decades. Bone-marrow stimulation techniques remain the first-line surgical strategy for OLT treatment without proven superiority. Adopting AD for OLT treatment instead of MF could represent a paradigm breakthrough in clinical practice given its many potential advantages while preserving the subchondral plate.
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Affiliation(s)
- Theodorakys Marín Fermín
- Department of Traumatology, Hospital Universitario Periférico de Coche "Dr. Leopoldo Manrique Terrero", Caracas, Venezuela.
| | - Jean M Hovsepian
- Department of Sports Orthopaedics, Hessing Klinik, Augsburg, Germany
| | - Pieter D'Hooghe
- Aspetar Orthopedic and Sports Medicine Hospital, Doha, Qatar
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11
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Satin AM, Norelli JB, Sgaglione NA, Grande DA. Effect of Combined Leukocyte-Poor Platelet-Rich Plasma and Hyaluronic Acid on Bone Marrow-Derived Mesenchymal Stem Cell and Chondrocyte Metabolism. Cartilage 2021; 13:267S-276S. [PMID: 31282189 PMCID: PMC8804819 DOI: 10.1177/1947603519858739] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Given the potential applications of combined biologics, the authors sought to evaluate the in vitro effect of combined platelet-rich plasma (PRP) and hyaluronic acid (HA) on cellular metabolism. DESIGN Bone marrow-derived mesenchymal stem cells (BMSCs) and chondrocytes were obtained from the femurs of Sprague-Dawley rats. An inflammatory model was created by adding 10 ng/mL interleukin-1-beta to culture media. Non-crosslinked high-molecular-weight HA, activated-PRP (aPRP), and unactivated-PRP (uPRP) were tested. Cellular proliferation and gene expression were measured at 1 week. Genes of interest included aggrecan, matrix metalloproteinase (MMP)-9, and MMP-13. RESULTS Combined uPRP-HA was associated with a significant increase in chondrocyte and BMSC proliferation at numerous preparations. There was a trend of increased chondrocyte aggrecan expression with combined PRP-HA. The greatest and only significant decrease in BMSC MMP-9 expression was observed with combined PRP-HA. While a significant reduction of BMSC MMP-13 expression was seen with PRP and HA-alone, a greater reduction was observed with PRP-HA. MMP-9 chondrocyte expression was significantly reduced in cells treated with PRP-HA. PRP-alone and HA-alone at identical concentrations did not result in a significant reduction. The greatest reduction of MMP-13 chondrocyte expression was observed in chondrocytes plus combined PRP-HA. CONCLUSIONS We demonstrated a statistically significant increase in BMSC and chondrocyte proliferation and decreased expression of catabolic enzymes with combined PRP-HA. These results demonstrate the additive in vitro effect of combined PRP-HA to stimulate cellular growth, restore components of the articular extracellular matrix, and reduce inflammation.
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Affiliation(s)
- Alexander M. Satin
- Department of Orthopaedic Surgery,
Long Island Jewish Medical Center, Northwell Health, New Hyde Park, NY,
USA
| | - Jolanta B. Norelli
- Donald and Barbara Zucker School
of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Orthopaedic Research Laboratory,
Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Nicholas A. Sgaglione
- Department of Orthopaedic Surgery,
Long Island Jewish Medical Center, Northwell Health, New Hyde Park, NY,
USA
- Donald and Barbara Zucker School
of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Daniel A. Grande
- Department of Orthopaedic Surgery,
Long Island Jewish Medical Center, Northwell Health, New Hyde Park, NY,
USA
- Donald and Barbara Zucker School
of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Orthopaedic Research Laboratory,
Feinstein Institute for Medical Research, Manhasset, NY, USA
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12
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Danilkowicz RM, Allen NB, Grimm N, Nettles DL, Nunley JA, Easley ME, Adams SB. Histological and Inflammatory Cytokine Analysis of Osteochondral Lesions of the Talus After Failed Microfracture: Comparison With Fresh Allograft Controls. Orthop J Sports Med 2021; 9:23259671211040535. [PMID: 34734096 PMCID: PMC8558807 DOI: 10.1177/23259671211040535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 05/19/2021] [Indexed: 11/21/2022] Open
Abstract
Background: The most common first-line treatment of osteochondral lesions of the talus (OLTs) is microfracture. Although many patients do well with this procedure, a number fail and require reoperation. The mechanism of failure of microfracture is unknown, and to our knowledge there has been no research characterizing failed microfracture regarding histological and inflammatory makeup of these lesions that may contribute to failure. Purpose: To characterize the structural and biochemical makeup of failed microfracture lesions. Study Design: Case series; Level of evidence, 4. Methods: Specimens from 8 consecutive patients with symptomatic OLTs after microfracture who later underwent fresh osteochondral allograft transplantation were analyzed. For each patient, the failed microfracture specimen and a portion of the fresh allograft replacement tissue were collected. The allograft served as a control. Histology of the failed microfracture and the allograft replacement was scored using the Osteoarthritis Research Society International (OARSI) system. Surface roughness was also compared. In addition, tissue culture supernatants were analyzed for 16 secreted cytokines and matrix metalloproteinases (MMPs) responsible for inflammation, pain, cartilage damage, and chondrocyte death. Results: The OARSI grade, stage, and total score as well as surface smoothness were significantly worse in the failed microfracture sample, indicating better cartilage and bone morphology for the allografts compared with the failed microfracture lesions. Analyzed cytokines and MMPs were significantly elevated in the microfracture tissue culture supernatants when compared with fresh osteochondral tissue supernatants. Conclusion: These data demonstrate a significantly rougher cartilage surface, cartilage and subchondral bone histology that more closely resembles osteoarthritis, and elevated inflammatory cytokines and MMPs responsible for pain, inflammation, cartilage damage, and chondrocyte death when compared with fresh osteochondral allografts used as controls.
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Affiliation(s)
- Richard M Danilkowicz
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Nicholas B Allen
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Nate Grimm
- Idaho Sports Medicine Institute, Boise, Idaho, USA
| | - Dana L Nettles
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - James A Nunley
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Mark E Easley
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Samuel B Adams
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
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13
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Drakos MC, Eble SK, Cabe TN, Patel K, Hansen OB, Sofka C, Fabricant PD, Deland JT. Comparison of Functional and Radiographic Outcomes of Talar Osteochondral Lesions Repaired With Micronized Allogenic Cartilage Extracellular Matrix and Bone Marrow Aspirate Concentrate vs Microfracture. Foot Ankle Int 2021; 42:841-850. [PMID: 33472436 DOI: 10.1177/1071100720983266] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Microfracture (MF) has been used historically to treat osteochondral lesions of the talus (OLTs), with favorable outcomes reported in approximately 80% to 85% of cases. However, MF repairs have been shown to degrade over time at long-term follow-up, suggesting that further study into optimal OLT treatment is warranted. The use of adjuvant extracellular matrix with bone marrow aspirate concentrate (ECM-BMAC) has not been extensively evaluated in the literature. We present a comparison of patient-reported and radiographic outcomes following ECM-BMAC repair vs traditional MF. METHODS Patients who underwent MF (n = 67) or ECM-BMAC (n = 62) treatment for an OLT were identified and their charts were retrospectively reviewed. Postoperative magnetic resonance imaging (MRI) was evaluated and patient-reported outcome scores, either Foot and Ankle Outcome Scores (FAOS) or Patient-Reported Measurement Information System (PROMIS) scores, were collected. MRIs were scored by a radiologist, fellowship trained in musculoskeletal radiology, using the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) system. Radiographic and clinical outcomes were compared between groups. RESULTS On average, patients treated with ECM-BMAC demonstrated a higher total MOCART score compared to the MF group (73 ± SD 11.5 vs 54.0 ± 24.1; P = .0015). ECM-BMAC patients also had significantly better scores for the Infill, Integration, and Signal MOCART subcategories. Last, patients treated with ECM-BMAC had a lower rate of revision compared to those treated with MF (4.8% vs 20.9%; P = .007). FAOS scores were compared between groups, with no significant differences observed. CONCLUSION When comparing outcomes between patients treated for an OLT with ECM-BMAC vs traditional MF, we observed superior MRI results for ECM-BMAC patients. The rate of revision surgery was higher for MF patients, although patient-reported outcomes were similar between groups. The use of ECM-BMAC as an adjuvant therapy in the treatment of OLTs may result in improved reparative tissue when compared to MF. LEVEL OF EVIDENCE Level III, comparative series.
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Affiliation(s)
- Mark C Drakos
- Foot and Ankle Service, Hospital for Special Surgery, New York, NY, USA
| | | | | | - Karan Patel
- Hospital for Special Surgery, New York, NY, USA.,Mayo Clinic Arizona, Phoenix, AZ, USA
| | | | | | | | - Jonathan T Deland
- Foot and Ankle Service, Hospital for Special Surgery, New York, NY, USA
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14
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Penner M, Younger A, Wing K, Cresswell M, Veljkovic A. Arthroscopic Repair of Talar Osteochondral Defects With Umbilical Cord Allograft: A Prospective, Single-Center, Pilot Study. Foot Ankle Spec 2021; 14:193-200. [PMID: 32172597 DOI: 10.1177/1938640020910953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cryopreserved umbilical cord (UC) allografts have been shown to promote postoperative wound healing by suppressing inflammation and reducing scar formation. The purpose of this study was to determine whether adjunctive use of UC may improve clinical and functional outcomes following arthroscopic repair of talar osteochondral defects (OCDs). A total of 10 patients with talar OCDs that failed nonoperative treatment were enrolled in this single-center, prospective, pilot study. Clinical and functional outcomes were assessed using the Ankle Osteoarthritis Scale (AOS), Foot and Ankle Ability Measure, and Visual Analog Scale (VAS) pain scale at 6, 12, 24, and 52 weeks postoperatively. Results showed a consistent improvement in all outcome measures. VAS pain scores significantly improved from 4.2 ± 2.9 to 1.3 ± 2.2 at 52 weeks (P = .015). AOS difficulty and pain scores nonsignificantly improved from 27.0 ± 24.6 and 33.1 ± 28.3 at baseline to 15.3 ± 20.5 and 14.8 ± 18.7 at 52 weeks, respectively. The clinical outcome improvement was accompanied by significant reduction in OCD defect size and associated bone marrow lesion. This pilot study suggests that adjunctive use of UC during arthroscopic repair of talar OCD may lead to clinical and functional improvement.Levels of Evidence: Level II: Prospective Cohort Study.
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Affiliation(s)
- Murray Penner
- Department of Orthopaedics (MP, AY, KW, AV).,Department of Radiology (MC), University of British Columbia, Vancouver, BC, Canada
| | - Alastair Younger
- Department of Orthopaedics (MP, AY, KW, AV).,Department of Radiology (MC), University of British Columbia, Vancouver, BC, Canada
| | - Kevin Wing
- Department of Orthopaedics (MP, AY, KW, AV).,Department of Radiology (MC), University of British Columbia, Vancouver, BC, Canada
| | - Mark Cresswell
- Department of Orthopaedics (MP, AY, KW, AV).,Department of Radiology (MC), University of British Columbia, Vancouver, BC, Canada
| | - Andrea Veljkovic
- Department of Orthopaedics (MP, AY, KW, AV).,Department of Radiology (MC), University of British Columbia, Vancouver, BC, Canada
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15
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Correlation of the Single-Assessment Numeric Evaluation (SANE) Score With Hip-Specific Patient-Reported Outcome Measures. Arthrosc Sports Med Rehabil 2021; 3:e435-e440. [PMID: 34027452 PMCID: PMC8129469 DOI: 10.1016/j.asmr.2020.10.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 10/25/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose The purpose of this study was to determine if the Single-Assessment Numeric Evaluation (SANE) score correlates with existing validated hip-specific patient-reported outcome measures (PROMs), including the Modified Harris Hip Score (mHHS), the International Hip Outcome Tool (IHOT-33), the Hip Outcome Score, Activities of Daily Living subscale (HOS-ADL), and the Hip Outcome Score, Sport-Specific subscale (HOS-SS), for patients preparing to undergo hip arthroscopy for treatment of femoroacetabular impingement syndrome (FAIS). Methods A single surgeon's operative database was retrospectively reviewed to identify patients undergoing primary hip arthroscopy for treatment of FAIS from April 2018 to October 2019. Patient-specific factors including age, sex, body mass index (BMI), and duration of symptoms were collected. Preoperative SANE, mHHS, IHOT-33, HOS-ADL, and HOS-SS scores were analyzed. Statistical analysis using Pearson correlation was performed to identify the relationship between the SANE score and the mHHS, IHOT-33, HOS-ADL, and HOS-SS, preoperatively. Results 154 patients were included in the study. The mean mHHS was 54.4 ± 11.7; mean IHOT-33 score was 32.7 ± 15.0; mean HOS-SS 42.9 ± 23.7; and mean HOS-ADL was 63.3 ± 1. The mean SANE score was 36.7 ± 19.9. The Simple Hip Score was directly correlated with the mHHS (P < .01), the IHOT-33 (P < .01); the HOS-ADL (P < .01), and the HOS-SS (P < .01). The mean patient age was 35.9 years; 109 (70.8%) were female and 45 (29.2%) were male. Average patient BMI was 26.9. At the time of patient completion of the questionnaire, the majority of patients (65%) had been having symptoms for >1 year. Conclusion The SANE score was strongly correlated with mHHS, IHOT-33, HOS-ADL, and HOS-SS in the preoperative setting for patients undergoing hip arthroscopy for treatment of FAIS. Given its simplicity, SANE may be a valuable tool for rapid assessment of joint function and pain in this patient population. Level of Evidence IV, therapeutic case series.
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16
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Rikken QGH, Dahmen J, Stufkens SAS, Kerkhoffs GMMJ. Satisfactory long-term clinical outcomes after bone marrow stimulation of osteochondral lesions of the talus. Knee Surg Sports Traumatol Arthrosc 2021; 29:3525-3533. [PMID: 34185110 PMCID: PMC8514351 DOI: 10.1007/s00167-021-06630-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 06/07/2021] [Indexed: 10/25/2022]
Abstract
PURPOSE The purpose of the present study was to evaluate the clinical and radiological outcomes of arthroscopic bone marrow stimulation (BMS) for the treatment of osteochondral lesions of the talus (OLTs) at long-term follow-up. METHODS A literature search was conducted from the earliest record until March 2021 to identify studies published using the PubMed, EMBASE (Ovid), and Cochrane Library databases. Clinical studies reporting on arthroscopic BMS for OLTs at a minimum of 8-year follow-up were included. The review was performed according to the PRISMA guidelines. Two authors independently conducted the article selection and conducted the quality assessment using the Methodological index for Non-randomized Studies (MINORS). The primary outcome was defined as clinical outcomes consisting of pain scores and patient-reported outcome measures. Secondary outcomes concerned the return to sport rate, reoperation rate, complication rate, and the rate of progression of degenerative changes within the tibiotalar joint as a measure of ankle osteoarthritis. Associated 95% confidence intervals (95% CI) were calculated based on the primary and secondary outcome measures. RESULTS Six studies with a total of 323 ankles (310 patients) were included at a mean pooled follow-up of 13.0 (9.5-13.9) years. The mean MINORS score of the included studies was 7.7 out of 16 points (range 6-9), indicating a low to moderate quality. The mean postoperative pooled American Orthopaedic Foot and Ankle Society (AOFAS) score was 83.8 (95% CI 83.6-84.1). 78% (95% CI 69.5-86.8) participated in sports (at any level) at final follow-up. Return to preinjury level of sports was not reported. Reoperations were performed in 6.9% (95% CI 4.1-9.7) of ankles and complications related to the BMS procedure were observed in 2% (95% CI 0.4-3.0) of ankles. Progression of degenerative changes was observed in 28% (95% CI 22.3-33.2) of ankles. CONCLUSION Long-term clinical outcomes following arthroscopic BMS can be considered satisfactory even though one in three patients show progression of degenerative changes from a radiological perspective. These findings indicate that OLTs treated with BMS may be at risk of progressing towards end-stage ankle osteoarthritis over time in light of the incremental cartilage damage cascade. The findings of this study can aid clinicians and patients with the shared decision-making process when considering the long-term outcomes of BMS. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Quinten G. H. Rikken
- grid.7177.60000000084992262
Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ,grid.509540.d0000 0004 6880 3010Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam UMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ,grid.509540.d0000 0004 6880 3010Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Jari Dahmen
- grid.7177.60000000084992262
Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ,grid.509540.d0000 0004 6880 3010Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam UMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ,grid.509540.d0000 0004 6880 3010Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Sjoerd A. S. Stufkens
- grid.7177.60000000084992262
Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ,grid.509540.d0000 0004 6880 3010Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam UMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ,grid.509540.d0000 0004 6880 3010Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Gino M. M. J. Kerkhoffs
- grid.7177.60000000084992262
Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ,grid.509540.d0000 0004 6880 3010Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam UMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ,grid.509540.d0000 0004 6880 3010Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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17
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Freitag J, Wickham J, Shah K, Li D, Norsworthy C, Tenen A. Mesenchymal stem cell therapy combined with arthroscopic abrasion arthroplasty regenerates cartilage in patients with severe knee osteoarthritis: a case series. Regen Med 2020; 15:1957-1977. [PMID: 33084503 DOI: 10.2217/rme-2020-0128] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Aim: To evaluate the safety and efficacy of adipose-derived mesenchymal stem cell (ADMSC) therapy in combination with arthroscopic abrasion arthroplasty (AAA) in advanced knee osteoarthritis (OA). Materials & methods: 27 patients with Grade IV OA of the knee underwent AAA and ADMSC therapy (50 × 106 ADMSCs at baseline and 6 months). Clinical outcome was assessed over 36 months. Structural change was determined using MRI. Results: Treatment was well tolerated with no serious adverse events. Clinically significant improvements in pain and function were observed. Reproducible hyaline-like cartilage regeneration was seen in all participants. Conclusion: ADMSC therapy combined with AAA in Grade IV OA results in reproducible pain, functional and structural improvements. This represents a joint preservation technique for patients with advanced OA of the knee. Trial registration number: ACTRN12617000638336.
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Affiliation(s)
- Julien Freitag
- School of Biomedical Sciences, Charles Sturt University, Orange, NSW, Australia.,Magellan Stem Cells, Box Hill, Victoria, Australia.,Melbourne Stem Cell Centre, Box Hill, Victoria, Australia
| | - James Wickham
- School of Biomedical Sciences, Charles Sturt University, Orange, NSW, Australia
| | - Kiran Shah
- Magellan Stem Cells, Box Hill, Victoria, Australia.,Department of Chemistry and Biotechnology, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Douglas Li
- Magellan Stem Cells, Box Hill, Victoria, Australia.,Orthopaedics Sports Arthroplasty, Melbourne, Victoria, Australia
| | | | - Abi Tenen
- Magellan Stem Cells, Box Hill, Victoria, Australia.,Melbourne Stem Cell Centre, Box Hill, Victoria, Australia.,School of Primary Healthcare, Faculty of Medicine, Monash University, Monash, Victoria, Australia
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18
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Wang CC, Yang KC, Chen IH. Current treatment concepts for osteochondral lesions of the talus. Tzu Chi Med J 2020; 33:243-249. [PMID: 34386361 PMCID: PMC8323653 DOI: 10.4103/tcmj.tcmj_106_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 05/29/2020] [Accepted: 06/13/2020] [Indexed: 11/22/2022] Open
Abstract
Osteochondral lesions of the talus (OLT) are a well-known cause of ankle joint pain and can sometimes lead to instability. These lesions are not only confined to articular hyaline cartilage, they can also affect the subchondral bone at the weight-bearing aspect of the talar dome. Nonoperative treatment is the preferred option for small lesions, however surgical intervention is recommended for large lesions or those for which conservative treatment has failed. Microfracture, abrasion arthroplasty and multiple drilling are all classified as bone marrow stimulation procedures; they are used to try to recruit precursor cells for cartilage regeneration and are especially suitable for small OLT lesions. For large lesions, osteochondral autografting and allografting are better options to reconstruct the articular defect, as they have better contours and mechanical strength. When there is limited subchondral bone involvement in large lesions, cell-based therapies such as autogenous chondrocyte implantation, potentially combined with a biomaterial matrix, are a promising option and acceptable functional outcomes have been reported. To provide evidence-based recommendations for clinicians, this article evaluates the currently available treatment strategies for OLT and their evolution over the past few decades.
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Affiliation(s)
- Chen-Chie Wang
- Department of Orthopedic Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan.,Department of Orthopedics, School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Kai-Chiang Yang
- School of Dental Technology, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ing-Ho Chen
- Department of Orthopedics, School of Medicine, Tzu Chi University, Hualien, Taiwan.,Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
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19
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Freitag J, Shah K, Wickham J, Li D, Norsworthy C, Tenen A. Evaluation of autologous adipose-derived mesenchymal stem cell therapy in focal chondral defects of the knee: a pilot case series. Regen Med 2020; 15:1703-1717. [PMID: 32735154 DOI: 10.2217/rme-2020-0027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Aim: To evaluate the safety, pain, functional and structural improvements after autologous adipose-derived mesenchymal stem cell (ADMSC) therapy in combination with arthroscopic abrasion arthroplasty in focal chondral defects of the knee. Methods: Eight patients with a focal full thickness chondral defect of the knee underwent arthroscopic abrasion arthroplasty followed by postoperative intra-articular injections of autologous ADMSCs (50 × 106 ADMSCs at baseline and 6 months). Clinical outcome was assessed using numeric pain rating scale, Knee Injury and Osteoarthritis Outcome Score and the Western Ontario and McMaster Universities Osteoarthritis Index. Structural outcome was determined by magnetic resonance imaging. Outcome was assessed over 24 months. Results: No serious adverse events occurred. Participants observed clinically significant improvement in pain and function. Magnetic resonance imaging analysis showed cartilage regeneration with T2 mapping values comparable to hyaline cartilage. Conclusion: Arthroscopic abrasion arthroplasty in combination with intra-articular ADMSC therapy results in reproducible pain, functional and structural improvements with regeneration of hyaline-like cartilage. Trial registration number: ACTRN12617000638336.
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Affiliation(s)
- Julien Freitag
- Charles Sturt University, Orange, NSW, Australia.,Magellan Stem Cells, Box Hill, Victoria, Australia.,Melbourne Stem Cell Centre, Box Hill, Victoria, Australia
| | - Kiran Shah
- Magellan Stem Cells, Box Hill, Victoria, Australia.,Swinburne University, Melbourne, Victoria, Australia
| | | | - Douglas Li
- Orthopaedics Sports Arthroplasty, Melbourne, Victoria, Australia
| | | | - Abi Tenen
- Magellan Stem Cells, Box Hill, Victoria, Australia.,Melbourne Stem Cell Centre, Box Hill, Victoria, Australia.,Monash University, Monash, Victoria, Australia
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20
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Hadeed MM, Dempsey IJ, Tyrrell Burrus M, Werner BC, Walker JB, Perumal V, Park JS. Predictors of Osteochondral Lesions of the Talus in Patients Undergoing Broström-Gould Ankle Ligament Reconstruction. J Foot Ankle Surg 2020; 59:21-26. [PMID: 31882142 DOI: 10.1053/j.jfas.2018.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Indexed: 02/03/2023]
Abstract
Chronic ankle instability is associated with intra-articular and extra-articular ankle pathologies, including osteochondral lesions of the talus. Patients with these lesions are at risk for treatment failure for their ankle instability. Identifying these patients is important and helps to guide operative versus nonoperative treatment. There is no literature examining which patient characteristics may be used to predict concomitant osteochondral lesions of the talus. A retrospective chart review was performed on patients (N = 192) who underwent a primary Broström-Gould lateral ankle ligament reconstruction for chronic ankle instability from 2010 to 2014. Preoperative findings, magnetic resonance imaging, and operative procedures were documented. Patients with and without a lesion were divided into 2 cohorts. Fifty-three (27.6%) patients had 1 lesion identified on preoperative magnetic resonance imaging. Forty (69.0%) of these lesions were medial, 18 (31.0%) were lateral, and 5 patients had both. Female sex was a negative predictor of a concomitant lesion (p = .013). Patients were less likely to have concomitant peroneal tendinopathy (30.2% vs 48.9%; p = .019) in the presence of a lesion. However, sports participation was a positive predictor of a concomitant lesion (p = .001). The remainder of the variables (age, body mass index, smoking, trauma, duration, contralateral instability, global laxity) did not show a significant difference. In patients who underwent lateral ankle ligament reconstruction, females were less likely to have a lesion than males. Patients with peroneal tendinopathy were less likely to have a lesion compared with patients without. Additionally, athletic participation was a positive predictor of a concomitant lesion.
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Affiliation(s)
- Michael M Hadeed
- Resident Physician, Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA
| | - Ian J Dempsey
- Resident Physician, Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA.
| | - M Tyrrell Burrus
- Resident Physician, Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA
| | - Brian C Werner
- Assistant Professor, Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA
| | - J Brock Walker
- Resident Physician, Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA
| | - Venkat Perumal
- Assistant Professor, Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA
| | - Joseph S Park
- Associate Professor, Foot and Ankle Service, Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA
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21
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Torchia MT, Austin DC, Werth PM, Lucas AP, Moschetti WE, Jevsevar DS. A SANE Approach to Outcome Collection? Comparing the Performance of Single- Versus Multiple-Question Patient-Reported Outcome Measures After Total Hip Arthroplasty. J Arthroplasty 2020; 35:S207-S213. [PMID: 32008770 DOI: 10.1016/j.arth.2020.01.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 12/18/2019] [Accepted: 01/08/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Several patient-reported outcome measures (PROMs) exist to measure outcomes after total hip arthroplasty (THA) but can be limited by patient-perceived burden and completion rates. We analyzed whether the modified single assessment numerical evaluation (M-SANE), a one-question PROM, would perform similarly to multiple-question PROMs among patients undergoing primary THA. METHODS Patients undergoing THA completed the Patient-Reported Outcomes Measurement Information System-10 (PROMIS-10), the Hip Disability and Osteoarthritis Outcomes Score Junior (HOOS-Jr), and M-SANE questionnaires both preoperatively and postoperatively. The M-SANE assessment asked patients to assess their hip on a scale from 0 to 10, with 10 being the best possible score. Validity of M-SANE compared with other PROMs was determined by Spearman's correlation and floor and ceiling effects. Responsiveness was analyzed using standardized response mean (SRM). RESULTS One hundred and thirty six patients with at least 1-year follow-up were reviewed. The average M-SANE score improved from 3.3 preoperatively to 7.1 at one year postoperatively. There was moderate to strong correlation at one-year follow-up between the M-SANE and HOOS-Jr (ρ = 0.75, P < .001) and PROMIS-10 physical component summary (ρ = 0.63, P < .001). Floor and ceiling effects of the M-SANE (floor 2.0%, ceiling 21.3%) were comparable to the HOOS-Jr (floor 0.0%, ceiling 20.8%). The responsiveness of the M-SANE after THA (SRM = 1.06, 95% CI: 0.79-1.33) was comparable to HOOS-Jr (SRM = 1.33, 95% CI: 1.08-1.59) and superior to PROMIS-10 physical component summary (SRM = 0.65, 95% CI: 0.55-0.74). CONCLUSION The M-SANE has performed similarly across multiple psychometric properties compared with more burdensome PROMs in assessing longitudinal patient-reported outcomes after THA.
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Affiliation(s)
- Michael T Torchia
- Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Daniel C Austin
- Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Paul M Werth
- Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Adriana P Lucas
- Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Wayne E Moschetti
- Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Department of Orthopaedics, Geisel School of Medicine Dartmouth College, Hanover, NH
| | - David S Jevsevar
- Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Department of Orthopaedics, Geisel School of Medicine Dartmouth College, Hanover, NH
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22
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Haraguchi N, Shiratsuchi T, Ota K, Ozeki T, Gibu M, Niki H. Fixation of the osteochondral talar fragment yields good results regardless of lesion size or chronicity. Knee Surg Sports Traumatol Arthrosc 2020; 28:291-297. [PMID: 31542817 DOI: 10.1007/s00167-019-05716-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 09/11/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE Osteochondral talar lesions, regardless of their size and/or chronicity, are, at our hospital, now treated by fixation of the fragment if the talar dome cartilage is judged to be healthy. The retrospective study described herein was conducted to assess clinical outcomes of this treatment strategy. METHODS The study group comprised 44 patients (18 men and 26 women) with 45 such talar lesions. In all cases, the osteochondral fragment was reduced and fixed with bone harvested from the osteotomy site and shaped into peg(s) (one to four pegs per lesion). Median follow-up was 2.1 years (1-9 years). The lesion area was measured on computed tomography arthrographs, and the Japanese Society for Surgery of the Foot (JSSF) ankle/hindfoot scale was used to evaluate postoperative outcomes. Clinical failure was defined as a JSSF score < 80 points. RESULTS The mean JSSF score improved significantly from 63.5 points preoperatively to 93.0 postoperatively (p < 0.001). Treatment failure occurred in only one ankle (0.02%). The mean lesion area was 51.2 mm2 (range 5-147 mm2). Correlation between lesion areas and the postoperative JSSF scores was weak (r = - 0.133). Correlation between the time of the trauma to the time of fixation surgery and the postoperative JSSF scores was also weak (r = 0.042). Radiographic outcomes were good for 28 ankles, fair for 10, and poor for 7. CONCLUSION Fixation of the lesion fragment, regardless of size and/or chronicity, appears to be appropriate in cases of an osteochondral talar lesion. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Naoki Haraguchi
- Department of Orthopaedic Surgery, St. Marianna University Yokohama Seibu Hospital, 1197-1 Yasashicho, Asahi-ku, Yokohama, Kanagawa, 241-0811, Japan.
| | - Takaki Shiratsuchi
- Department of Orthopaedic Surgery, St. Marianna University Yokohama Seibu Hospital, 1197-1 Yasashicho, Asahi-ku, Yokohama, Kanagawa, 241-0811, Japan
| | - Koki Ota
- Department of Orthopaedic Surgery, Tokyo Metropolitan Police Hospital, 4-22-1 Nakano, Nakano-ku, Tokyo, 164-8541, Japan
| | - Takuma Ozeki
- Department of Orthopaedic Surgery, Tokyo Metropolitan Police Hospital, 4-22-1 Nakano, Nakano-ku, Tokyo, 164-8541, Japan
| | - Masaki Gibu
- Department of Orthopaedic Surgery, Tokyo Metropolitan Police Hospital, 4-22-1 Nakano, Nakano-ku, Tokyo, 164-8541, Japan
| | - Hisateru Niki
- Department of Orthopaedic Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
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23
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Choi SW, Lee GW, Lee KB. Arthroscopic Microfracture for Osteochondral Lesions of the Talus: Functional Outcomes at a Mean of 6.7 Years in 165 Consecutive Ankles. Am J Sports Med 2020; 48:153-158. [PMID: 31877099 DOI: 10.1177/0363546519887957] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Arthroscopic microfracture for osteochondral lesions of the talus (OLT) has shown good functional outcomes. However, some studies have reported that functional outcomes deteriorate over time after surgery. PURPOSE To use various functional scoring systems to evaluate functional outcomes in a large sample of patients with OLT treated by arthroscopic microfracture. STUDY DESIGN Case series; Level of evidence, 4. METHODS The study cohort consisted of 165 ankles (156 patients) that underwent arthroscopic microfracture for small to mid-sized OLT. The mean lesion size was 73 mm2 (range, 17-146 mm2), and the mean follow-up period was 6.7 years (range, 2.0-13.6 years). The Foot and Ankle Outcome Score (FAOS), American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale, visual analog scale (VAS) for pain, and 36-Item Short Form Health Survey (SF-36) were used to compare the functional outcomes between the preoperative and final follow-up assessments. RESULTS The mean FAOS significantly improved in regard to all subscores (P < .001). The AOFAS ankle-hindfoot scale showed an improvement from 71.0 points (range, 47.0-84.0) preoperatively to 89.5 points (range, 63.0-100) at the final follow-up (P < .001). The VAS score showed an improvement from 6.2 points (range, 4.0-9.0) preoperatively to 1.7 points (range, 0-6.0) at the final follow-up (P < .001). The mean SF-36 score improved from 62.4 points (range, 27.4-76.6) preoperatively to 76.2 points (range, 42.1-98.0) at the final follow-up (P < .001). Among 165 ankles, 22 ankles (13.3%) underwent repeat arthroscopic surgery for evaluation of repaired cartilage status. CONCLUSION Arthroscopic microfracture showed good functional outcomes and improved quality of life with maintenance of satisfactory outcomes at a mean follow-up of 6.7 years. Therefore, arthroscopic microfracture seems to be reliable as a first-line treatment for OLT at an intermediate-term follow-up.
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Affiliation(s)
- Seung-Won Choi
- Department of Orthopedic Surgery, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
| | - Gun-Woo Lee
- Department of Orthopedic Surgery, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
| | - Keun-Bae Lee
- Department of Orthopedic Surgery, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
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Garcia AN, Cook C, Lutz A, Thigpen CA. Concurrent validity of the single assessment numerical evaluation and patient-reported functional measures in patients with musculoskeletal disorders: An observational study. Musculoskelet Sci Pract 2019; 44:102057. [PMID: 31542682 DOI: 10.1016/j.msksp.2019.102057] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 08/15/2019] [Accepted: 09/08/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION As patient-reported outcome measures (PROMs) continue to evolve as vital measures of patient status, it may be useful to identify efficiently, Single Assessment Numeric Evaluation (SANE) scores that are valid and related to the patient's specific functional needs. OBJECTIVE To evaluate the concurrent validity between SANE scores and commonly used body region-specific functional PROMs, functional percentage change scores, and total visits in patients with musculoskeletal (MSK) disorders. METHODS 479 patients completed the SANE and one of the following PROMs at physical therapy discharge: Modified Low Back Pain Disability Questionnaire [MDQ], Neck Disability Index [NDI], Penn Shoulder Score [PSS], International Knee Documentation Committee [IKDC], Lower Extremity Functional Scale [LEFS]. Pearson correlation coefficients were used to assess the relationship between SANE and the aforementioned outcomes and total visits. RESULTS The SANE was moderately negatively correlated with the MDQ and NDI at discharge. There were high positive correlations between SANE and PSS and IKDC and moderate positive correlation between SANE and LEFS. The SANE and MDQ and IKDQ demonstrated low positive correlation for functional percentage change scores, and the SANE and NDI demonstrated moderate positive correlation for functional percentage change scores. For total visits outcome, there was a negligible negative correlation between SANE and MDQ and NDI at discharge. CONCLUSION The SANE exhibits acceptable concurrent validity across all investigated PROMs at physical therapy discharge. However, inconsistent relationships across body regions for functional percentage change and total visits suggest differences in these values as compared to raw discharge scores.
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Affiliation(s)
- Alessandra N Garcia
- Doctor of Physical Therapy Division, Department of Orthopaedic Surgery, Duke University, 311 Trent Drive, Durham, NC, 27710, USA.
| | - Chad Cook
- Doctor of Physical Therapy Division, Department of Orthopaedic Surgery, Duke University, Duke Clinical Research Institute, Duke University, 311 Trent Drive, Durham, NC, 27710, USA
| | - Adam Lutz
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia SC, Center for Effectiveness Research in Orthopaedics, Arnold School of Public Health, University of South Carolina, Columbia SC, Clinical Excellence, ATI Physical Therapy, Greenville SC, 200 Patewood Dr Ste 150C, Greenville, SC, 29615, USA
| | - Charles A Thigpen
- Sr. Director of Practice Innovation & Analytics, ATI Physical Therapy, Program in Observational Clinical Research in Orthopedics, Center for Effectiveness Research in Orthopaedics, Arnold School of Public Health, University of South Carolina, Greenville, SC, 29681, USA
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25
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Toale J, Shimozono Y, Mulvin C, Dahmen J, Kerkhoffs GM, Kennedy JG. Midterm Outcomes of Bone Marrow Stimulation for Primary Osteochondral Lesions of the Talus: A Systematic Review. Orthop J Sports Med 2019; 7:2325967119879127. [PMID: 31696137 PMCID: PMC6822192 DOI: 10.1177/2325967119879127] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Bone marrow stimulation (BMS) is a common surgical intervention in the treatment of small osteochondral lesions of the talus (OLTs). Evidence has shown good clinical outcomes after BMS in the short term, but several studies have shown less favorable results at midterm and long-term follow-up because of fibrocartilaginous repair tissue degeneration. PURPOSE To evaluate the clinical and radiological outcomes of BMS in the treatment of primary OLTs at midterm and long-term follow-up and to investigate reported data in these studies. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS A systematic search of the MEDLINE, Embase, and Cochrane Library databases was performed in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Clinical and radiological outcomes as well as reported data were evaluated. RESULTS A total of 15 studies comprising 853 patients (858 ankles) were included at a weighted mean follow-up time of 71.9 months. There were 9 studies that used the American Orthopaedic Foot & Ankle Society (AOFAS) score, with a weighted mean postoperative score of 89.9. There were 3 studies that measured postoperative magnetic resonance imaging results in the midterm using the MOCART (magnetic resonance observation of cartilage repair tissue) scoring system and showed 48% of patients with complete filling, 74% with complete integration, and 76% with surface damage. There was a complication rate of 3.4% and a reoperation rate of 6.0% after BMS in the midterm. CONCLUSION This systematic review found good clinical outcomes after BMS at midterm follow-up for primary OLTs. Radiological outcomes showed repair tissue surface damage in the majority of patients, which may be a harbinger for long-term problems. Data were variable, and numerous data were underreported. Further high-quality studies, a validated outcome scoring system, and further radiological reports at midterm follow-up are required to accurately assess the success of BMS in the midterm.
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Affiliation(s)
- James Toale
- Hospital for Special Surgery, New York, New York, USA
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Yoshiharu Shimozono
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
| | - Conor Mulvin
- Hospital for Special Surgery, New York, New York, USA
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Jari Dahmen
- Amsterdam UMC, University of Amsterdam, Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, The Netherlands
- Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center Amsterdam UMC, Amsterdam, The Netherlands
| | - Gino M.M.J. Kerkhoffs
- Amsterdam UMC, University of Amsterdam, Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, The Netherlands
- Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center Amsterdam UMC, Amsterdam, The Netherlands
| | - John G. Kennedy
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
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Lau BC, Scribani M, Lassiter T, Wittstein J. Correlation of Single Assessment Numerical Evaluation Score for Sport and Activities of Daily Living to Modified Harris Hip Score and Hip Outcome Score in Patients Undergoing Arthroscopic Hip Surgery. Am J Sports Med 2019; 47:2646-2650. [PMID: 31348867 DOI: 10.1177/0363546519863411] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The Single Assessment Numerical Evaluation (SANE) is a single-question outcome score that has been shown to be a reliable measure of outcomes for shoulder and knee injuries but has not been compared with other validated outcome scores in hip pathology managed arthroscopically. PURPOSE To correlate SANE Activities of Daily Living (ADL) and Sport subscales with the modified Harris Hip Score (mHHS) and Hip Outcome Score (HOS) ADL and Sport subscales before and after arthroscopic hip surgery. STUDY DESIGN Cohort study (diagnosis); Level of evidence, 3. METHODS A retrospective review of a prospectively filled database of patients undergoing arthroscopic hip surgery by a single surgeon was conducted. Inclusion criteria included patients scheduled for arthroscopic hip surgery for femoroacetabular impingement, labral tear, or gluteus medius tear. Exclusion criteria included previous surgery to the hip. Outcome scores, including the mHHS, HOS ADL and Sport, and SANE ADL and Sport, were measured preoperatively and postoperatively at 3 months, 1 year, and then annually. Pearson correlation coefficients between preoperative SANE ADL and Sport and the mHHS, HOS ADL, and HOS Sport were calculated. Pearson correlation coefficients between postoperative SANE ADL and Sport and the mHHS, HOS ADL, and HOS Sport were also calculated. RESULTS Eighty-five patients (mean age, 37.9 years; range, 14-66 years; 57 females, 28 males) underwent arthroscopic hip surgery for assorted pathology. Mean follow-up was 8 months (range, 3-64 months). Based on the Pearson correlation coefficient, preoperative SANE ADL and Sport had a moderate correlation with the mHHS (r = 0.66; 95% CI, 0.47-0.79; P < .0001; r = 0.54; 95% CI, 0.31-0.71; P < .0001, respectively). Preoperative SANE ADL and Sport had a moderate correlation with HOS ADL (r = 0.60; 95% CI, 0.39-0.75; P < .0001) and HOS Sport (r = 0.65; 95% CI, 0.45-0.79; P < .0001). Postoperative SANE ADL and Sport had a strong correlation with the mHHS (r = 0.69; 95% CI, 0.50-0.82; P < .0001; r = 0.78; 95% CI, 0.61-0.88; P < .0001). Postoperative SANE ADL and Sport had a strong correlation with HOS ADL (r = 0.79; 95% CI, 0.65-0.88; P < .0001) and HOS Sport (r = 0.88; 95% CI, 0.78-0.94; P < .0001). CONCLUSION This study showed a significant correlation between SANE and mHHS in patients undergoing arthroscopic hip surgery both pre- and postoperatively. SANE ADL and Sport had a strong correlation with HOS ADL and Sport preoperatively and short-term postoperatively. SANE scores are more highly correlated with traditional subjective outcome measures during the short-term postoperative period than they are preoperatively. The SANE score provides an efficient method of assessing outcomes after hip arthroscopy.
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Affiliation(s)
- Brian C Lau
- Duke Sport Science Institute, Department of Orthopaedics, Duke University Medical Center, Wake Forest, North Carolina, USA
| | | | - Tally Lassiter
- Duke Sport Science Institute, Department of Orthopaedics, Duke University Medical Center, Wake Forest, North Carolina, USA
| | - Jocelyn Wittstein
- Duke Sport Science Institute, Department of Orthopaedics, Duke University Medical Center, Wake Forest, North Carolina, USA
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27
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Murphy EP, McGoldrick NP, Curtin M, Kearns SR. A prospective evaluation of bone marrow aspirate concentrate and microfracture in the treatment of osteochondral lesions of the talus. Foot Ankle Surg 2019; 25:441-448. [PMID: 30321966 DOI: 10.1016/j.fas.2018.02.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 02/12/2018] [Accepted: 02/14/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND The term osteochondral lesion (OCL) refers to a defect involving the chondral surface and or subchondral bone. These lesions are associated with ankle injuries with bony and soft tissue and cause pain, decreased range of motion, swelling and impact adversely on quality of life. To date the standard treatment has been isolated microfracture (BMS). The aim of this study was to compare the outcomes of BMS alone to BMS augmented with bone marrow aspirate concentrate (BMAC) in the treatment of ankle OCLs. METHODS This study was a prospective cohort study carried out from 2010-2015 in a single surgeon's practice. Patients from 2010-2012 were treated with microfracture alone while patients from 2013-2015 were treated with micro fracture augmented with bone marrow aspirate concentrate and fibrin glue. Self-reported patient outcome measures were measured. Complications, revision rates, and visual analogue pain scores were compared. RESULTS 101 patients were included in the study. 52 patients were in the microfracture group while 49 patients were in the microfracture/BMAC group. The minimum follow-up for both groups was 36 months. Both groups had a statistically significant improvement in pain scores, quality of life scores, participation in sport and activities of daily living. The revision rate was 28.8% in the microfracture group versus 12.2% in the microfracture/BMAC group, which was statistically significant, p=0.0145. The majority of the lesions were less than 1.5cm2 in diameter in both cohorts. CONCLUSIONS Microfracture and bone marrow aspirate concentrate appears to be a safe and effective treatment option for osteochondral lesions of the talus. The addition of bone marrow aspirate concentrate does not result in any increase in ankle or donor site morbidity. It is a well-tolerated therapy which decreases revision rates for treatment of the osteochondral lesions when compared to microfracture alone. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Evelyn P Murphy
- Department of Trauma and Orthopaedics, Galway University Hospital, Saolta Hospital Group, Ireland.
| | - Niall P McGoldrick
- Department of Trauma and Orthopaedics, Galway University Hospital, Saolta Hospital Group, Ireland.
| | - Mark Curtin
- Department of Trauma and Orthopaedics, Galway University Hospital, Saolta Hospital Group, Ireland.
| | - Stephen R Kearns
- Department of Trauma and Orthopaedics, Galway University Hospital, Saolta Hospital Group, Ireland.
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Hashimoto Y, Nishida Y, Takahashi S, Nakamura H, Mera H, Kashiwa K, Yoshiya S, Inagaki Y, Uematsu K, Tanaka Y, Asada S, Akagi M, Fukuda K, Hosokawa Y, Myoui A, Kamei N, Ishikawa M, Adachi N, Ochi M, Wakitani S. Transplantation of autologous bone marrow-derived mesenchymal stem cells under arthroscopic surgery with microfracture versus microfracture alone for articular cartilage lesions in the knee: A multicenter prospective randomized control clinical trial. Regen Ther 2019; 11:106-113. [PMID: 31312692 PMCID: PMC6610227 DOI: 10.1016/j.reth.2019.06.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 06/06/2019] [Indexed: 12/27/2022] Open
Abstract
Introduction To investigate the efficacy of the transplantation of autologous bone marrow-derived mesenchymal stem cells (BMSCs) under arthroscopy with microfracture (MFX) compared with microfracture alone. Methods Eleven patients with a symptomatic articular cartilage defect of the knee were included in the study. They were randomized to receive BMSCs with MFX (cell-T group, n=7) or MFX alone (control group, n=4). Clinical results were evaluated using International Knee Documentation committee (IKDC) knee evaluation questionnaires and the Knee Injury and Osteoarthritis Outcome Score (KOOS) before and 48 weeks after surgery. Quantitative and qualitative assessments of repair tissue were carried out at 48 weeks by T2 mapping of magnetic resonance images (MRIs) and the magnetic resonance observation of cartilage repair tissue (MOCART) scoring system with follow-up MRI. Results No significant differences between preoperative and postoperative IKDC and KOOS were observed in the cell-T or control group. However, forty-eight weeks after surgery, the cell-T group showed a trend for a greater KOOS QOL score compared with the control group (79.4 vs. 39.1, respectively; P=0.07). The T2 value did not differ significantly between the two groups, but the mean MOCART score was significantly higher in the cell-T group than in the control group (P=0.02). Conclusions Compared with MFX alone, BMSC transplantation with MFX resulted in better postoperative healing of the cartilage and subchondral bone as determined by the MOCART score. Clinically, BMSC transplantation with MFX gave a higher KOOS QOL score after 48 weeks.
This is the first prospective randomized clinical trial between BMSCs with MFX and MFX alone. BMSCs with MFX showed a trend for a greater KOOS QOL score compared with MFX alone. BMSCs with MFX resulted in better healing of the cartilage by the MOCART score.
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Key Words
- BMSCs, bone marrow-derived mesenchymal stem cells
- Bone marrow-derived mesenchymal stem cells
- CPC, cell processing centers
- GFP, green fluorescent protein
- HA, hyaluronic acid
- IKDC, International Knee Documentation committee
- KL, Kellgren–Lawrence
- KOOS, Knee Injury and Osteoarthritis Outcome Score
- MFX, microfracture
- MOCART, magnetic resonance observation of cartilage repair tissue
- MRIs, magnetic resonance images
- Microfracture
- Prospective randomized control clinical trial
- QOL, quality of life
- RCT, randomized controlled trial
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Affiliation(s)
- Yusuke Hashimoto
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yohei Nishida
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Shinji Takahashi
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hisashi Mera
- Department of Orthopaedic Surgery, Uonuma Kikan Hospital, Minamiuonuma, Japan
| | - Kaori Kashiwa
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - Shinichi Yoshiya
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - Yusuke Inagaki
- Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan
| | - Kota Uematsu
- Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan
| | - Yasuhito Tanaka
- Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan
| | - Shigeki Asada
- Department of Orthopaedic Surgery, Kindai University Faculty Medicine, Osaka, Japan
| | - Masao Akagi
- Department of Orthopaedic Surgery, Kindai University Faculty Medicine, Osaka, Japan
| | - Kanji Fukuda
- Institute of Advanced Clinical Medicine, Division of Cell Biology for Regenerative Medicine, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Yoshiya Hosokawa
- Medical Center for Translational Research, Osaka University Hospital, Osaka, Japan
| | - Akira Myoui
- Medical Center for Translational Research, Osaka University Hospital, Osaka, Japan
| | - Naosuke Kamei
- Department of Orthopaedic Surgery, Graduate School of Biomedical & Health Sciences. Hiroshima University, Hiroshima, Japan
| | - Masakazu Ishikawa
- Department of Orthopaedic Surgery, Graduate School of Biomedical & Health Sciences. Hiroshima University, Hiroshima, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical & Health Sciences. Hiroshima University, Hiroshima, Japan
| | - Mitsuo Ochi
- Department of Orthopaedic Surgery, Graduate School of Biomedical & Health Sciences. Hiroshima University, Hiroshima, Japan
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Gobbi A, Nehrer S, Neubauer M, Herman K. Tissue Engineering for the Cartilage Repair of the Ankle. SPORTS INJURIES OF THE FOOT AND ANKLE 2019:119-124. [DOI: 10.1007/978-3-662-58704-1_10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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Karnovsky SC, DeSandis B, Haleem AM, Sofka CM, O'Malley M, Drakos MC. Comparison of Juvenile Allogenous Articular Cartilage and Bone Marrow Aspirate Concentrate Versus Microfracture With and Without Bone Marrow Aspirate Concentrate in Arthroscopic Treatment of Talar Osteochondral Lesions. Foot Ankle Int 2018; 39:393-405. [PMID: 29323942 DOI: 10.1177/1071100717746627] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to compare the functional and radiographic outcomes of patients who received juvenile allogenic chondrocyte implantation with autologous bone marrow aspirate (JACI-BMAC) for treatment of talar osteochondral lesions with those of patients who underwent microfracture (MF). METHODS A total of 30 patients who underwent MF and 20 who received DeNovo NT for JACI-BMAC treatment between 2006 and 2014 were included. Additionally, 17 MF patients received supplemental BMAC treatment. Retrospective chart review was performed and functional outcomes were assessed pre- and postoperatively using the Foot and Ankle Outcome Score and Visual Analog pain scale. Postoperative magnetic resonance images were reviewed and evaluated using a modified Magnetic Resonance Observation of Cartilage Tissue (MOCART) score. Average follow-up for functional outcomes was 30.9 months (range, 12-79 months). Radiographically, average follow-up was 28.1 months (range, 12-97 months). RESULTS Both the MF and JACI-BMAC showed significant pre- to postoperative improvements in all Foot and Ankle Outcome Score subscales. Visual Analog Scale scores also showed improvement in both groups, but only reached a level of statistical significance ( P < .05) in the MF group. There were no significant differences in patient reported outcomes between groups. Average osteochondral lesion diameter was significantly larger in JACI-BMAC patients compared to MF patients, but size difference had no significant impact on outcomes. Both groups produced reparative tissue that exhibited a fibrocartilage composition. The JACI-BMAC group had more patients with hypertrophy exhibited on magnetic resonance imaging (MRI) than the MF group ( P = .009). CONCLUSION JACI-BMAC and MF resulted in improved functional outcomes. However, while the majority of patients improved, functional outcomes and quality of repair tissue were still not normal. Based on our results, lesions repaired with DeNovo NT allograft still appeared fibrocartilaginous on MRI and did not result in significant functional gains as compared to MF. LEVEL OF EVIDENCE Level III, comparative series.
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Affiliation(s)
| | | | - Amgad M Haleem
- 2 Department of Orthopedic Surgery, Oklahoma University College of Medicine Health Sciences Center, Oklahoma City, OK, USA.,3 Department of Orthopedic Surgery, Kasr Al-Ainy College of Medicine, Cairo University, Cairo, Egypt
| | - Carolyn M Sofka
- 4 Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Martin O'Malley
- 5 Department of Orthopedic Surgery, Foot and Ankle, Hospital for Special Surgery, New York, NY, USA
| | - Mark C Drakos
- 5 Department of Orthopedic Surgery, Foot and Ankle, Hospital for Special Surgery, New York, NY, USA
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Freitag J, Li D, Wickham J, Shah K, Tenen A. Effect of autologous adipose-derived mesenchymal stem cell therapy in the treatment of a post-traumatic chondral defect of the knee. BMJ Case Rep 2017; 2017:bcr-2017-220852. [PMID: 29038190 PMCID: PMC5652344 DOI: 10.1136/bcr-2017-220852] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Isolated chondral defects have a limited capacity to heal and predispose to the development of osteoarthritis. Current surgical management can be unpredictable in outcome. Improved understanding of the action of mesenchymal stem cells (MSCs) has seen renewed interest in their role in cartilage repair. A 26-year-old athlete presented with a post-traumatic, isolated patella chondral defect. The patient underwent an arthroscopy with removal of a chondral loose body. After failure to symptomatically improve 12 months following surgery, the patient received intra-articular autologous adipose-derived mesenchymal stem cell (ADMSC) therapy.
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Affiliation(s)
- Julien Freitag
- Melbourne Stem Cell Centre, Box Hill, Victoria, Australia.,School of Biomedical Sciences, Charles Sturt University-Orange Campus, Orange, New South Wales, Australia.,Magellan Stem Cells, Box Hill North, Victoria, Australia
| | - Douglas Li
- Orthopaedic Associates Melbourne, East Melbourne, Victoria, Australia
| | - James Wickham
- School of Biomedical Sciences, Charles Sturt University-Orange Campus, Orange, New South Wales, Australia
| | - Kiran Shah
- Magellan Stem Cells, Box Hill North, Victoria, Australia
| | - Abi Tenen
- Magellan Stem Cells, Box Hill North, Victoria, Australia.,Monash University, Clayton, Victoria, Australia
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Jiang T, Xu G, Wang Q, Yang L, Zheng L, Zhao J, Zhang X. In vitro expansion impaired the stemness of early passage mesenchymal stem cells for treatment of cartilage defects. Cell Death Dis 2017; 8:e2851. [PMID: 28569773 PMCID: PMC5520885 DOI: 10.1038/cddis.2017.215] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 04/07/2017] [Accepted: 04/10/2017] [Indexed: 02/08/2023]
Abstract
In vitro cultured autologous mesenchymal stem cells (MSCs) within passage 5 have been approved for clinical application in stem cell-based treatment of cartilage defects. However, their chondrogenic potential has not yet been questioned or verified. In this study, the chondrogenic potential of bone marrow MSCs at passage 3 (P3 BMSCs) was investigated both in cartilage repair and in vitro, with freshly isolated bone marrow mononuclear cells (BMMNCs) as controls. The results showed that P3 BMSCs were inferior to BMMNCs not only in their chondrogenic differentiation ability but also as candidates for long-term repair of cartilage defects. Compared with BMMNCs, P3 BMSCs presented a decay in telomerase activity and a change in chromosomal morphology with potential anomalous karyotypes, indicating senescence. In addition, interindividual variability in P3 BMSCs is much higher than in BMMNCs, demonstrating genomic instability. Interestingly, remarkable downregulation in cell cycle, DNA replication and mismatch repair (MMR) pathways as well as in multiple genes associated with telomerase activity and chromosomal stability were found in P3 BMSCs. This result indicates that telomerase and chromosome anomalies might originate from expansion, leading to impaired stemness and pluripotency of stem cells. In vitro culture and expansion are not recommended for cell-based therapy, and fresh BMMNCs are the first choice.
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Affiliation(s)
- Tongmeng Jiang
- Guangxi Engineering Center in Biomedical Materials for Tissue and Organ Regeneration, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
- Department of Orthopaedics Trauma and Hand Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
| | - Guojie Xu
- Guangxi Engineering Center in Biomedical Materials for Tissue and Organ Regeneration, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
- Department of Orthopaedics Trauma and Hand Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
| | - Qiuyan Wang
- Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning 530021, China
| | - Lihui Yang
- School of Nursing, Guangxi Medical University, Nanning 530021, China
| | - Li Zheng
- Guangxi Engineering Center in Biomedical Materials for Tissue and Organ Regeneration, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
- Collaborative Innovation Center of Guangxi Biological Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
| | - Jinmin Zhao
- Guangxi Engineering Center in Biomedical Materials for Tissue and Organ Regeneration, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
- Department of Orthopaedics Trauma and Hand Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
- Collaborative Innovation Center of Guangxi Biological Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
- Guangxi Key Laboratory of Regenerative Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
| | - Xingdong Zhang
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610064, China
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Gül M, Çetinkaya E, Aykut ÜS, Özkul B, Saygılı MS, Akman YE, Kabukcuoglu YS. Effect of the Presence of Subchondral Cysts on Treatment Results of Autologous Osteochondral Graft Transfer in Osteochondral Lesions of the Talus. J Foot Ankle Surg 2016; 55:1003-6. [PMID: 27432027 DOI: 10.1053/j.jfas.2016.05.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Indexed: 02/03/2023]
Abstract
The aim of the present study was to clinically evaluate whether the presence of subchondral cysts had an effect on the treatment results of autologous osteochondral graft transfer in osteochondral lesions of the talus. Patients were enrolled in the present study according to the inclusion criteria. In the evaluation, we divided the patients into 2 groups according to presence (n = 13 patients) or absence (n = 15 patients) of a subchondral cyst. The mean age, body mass index, follow-up period, and lesion size in each group were measured and compared, and no statistically significant differences were found between the 2 groups (p > .05). The clinical assessment was performed using the American Orthopaedic Foot and Ankle Society Hindfoot scoring system, visual analog scale, and International Knee Society scoring system. No statistically significant difference was found between the pre- and postoperative scores of the 2 patient groups (p > .05). The successful results in both groups after a 2-year follow-up period have demonstrated that treatment of osteochondral lesions of the talus with osteochondral graft transfer is a safe method that can be performed independently of the presence of a subchondral cyst.
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Affiliation(s)
- Murat Gül
- Baltalimani Bone and Joint Diseases Education and Research Hospital, Istanbul, Turkey
| | - Engin Çetinkaya
- Baltalimani Bone and Joint Diseases Education and Research Hospital, Istanbul, Turkey.
| | - Ümit Selçuk Aykut
- Baltalimani Bone and Joint Diseases Education and Research Hospital, Istanbul, Turkey
| | - Barış Özkul
- Baltalimani Bone and Joint Diseases Education and Research Hospital, Istanbul, Turkey
| | - Mehmet Selçuk Saygılı
- Baltalimani Bone and Joint Diseases Education and Research Hospital, Istanbul, Turkey
| | - Yunus Emre Akman
- Baltalimani Bone and Joint Diseases Education and Research Hospital, Istanbul, Turkey
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Comparison of clinical outcomes between arthroscopic subchondral drilling and microfracture for osteochondral lesions of the talus. Knee Surg Sports Traumatol Arthrosc 2016; 24:2140-7. [PMID: 25649727 DOI: 10.1007/s00167-015-3511-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Accepted: 01/12/2015] [Indexed: 01/25/2023]
Abstract
PURPOSE The objectives of this study were to compare the clinical outcomes of the two common bone marrow stimulation techniques such as subchondral drilling and microfracture for symptomatic osteochondral lesions of the talus and to evaluate prognostic factors affecting the outcomes. METHODS Ninety patients (90 ankles) who underwent arthroscopic bone marrow stimulation for small- to mid-sized osteochondral lesions of the talus constituted the study cohort. The 90 ankles were divided into two groups: a drilling group (40 ankles) and a microfracture group (50 ankles). Each group was matched for age and gender, and both groups had characteristics similar to those obtained from pre-operative demographic data. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and the ankle activity score (AAS) were used to compare clinical outcomes, during a mean follow-up period of 43 months. RESULTS The median AOFAS scores were 66.0 points (51-80) in drilling group and 66.5 points (45-81) in microfracture group pre-operatively, and these improved to 89.4 points (77-100) and 90.1 points (69-100) at the final follow-up, respectively. The median VAS scores improved at the final follow-up compared with the pre-operative condition. The median AAS for the drilling group improved from 4.5 (1-6) pre-operatively to 6.0 (1-8) at the final follow-up, while those for the microfracture group improved from 3.0 (2-8) to 6.0 (3-9). No significant differences were observed between the two groups in terms of the AOFAS scores, VAS, and AAS. CONCLUSIONS The arthroscopic subchondral drilling and microfracture techniques that were used to stimulate bone marrow showed similar clinical outcomes. The results of this study suggest that both techniques are effective and reliable in treating small- to mid-sized osteochondral lesions of the talus, regardless of which of the two techniques is used. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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35
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Freitag J, Bates D, Boyd R, Shah K, Barnard A, Huguenin L, Tenen A. Mesenchymal stem cell therapy in the treatment of osteoarthritis: reparative pathways, safety and efficacy - a review. BMC Musculoskelet Disord 2016; 17:230. [PMID: 27229856 PMCID: PMC4880954 DOI: 10.1186/s12891-016-1085-9] [Citation(s) in RCA: 193] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 05/17/2016] [Indexed: 01/15/2023] Open
Abstract
Osteoarthritis is a leading cause of pain and disability across the world. With an aging population its prevalence is likely to further increase. Current accepted medical treatment strategies are aimed at symptom control rather than disease modification. Surgical options including joint replacement are not without possible significant complications. A growing interest in the area of regenerative medicine, led by an improved understanding of the role of mesenchymal stem cells in tissue homeostasis and repair, has seen recent focused efforts to explore the potential of stem cell therapies in the active management of symptomatic osteoarthritis. Encouragingly, results of pre-clinical and clinical trials have provided initial evidence of efficacy and indicated safety in the therapeutic use of mesenchymal stem cell therapies for the treatment of knee osteoarthritis. This paper explores the pathogenesis of osteoarthritis and how mesenchymal stem cells may play a role in future management strategies of this disabling condition.
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Affiliation(s)
- Julien Freitag
- Melbourne Stem Cell Centre, Level 2, 116-118 Thames St, Box Hill North, VIC, 3128, Australia.
| | - Dan Bates
- Melbourne Stem Cell Centre, Level 2, 116-118 Thames St, Box Hill North, VIC, 3128, Australia
| | | | - Kiran Shah
- Magellan Stem Cells, Melbourne, Australia
| | | | - Leesa Huguenin
- Melbourne Stem Cell Centre, Level 2, 116-118 Thames St, Box Hill North, VIC, 3128, Australia
| | - Abi Tenen
- Monash University, Melbourne, Australia
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36
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Pinski JM, Boakye LA, Murawski CD, Hannon CP, Ross KA, Kennedy JG. Low Level of Evidence and Methodologic Quality of Clinical Outcome Studies on Cartilage Repair of the Ankle. Arthroscopy 2016; 32:214-22.e1. [PMID: 26372522 DOI: 10.1016/j.arthro.2015.06.050] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Revised: 06/16/2015] [Accepted: 06/30/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To examine the level of evidence and methodologic quality of studies reporting surgical treatments for osteochondral lesions of the ankle. METHODS A search was performed using the PubMed/Medline, Embase, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and Cochrane databases for all studies in which the primary objective was to report the outcome after surgical treatment of osteochondral lesions of the ankle. Studies reporting outcomes of microfracture, bone marrow stimulation, autologous osteochondral transplantation, osteochondral allograft transplantation, and autologous chondrocyte implantation were the focus of this analysis because they are most commonly reported in the literature. Two independent investigators scored each study from 0 to 100 based on 10 criteria from the modified Coleman Methodology Score (CMS) and assigned a level of evidence using the criteria established by the Journal of Bone and Joint Surgery. Data were collected on the study type, year of publication, number of surgical procedures, mean follow-up, preoperative and postoperative American Orthopaedic Foot & Ankle Society score, measures used to assess outcome, geography, institution type, and conflict of interest. RESULTS Eighty-three studies reporting the results of 2,382 patients who underwent 2,425 surgical procedures for osteochondral lesions of the ankle met the inclusion criteria. Ninety percent of studies were of Level IV evidence. The mean CMS for all scored studies was 53.6 of 100, and 5 areas were identified as methodologically weak: study size, type of study, description of postoperative rehabilitation, procedure for assessing outcome, and description of the selection process. There was no significant difference between the CMS and the type of surgical technique (P = .1411). A statistically significant patient-weighted correlation was found between the CMS and the level of evidence (r = -0.28, P = .0072). There was no statistically significant patient-weighted correlation found between the CMS and the institution type (r = 0.05, P = .6480) or financial conflict of interest (r = -0.16, P = .1256). CONCLUSIONS Most studies assessing the clinical outcomes of cartilage repair of the ankle are of a low level of evidence and of poor methodologic quality. LEVEL OF EVIDENCE Level IV, systematic review of Level I through IV studies.
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Affiliation(s)
- John M Pinski
- Hospital for Special Surgery, New York, New York, U.S.A
| | | | | | | | - Keir A Ross
- Hospital for Special Surgery, New York, New York, U.S.A
| | - John G Kennedy
- Hospital for Special Surgery, New York, New York, U.S.A..
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Koh YG, Kwon OR, Kim YS, Choi YJ, Tak DH. Adipose-Derived Mesenchymal Stem Cells With Microfracture Versus Microfracture Alone: 2-Year Follow-up of a Prospective Randomized Trial. Arthroscopy 2016; 32:97-109. [PMID: 26585585 DOI: 10.1016/j.arthro.2015.09.010] [Citation(s) in RCA: 172] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 09/10/2015] [Accepted: 09/16/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the clinical and radiologic efficacy of adipose-derived stem cells (ADSCs) with fibrin glue and microfracture (MFX) versus MFX alone in patients with symptomatic knee cartilage defects. METHODS Patients who were aged 18 to 50 years and had a single International Cartilage Repair Society grade III/IV symptomatic cartilage defect (≥3 cm(2)) on the femoral condyle were randomized to receive ADSCs with fibrin glue and MFX treatment (group 1, n = 40) or MFX treatment alone (group 2, n = 40). There was a lack of blinding for patients because of the additional intervention method (liposuction). The cartilage defect was diagnosed using preoperative magnetic resonance imaging (MRI), and quantitative and qualitative assessments of the repair tissue were carried out at 24 months by using the Magnetic Resonance Observation of Cartilage Repair Tissue scoring system with follow-up MRI. Clinical results were evaluated using the Lysholm score, the Knee Injury and Osteoarthritis Outcome Score (KOOS), and a 10-point visual analog scale for pain (0 points, no pain; 10 points, worst possible pain) preoperatively and postoperatively at 3 months, 12 months, and the last follow-up visit. RESULTS The 2 groups had similar baseline patient characteristics. Follow-up MRI was performed at 24 months (mean, 24.3 months; range, 24.0 to 25.1 months) after the operation. Group 1 included 26 patients (65%) who had complete cartilage coverage of the lesion at follow-up compared with 18 patients (45%) in group 2. Significantly better signal intensity was observed for the repair tissue in group 1, with 32 patients (80%) having normal or nearly normal signal intensity (i.e., complete cartilage coverage of the lesion) compared with 28 patients (72.5%) in group 2. The mean clinical follow-up period was 27.4 months (range, 26 to 30 months). The improvements in the mean KOOS pain and symptom subscores were significantly greater at follow-up in group 1 than in group 2 (pain, 36.6 ± 11.9 in group 1 and 30.1 ± 14.7 in group 2 [P = .034]; symptoms, 32.3 ± 7.2 in group 1 and 27.8 ± 6.8 in group 2 [P = .005]). However, the improvements in the other subscores were not significantly different between group 1 and group 2 (activities of daily living, 38.5 ± 12.8 and 37.6 ± 12.9, respectively [P = .767]; sports and recreation, 33.9 ± 10.3 and 31.6 ± 11.0, respectively [P = .338]; quality of life, 38.4 ± 13.1 and 37.8 ± 12.0, respectively [P = .650]). Among the 80 patients, second-look arthroscopies were performed in 57 knees (30 in group 1 and 27 in group 2), and biopsy procedures were performed during these arthroscopies for 18 patients in group 1 and 16 patients in group 2. The second-look arthroscopies showed good repair tissue quality, although no significant intergroup difference was observed. The mean total histologic score was 1,054 for group 1 compared with 967 for group 2 (P = .036). Age, lesion size, duration of symptoms before surgery, mechanism of injury, and combined procedures were not correlated with clinical results, Magnetic Resonance Observation of Cartilage Repair Tissue scores, and histologic outcomes at short-term follow-up. CONCLUSIONS Compared with MFX alone, MFX and ADSCs with fibrin glue provided radiologic and KOOS pain and symptom subscore improvements, with no differences in activity, sports, or quality-of-life subscores, in symptomatic single cartilage defects of the knee that were 3 cm(2) or larger, with similar structural repair tissue. LEVEL OF EVIDENCE Level II, prospective comparative study.
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Affiliation(s)
- Yong-Gon Koh
- Department of Orthopedic Surgery, Center for Stem Cell & Arthritis Research, Yonsei Sarang Hospital, Seoul, Republic of Korea
| | - Oh-Ryong Kwon
- Department of Orthopedic Surgery, Center for Stem Cell & Arthritis Research, Yonsei Sarang Hospital, Seoul, Republic of Korea
| | - Yong-Sang Kim
- Department of Orthopedic Surgery, Center for Stem Cell & Arthritis Research, Yonsei Sarang Hospital, Seoul, Republic of Korea
| | - Yun-Jin Choi
- Department of Orthopedic Surgery, Center for Stem Cell & Arthritis Research, Yonsei Sarang Hospital, Seoul, Republic of Korea.
| | - Dae-Hyun Tak
- Department of Orthopedic Surgery, Center for Stem Cell & Arthritis Research, Yonsei Sarang Hospital, Seoul, Republic of Korea
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Cartilage Mesh Augmentation Technique for Treatment of Osteochondral Lesions of the Talus. TECHNIQUES IN FOOT AND ANKLE SURGERY 2015. [DOI: 10.1097/btf.0000000000000107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Görmeli G, Karakaplan M, Görmeli CA, Sarıkaya B, Elmalı N, Ersoy Y. Clinical Effects of Platelet-Rich Plasma and Hyaluronic Acid as an Additional Therapy for Talar Osteochondral Lesions Treated with Microfracture Surgery: A Prospective Randomized Clinical Trial. Foot Ankle Int 2015; 36:891-900. [PMID: 25825393 DOI: 10.1177/1071100715578435] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Osteochondral ankle injuries commonly affect the dome of the talus, and these injuries are a common cause of athletic disability. Various treatment options are available for these injuries including intra-articular hyaluronic acid (HA) and platelet-rich plasma (PRP) injections. The purpose of this study was to compare the effects of HA and PRP as adjunct therapies after arthroscopic microfracture in osteochondral lesions (OCLs) of the talus. METHODS In this prospective, randomized blinded study, 40 patients with talar OCLs in their ankle joints were treated with arthroscopic debridement and a microfracture technique. Thirteen randomly selected patients received PRP, 14 patients received HA, and the remaining 13 patients received saline as a control group. The participants were assessed using the American Orthopaedic Foot & Ankle Society (AOFAS) and visual analog pain scale (VAS) scores after a 15.3-month (range, 11-25 months) follow-up. RESULTS Postoperatively, all the groups exhibited significantly increased AOFAS scores and decreased VAS scores compared with their preoperative results (P < .005). The AOFAS scores were significantly increased in the PRP group versus the HA and control groups (P < .005), although the increased AOFAS scores in the HA group versus the control group were also significant (P < .005). Similar to the AOFAS scores, the decrease in the VAS scores was significantly lower in the PRP group versus the HA and control groups (P < .005). In addition, the HA group had significantly lower VAS scores than the control group (P < .005). CONCLUSION Both PRP and HA injections improved the clinical outcomes of patients who underwent operation for talar OCLs in the midterm period and can be used as adjunct therapies for these patients. Because a single dose of PRP provided better results, we recommend PRP as the primary adjunct treatment option in the talar OCL postoperative period. LEVEL OF EVIDENCE Level I, prospective randomized study.
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Affiliation(s)
- Gökay Görmeli
- Inonu University, Turgut Ozal Medical Center, Department of Orthopedics and Traumatology, Malatya, Turkey
| | - Mustafa Karakaplan
- Inonu University, Turgut Ozal Medical Center, Department of Orthopedics and Traumatology, Malatya, Turkey
| | - Cemile Ayşe Görmeli
- Inonu University, Turgut Ozal Medical Center, Department of Radiology, Malatya, Turkey
| | - Baran Sarıkaya
- Baskent University, Department of Orthopedics and Traumatology, Adana, Turkey
| | - Nurzat Elmalı
- Vakıf Gureba University, Department of Orthopedics and Traumatology, İstanbul, Turkey
| | - Yüksel Ersoy
- Inonu University, Turgut Ozal Medical Center, Department of Physiotherapy and Rehabilitation, Malatya, Turkey
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Chen W, Tang K, Yuan C, Zhou Y, Tao X. Intermediate Results of Large Cystic Medial Osteochondral Lesions of the Talus Treated With Osteoperiosteal Cylinder Autografts From the Medial Tibia. Arthroscopy 2015; 31:1557-64. [PMID: 25882178 DOI: 10.1016/j.arthro.2015.02.027] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 02/06/2015] [Accepted: 02/19/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the clinical and radiologic outcomes of an autologous osteoperiosteal cylinder graft from the medial tibia for the treatment of large cystic medial osteochondral lesions (OCLs) of the talus. METHODS The study included 15 patients with large cystic medial OCLs. All underwent medial malleolus osteotomy and excision and curettage of the defect site, followed by transplantation with an autologous osteoperiosteal cylinder graft from the medial tibia. They were evaluated preoperatively and after a minimum of 24 months (mean, 44.8 months; range, 24 to 72 months) postoperatively by a visual analog scale, the American Orthopaedic Foot & Ankle Society ankle-hindfoot scale, the Ogilvie-Harris scale, and magnetic resonance imaging of the ankle. RESULTS The mean visual analog scale score decreased from 5.40 ± 1.06 points to 1.00 ± 1.00 points (P < .001), and the mean American Orthopaedic Foot & Ankle Society score increased from 49.00 ± 8.96 points to 89.00 ± 4.17 points (P < .001). The mean Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score was 64.00 ± 5.07 points. According to the Ogilvie-Harris scale, 7 cases were rated as excellent, 5 as good, 3 as fair, and 0 as poor. No complications were observed. CONCLUSIONS An autologous osteoperiosteal cylinder graft from the medial tibia is effective for treating large cystic medial OCLs of the talus and has a low rate of complications. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Wan Chen
- Department of Orthopaedic Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Kanglai Tang
- Department of Orthopaedic Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China.
| | - Chengsong Yuan
- Department of Orthopaedic Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - You Zhou
- Department of Orthopaedic Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Xu Tao
- Department of Orthopaedic Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China
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Trends in Ankle Arthroscopy and Its Use in the Management of Pathologic Conditions of the Lateral Ankle in the United States: A National Database Study. Arthroscopy 2015; 31:1330-7. [PMID: 25771425 DOI: 10.1016/j.arthro.2015.01.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 01/11/2015] [Accepted: 01/21/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE This study aimed to investigate current trends in ankle arthroscopy across time, sex, age, and region of the United States as well as the use of ankle arthroscopy in the management of lateral ankle instability. METHODS Patients who underwent ankle arthroscopy and those who underwent ankle arthroscopy and lateral ankle ligament repair or peroneal retinacular repair from 2007 through 2011 were identified using the PearlDiver national database. These searches yielded volumes of unique patients, sex and age distribution, and regional volumes of patients. Χ-square linear-by-linear association analysis was used for comparisons, with P < .05 considered significant. RESULTS We identified 15,366 ankle arthroscopy procedures in the database from 2007 to 2011. Over the 5-year study period, there was a significant increase in the overall number of ankle arthroscopies being performed, from 2,814 in 2007 to 3,314 in 2011 (P < .0001). Female patients had ankle arthroscopy more frequently than did male patients (P = .027). The majority of patients who had ankle arthroscopy were between the ages of 30 and 49 years. The use of ankle arthroscopy during lateral ligament repair procedures increased from 37.2% in 2007 to 43.7% in 2011 (P < .0001). The incidence of combined ankle arthroscopy and peroneal tendon retinacular repair increased 50%, from 2.8/100 ankle arthroscopies in 2007 to 4.2/100 ankle arthroscopies in 2011 (P < .0001). CONCLUSIONS The incidence of ankle arthroscopy increased significantly from 2007 to 2011, outpacing shoulder, knee, and elbow arthroscopy. Ankle arthroscopy was performed more frequently in female patients and most commonly in patients younger than 50 years. The use of ankle arthroscopy in the surgical management of lateral ankle instability also increased significantly. The incidence of concomitant ankle arthroscopy and lateral ligament repair increased significantly, as did the incidence of concomitant ankle arthroscopy and repair of peroneal tendon subluxation. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Abstract
Anterior ankle arthroscopy is a useful, minimally invasive technique for diagnosing and treating ankle conditions. Arthroscopic treatment offers the benefit of decreased surgical morbidity, less postoperative pain, and earlier return to activities. Indications for anterior ankle arthroscopy continue to expand, including ankle instability, impingement, management of osteochondritis dissecans, synovectomy, and loose body removal. Anterior ankle arthroscopy has its own set of inherent risks and complications. Surgeons can decrease the risk of complications through mastery of ankle anatomy and biomechanics, and by careful preoperative planning and meticulous surgical technique.
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Affiliation(s)
- David M Epstein
- Tri-County Orthopedics & Sports Medicine, 197 Ridgedale Avenue, Suite 300, Cedar Knolls, NJ 07927, USA; Morristown Medical Center, 100, Madison Avenue, Morristown, NJ 07960, USA.
| | - Brandee S Black
- Department of Orthopaedic Surgery, University of Missouri, 1100 Virginia Avenue, Columbia, MO 65212, USA
| | - Seth L Sherman
- Department of Orthopaedic Surgery, University of Missouri, 1100 Virginia Avenue, Columbia, MO 65212, USA
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de l'Escalopier N, Barbier O, Mainard D, Mayer J, Ollat D, Versier G. Outcomes of talar dome osteochondral defect repair using osteocartilaginous autografts: 37 cases of Mosaicplasty®. Orthop Traumatol Surg Res 2015; 101:97-102. [PMID: 25599924 DOI: 10.1016/j.otsr.2014.11.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Revised: 11/05/2014] [Accepted: 11/21/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND The indications of osteochondral autograft implantation using the Mosaicplasty(®) technique were only recently extended to osteochondral lesions of the talus (OLT), a site for which no medium- or long-term outcome data are available. Our objective here was to evaluate medium-term outcomes in case-series of patients who underwent Mosaicplasty(®) for OLT repair. HYPOTHESIS Mosaicplasty(®) provides good medium-term outcomes with low morbidity when used for OLT repair. PATIENTS ET METHODS We retrospectively reviewed cases of Mosaicplasty(®) for OLT repair, performed in combination with malleolar osteotomy on the side of the OLT, at either of two centres, between 1997 and 2013. Pre-operative clinical data were collected from the medical records and all patients were re-evaluated. We studied 37 patients with a mean age of 33 years. RESULTS Mean follow-up at re-evaluation was 76 months. Mean AOFAS score at re-evaluation was 83 (range, 9-100). A work-related cause to the OLT was associated with significantly poorer outcomes (P=0.01). AOFAS values were significantly better in patients whose OLT size was 0.5 to 1cm(2). The Ogilvie-Harris score at last follow-up was good or excellent in 78% of patients. No patient experienced morbidity related to the malleolar osteotomy. Persistent patellar syndrome was noted in 6 patients. DISCUSSION In our case-series, Mosaicplasty(®) for OLT repair provided good medium-term outcomes in 78% of patients. Nevertheless, the donor-site morbidity should be borne in mind. Mosaicplasty(®) deserves to be viewed as a reference standard method for OLT repair. LEVEL OF EVIDENCE IV, retrospective study.
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Affiliation(s)
- N de l'Escalopier
- Service de chirurgie orthopédique, HIA Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France.
| | - O Barbier
- Service de chirurgie orthopédique, HIA Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France
| | - D Mainard
- Service de chirurgie orthopédique et traumatologie, Hôpital Central, 29, avenue de Lattre-de-Tassigny, 54000 Nancy, France
| | - J Mayer
- Service de chirurgie orthopédique et traumatologie, Hôpital Central, 29, avenue de Lattre-de-Tassigny, 54000 Nancy, France
| | - D Ollat
- Service de chirurgie orthopédique, HIA Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France
| | - G Versier
- Service de chirurgie orthopédique, HIA Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France
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Kim YS, Lee HJ, Choi YJ, Kim YI, Koh YG. Does an injection of a stromal vascular fraction containing adipose-derived mesenchymal stem cells influence the outcomes of marrow stimulation in osteochondral lesions of the talus? A clinical and magnetic resonance imaging study. Am J Sports Med 2014; 42:2424-34. [PMID: 25106781 DOI: 10.1177/0363546514541778] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Marrow stimulation for the treatment of osteochondral lesions of the talus (OLTs) is controversial in patients with poor prognostic factors of OLTs. Currently, mesenchymal stem cells (MSCs) are expected to biologically augment the treatment of OLTs. PURPOSE To compare the clinical and magnetic resonance imaging (MRI) outcomes between an injection of MSCs with marrow stimulation and marrow stimulation alone in patients with OLTs. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 49 patients (50 ankles) with OLTs underwent follow-up MRI after arthroscopic treatment. Among these 50 ankles, 26 underwent marrow stimulation alone (conventional group), and 24 underwent marrow stimulation with an injection of a stromal vascular fraction (SVF) containing MSCs (MSC group). Clinical outcomes were evaluated according to the visual analog scale (VAS) for pain, American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale, and Tegner activity scale. The magnetic resonance observation of cartilage repair tissue (MOCART) score was used for the MRI evaluation of repaired lesions. RESULTS The mean VAS score, AOFAS score, and Tegner score improved from 7.1 ± 1.2, 68.5 ± 5.6, and 3.4 ± 0.6 to 3.9 ± 0.8, 78.3 ± 4.9, and 3.5 ± 0.8, respectively, in the conventional group and from 7.1 ± 0.8, 67.7 ± 4.7, and 3.4 ± 0.5 to 3.2 ± 0.8, 83.3 ± 7.0, and 3.9 ± 0.7, respectively, in the MSC group. All clinical outcomes, including the VAS, AOFAS, and Tegner scores, improved significantly in the MSC group compared with the conventional group (P = .003, .009, and .041, respectively). There was a significant difference (P = .037) in the mean MOCART score between the conventional and MSC groups (49.4 ± 16.6 vs 62.1 ± 21.8, respectively), and significant correlations of the MOCART score with clinical outcomes were found in both groups (P < .05). Patient age (≥46.1 years), large lesion size (≥151.2 mm(2)), and the presence of subchondral cysts were associated with a worse MOCART score in the conventional group (P = .015, .004, and .013, respectively) but not in the MSC group. CONCLUSION Clinical and MRI outcomes of an injection of an SVF containing MSCs with marrow stimulation were encouraging, compared with marrow stimulation alone, for the treatment of OLTs. Therefore, an injection of an SVF containing MSCs with marrow stimulation should be considered as a treatment for OLTs, even when poor prognostic factors, including older age, large-sized lesion, or the presence of subchondral cysts, exist.
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Affiliation(s)
- Yong Sang Kim
- Center for Stem Cell and Arthritis Research, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, Seoul, Korea
| | - Ho Jin Lee
- Center for Stem Cell and Arthritis Research, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, Seoul, Korea
| | - Yun Jin Choi
- Center for Stem Cell and Arthritis Research, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, Seoul, Korea
| | - Yong Il Kim
- Center for Stem Cell and Arthritis Research, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, Seoul, Korea
| | - Yong Gon Koh
- Center for Stem Cell and Arthritis Research, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, Seoul, Korea
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Savage-Elliott I, Ross KA, Smyth NA, Murawski CD, Kennedy JG. Osteochondral lesions of the talus: a current concepts review and evidence-based treatment paradigm. Foot Ankle Spec 2014; 7:414-422. [PMID: 25100765 DOI: 10.1177/1938640014543362] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
UNLABELLED Osteochondral lesions of the talar dome are increasingly diagnosed and are a difficult pathology to treat. Conservative treatment yields best results in pediatric patients, often leaving surgical options for adult populations. There is a paucity of long-term data and comparisons of treatment options. Arthroscopic bone marrow stimulation is a common first-line treatment for smaller lesions. Despite promising short to medium term clinical results, bone marrow stimulation results in fibrocartilagenous tissue that incurs differing mechanical and biological properties compared with normal cartilage. Autologous osteochondral transplantation has demonstrated promising clinical results in the short to medium term for larger, cystic lesions and can restore the contact pressure of the joint. However, concerns remain over postoperative cyst formation and donor site morbidity. Recent developments have emphasized the usefulness of biological adjuncts such as platelet-rich plasma and concentrated bone marrow aspirate, as well as particulate juvenile cartilage, in augmenting reparative and replacement strategies in osteochondral lesion treatment. The purpose of this article is to review diagnosis and treatment of talar osteochondral lesions so that current practice guidelines can be more efficiently used given the available treatment strategies. A treatment paradigm based on current evidence is described. LEVELS OF EVIDENCE Therapeutic, Level V, Expert Opinion.
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Affiliation(s)
- Ian Savage-Elliott
- Foot and Ankle Service, Hospital for Special Surgery, New York, New York
| | - Keir A Ross
- Foot and Ankle Service, Hospital for Special Surgery, New York, New York
| | - Niall A Smyth
- Foot and Ankle Service, Hospital for Special Surgery, New York, New York
| | | | - John G Kennedy
- Foot and Ankle Service, Hospital for Special Surgery, New York, New York
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Treatment of osteochondral defects of the talus in children. Knee Surg Sports Traumatol Arthrosc 2014; 22:2243-9. [PMID: 24045918 DOI: 10.1007/s00167-013-2685-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Accepted: 09/07/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Osteochondral talar defects are infrequent in children, and little is known about the treatment and clinical outcome of these defects. The purpose of this study was to evaluate the clinical and radiographic outcomes of conservative and primary surgically treated osteochondral talar defects in skeletally immature children. METHODS Thirty-six (97%) of 37 eligible patients with a symptomatic primary osteochondral talar defect were evaluated after a median follow-up of 4 years (range 1-12 years). Clinical assessment included the Berndt and Harty outcome question, Ogilvie-Harris score, Visual Analog Scale pain score (at rest, during walking and during running), the American Orthopaedic Foot and Ankle Society (AOFAS) score, and the SF-36. Weight-bearing radiographs were compared with preoperative radiographs with the use of an ankle osteoarthritis classification system. RESULTS Ninety-two per cent of the initially conservatively treated children [mean age 13 years (SD 2)] were eventually scheduled to undergo surgery. After fixation of the fragment, seven cases (78%) reported a good Berndt and Harty outcome, and two cases (22%) a fair outcome; the median AOFAS score was 95.0 (range 77-100). After debridement and bone marrow stimulation, 13 cases (62%) reported a good Berndt and Harty outcome, three cases (14%) a fair outcome, and five cases (24%) a poor outcome; the median AOFAS score was 95.0 (range 45-100). No signs of degenerative changes were seen in both groups at follow-up. CONCLUSIONS Fixation and debridement and bone marrow stimulation of an osteochondral talar defect are both good surgical options after failed conservative treatment. LEVEL OF EVIDENCE Retrospective case series, Therapeutic, Level IV.
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Haleem AM, Ross KA, Smyth NA, Duke GL, Deyer TW, Do HT, Kennedy JG. Double-Plug Autologous Osteochondral Transplantation Shows Equal Functional Outcomes Compared With Single-Plug Procedures in Lesions of the Talar Dome: A Minimum 5-Year Clinical Follow-up. Am J Sports Med 2014; 42:1888-1895. [PMID: 24948585 DOI: 10.1177/0363546514535068] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Autologous osteochondral transplantation (AOT) is used for large (>100-150 mm(2)) or cystic osteochondral lesions (OCLs) of the talus. Larger lesions may require using more than 1 graft to fill the defect. While patients with larger OCLs treated with microfracture exhibit inferior clinical outcomes, there is little evidence regarding the effect of lesion size and number of grafts required on clinical and radiological outcomes after AOT. HYPOTHESIS Larger OCLs of the talar dome treated by double-plug AOT (dp-AOT) have inferior clinical and radiological MRI outcomes compared with smaller OCLs requiring single-plug AOT (sp-AOT). STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Fourteen consecutive patients with a large OCL (mean, 208 ± 54 mm(2)) treated using dp-AOT with a minimum 5-year follow-up were matched by age and sex to a control cohort of 28 patients who underwent sp-AOT for a smaller OCL (mean, 74 ± 26 mm(2)) over the same period. Functional outcomes were assessed both pre- and postoperatively using the Foot and Ankle Outcome Score (FAOS) and Short Form-12 (SF-12) general health questionnaire. Mean follow-up was 85 months (range, 65-118 months). Latest postoperative MRI was evaluated with modified magnetic resonance observation of cartilage repair tissue (MOCART) score. RESULTS There was no significant difference between groups demographically (P > .05). All patients with dp-AOT and sp-AOT showed a significant pre- to postoperative increase in FAOS and SF-12 scores (P < .001). When comparing preoperative scores for both groups, there was no statistical significance between sp-AOT and dp-AOT scores (FAOS, P = .719; SF-12, P = .947). There was no significant difference in functional scores between the 2 groups postoperatively for both FAOS (P = .883) and SF-12 (P = .246). Mean MOCART scores did not exhibit any statistically significant difference between groups (P = .475). Two patients complained of knee donor site stiffness (4.8%), which later resolved. CONCLUSION Patients with large OCLs treated using a dp-AOT procedure did not show inferior clinical or radiological outcomes compared with those treated with sp-AOT at a minimum 5-year follow-up. The dp-AOT procedure is as effective as sp-AOT in treating larger OCLs of the talar dome in the intermediate term, with similar high postoperative clinical and radiological outcomes.
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Affiliation(s)
- Amgad M Haleem
- Department of Orthopedic Surgery, Foot and Ankle Service, Hospital for Special Surgery, New York, NY, USA
| | - Keir A Ross
- Department of Orthopedic Surgery, Foot and Ankle Service, Hospital for Special Surgery, New York, NY, USA
| | - Niall A Smyth
- Department of Orthopedic Surgery, Foot and Ankle Service, Hospital for Special Surgery, New York, NY, USA
| | - Gavin L Duke
- Department of Radiology, East River Medical Imaging, New York, NY, USA
| | - Timothy W Deyer
- Department of Radiology, East River Medical Imaging, New York, NY, USA
| | - Huong T Do
- Epidemiology and Biostatistics Core, Hospital for Special Surgery, New York, NY, USA
| | - John G Kennedy
- Department of Orthopedic Surgery, Foot and Ankle Service, Hospital for Special Surgery, New York, NY, USA
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Wajsfisz A, Makridis KG, Naji O, Hirsh C, Boisrenoult P, Beaufils P. An anterior ankle arthroscopic technique for retrograde osteochondral autograft transplantation of posteromedial and central talar dome cartilage defects. Knee Surg Sports Traumatol Arthrosc 2014; 22:1298-303. [PMID: 23579227 DOI: 10.1007/s00167-013-2502-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Accepted: 04/03/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study was to present an arthroscopic technique for the treatment for posteromedial and central cartilage defects of the talus using anterior arthroscopic portals and without performing a medial malleolar osteotomy. METHODS Nine fresh cadavers were dissected. Autografts were implanted under arthroscopy using a retrograde osteochondral transplantation system, and their position was estimated using specific angular calibrators and later confirmed by software analysis of two photographs of the disarticulated ankle joint. RESULTS In eight cases, the congruence between the surrounding articular cartilage and the cartilage of the graft was high, with differences measuring <1 mm. There were no iatrogenic cartilage lesions of the tibial plafond and no fractures of the talus. All the autografts remained stable during full range of motion cycles of the ankle joint. One failure was reported. CONCLUSION This cadaveric study showed that the retrograde osteochondral autograft transplantation technique in the talus is feasible. It can be used to restore the posteromedial and central talar articular surfaces using conventional ankle arthroscopic instrumentation and anterior arthroscopic portals without resorting to a medial malleolar osteotomy. Further clinical and biomechanical studies are required to prove the efficacy of this technique and its reproducibility in routine clinical practice.
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Affiliation(s)
- Anthony Wajsfisz
- Centre Hospitalier de Versailles, Université Versailles Saint-Quentin, 177, rue de, Versailles, 78157 Le Chesnay and Ecole de Chirurgie du Fer à Moulin, AP-HP, Paris, France,
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Hannon CP, Smyth NA, Murawski CD, Savage-Elliott I, Deyer TW, Calder JDF, Kennedy JG. Osteochondral lesions of the talus: aspects of current management. Bone Joint J 2014; 96-B:164-171. [PMID: 24493179 DOI: 10.1302/0301-620x.96b2.31637] [Citation(s) in RCA: 105] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 10/17/2013] [Indexed: 12/20/2022]
Abstract
Osteochondral lesions (OCLs) occur in up to 70% of sprains and fractures involving the ankle. Atraumatic aetiologies have also been described. Techniques such as microfracture, and replacement strategies such as autologous osteochondral transplantation, or autologous chondrocyte implantation are the major forms of surgical treatment. Current literature suggests that microfracture is indicated for lesions up to 15 mm in diameter, with replacement strategies indicated for larger or cystic lesions. Short- and medium-term results have been reported, where concerns over potential deterioration of fibrocartilage leads to a need for long-term evaluation. Biological augmentation may also be used in the treatment of OCLs, as they potentially enhance the biological environment for a natural healing response. Further research is required to establish the critical size of defect, beyond which replacement strategies should be used, as well as the most appropriate use of biological augmentation. This paper reviews the current evidence for surgical management and use of biological adjuncts for treatment of osteochondral lesions of the talus.
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Affiliation(s)
- C P Hannon
- Hospital for Special Surgery, 523 East 72nd Street, 5th Floor Rm 514, New York, USA
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Winterstein AP, McGuine TA, Carr KE, Hetzel SJ. Comparison of IKDC and SANE Outcome Measures Following Knee Injury in Active Female Patients. Sports Health 2014; 5:523-9. [PMID: 24427427 PMCID: PMC3806180 DOI: 10.1177/1941738113499300] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Knee injury among young, active female patients remains a public health issue. Clinicians are called upon to pay greater attention to patient-oriented outcomes to evaluate the impact of these injuries. Little agreement exists on which outcome measures are best, and clinicians cite several barriers to their use. Single Assessment Numerical Evaluation (SANE) may provide meaningful outcome information while lessening the time burden associated with other patient-oriented measures. HYPOTHESIS The SANE and International Knee Documentation Committee (IKDC) scores would be strongly correlated in a cohort of young active female patients with knee injuries from preinjury through 1-year follow-up and that a minimal clinically important difference (MCID) could be calculated for the SANE score. STUDY DESIGN Observational prospective cohort. METHODS Two hundred sixty-three subjects completed SANE and IKDC at preinjury by recall, time of injury, and 3, 6, and 12 months postinjury. Pearson correlation coefficients were used to assess the association between SANE and IKDC. Repeated-measures analysis of variance was used to determine differences in SANE and IKDC over time. MCID was calculated for SANE using IKDC MCID as an anchor. RESULTS Moderate to strong correlations were seen between SANE and IKDC (0.65-0.83). SANE, on average, was 2.7 (95% confidence interval, 1.5-3.9; P < 0.00) units greater than IKDC over all time points. MCID for the SANE was calculated as 7 for a 6-month follow-up and 19 for a 12-month follow-up. CONCLUSION SANE scores were moderately to strongly correlated to IKDC scores across all time points. Reported MCID values for the SANE should be utilized to measure meaningful changes over time for young, active female patients with knee injuries. CLINICAL RELEVANCE Providing clinicians with patient-oriented outcome measures that can be obtained with little clinician and patient burden may allow for greater acceptance and use of outcome measures in clinical settings.
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