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Nguyen JC, Kan JH, Patel VS, Blankenbaker DG, Rubin DA, Shea KG, Nissen CW, Jaramillo D, Ganley TJ. Osteochondritis dissecans in children: location-dependent differences (part II: ankle and elbow). Pediatr Radiol 2025:10.1007/s00247-025-06259-6. [PMID: 40377713 DOI: 10.1007/s00247-025-06259-6] [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] [Received: 12/27/2024] [Revised: 04/24/2025] [Accepted: 04/25/2025] [Indexed: 05/18/2025]
Abstract
The classic terminology "osteochondritis dissecans (OCD)" describes a pathologic alteration, centered at the osteochondral junction, involving the subchondral bone and/or its cartilaginous precursor, with risk for lesion instability and disruption of adjacent articular cartilage. Among children and young adults, these sites of osteochondrosis can be a cause of chronic joint pain and are most often found within the knee, the ankle, and the elbow joints. While Part I of this review series focused on shared key definitions, pathophysiologic principles, and imaging considerations, as well as unique differences between lesions at different locations within the knee joint, the current Part II article is devoted to lesions that involve the ankle and elbow joints. Following the outline of the Part I article, an evidence-based literature review on location-specific pathophysiology, imaging considerations, findings of lesion instability, and treatment selection considerations will be discussed for lesions involving the talar dome, capitellum, and humeral trochlea.
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Affiliation(s)
- Jie C Nguyen
- Section of Musculoskeletal Imaging, Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, 19104, Philadelphia, PA, USA.
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.
| | - J Herman Kan
- Texas Children's Hospital, Baylor College of Medicine, Houston, USA
| | - Vandan S Patel
- Section of Musculoskeletal Imaging, Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, 19104, Philadelphia, PA, USA
- Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, US
| | - Donna G Blankenbaker
- Musculoskeletal Imaging and Intervention, Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, USA
| | - David A Rubin
- Department of Radiology, New York University Grossman School of Medicine, New York, USA
| | - Kevin G Shea
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, USA
| | - Carl W Nissen
- Department of Orthopaedic Surgery, University of Connecticut and the Bone and Joint Institute at Hartford Hospital, Hartford, CT, USA
| | - Diego Jaramillo
- Department of Radiology, Hospital for Special Surgery, New York, USA
| | - Theodore J Ganley
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
- Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, US
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Feng SM, Maffulli N, van Dijk CN, Xu HL, Fehske K, Plaass C, Oliva F, Karius T, Gao SH, Xu W, Bai L, Song RL, Hao YF, Zhang H, Xu YB, Zhang N, Lou L, Ren TT, Wang GD, Li Q, Wu JH, Zhu YZ, Yin G, Wang TF, Qin JZ, Saxena A, Ma C. All-inside arthroscopic procedures for chronic lateral ankle instability: evidence-based clinical practice guidelines. Br Med Bull 2025; 154:ldaf001. [PMID: 40183802 PMCID: PMC11970022 DOI: 10.1093/bmb/ldaf001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2024] [Revised: 02/10/2025] [Accepted: 03/07/2025] [Indexed: 04/05/2025]
Abstract
BACKGROUND All-inside arthroscopic procedures are now frequently employed to manage chronic lateral ankle instability (CLAI) with satisfactory functional outcomes. Currently, no evidence-based guidelines exist for all-inside arthroscopic procedures for CLAI. Many surgical decisions remain uncertain and challenging. SOURCES OF DATA Published scientific literature in PubMed, MEDLINE, Web of Science, EMBASE, and Cochrane databases. AREAS OF AGREEMENT All-inside arthroscopic repair and reconstruction procedures are reliable treatments for CLAI. AREAS OF CONTROVERSY The all-inside arthroscopic procedures for CLAI present significant challenges, particularly in the following aspects. GROWING POINTS Given the lack of guidelines for the all-inside arthroscopic procedures for CLAI, this evidence-based clinical practice guideline provides 11 recommendations to address the controversy. AREAS TIMELY FOR DEVELOPING RESEARCH In patients with CLAI undergoing all-inside arthroscopic procedures, comparative studies are urgently needed to establish the optimal timing for weight-bearing, as well as return to work and sports.
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Affiliation(s)
- Shi-Ming Feng
- Sports Medicine Department, Xuzhou Central Hospital, Xuzhou Clinical College of Xuzhou Medical University, NO.199 Jiefang South Road, Quanshan district, Xuzhou 221009, PR China
| | - Nicola Maffulli
- Department of Orthopaedics and Traumatology, University La Sapienza, Faculty of Medicine and Psychology, Via di Grottarossa, 00189, Rome, Italy
- Guy Hilton Research Centre, School of Pharmacy and Bioengineering, Keele University, Thornburrow Drive, Stoke-on-Trent ST4 7QB, United Kingdom
- Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London E1 4DG, United Kingdom
| | - C Niek van Dijk
- Department of Orthopedic Surgery, University of Amsterdam, Meibergdreef 9, Amsterdam, 1081 HV, The Netherlands
- Ankle Unit, FIFA Medical Centre of Excellence Ripoll-DePrado Sport Clinic, C. de Almagro, 34, Chamberí, Madrid 28010, Spain
- Ankle Unit, FIFA Medical Centre of Excellence Clínica do Dragão, Estádio Dragão Entrada Nascente, Porto 4350-415, Portugal
- Casa di Cura, San Rossore, Viale delle Cascine, 152/f, Pisa 56122, Italy
| | - Hai-Lin Xu
- Department of Trauma and Orthopedic, People’s Hospital, Peking University, No. 11 Xizhimen South Street, Xicheng District, Beijing 100044, PR China
| | - Kai Fehske
- Department of Trauma Surgery, University Hospital Wuerzburg, Josef-Schneider-Straße 2, Wuerzburg 97080, Germany
- Department of Orthopedic and Trauma Surgery, Johanniter Waldkrankenhaus Bonn, Waldstraße 73, Bonn 53177, Germany
| | - Christian Plaass
- Department for Foot and Ankle surgery, DIAKOVERE Annastift, Orthopedic Clinic of the Hannover Medical School, Anna-von-Borries Strasse 1-7, Hannover 30625, Germany
| | - Francesco Oliva
- Department of Sports Traumatology, Universita’ Telematica San Raffaele, Via di Val Cannuta, 247 Roma, Italy
| | - Thomas Karius
- Department of Orthopedic and Trauma Surgery, Johanniter Waldkrankenhaus Bonn, Waldstraße 73, Bonn 53177, Germany
| | - Shun-Hong Gao
- Orthopaedic Department, The Second Hospital of Tangshan, No. 21, North Jianshe Road, Lubei District, Tangshan 063000, PR China
| | - Wei Xu
- Department of Orthopaedics, The Second Affiliated Hospital of Soochow University, No. 1055, Sanxiang Road, Gusu District, Suzhou 215004, PR China
| | - Lu Bai
- Department of Orthopaedics, Peking University Shenzhen Hospital, No. 1120, Lianhua Road, Futian District, Shenzhen 518035, PR China
| | - Run-Lai Song
- Orthopedic Medical Center, Yibin Second People's Hospital, No. 96 Beida Street, Cuiping District, YiBin 644000, China
| | - Yue-Feng Hao
- Orthopedics and Sports Medicine Center, Suzhou Municipal Hospital, Nanjing Medical University Affiliated Suzhou Hospital, No. 242, Guangji Road, Gusu District, Suzhou 215008, PR China
| | - Hui Zhang
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37, Guoxue Lane, Wuhou District, Chengdu 610041, China
| | - Yang-Bo Xu
- Department of Bone and Joint Surgery, Affiliated Hospital of Southwest Medical University, No. 8, Section 2, Kangcheng Road, Jiangyang District, Luzhou 646099, PR China
| | - Ning Zhang
- Department of Foot and Ankle Surgery, The Second Hospital of Shandong University, 247 Beiyuan Street, Tianqiao District, Jinan 250033, PR China
| | - Lei Lou
- Department of Orthopaedics, Luoyang Orthopedic-Traumatological Hospital of Henan Province, No. 82, Qiming South Road, Chanhe Hui District, Luoyang 471002, PR China
| | - Tian-Tian Ren
- Department of Orthopaedics, The First Affiliated Hospital of Ningbo University, No. 59 Liuting Street, Haishu District, Ningbo 315000, PR China
| | - Guo-Dong Wang
- Department of Orthopaedics, Affiliated Hospital of Jining Medical University, No. 89 Guhuai Road, Rencheng District, Jining City 272000, PR China
| | - Qi Li
- Sports Medicine Center, West China Hospital, Sichuan University, No. 37, Guoxue Lane, Wuhou District, Chengdu 610041, China
| | - Jian-Hua Wu
- Department of Trauma Orthopedics, The Affiliated Hospital of Guizhou Medical University, No. 28, Guiyi Street, Yunyan District, Guiyang 550004, China
| | - Yong-Zhan Zhu
- Department of Orthopedics, Foshan Hospital of Traditional Chinese Medicine, No. 6, Qinren Road, Chancheng District, Foshan 528000, China
| | - Gang Yin
- Department of Orthopedics, Binzhou Medical University Hospital, No. 661, Huanghe 2nd Road, Bincheng District, Binzhou 256603, China
| | - Tong-Fu Wang
- Department of Sports Medicine and Arthroscopy, Tianjin Hospital of Tianjin University, No. 406, Jiefang South Road, Hexi District, Tianjin 300211, China
| | - Jian-Zhong Qin
- Department of Hand and Foot, The Second Affiliated Hospital of Soochow University, No. 1055, Sanxiang Road, Gusu District, Suzhou 215004, PR China
| | - Amol Saxena
- Department of Sports Medicine, Sutter-PAMF, 795 El Camino Real, Palo Alto, CA 94301, United States
| | - Chao Ma
- Sports Medicine Department, Xuzhou Central Hospital, Xuzhou Clinical College of Xuzhou Medical University, NO.199 Jiefang South Road, Quanshan district, Xuzhou 221009, PR China
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Fritz B, de Cesar Netto C, Fritz J. Multiaxial 3D MRI of the Ankle: Advanced High-Resolution Visualization of Ligaments, Tendons, and Articular Cartilage. Clin Podiatr Med Surg 2024; 41:685-706. [PMID: 39237179 DOI: 10.1016/j.cpm.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2024]
Abstract
MRI is a valuable tool for diagnosing a broad spectrum of acute and chronic ankle disorders, including ligament tears, tendinopathy, and osteochondral lesions. Traditional two-dimensional (2D) MRI provides a high image signal and contrast of anatomic structures for accurately characterizing articular cartilage, bone marrow, synovium, ligaments, tendons, and nerves. However, 2D MRI limitations are thick slices and fixed slice orientations. In clinical practice, 2D MRI is limited to 2 to 3 mm slice thickness, which can cause blurred contours of oblique structures due to volume averaging effects within the image slice. In addition, image plane orientations are fixated and cannot be changed after the scan, resulting in 2D MRI lacking multiplanar and multiaxial reformation abilities for individualized image plane orientations along oblique and curved anatomic structures, such as ankle ligaments and tendons. In contrast, three-dimensional (3D) MRI is a newer, clinically available MRI technique capable of acquiring high-resolution ankle MRI data sets with isotropic voxel size. The inherently high spatial resolution of 3D MRI permits up to five times thinner (0.5 mm) image slices. In addition, 3D MRI can be acquired image voxel with the same edge length in all three space dimensions (isotropism), permitting unrestricted multiplanar and multiaxial image reformation and postprocessing after the MRI scan. Clinical 3D MRI of the ankle with 0.5 to 0.7 mm isotropic voxel size resolves the smallest anatomic ankle structures and abnormalities of ligament and tendon fibers, osteochondral lesions, and nerves. After acquiring the images, operators can align image planes individually along any anatomic structure of interest, such as ligaments and tendons segments. In addition, curved multiplanar image reformations can unfold the entire course of multiaxially curved structures, such as perimalleolar tendons, into one image plane. We recommend adding 3D MRI pulse sequences to traditional 2D MRI protocols to visualize small and curved ankle structures to better advantage. This article provides an overview of the clinical application of 3D MRI of the ankle, compares diagnostic performances of 2D and 3D MRI for diagnosing ankle abnormalities, and illustrates clinical 3D ankle MRI applications.
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Affiliation(s)
- Benjamin Fritz
- Department of Radiology, Balgrist University Hospital, Forchstrasse 340, Zurich 8008, Switzerland; Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Cesar de Cesar Netto
- Department of Orthopaedics and Rehabilitation, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | - Jan Fritz
- Department of Radiology, Division of Musculoskeletal Radiology, NYU Grossman School of Medicine, 660 1st Avenue, New York, NY 10016, USA.
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Veronesi F, Zielli SO, Brogini S, Artioli E, Arceri A, Mazzotti A, Faldini C, Giavaresi G. Scaffolds for Osteochondral Lesions of the Talus: Systematic Review and Meta-Analysis of the Last Ten Years Literature. Bioengineering (Basel) 2024; 11:970. [PMID: 39451345 PMCID: PMC11505056 DOI: 10.3390/bioengineering11100970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2024] [Revised: 09/25/2024] [Accepted: 09/25/2024] [Indexed: 10/26/2024] Open
Abstract
Scaffolds are widely used devices for the treatment of osteochondral lesions of the talus (OCLT), aimed at enhancing mechanical stability and fostering chondrogenic differentiation. A systematic review and meta-analysis were performed to evaluate the safety, and clinical and radiological results of scaffolds for OCLT management. On 2 January 2024, a search was performed in four databases (PubMed, Embase, Web of Science, and Scopus), according to PRISMA guidelines. The risk of bias in the included studies was also evaluated. Thirty clinical studies were included in the qualitative analysis: 12 retrospective case series, 3 retrospective comparative studies, 9 prospective case series, 1 prospective comparative study, and 1 Randomized Controlled Trial (RCT). Natural scaffolds, such as bilayer collagen (COLL)I/III and hyaluronic scaffolds, were the most employed. Only minor adverse events were observed, even if more serious complications were shown, especially after medial malleolar osteotomy. An overall clinical and radiological improvement was observed after a mean of 36.3 months of follow-up. Patient age and Body Mass Index (BMI), lesion size, and location were correlated with the clinical outcomes, while meta-analysis revealed significant improvement in clinical scores with hyaluronic scaffolds compared to microfracture alone. This study highlights the safety and positive clinical outcomes associated with the use of scaffolds for OCLT. In the few available comparative studies, scaffolds have also demonstrated superior clinical outcomes compared to microfractures alone. Nevertheless, the analysis has shown the limitations of the current literature, characterized by an overall low quality and scarcity of RCTs.
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Affiliation(s)
- Francesca Veronesi
- Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, Via Di Barbiano 1/10, 40136 Bologna, Italy; (F.V.); (S.B.); (G.G.)
| | - Simone Ottavio Zielli
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Putti 1, 40136 Bologna, Italy; (E.A.); (A.A.); (A.M.); (C.F.)
| | - Silvia Brogini
- Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, Via Di Barbiano 1/10, 40136 Bologna, Italy; (F.V.); (S.B.); (G.G.)
| | - Elena Artioli
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Putti 1, 40136 Bologna, Italy; (E.A.); (A.A.); (A.M.); (C.F.)
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy
| | - Alberto Arceri
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Putti 1, 40136 Bologna, Italy; (E.A.); (A.A.); (A.M.); (C.F.)
| | - Antonio Mazzotti
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Putti 1, 40136 Bologna, Italy; (E.A.); (A.A.); (A.M.); (C.F.)
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy
| | - Cesare Faldini
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Putti 1, 40136 Bologna, Italy; (E.A.); (A.A.); (A.M.); (C.F.)
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy
| | - Gianluca Giavaresi
- Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, Via Di Barbiano 1/10, 40136 Bologna, Italy; (F.V.); (S.B.); (G.G.)
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Darwich A, Nörenberg D, Adam J, Hetjens S, Bdeir M, Schilder A, Thier S, Gravius S, Jawhar A. Higher Accuracy of Arthroscopy Compared to MRI in the Diagnosis of Chondral Lesions in Acute Ankle Fractures: A Prospective Study. Diagnostics (Basel) 2024; 14:1810. [PMID: 39202298 PMCID: PMC11353890 DOI: 10.3390/diagnostics14161810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2024] [Revised: 08/09/2024] [Accepted: 08/19/2024] [Indexed: 09/03/2024] Open
Abstract
Even after successful surgery for acute ankle fractures, many patients continue having complaints. A possible explanation is the presence of concomitant chondral lesions. The aim of this study is to investigate the accuracy of MRI compared to that of arthroscopy in the assessment of chondral lesions in acute ankle fractures. In this prospective single-center study, patients presenting with acute ankle fractures over a period of three years were identified. A preoperative MRI was performed within a maximum of 10 days after trauma. During surgery, ankle arthroscopy was also performed. The International Cartilage Repair Society (ICRS) cartilage lesion classification was used to grade the detected chondral lesions. To localize the chondral lesions, the talar dome was divided into eight zones and the tibial/fibular articular surfaces into three zones. In total, 65 patients (28 females) with a mean age of 41.1 ± 15 years were included. In the MRI scans, 70 chondral lesions were detected (69.2% of patients) affecting mostly the tibial plafond (30%) and mostly graded as ICRS 3. The mean lesion area measured was 20.8 mm2. In the arthroscopy, 85 chondral lesions were detected (70.8% of patients) affecting mostly the medial surface of the talar dome (25.9%) and mostly graded ICRS 3. The mean lesion area measured was 43.4 mm2. The highest agreement between the two methods was observed in the size estimation of the chondral lesions. The present study shows the reduced accuracy of MRI when compared to arthroscopy in the assessment of traumatic chondral lesions in the setting of acute ankle fractures especially regarding lesion size. MRI remains an essential instrument in the evaluation of such lesions; however, surgeons should take this discrepancy into consideration, particularly the underestimation of chondral lesions' size in the preoperative planning of surgical treatment and operative technique.
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Affiliation(s)
- Ali Darwich
- Department of Orthopedic and Trauma Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1–3, 68167 Mannheim, Germany; (J.A.); (M.B.); (S.T.); (S.G.); (A.J.)
| | - Dominik Nörenberg
- Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1–3, 68167 Mannheim, Germany;
| | - Julia Adam
- Department of Orthopedic and Trauma Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1–3, 68167 Mannheim, Germany; (J.A.); (M.B.); (S.T.); (S.G.); (A.J.)
| | - Svetlana Hetjens
- Institute of Medical Statistics and Biomathematics, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1–3, 68167 Mannheim, Germany;
| | - Mohamad Bdeir
- Department of Orthopedic and Trauma Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1–3, 68167 Mannheim, Germany; (J.A.); (M.B.); (S.T.); (S.G.); (A.J.)
| | - Andreas Schilder
- Department of Orthopedic and Trauma Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1–3, 68167 Mannheim, Germany; (J.A.); (M.B.); (S.T.); (S.G.); (A.J.)
| | - Steffen Thier
- Department of Orthopedic and Trauma Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1–3, 68167 Mannheim, Germany; (J.A.); (M.B.); (S.T.); (S.G.); (A.J.)
- ATOS-Clinic Heidelberg, Bismarckstrasse 9-15, 69115 Heidelberg, Germany
| | - Sascha Gravius
- Department of Orthopedic and Trauma Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1–3, 68167 Mannheim, Germany; (J.A.); (M.B.); (S.T.); (S.G.); (A.J.)
| | - Ahmed Jawhar
- Department of Orthopedic and Trauma Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1–3, 68167 Mannheim, Germany; (J.A.); (M.B.); (S.T.); (S.G.); (A.J.)
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Oh J, Kang JH, Chae HD, Yoo HJ, Hong SH, Lee DY, Choi JY. Diagnosis of osteochondral lesions of the talus on Dual-layer spectral detector CT arthrography: clinical feasibility of virtual noncontrast images. Clin Radiol 2024; 79:e908-e915. [PMID: 38649313 DOI: 10.1016/j.crad.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 03/05/2024] [Accepted: 03/12/2024] [Indexed: 04/25/2024]
Abstract
AIM To compare the image quality of virtual noncontrast (VNC) and true noncontrast (TNC) CT images and to evaluate the clinical feasibility of VNC CT images for assessing osteochondral lesions of the talus (OLTs). MATERIALS AND METHODS Forty-five OLT patients who underwent ankle CT arthrography (CTA) using dual-layer spectral detector CT were enrolled. Reconstruction of VNC and three-dimensional volume rendering images was performed. Afterward, image noise, the signal-to-noise ratio (SNR), and the contrast-to-noise ratio (CNR) were measured. For the subjective evaluation, two board-certified musculoskeletal radiologists [R2-1] assessed spatial resolution, overall image quality, and lesion conspicuity. The accuracy rate for OLT grading was determined in 23 patients who underwent arthroscopic surgery. RESULTS While VNC images showed significantly less noise than TNC images, TNC images showed better SNRs and CNRs (p<.01). In the subjective analysis, TNC images showed better overall image quality (p<.001). For the 3D volume rendering images, VNC images scored significantly higher for lesion conspicuity (p<.001). The accuracy rates of CTA and CTA with VNC images for OLT grading were 79.2% and 83.3%, respectively. Regarding confidence level, when CTA and VNC images were evaluated together, the confidence level was significantly higher than that when only CTA images were evaluated (p<.001). CONCLUSION VNC imaging can provide better confidence level of OLT grading and evaluation of the integrity of the subchondral bone plate when combined with conventional CTA without additional radiation dose to the patient. In addition, VNC images-based 3D volume rendering reconstruction would be helpful for preoperative planning in OLT patients.
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Affiliation(s)
- J Oh
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - J H Kang
- Department of Radiology, Konkuk University Medical Center, Seoul, Republic of Korea
| | - H-D Chae
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea; Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - H J Yoo
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea; Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - S H Hong
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea; Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - D Y Lee
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - J-Y Choi
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea; Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea.
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7
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Gross CE, Palanca A. Fresh Osteochondral Allograft for Large Talar Osteochondral Lesions. Foot Ankle Clin 2024; 29:343-356. [PMID: 38679444 DOI: 10.1016/j.fcl.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
Osteochondral lesions of the talus are being recognized as an increasingly common injury. Large osteochondral lesions have significant biomechanical consequences and often require resurfacing with both boney and cartilaginous graft. The current treatment options include osteochondral autograft transfer, mosaicplasty, autologous chondrocyte implantation, or osteochondral allograft transplantation. Allograft procedures have the advantage of no donor site morbidity and ability to match the defect line to line. Careful transportation, storage, and handling of the allograft are critical to success. The failure of nonoperative management, failure of arthroscopic treatment, or large defects are an indication for resurfacing.
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Affiliation(s)
| | - Ariel Palanca
- Department of Orthopaedics, Palomar Health Medical Group, 15611 Pomerado Road, Poway, CA 92064, USA.
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Mann TS, Nery C. Osteochondral Lesion of the Talus: Quality of Life, Lesion Site, and Lesion Size. Foot Ankle Clin 2024; 29:213-224. [PMID: 38679434 DOI: 10.1016/j.fcl.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
Osteochondral lesions of the talus (OLTs) are the lesions that affect the articular cartilage and the subchondral bone of the talus. Symptoms develop between 6 and 12 months after the index trauma and are associated with degradation of quality of life. Two-thirds of the lesions (73%) are located on the medial part of the talus, 28% of the lesions are posteromedial, and 31% of the lesions are centromedial. Currently, OLT of up to 100 mm2 can behave in a more indolent condition, and above that area, the defect tends to transmit more shearing forces to adjacent cartilage and is more symptomatic.
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Affiliation(s)
- Tania Szejnfeld Mann
- Orthopedic Surgery, Federal University of São Paulo, Escola Paulista de Medicina, Sao Paulo, Brazil
| | - Caio Nery
- Orthopedics and Traumatology, UNIFESP, Federal University of São Paulo, Brazil.
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9
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Anastasio AT, Wixted CM, McGroarty NK. Osteochondral Lesions of the Talus: Etiology, Clinical Presentation, Treatment Options, and Outcomes. Foot Ankle Clin 2024; 29:193-211. [PMID: 38679433 DOI: 10.1016/j.fcl.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
This article reviews the etiology, clinical presentation, classification schemes, and treatment options for osteochondral lesions of the talus. These lesions typically occur after a traumatic injury and are best diagnosed on MRI. Asymptomatic lesions and incidentally found lesions are best treated conservatively; however, acute displaced osteochondral fragments may require surgical treatment. Lesion characteristics may dictate surgical technique. Outcomes following surgical treatment may be impacted by patient age, BMI, and lesion characteristics.
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Affiliation(s)
- Albert T Anastasio
- Department of Orthopaedics, Duke University Hospital, 200 Trent Drive, Durham, NC 27710, USA
| | - Colleen M Wixted
- Duke University School of Medicine, 8 Searle Center Drive, Durham, NC 27710, USA.
| | - Neil K McGroarty
- Department of Orthopaedics, Duke University Hospital, 200 Trent Drive, Durham, NC 27710, USA
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10
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Kimball JS, Ferkel RD, Ferkel EI. Regeneration: Bone-Marrow Stimulation of the Talus-Limits and Goals. Foot Ankle Clin 2024; 29:281-290. [PMID: 38679439 DOI: 10.1016/j.fcl.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
Bone Marrow Stimulation of osteochondral lesions of the talus has been shown to be a successful way to treat cartilage injuries. Newer data suggest that Bone Marrow Stimulation is best reserved for osteochondral lesions of the talus Sizes Less Than 107.4 mm2 in area. Additionally, newer smaller and deeper techniques to perform bone marrow stimulation have resulted in less subchondral bone damage, less cancellous compaction, and superior bone marrow access with multiple trabecular access channels. Biologic adjuvants such as platelet-rich plasma (PRP), hyaluronic acid (HA), and bone marrow aspirate concentrate (BMAC) may lead to better functional outcomes when used concomitant to bone marrow stimulation.
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Affiliation(s)
- Jeff S Kimball
- Department of Orthopaedic Surgery, Southern California Orthopedic Institute, Van Nuys, CA, USA
| | - Richard D Ferkel
- Department of Orthopaedic Surgery, Southern California Orthopedic Institute, Van Nuys, CA, USA
| | - Eric I Ferkel
- Department of Orthopaedic Surgery, Southern California Orthopedic Institute, Van Nuys, CA, USA.
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11
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Khan I, Ranjit S, Welck M, Saifuddin A. The role of imaging in the diagnosis, staging, and management of the osteochondral lesions of the talus. Br J Radiol 2024; 97:716-725. [PMID: 38321227 PMCID: PMC11027257 DOI: 10.1093/bjr/tqae030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 07/12/2023] [Accepted: 01/29/2024] [Indexed: 02/08/2024] Open
Abstract
Osteochondral lesions of the talus (OLT) represent an abnormality of the articular cartilage and sub-chondral bone. The abnormality is typically associated with trauma though the exact aetiology remains unknown. Multiple staging systems have been developed to classify the abnormality and management can vary from conservative treatment to different surgical options. Early diagnosis is essential for optimal outcome and all imaging modalities have a role to play in patient management. The aim of this article is to review the pathology, classification, multimodality imaging appearances of OLT, and how the imaging affects patient management.
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Affiliation(s)
- Imran Khan
- Department of Radiology, University Hospitals of Leicester NHS Trust, LE5 4PW, Leicester, United Kingdom
| | - Srinath Ranjit
- Foot and Ankle Reconstruction Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, United Kingdom
| | - Matt Welck
- Foot and Ankle Reconstruction Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, United Kingdom
| | - Asif Saifuddin
- Department of Radiology, Royal National Orthopaedic Hospital NHS Trust, Brockley Hill, Stanmore, Middlesex, HA7 4LP, United Kingdom
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12
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Vreeken JT, Dahmen J, Stornebrink T, Emanuel KS, Walinga AB, Stufkens SA, Kerkhoffs GM. Second-Look Arthroscopy Shows Inferior Cartilage after Bone Marrow Stimulation Compared with Other Operative Techniques for Osteochondral Lesions of the Talus: A Systematic Review and Meta-Analysis. Cartilage 2024:19476035241227332. [PMID: 38323533 PMCID: PMC11569557 DOI: 10.1177/19476035241227332] [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] [Received: 10/23/2023] [Revised: 12/19/2023] [Accepted: 01/05/2024] [Indexed: 02/08/2024] Open
Abstract
OBJECTIVE To compare cartilage quality after different surgical interventions for osteochondral lesions of the talus (OLT), evaluated by second-look arthroscopy. Secondary aims were to report concomitant diagnoses, and to correlate cartilage quality with clinical and radiological outcomes. This review hypothesizes that the cartilage repair after bone marrow stimulation (BMS) is inferior to the other available treatment options. METHODS PROSPERO ID: CRD42022311489. Studies were retrieved through PubMed, EMBASE (Ovid), and Cochrane Library. Studies were included if they reported cartilage quality after second-look investigation after surgical treatment of OLT. The primary outcome measure was the cartilage quality success and failure rates (%) per surgical intervention group. Correlations between the cartilage quality and clinical or radiological outcomes were calculated. RESULTS Twenty-nine studies were included, comprising 586 ankles that had undergone second-look arthroscopy on average 16 months after initial surgery. The success rate for BMS was 57% (95% confidence interval [CI] = 48%-65%), for fixation (FIX) 86% (95% CI = 70%-94%), for osteo(chondral) transplantation (OCT) 91% (95% CI = 80%-96%), for cartilage implementation techniques (CITs) 80% (95% CI = 69%-88%), and for retrograde drilling 100% (95% CI = 66%-100%). The success rate of BMS was significantly lower than FIX, OCT, and CIT (P < 0.01). There were no significant differences between other treatment groups. A moderate positive significant correlation between the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score and the International Cartilage Repair Society score (ICRS) was found (ρ = 0.51, P < 0.001). CONCLUSIONS Successful restoration of cartilage quality was found in the majority of surgically treated OLTs. However, BMS yields inferior cartilage quality compared with FIX, OCT, and CIT. Study Design. Systematic review and meta-analysis. Level of evidence. Level IV, systematic review and meta-analysis.
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Affiliation(s)
- Jelmer T. Vreeken
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health & Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - Jari Dahmen
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health & Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - Tobias Stornebrink
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health & Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - Kaj S. Emanuel
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health & Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - Alex B. Walinga
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health & Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - Sjoerd A.S. Stufkens
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health & Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - Gino M.M.J. Kerkhoffs
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health & Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands
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13
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Chang EY, Bencardino JT, French CN, Fritz J, Hanrahan CJ, Jibri Z, Kassarjian A, Motamedi K, Ringler MD, Strickland CD, Tiegs-Heiden CA, Walker REA. SSR white paper: guidelines for utilization and performance of direct MR arthrography. Skeletal Radiol 2024; 53:209-244. [PMID: 37566148 PMCID: PMC10730654 DOI: 10.1007/s00256-023-04420-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/23/2023] [Accepted: 07/29/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVE Direct magnetic resonance arthrography (dMRA) is often considered the most accurate imaging modality for the evaluation of intra-articular structures, but utilization and performance vary widely without consensus. The purpose of this white paper is to develop consensus recommendations on behalf of the Society of Skeletal Radiology (SSR) based on published literature and expert opinion. MATERIALS AND METHODS The Standards and Guidelines Committee of the SSR identified guidelines for utilization and performance of dMRA as an important topic for study and invited all SSR members with expertise and interest to volunteer for the white paper panel. This panel was tasked with determining an outline, reviewing the relevant literature, preparing a written document summarizing the issues and controversies, and providing recommendations. RESULTS Twelve SSR members with expertise in dMRA formed the ad hoc white paper authorship committee. The published literature on dMRA was reviewed and summarized, focusing on clinical indications, technical considerations, safety, imaging protocols, complications, controversies, and gaps in knowledge. Recommendations for the utilization and performance of dMRA in the shoulder, elbow, wrist, hip, knee, and ankle/foot regions were developed in group consensus. CONCLUSION Although direct MR arthrography has been previously used for a wide variety of clinical indications, the authorship panel recommends more selective application of this minimally invasive procedure. At present, direct MR arthrography remains an important procedure in the armamentarium of the musculoskeletal radiologist and is especially valuable when conventional MRI is indeterminant or results are discrepant with clinical evaluation.
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Affiliation(s)
- Eric Y Chang
- Radiology Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Radiology, University of California, San Diego Medical Center, San Diego, CA, USA
| | - Jenny T Bencardino
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Cristy N French
- Department of Radiology, Penn State Hershey Medical Center, Hummelstown, PA, USA
| | - Jan Fritz
- Department of Radiology, New York University Grossman School of Medicine, New York, NY, USA
| | | | - Zaid Jibri
- GNMI in Mississauga, Greater Toronto Area, Toronto, ON, Canada
| | - Ara Kassarjian
- Department of Radiology, Division of Musculoskeletal Imaging, Olympia Medical Center, Elite Sports Imaging, Madrid, Spain
| | - Kambiz Motamedi
- Department of Radiology, University of California, Los Angeles Medical Center, Los Angeles, CA, USA
| | | | - Colin D Strickland
- Department of Radiology, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Richard E A Walker
- McCaig Institute for Bone and Joint Health, Calgary, Canada.
- Cumming School of Medicine, University of Calgary, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada.
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14
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Nudelman H, Lőrincz A, Lamberti AG, Varga M, Kassai T, Józsa G. Management of Juvenile Osteochondral Fractures Utilising Absorbable PLGA Implants. J Clin Med 2024; 13:375. [PMID: 38256509 PMCID: PMC10816157 DOI: 10.3390/jcm13020375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 12/29/2023] [Accepted: 01/08/2024] [Indexed: 01/24/2024] Open
Abstract
The incidence of articular injury, particularly osteochondral fractures (OCFs), has seen a cinnotable increase in recent years. Regardless of their location, fragments can be overlooked by plain radiographs, which might lead to osteoarthritis in the long run. Diagnostic imaging has a pivotal role in the assessment and classification of the fracture severity, as well as the presence of any associated dislocations. These fractures require surgical intervention for the restoration of joint function and the reduction of long-term complications. This paper aims to present the surgical correction and post-operative treatment of osteochondral fractures with absorbable implants in four children. The following affected areas are discussed: lateral condyle of the femur, patella and radial head. Utilising absorbable implants for the management of OCFs provides numerous advantages, including the elimination of the need for re-anaesthesia and reoperation, reduction of complications and facilitation of early rehabilitation. This approach also minimises the period of hospitalisation and proves effective in pediatric OCF treatment.
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Affiliation(s)
- Hermann Nudelman
- Division of Surgery, Traumatology and Otorhinolaryngology, Department of Paediatrics, Clinical Complex, University of Pécs, 7 József Attila Street, 7623 Pécs, Hungary; (H.N.)
| | - Aba Lőrincz
- Department of Thermophysiology, Institute for Translational Medicine, Medical School, University of Pécs, 12 Szigeti Street, 7624 Pécs, Hungary;
| | - Anna Gabriella Lamberti
- Division of Surgery, Traumatology and Otorhinolaryngology, Department of Paediatrics, Clinical Complex, University of Pécs, 7 József Attila Street, 7623 Pécs, Hungary; (H.N.)
| | - Marcell Varga
- Department of Pediatric Traumatology, Péterfy Hospital, Manninger Jenő National Trauma Center, 17 Fiumei Street, 1081 Budapest, Hungary
| | - Tamás Kassai
- Department of Pediatric Traumatology, Péterfy Hospital, Manninger Jenő National Trauma Center, 17 Fiumei Street, 1081 Budapest, Hungary
| | - Gergő Józsa
- Division of Surgery, Traumatology and Otorhinolaryngology, Department of Paediatrics, Clinical Complex, University of Pécs, 7 József Attila Street, 7623 Pécs, Hungary; (H.N.)
- Department of Thermophysiology, Institute for Translational Medicine, Medical School, University of Pécs, 12 Szigeti Street, 7624 Pécs, Hungary;
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15
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Zhao Q, Xu J, Yang YX, Yu D, Zhao Y, Wang Q, Yuan H. AI-assisted accelerated MRI of the ankle: clinical practice assessment. Eur Radiol Exp 2023; 7:62. [PMID: 37857868 PMCID: PMC10587051 DOI: 10.1186/s41747-023-00374-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 08/04/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND High-spatial resolution magnetic resonance imaging (MRI) is essential for imaging ankle joints. However, the clinical application of fast spin-echo sequences remains limited by their lengthy acquisition time. Artificial intelligence-assisted compressed sensing (ACS) technology has been recently introduced as an integrative acceleration solution. We compared ACS-accelerated 3-T ankle MRI to conventional methods of compressed sensing (CS) and parallel imaging (PI) . METHODS We prospectively included 2 healthy volunteers and 105 patients with ankle pain. ACS acceleration factors for ankle protocol of T1-, T2-, and proton density (PD)-weighted sequences were optimized in a pilot study on healthy volunteers (acceleration factor 3.2-3.3×). Images of patients acquired using ACS and conventional acceleration methods were compared in terms of acquisition times, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), subjective image quality, and diagnostic agreement. Shapiro-Wilk test, Cohen κ, intraclass correlation coefficient, and one-way ANOVA with post hoc tests (Tukey or Dunn) were used. RESULTS ACS acceleration reduced the acquisition times of T1-, T2-, and PD-weighted sequences by 32-43%, compared with conventional CS and PI, while maintaining image quality (mostly higher SNR with p < 0.004 and higher CNR with p < 0.047). The diagnostic agreement between ACS and conventional sequences was rated excellent (κ = 1.00). CONCLUSIONS The optimum ACS acceleration factors for ankle MRI were found to be 3.2-3.3× protocol. The ACS allows faster imaging, yielding similar image quality and diagnostic performance. RELEVANCE STATEMENT AI-assisted compressed sensing significantly accelerates ankle MRI times while preserving image quality and diagnostic precision, potentially expediting patient diagnoses and improving clinical workflows. KEY POINTS • AI-assisted compressed sensing (ACS) significantly reduced scan duration for ankle MRI. • Similar image quality achieved by ACS compared to conventional acceleration methods. • A high agreement by three acceleration methods in the diagnosis of ankle lesions was observed.
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Affiliation(s)
- Qiang Zhao
- Department of Radiology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Jiajia Xu
- Department of Radiology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Yu Xin Yang
- United Imaging Research Institute of Intelligent Imaging, Beijing, People's Republic of China
| | - Dan Yu
- United Imaging Research Institute of Intelligent Imaging, Beijing, People's Republic of China
| | - Yuqing Zhao
- Department of Radiology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Qizheng Wang
- Department of Radiology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Huishu Yuan
- Department of Radiology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China.
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16
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Kim DY, Yoon JM, Park GY, Kang HW, Lee DO, Lee DY. Computed tomography arthrography versus magnetic resonance imaging for diagnosis of osteochondral lesions of the talus. Arch Orthop Trauma Surg 2023; 143:5631-5639. [PMID: 37069413 DOI: 10.1007/s00402-023-04871-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 03/26/2023] [Indexed: 04/19/2023]
Abstract
INTRODUCTION Osteochondral lesions of the talus (OLT) usually have non-specific clinical symptoms, and radiographs have a low sensitivity for detecting OLT. The purpose of this study is to compare the diagnostic value of CT arthrography (CTa) with that of MRI using arthroscopy as the reference standard for grading OLT. MATERIALS AND METHODS We retrospectively reviewed patients who had OLT between 2015 and 2020. Patients with symptomatic OLT as a surgical indication, who were treated arthroscopically, and underwent both CTa and MRI before surgery were included. OLT was evaluated by both CTa and MRI using arthroscopy as the standard. We graded CTa, MRI, arthroscopic findings using Mintz classification. RESULTS Thirty-five patients were included. Accuracy rates of MRI and CTa for grading OLT, compared to those of arthroscopy, were 57.1% and 88.6%, respectively. Among 15 mismatched cases in MRI, 12 lesions (80%) were matched in CTa and arthroscopy. CTa had significantly higher diagnostic performance than MRI for the detection of grade III lesions (p = 0.041). Using the receiver operating characteristics curves, the area under the curve values for lesion grading were 0.893 for CTa and 0.762 for MRI. CONCLUSION CTa was statistically significantly better in detecting chondral flapping or subchondral exposure lesions for OLT than MRI on using arthroscopy as the reference standard. Because the stability of the OLT is essential in determining the treatment method, if an OLT is observed on MRI and is suspected to cause ankle pain, we recommend additional CTa examination to determine the more correct treatment strategies for OLT. LEVEL OF EVIDENCE Diagnostic Level III.
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Affiliation(s)
- Dae-Yoo Kim
- Department of Orthopedic Surgery, Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - Jun-Min Yoon
- Department of Orthopedic Surgery, Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - Gil Young Park
- Department of Orthopedic Surgery, SNU Seoul Hospital, Seoul, Republic of Korea
| | - Ho Won Kang
- Department of Orthopedic Surgery, Ewha Womans University Mokdong Hospital, Ewha Womans University, Seoul, Republic of Korea
| | - Dong-Oh Lee
- Department of Orthopedic Surgery, SNU Seoul Hospital, Seoul, Republic of Korea
| | - Dong Yeon Lee
- College of Medicine, Seoul National University, Seoul, Republic of Korea.
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, Republic of Korea.
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Fritz B, de Cesar Netto C, Fritz J. Multiaxial 3D MRI of the Ankle: Advanced High-Resolution Visualization of Ligaments, Tendons, and Articular Cartilage. Foot Ankle Clin 2023; 28:529-550. [PMID: 37536817 DOI: 10.1016/j.fcl.2023.05.008] [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: 08/05/2023]
Abstract
MRI is a valuable tool for diagnosing a broad spectrum of acute and chronic ankle disorders, including ligament tears, tendinopathy, and osteochondral lesions. Traditional two-dimensional (2D) MRI provides a high image signal and contrast of anatomic structures for accurately characterizing articular cartilage, bone marrow, synovium, ligaments, tendons, and nerves. However, 2D MRI limitations are thick slices and fixed slice orientations. In clinical practice, 2D MRI is limited to 2 to 3 mm slice thickness, which can cause blurred contours of oblique structures due to volume averaging effects within the image slice. In addition, image plane orientations are fixated and cannot be changed after the scan, resulting in 2D MRI lacking multiplanar and multiaxial reformation abilities for individualized image plane orientations along oblique and curved anatomic structures, such as ankle ligaments and tendons. In contrast, three-dimensional (3D) MRI is a newer, clinically available MRI technique capable of acquiring high-resolution ankle MRI data sets with isotropic voxel size. The inherently high spatial resolution of 3D MRI permits up to five times thinner (0.5 mm) image slices. In addition, 3D MRI can be acquired image voxel with the same edge length in all three space dimensions (isotropism), permitting unrestricted multiplanar and multiaxial image reformation and postprocessing after the MRI scan. Clinical 3D MRI of the ankle with 0.5 to 0.7 mm isotropic voxel size resolves the smallest anatomic ankle structures and abnormalities of ligament and tendon fibers, osteochondral lesions, and nerves. After acquiring the images, operators can align image planes individually along any anatomic structure of interest, such as ligaments and tendons segments. In addition, curved multiplanar image reformations can unfold the entire course of multiaxially curved structures, such as perimalleolar tendons, into one image plane. We recommend adding 3D MRI pulse sequences to traditional 2D MRI protocols to visualize small and curved ankle structures to better advantage. This article provides an overview of the clinical application of 3D MRI of the ankle, compares diagnostic performances of 2D and 3D MRI for diagnosing ankle abnormalities, and illustrates clinical 3D ankle MRI applications.
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Affiliation(s)
- Benjamin Fritz
- Department of Radiology, Balgrist University Hospital, Forchstrasse 340, Zurich 8008, Switzerland; Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Cesar de Cesar Netto
- Department of Orthopaedics and Rehabilitation, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | - Jan Fritz
- Department of Radiology, Division of Musculoskeletal Radiology, NYU Grossman School of Medicine, 660 1st Avenue, New York, NY 10016, USA.
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18
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Walther M, Gottschalk O, Madry H, Müller PE, Steinwachs M, Niemeyer P, Niethammer TR, Tischer T, Petersen J, Feil R, Fickert S, Schewe B, Hörterer H, Ruhnau K, Becher C, Klos K, Plaass C, Rolauffs B, Behrens P, Spahn G, Welsch G, Angele P, Ahrend MD, Kasten P, Erggelet C, Ettinger S, Günther D, Körner D, Aurich M. Etiology, Classification, Diagnostics, and Conservative Management of Osteochondral Lesions of the Talus. 2023 Recommendations of the Working Group "Clinical Tissue Regeneration" of the German Society of Orthopedics and Traumatology. Cartilage 2023; 14:292-304. [PMID: 37082983 PMCID: PMC10601568 DOI: 10.1177/19476035231161806] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 02/18/2023] [Accepted: 02/19/2023] [Indexed: 04/22/2023] Open
Abstract
METHODS Peer-reviewed literature was analyzed regarding different topics relevant to osteochondral lesions of the talus (OLTs) treatment. This process concluded with a statement for each topic reflecting the best scientific evidence available for a particular diagnostic or therapeutic concept, including the grade of recommendation. Besides the scientific evidence, all group members rated the statements to identify possible gaps between literature and current clinical practice. CONCLUSION In patients with minimal symptoms, OLT progression to ankle osteoarthritis is unlikely. Risk factors for progression are the depth of the lesion on MRI, subchondral cyst formation, and the extent of bone marrow edema. Conservative management is the adaptation of activities to the performance of the ankle joint. A follow-up imaging after 12 months helps not to miss any progression. It is impossible to estimate the probability of success of conservative management from initial symptoms and imaging. Cast immobilization is an option in OLTs in children, with a success rate of approximately 50%, although complete healing, estimated from imaging, is rare. In adults, improvement by conservative management ranges between 45% and 59%. Rest and restrictions for sports activities seem to be more successful than immobilization. Intra-articular injections of hyaluronic acid and platelet-rich plasma can improve pain and functional scores for more than 6 months. If 3 months of conservative management does not improve symptoms, surgery can be recommended.
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Affiliation(s)
- Markus Walther
- Schön Klinik München Harlaching, FIFA Medical Centre of Excellence, Munich, Germany
- Department of Orthopeadics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, Ludwig Maximilian University Munich, Munich, Germany
- König-Ludwig-Haus, Julius Maximilian University of Würzburg, Würzburg, Germany
- Paracelsus Medizinische Privatuniversität, Salzburg, Austria
| | - Oliver Gottschalk
- Schön Klinik München Harlaching, FIFA Medical Centre of Excellence, Munich, Germany
- Department of Orthopeadics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Henning Madry
- Institute of Experimental Orthopaedics and Department of Orthopaedic Surgery, Saarland University, Homburg, Germany
| | - Peter E. Müller
- Department of Orthopeadics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Matthias Steinwachs
- SportClinic Zürich, Klinik Hirslanden, Zürich, Switzerland
- ETH Zürich, Zürich, Switzerland
- Albert-Ludwigs-Universität Freiburg, Freiburg, Germany
| | - Philipp Niemeyer
- Albert-Ludwigs-Universität Freiburg, Freiburg, Germany
- OCM—Hospital for Orthopedic Surgery Munich, Munich, Germany
| | - Thomas R. Niethammer
- Department of Orthopeadics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Thomas Tischer
- Klinik für Orthopädie und Unfallchirurgie, Malteser Waldkrankenhaus St. Marien, Erlangen, Germany
| | | | - Roman Feil
- Klinik für Unfallchirurgie und Orthopädie, Kath. Marienkrankenhaus gGmbH, Hamburg, Germany
| | - Stefan Fickert
- Sporthopaedicum Straubing, Straubing, Germany
- Sporthopaedicum Regensburg, Regensburg, Germany
| | - Bernhard Schewe
- Orthopädisch Chirurgisches Centrum Tübingen, Tübingen, Germany
| | - Hubert Hörterer
- Schön Klinik München Harlaching, FIFA Medical Centre of Excellence, Munich, Germany
- Department of Orthopeadics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | | | - Christoph Becher
- Internationales Zentrum für Orthopädie, ATOS Klinik Heidelberg, Heidelberg, Germany
| | | | - Christian Plaass
- Orthopedic Clinic of Medical School Hannover, DIAKOVERE Annastift, Hannover, Germany
| | - Bernd Rolauffs
- Klinik für Orthopädie und Unfallchirurgie and G.E.R.N. Forschungszentrum, Universitätsklinikum Freiburg, Freiburg, Germany
| | | | - Gunter Spahn
- Center of Trauma and Orthopaedic Surgery Eisenach, Eisenach, Germany
| | | | - Peter Angele
- Sporthopaedicum Straubing, Straubing, Germany
- Sporthopaedicum Regensburg, Regensburg, Germany
- Department of Trauma and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Marc-Daniel Ahrend
- BG Unfallklinik Tübingen, Klinik für Unfall- und Wiederherstellungschirurgie, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - Philip Kasten
- Orthopädisch Chirurgisches Centrum Tübingen, Tübingen, Germany
| | - Christoph Erggelet
- Albert-Ludwigs-Universität Freiburg, Freiburg, Germany
- alphaclinic zürich, Zürich, Switzerland
| | - Sarah Ettinger
- Orthopedic Clinic of Medical School Hannover, DIAKOVERE Annastift, Hannover, Germany
| | - Daniel Günther
- Department of Orthopaedic Surgery, Trauma Surgery, and Sports Medicine, Cologne-Merheim Medical Center, Witten/Herdecke University, Cologne, Germany
| | - Daniel Körner
- BG Unfallklinik Tübingen, Klinik für Unfall- und Wiederherstellungschirurgie, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - Matthias Aurich
- BG Klinikum Bergmannstrost Halle, Halle (Saale), Germany
- Abteilung für Unfall- und Wiederherstellungschirurgie, Martin-Luther-University Halle-Wittenberg, Universitätsklinikum Halle (Saale), Halle, Germany
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Wei Y, Yun X, Song J, Qi W, Li J, Liu Y, Quan Q, Wei M. Clinical Outcomes After Arthroscopic Microfracture Treatment of Coexisting Talar and Tibial Osteochondral Lesions. Orthop J Sports Med 2023; 11:23259671231172977. [PMID: 37378280 PMCID: PMC10291148 DOI: 10.1177/23259671231172977] [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: 02/10/2023] [Accepted: 02/26/2023] [Indexed: 06/29/2023] Open
Abstract
Background Despite increased recognition of coexisting tibial and talar osteochondral lesions (OCLs), the risk factors influencing clinical outcomes remain unclear. Purpose To report clinical follow-up results after arthroscopic microfracture surgery in patients with OCLs of the distal tibial plafond and talus and assess possible factors affecting these clinical outcomes. Study Design Case series; Level of evidence, 4. Methods A total of 40 patients with coexisting talar and tibial OCLs who underwent arthroscopic microfracture surgery were included. For analysis, the study used the American Orthopaedic Foot & Ankle Society (AOFAS) scale, Karlsson-Peterson scale, and visual analog scale (VAS) for pain for clinical evaluations on the day before surgery, 12 months after surgery, and at the last follow-up. A stepwise regression model and Spearman rank correlation were used to assess possible factors affecting these clinical outcomes. Results The median follow-up time was 34.5 months (interquartile range [IQR], 26.5-54 months). At the final follow-up, the cohort included 40 patients (26 men and 14 women) with a mean age of 38.8 years (range, 19-60 years). The median AOFAS score increased from 57.5 (IQR, 47-65) before surgery to 88 (IQR, 83-92.5) at the final follow-up, the median Karlsson-Peterson score increased from 48 (IQR, 38.5-67) to 82 (IQR, 76-92), and the median VAS score improved from 5 (IQR, 4-6) to 1 (IQR, 0-2). All scale scores showed significant differences between the preoperative and final follow-up evaluations (P < .001). In the stepwise regression model and Spearman rank correlation analysis, the grade of tibial OCL had a significant independent effect on the final postoperative AOFAS scores of the patients (β = -0.502, P = .001; r = -0.456, P = .003). The size of the tibial lesion also had a significant independent effect on the final postoperative Karlsson-Peterson scores of the patients (β = -0.444, P = .004; r = -0.357, P = .024). Conclusion Arthroscopic microfracture treatment for coexisting talar and tibial OCLs can achieve good short- to midterm clinical outcomes. The grade and size of tibial OCLs are the main risk factors affecting the prognostic functional scores of such patients.
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Affiliation(s)
- Yu Wei
- Department of Orthopedic Surgery, the Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xing Yun
- Department of Orthopedic Surgery, the Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jianing Song
- Department of Rehabilitation, Beijing Rehabilitation Hospital of Capital Medical University, Beijing, China
| | - Wei Qi
- Department of Orthopedic Surgery, the Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jia Li
- Department of Orthopedic Surgery, the Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yujie Liu
- Department of Orthopedic Surgery, the Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Qi Quan
- Department of Orthopedic Surgery, the Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
- Department of Orthopedic Surgery, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Beijing Key Lab of Regenerative Medicine in Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Min Wei
- Department of Orthopedic Surgery, the Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
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Park EH, de Cesar Netto C, Fritz J. MRI in Acute Ankle Sprains: Should We Be More Aggressive with Indications? Foot Ankle Clin 2023; 28:231-264. [PMID: 37137621 DOI: 10.1016/j.fcl.2023.01.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Acute ankle sprains are common sports injuries. MRI is the most accurate test for assessing the integrity and severity of ligament injuries in acute ankle sprains. However, MRI may not detect syndesmotic and hindfoot instability, and many ankle sprains are treated conservatively, questioning the value of MRI. In our practice, MRI adds value in confirming the absence or presence of ankle sprain-associated hindfoot and midfoot injuries, especially when clinical examinations are challenging, radiographs are inconclusive, and subtle instability is suspected. This article reviews and illustrates the MRI appearances of the spectrum of ankle sprains and associated hindfoot and midfoot injuries.
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Affiliation(s)
- Eun Hae Park
- Division of Musculoskeletal Radiology, Department of Radiology, NYU Grossman School of Medicine, 660 1St Ave, 3rd Floor, New York, NY 10016, USA; Department of Radiology, Jeonbuk National University Medical School, Jeonju, Republic of Korea
| | - Cesar de Cesar Netto
- Department of Orthopaedics and Rehabilitation, University of Iowa, 200 Hawkins Dr, Iowa City, IA 52242, USA
| | - Jan Fritz
- Division of Musculoskeletal Radiology, Department of Radiology, NYU Grossman School of Medicine, 660 1St Ave, 3rd Floor, New York, NY 10016, USA.
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21
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Lohrer H, Wagner S, Wenning M, Kühle J, Schmal H, Gollhofer A. Development and validation of a questionnaire to measure the severity of pain, functional limitations, and reduction of sports ability for german-speaking patients with osteochondral lesions of the ankle (OCLA-G). BMC Musculoskelet Disord 2023; 24:340. [PMID: 37127617 PMCID: PMC10150525 DOI: 10.1186/s12891-023-06445-3] [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] [Received: 12/22/2022] [Accepted: 04/19/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND There is no patient-reported functional scale specific for osteochondral lesion of the ankle (OCLA). Therefore, the objectives of this study were to develop a questionnaire that measures symptom severity, function, and sports capacity in patients with osteochondral lesions of the ankle and to determine the psychometric properties of the tool in German language (OCLA-G). METHODS The OCLA-G questionnaire was developed according to the COSMIN guidelines. Scalable items were generated from a literature search, based on an evaluation of 71 own OCLA patients, and from expert opinions. Following a twofold item reduction the questionnaire underwent explorative data analysis and principal component analysis. Validity and reliability were analysed in four groups of participants (40 patients with OCLA, 40 patients with other foot and ankle injuries, 40 asymptomatic athletes serving as a population at risk, and 40 asymptomatic persons playing sports not at risk). The minimum age for participation in the study was set at 18 years. The mean age was 39.3 ± 15.1 years. RESULTS The final OCLA-G questionnaire consists of eight and five questions to mirror activities of daily life (ADL) and sports, respectively. Excellent internal consistency (Cronbach's α = 0.950 for the ADL subscore and 0.965 for the sport subscale, respectively) was found. Spearman's rank correlation coefficients for test-retest reliability were 0.992 for the ADL subscore and 0.999 for the sport subscale (p < 0.001). The results of the exploratory and confirmatory factor analyses indicated that item difficulty was between 23.4 and 62.8. The Pearson correlation for the OCLA subscales ADL and sport was 0.853 (p < 0.001). Construct validity as tested against the SF-12 questionnaire subscales (Physical and Mental component scale) were r = -0.164 to -0.663 (p < 0.05). Statistically, there was no ADL and sport OCLA mean score difference between OCLA patients and patients with other foot and ankle injuries (p = 0.993 and 0.179, respectively), but both groups differed from the uninjured control groups (p < 0.001). There were no ceiling or floor effects. CONCLUSIONS The OCLA-G was successfully developed as the first patient reported and injury specific outcome scale to measure the impact of OCLA induced symptoms on activities of daily living and sport. This study provides evidence for the reliability and validity of the OCLA-G assessing patients with OCLA. TRIAL REGISTRATION The registration trial number is DRKS00009401 on DRKS. 'Retrospectively registered'. Date of registration: 10/12/2015.
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Affiliation(s)
- Heinz Lohrer
- Department for Sports and Sport Science, University of Freiburg, Schwarzwaldstraße 175, Freiburg, 79117, Germany.
- European SportsCare Network (ESN), Zentrum für Sportorthopädie, Borsigstrasse 2, Wiesbaden-Nordenstadt, 65205, Germany.
| | - Stephanie Wagner
- BDH Klinik Waldkirch gGmbH, Heitere Weg 10, Waldkirch, 79183, Germany
| | - Markus Wenning
- Department of Orthopedics and Trauma Surgery, Medical Center, University of Freiburg, Hugstetter Straße 55, Freiburg, 79106, Germany
| | - Jan Kühle
- Department of Orthopedics and Trauma Surgery, Medical Center, University of Freiburg, Hugstetter Straße 55, Freiburg, 79106, Germany
| | - Hagen Schmal
- Department of Orthopedics and Trauma Surgery, Medical Center, University of Freiburg, Hugstetter Straße 55, Freiburg, 79106, Germany
| | - Albert Gollhofer
- Department for Sports and Sport Science, University of Freiburg, Schwarzwaldstraße 175, Freiburg, 79117, Germany
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22
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Fritz B, Fritz J. MR Imaging–Ultrasonography Correlation of Acute and Chronic Foot and Ankle Conditions. Magn Reson Imaging Clin N Am 2023; 31:321-335. [PMID: 37019553 DOI: 10.1016/j.mric.2023.01.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Foot and ankle injuries are common musculoskeletal disorders. In the acute setting, ligamentous injuries are most common, whereas fractures, osseous avulsion injuries, tendon and retinaculum tears, and osteochondral injuries are less common. The most common chronic and overuse injuries include osteochondral and articular cartilage defects, tendinopathies, stress fractures, impingement syndromes, and neuropathies. Common forefoot conditions include traumatic and stress fractures, metatarsophalangeal and plantar plate injuries and degenerations, intermittent bursitis, and perineural fibrosis. Ultrasonography is well-suited for evaluating superficial tendons, ligaments, and muscles. MR imaging is best for deeper-located soft tissue structures, articular cartilage, and cancellous bone.
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23
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Arthroscopic defect size measurement in osteochondral lesions of the talus underestimates the exact defect size and size measurement with arthro-MRI (MR-A) and high-resolution flat-panel CT-arthro imaging (FPCT-A). Knee Surg Sports Traumatol Arthrosc 2023; 31:716-723. [PMID: 36441219 DOI: 10.1007/s00167-022-07241-7] [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] [Received: 07/18/2022] [Accepted: 11/15/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE The size of osteochondral lesions of the talus (OLTs) is highly relevant for their treatment. In addition to intraoperative measurement of defect size, preoperative planning by means of magnetic resonance imaging (MRI) or computed tomography (CT) is crucial. METHODS Four defects of different sizes and depths were created on the talar joint surface in 14 cadaver feet. All defects were evaluated, both arthroscopically and via arthrotomy with a probe. Arthro-MRI (MR-A) and high-resolution flat-panel CT arthro scans (FPCT-A) were acquired. Length, width, and depth were measured for every defect and the defect volume was calculated. To determine the exact defect size, each talar defect was filled with plastic pellets to form a cast and the casts were scanned using FPCT to create a 3D multiplanar reconstruction data set. Finally, the surgically measured values were compared with the radiological values and the exact defect size. RESULTS Overall, the surgically measured values (both arthroscopic and open) underestimated the exact defect size (p < 0.05). Arthroscopically determined defect length and width showed the largest deviation (p < 0.05) and underestimated the size in comparison with MR-A and FPCT-A. The FPCT-A measurements demonstrated higher correlation with both the arthroscopic and open surgical measurements than did the MR-A measurements (p < 0.05). CONCLUSION The exact defect size is underestimated on intraoperative measurement, in both arthroscopic and open approaches. Arthroscopic defect size measurement underestimates defect size in comparison with MR-A and FPCT-A. FPCT-A was shown to be a reliable imaging technique that allows free image reconstruction in every plane and could be considered as the new reference standard for preoperative evaluation of defect size in OLT.
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Casciato D, Zulauf E, Steginsky B. Use of Small Joint Arthroscopy for Diagnosis and Treatment of a First Metatarsal Head Osteochondral Defect: A Case Report. JBJS Case Connect 2022; 12:01709767-202212000-00009. [PMID: 36240292 DOI: 10.2106/jbjs.cc.22.00276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 08/12/2022] [Indexed: 02/24/2023]
Abstract
CASE A case of a painful first metatarsophalangeal joint in a 28-year-old woman is reported. Clinical examination and imaging were suspicious for osteochondral lesion of the first metatarsal head. A 1.9-mm arthroscope was used for diagnosis and treatment of an osteochondral defect with microfracture and dehydrated, micronized allogenic cartilage application with an excellent postoperative outcome. CONCLUSION From the 3-month through 1-year follow-up, the patient continued a pain-free return to normal function. This case suggests that arthroscopy is as a viable approach to resurfacing osteochondral lesions of the big toe joint.
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Williamson ERC, Shimozono Y, Toale J, Dankert J, Hurley ET, Egol KA, Kennedy JG. Incidence of Chondral and Osteochondral Lesions in Ankle Fracture Patients Identified With Ankle Arthroscopy Following Rotational Ankle Fracture: A Systematic Review. J Foot Ankle Surg 2022; 61:668-673. [PMID: 35033444 DOI: 10.1053/j.jfas.2021.12.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 12/16/2020] [Accepted: 12/06/2021] [Indexed: 02/03/2023]
Abstract
A systematic literature search was performed using the PubMed, MEDLINE, and the Cochrane Library databases according to the Preferred Reporting Items for Systematic review and Meta-Analyses guidelines on May 20, 2019. The keywords used were: ankle, distal tibia, distal fibula, fracture, arthroscopic, cartilage, and chondral. The objective of this study is to systematically review the characterization of intra-articular chondral injuries of the talus, tibial plafond, medial malleolus, and lateral malleolus in patients who undergo ankle arthroscopy following ankle fracture. Studies evaluating the incidence of chondral lesions at the time of arthroscopy for ankle fractures within any timeframe were included. The incidence of intra-articular chondral lesions was recorded, the location within the ankle, ankle fracture type, time of arthroscopy, characterization of chondral injury, complications, and outcome if available. Fifteen studies with 1355 ankle fractures were included. About 738 demonstrated evidence of chondral or osteochondral lesion (54.5%). Statistical analyses were carried out with statistical software package SPSS 24.0 (SPSS, Chicago, IL). We compared incidence rates of chondral injury based on Weber classification, malleolar fracture type, and Lauge-Hansen classification, using Pearson chi-square test. For all analyses, p < .05 was considered statistically significant. We found a high incidence of intra-articular chondral lesion in the setting of ankle fractures as demonstrated by arthroscopy.
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Affiliation(s)
- Emilie R C Williamson
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY.
| | - Yoshiharu Shimozono
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY
| | - James Toale
- Royal College Surgeons in Ireland, Dublin, Ireland
| | - John Dankert
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY
| | - Eoghan T Hurley
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY; Royal College Surgeons in Ireland, Dublin, Ireland
| | - Kenneth A Egol
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY
| | - John G Kennedy
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY
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Waltenspül M, Zindel C, Altorfer FCS, Wirth S, Ackermann J. Correlation of Postoperative Imaging With MRI and Clinical Outcome After Cartilage Repair of the Ankle: A Systematic Review and Meta-analysis. FOOT & ANKLE ORTHOPAEDICS 2022; 7:24730114221092021. [PMID: 35520475 PMCID: PMC9067057 DOI: 10.1177/24730114221092021] [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] [Indexed: 11/25/2022] Open
Abstract
Background Magnetic resonance imaging (MRI) is commonly used for evaluation of ankle cartilage repair, yet its association with clinical outcome is controversial. This study analyzes the correlation between MRI and clinical outcome after cartilage repair of the talus including bone marrow stimulation, cell-based techniques, as well as restoration with allo- or autografting. Methods A systematic search was performed in MEDLINE, Embase, and Cochrane Collaboration. Articles were screened for correlation of MRI and clinical outcome. Guidelines of Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) were used. Chi-square test and regression analysis were performed to identify variables that determine correlation between clinical and radiologic outcome. Results Of 2687 articles, a total of 43 studies (total 1212 cases) were included with a mean Coleman score of 57 (range, 33-70). Overall, 93% were case series, and 5% were retrospective and 2% prospective cohort studies. Associations between clinical outcome and ≥1 imaging variable were found in 21 studies (49%). Of 24 studies (56%) using the composite magnetic resonance observation of cartilage repair tissue (MOCART) score, 7 (29%) reported a correlation of the composite score with clinical outcome. Defect fill was associated with clinical outcome in 5 studies (12%), and 5 studies (50%) reported a correlation of T2 mapping and clinical outcome. Advanced age, shorter follow-up, and larger study size were associated with established correlation between clinical and radiographic outcome (P = .021, P = .028, and P = .033). Conclusion Interpreting MRI in prediction of clinical outcome in ankle cartilage repair remains challenging; however, it seems to hold some value in reflecting clinical outcome in patients with advanced age and/or at a shorter follow-up. Yet, further research is warranted to optimize postoperative MRI protocols and assessments allowing for a more comprehensive repair tissue evaluation, which eventually reflect clinical outcome in patients after cartilage repair of the ankle.Level of Evidence: Level III, systematic review and meta-analysis.
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Affiliation(s)
- Manuel Waltenspül
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Clinic for Orthopaedics and Traumatology, Department of Surgery, Triemli Hospital, Zürich, Switzerland
| | - Christoph Zindel
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Franziska C. S. Altorfer
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Stephan Wirth
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Jakob Ackermann
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Clinic for Orthopaedics and Traumatology, Department of Surgery, Kantonsspital Winterthur, Winterthur, Switzerland
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Wei Y, Song J, Yun X, Zhang Z, Qi W, Wei M. Outcomes of Single-Stage Versus Staged Treatment of Osteochondral Lesions in Patients With Chronic Lateral Ankle Instability: A Prospective Randomized Study. Orthop J Sports Med 2022; 10:23259671211069909. [PMID: 35141339 PMCID: PMC8819770 DOI: 10.1177/23259671211069909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 10/07/2021] [Indexed: 11/17/2022] Open
Abstract
Background: There is controversy about whether treatment of chronic lateral ankle
instability (CLAI) with osteochondral lesions of the talus (OLT) can be
performed concurrently. Purpose: To investigate the midterm results of arthroscopic treatment of CLAI combined
with OLT in different surgical settings. It was hypothesized that the
outcomes of treating both injuries at the same time would not be inferior to
those of staged surgery. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Included were 103 patients with both CLAI and OLT who underwent arthroscopic
microfracture surgery and an open, modified Broström-Gould procedure for
ligament repair from January 2015 to December 2016. The patients were
assigned randomly to a staged group (51 patients) and a single-stage group
(52 patients). The staged group underwent arthroscopic debridement of the
OLT and microfracture, then rehabilitation for 4 to 6 months before
undergoing modified Broström-Gould ligament repair. The single-stage group
underwent both procedures simultaneously. Clinical evaluations were
performed on the day before surgery and at 12-month, 24-month, and final
follow-up periods using the Karlsson-Peterson score, American Orthopaedic
Foot & Ankle Society (AOFAS) score, and pain visual analog scale. The
Karlsson-Peterson score at 24 months postoperatively was considered the
primary outcome. The predefined noninferiority margin for the primary
outcome was −5 points. Results: At the final follow-up, 50 patients in the single-stage group and 48 patients
in the staged group completed the study. The median lesion size was 0.72
cm2 (interquartile range [IQR], 0.5-1.12 cm2) in
the single-stage group and 0.84 cm2 (IQR, 0.7-1.05
cm2) in the staged group. At 12-month follow-up, the single-stage
group had a significantly higher median Karlsson-Peterson score (79 [IQR,
70-85] vs 75 [IQR 65-80] for staged; P = .024) and median
AOFAS score (85 [IQR, 76-89] vs 79.5 [IQR, 70-87] for staged;
P = .045). At 24-month follow-up, the median difference
in the Karlsson-Peterson score for single-stage versus staged surgery was 2
points (95% CI, −2 to 5 points), and the confidence interval was greater
than the predefined value. Conclusion: At midterm follow-up, there was no clinical difference between single-stage
versus staged surgery to treat CLAI with OLT. Single-stage surgery achieved
better clinical outcomes than staged surgery at short-term follow-up.
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Affiliation(s)
- Yu Wei
- Senior Department of Orthopedics, the Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jianing Song
- Department of Rehabilitation, Beijing Rehabilitation Hospital of Capital Medical University, Beijing, China
| | - Xing Yun
- Senior Department of Orthopedics, the Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Zhuo Zhang
- Senior Department of Orthopedics, the Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Wei Qi
- Senior Department of Orthopedics, the Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Min Wei
- Senior Department of Orthopedics, the Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
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Nery C, Prado MP. Diagnosis and Treatment of Talus Osteochondral Lesions: Current Concepts. FOOT AND ANKLE DISORDERS 2022:1065-1105. [DOI: 10.1007/978-3-030-95738-4_48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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Osteochondral lesion of the talus: What are we talking about? Orthop Traumatol Surg Res 2021; 107:103068. [PMID: 34547540 DOI: 10.1016/j.otsr.2021.103068] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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 analysis of osteochondral lesions of talus (OLT) is currently mostly descriptive, not permitting an understanding of the different nosological frameworks of these lesions. Better knowledge of the characteristics of patients with OLT should make it possible to optimize the surgical indications and anticipate the associated lesions, which should not be overlooked. The main objective of this study was, therefore, to assess the characteristics of patients with OLT, and to analyze the lesions encountered. HYPOTHESIS OLTs correspond to variable entities responding to specific treatments. MATERIAL AND METHOD This was a prospective multicenter descriptive study including all patients operated on for an OLT, aged between 15 and 65 years, across 10 French specialist centers. The demographic, clinical and radiological data of the patients were analyzed. RESULTS OLTs predominantly affect males and patients in their thirties. Two types of OLT should be distinguished: a lateral OLT; smaller and more superficial, most often presenting with painful instability, in the context of trauma, and a medial OLT; more frequent, wider and deeper. DISCUSSION Two nosological frameworks exist for OLTs, and correspond to precise surgical indications: medial lesions of more than 10mm2 and more than 5mm in depth, with isolated anteromedial pain and significant functional impairment, most often idiopathic, generally requiring treatment by osteochondral autografts. Lateral lesions less than 5mm in depth and less than 10mm2, often superficial, following trauma or ankle laxity, associated with lateral ligament damage in one-third of cases, and a clinical presentation associated to instability and pain, requiring treatment most often by microfracture with associated ligament repair. LEVEL OF EVIDENCE III.
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Bruns J, Habermann C, Werner M. Osteochondral Lesions of the Talus: A Review on Talus Osteochondral Injuries, Including Osteochondritis Dissecans. Cartilage 2021; 13:1380S-1401S. [PMID: 33423507 PMCID: PMC8808845 DOI: 10.1177/1947603520985182] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
This is a review on talus osteochondritis dissecans and talus osteochondral lesions. A majority of the osteochondral lesions are associated with trauma while the cause of pure osteochondritis dissecans is still much discussed with a possible cause being repetitive microtraumas associated with vascular disturbances causing subchondral bone necrosis and disability. Symptomatic nondisplaced osteochondral lesions can often be treated conservatively in children and adolescents while such treatment is less successful in adults. Surgical treatment is indicated when there is an unstable cartilage fragment. There are a large number of different operative technique options with no number one technique to be recommended. Most techniques have been presented in level II to IV studies with a low number of patients with short follow ups and few randomized comparisons exist. The actual situation in treating osteochondral lesions in the ankle is presented and discussed.
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Affiliation(s)
- Juergen Bruns
- Wilhelmsburger Krankenhaus Gross-Sand,
Hamburg, Germany,Juergen Bruns, Wilhelmsburger Krankenhaus
Gross-Sand, Groß Sand 3, Hamburg, 21107, Germany.
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Schwartz AM, Niu S, Mirza FA, Thomas AR, Labib SA. Surgical Treatment of Talus OCL: Mid- to Long-Term Clinical Outcome With Detailed Analyses of Return to Sport. J Foot Ankle Surg 2021; 60:1188-1192. [PMID: 34130931 DOI: 10.1053/j.jfas.2021.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/28/2021] [Accepted: 05/05/2021] [Indexed: 02/03/2023]
Abstract
Talus osteochondral lesions are a commonly underdiagnosed problem in young athletes. Talus osteochondral lesions surgical algorithm remains controversial. Current metrics suggest that conventional treatment of osteochondral lesions of the talus is promising; yet return to sport is poorly studied. Fifty-seven patients following talus osteochondral lesion surgical intervention were included in this study. About 63.1% were female with mean age 37.1 years, mean lesion size 10 × 12.5 mm, and mean follow-up 79.9 months postoperatively. Patients were divided into 4 groups by surgery performed: antegrade arthroscopic bone marrow stimulation, retrograde arthroscopic drilling, osteochondral autograft transfer, and allograft cartilage implantation. Outcome metrics include Visual Analog Scale for pain and function, Short Form-12, Foot and Ankle Disability Scale, Tegner, Marx activity scores, Naal Sports inventory, and patient satisfaction. Over 77% of patients were satisfied with surgical intervention. Each intervention significantly decreased pain and increased function, except retrograde drilling. All interventions trended toward decreased Tegner score; only antegrade drilling showed significant decrease. Based on Naal's sports inventory, 85.7% of surgically treated patients reported participating in sport activities, on average 3 times/week and 50.6 minutes/session. Traditionally, talus osteochondral lesions present a difficult problem that is marred by unsatisfactory nonoperative outcomes in typically active patients. As our surgical understanding has evolved, we've continued to improve on outcomes. Our patients demonstrated 77.2% overall satisfaction rate, a statistically significant improvement in pain and function, at an average follow-up of 79.9 months postoperatively, and a high rate of return to sport with little difference between surgical interventions.
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Affiliation(s)
| | - Shuo Niu
- Emory University School of Medicine, Atlanta, GA
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Lopes R, Geffroy L, Padiolleau G, Ngbilo C, Baudrier N, Mainard D, Benoist J, Leiber Wackenheim F, Cordier G, Dubois Ferriere V, Freychet B, Barbier O, Amouyel T. Proposal of a new CT arthrographic classification system of osteochondral lesions of the talus. Orthop Traumatol Surg Res 2021; 107:102890. [PMID: 33713874 DOI: 10.1016/j.otsr.2021.102890] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 08/19/2020] [Accepted: 09/16/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Surgical treatment of osteochondral lesions of the talus (OLT) is warranted if medical treatments fail, achieving good results in around 85% of cases. Numerous classification systems, based on all possible imaging modalities (radiography, MRI, CT scan, scintigraphy, and CT arthrography), have been proposed to guide surgical treatments, but none has proven to be superior. A recent study demonstrated the prognostic value of CT arthrography by accurately describing the subchondral bone plate. A systematic review of the literature has brought new criteria to predict good outcome following bone marrow stimulation surgical techniques: lesions should measure less than 1 centimeter in size and 5 millimeters in depth. Based on these data, we are proposing a new simple, 3-stage CT arthrographic classification system of OLT. MATERIALS AND METHODS After a brief overview of the classification, 60 CT-arthrographies of ankles with OLT were organized according to this new CT arthrographic classification system by four surgeons (two juniors and two seniors). Two imaging assessments were performed one month apart. Statistical analysis was performed using the Fleiss' kappa coefficient to determine the inter- and intraobserver agreement. RESULTS An excellent inter- and intraobserver agreement was found with overall Fleiss' kappa coefficients of 0.897 and 0.847, respectively. CONCLUSION The results of our study showed an excellent inter- and intraobserver agreement for this new CT arthrographic classification system of OLT. The principal advantage of this new classification system, based on the latest data in the literature, is its ability to easily distinguish lesions that are more amenable to bone marrow stimulation techniques. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Ronny Lopes
- Santé Atlantique, avenue Claude Bernard, 44800 Saint-Herblain, France.
| | - Loïc Geffroy
- Santé Atlantique, avenue Claude Bernard, 44800 Saint-Herblain, France
| | | | - Cédric Ngbilo
- Centre Orthopédique SANTY, 24, avenue Paul Santy, 69008 Lyon, France
| | - Nicolas Baudrier
- CHU Ambroise Paré, 9, avenue Charles de Gaulle, 92100 Boulogne-Billancourt, France
| | - Didier Mainard
- CHU Nancy, 29, avenue du Maréchal de Lattre de Tassigny, 54035 Nancy, France
| | - Jonathan Benoist
- CH Saint Grégoire, 6, boulevard de la Boutière, 35760 Saint-Grégoire, France
| | | | - Guillaume Cordier
- Clinique du sport, 4, rue Georges Negrevergne, 33700 Mérignac, France
| | | | - Benjamin Freychet
- Centre Orthopédique SANTY, 24, avenue Paul Santy, 69008 Lyon, France
| | - Olivier Barbier
- Hôpital d'instruction des Armées Sainte Anne, 2, boulevard Sainte-Anne, 83000 Toulon, France
| | - Thomas Amouyel
- Service d'orthopédie 1, hôpital Roger Salengro, CHRU, place de Verdun, 59037 France
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Fritz B, Fritz J, Sutter R. 3D MRI of the Ankle: A Concise State-of-the-Art Review. Semin Musculoskelet Radiol 2021; 25:514-526. [PMID: 34547816 DOI: 10.1055/s-0041-1731332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Magnetic resonance imaging (MRI) is a powerful imaging modality for visualizing a wide range of ankle disorders that affect ligaments, tendons, and articular cartilage. Standard two-dimensional (2D) fast spin-echo (FSE) and turbo spin-echo (TSE) pulse sequences offer high signal-to-noise and contrast-to-noise ratios, but slice thickness limitations create partial volume effects. Modern three-dimensional (3D) FSE/TSE pulse sequences with isotropic voxel dimensions can achieve higher spatial resolution and similar contrast resolutions in ≤ 5 minutes of acquisition time. Advanced acceleration schemes have reduced the blurring effects of 3D FSE/TSE pulse sequences by affording shorter echo train lengths. The ability for thin-slice partitions and multiplanar reformation capabilities eliminate relevant partial volume effects and render modern 3D FSE/TSE pulse sequences excellently suited for MRI visualization of several oblique and curved structures around the ankle. Clinical efficiency gains can be achieved by replacing two or three 2D FSE/TSE sequences within an ankle protocol with a single isotropic 3D FSE/TSE pulse sequence. In this article, we review technical pulse sequence properties for 3D MRI of the ankle, discuss practical considerations for clinical implementation and achieving the highest image quality, compare diagnostic performance metrics of 2D and 3D MRI for major ankle structures, and illustrate a broad spectrum of ankle abnormalities.
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Affiliation(s)
- Benjamin Fritz
- Department of Radiology, University Hospital Balgrist, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Jan Fritz
- New York University Grossman School of Medicine, New York University, New York, New York
| | - Reto Sutter
- Department of Radiology, University Hospital Balgrist, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
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Doğar F, Uzun E, Gürbüz K, Topak D, Akar M, Bilal Ö, Güney A. Comparison of Arthroscopic Treatment Methods in Talar Osteochondral Lesions: A Multicenter, Prospective, Randomized Clinical Trial. J Am Podiatr Med Assoc 2021; 111:470039. [PMID: 34478532 DOI: 10.7547/20-218] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The aim of the present study was to contribute new and updated information to the literature by comparing the clinical and radiologic results of arthroscopic microfracture, platelet-rich plasma (PRP) after arthroscopic microfracture, and BST-Cargel scaffold application after arthroscopic microfracture in the treatment of talar osteochondral lesions. METHODS Sixty-two talar osteochondral lesion patients (31 women and 31 men) who underwent ankle arthroscopy in two different centers were randomized into three groups. The first group consisted of patients who underwent only arthroscopic microfracture (MF) (n = 22); the second group consisted of patients who underwent the PRP procedure after arthroscopic MF (PRP; n = 19); and the third group consisted of patients who underwent the BST-Cargel procedure after arthroscopic MF was (BST-Cargel; n = 21). The talar osteochondral lesions in the three groups were classified according to magnetic resonance and arthroscopic images. American Orthopedic Foot and Ankle Society, Foot and Ankle Ability Measurement (overall pain, 15-minute walking, running function), and visual analog scale scores were evaluated preoperatively and postoperatively, and postoperative return time to sports activities was performed. RESULTS Compared to the preoperative score, postoperative American Orthopedic Foot and Ankle Society score increased 48.80 ± 9.60 in the BST-Cargel group, whereas there was an increase of 46.68 ± 3.65 in the PRP group and 29.63 ± 3.69 in the MF group, which were statistically significant (P < .05).There was a statistically significant postoperative change in the visual analog scale scores of the patients in all three groups compared to the preoperative scores (P < .05). At the end of the follow-up, the Foot and Ankle Ability Measurement overall pain, 15-minute walking, and running function results of all three groups increased significantly postoperatively compared to the preoperative values (P < .005). CONCLUSIONS BST-Cargel application with microfracture is a method that can be applied easily and safely with arthroscopy to lesions larger than 1.5 cm2 regardless of the size of the cartilage defect, and it has been found to be superior to the other two methods in terms of pain, functional score, radiologic recovery, and return to sports activities.
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Hamilton C, Burgul R, Kourkounis G, Howieson A, Papadopoulos A. Osteochondral defects of the talus: radiological appearance and surgical candidate profiling - A retrospective analysis. Foot (Edinb) 2021; 46:101767. [PMID: 33453612 DOI: 10.1016/j.foot.2020.101767] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 11/24/2020] [Accepted: 11/29/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Osteochondral defects of the talus (OCD) are a well-established pathology within the ankle. They are most commonly associated with ankle trauma and whilst many are asymptomatic, they can have a significant negative impact on the patient, most notably with regards pain and mobility. Treatment of these lesions remains variable across the diverse cohort of these patients. AIMS Evaluating the incidence of talus OCDs. Evaluating anatomic and morphologic data of the lesions against previous studies. Establishing if there was there any associated ligamentous injury. Determining the cohort of patients who were considered/underwent surgical intervention. METHODS A retrospective review was performed on patients presenting to a single Scottish Hospital with Talar OCDs between 2012-2016. Data collected included radiological appearance of the lesions (location and size), clinical history, associated ligament injury, treatment given and subsequent outcome. Categorical variables were presented as count and percentage while non-parametric variables were presented as median and interquartile range. RESULTS 90 new cases that matched our inclusion criteria were identified. Using the Raikin classification, the majority of injuries are in the posteromedial (26%), centrolateral (21%), and centromedial (18%) segments of the talus. Of note, no lesions were identified in the posterocentral segment. 46% of patients had an associated ligamentous injury, either in the form of a sprain or tear. Most commonly the injury involved both ATFL and CFL (82%). 70% of patients that underwent surgery had radiological evidence of ligamentous injury. No statistically significant difference was identified between the management option and the involved segment according to Orr/Raikin classifications. CONCLUSION Talus osteochondral defects are a pathology which is more common than originally thought and their treatment remain a controversial topic. Little is known about the physical history of the condition as most cases are asymptomatic, thus poorly documented by definition. There is a clear opportunity and need for further research into developing evidence-based guidelines for their management. This study tried to correlate the management of OCDs with epidemiological and radiological data.
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Affiliation(s)
- C Hamilton
- Forth Valley Royal Hospital, Larbert, FK5 4WR, UK.
| | - R Burgul
- Forth Valley Royal Hospital, Larbert, FK5 4WR, UK
| | - G Kourkounis
- Glasgow Royal Infirmary, Glasgow, UK; University of Glasgow, Glasgow, UK
| | - A Howieson
- Forth Valley Royal Hospital, Larbert, FK5 4WR, UK
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Masquijo JJ, Allende F, Carabajal M. Ankle Morphology and Juvenile Osteochondritis Dissecans (JOCD) of the Talus: Is There an Association? An MRI Study. J Pediatr Orthop 2021; 41:e147-e152. [PMID: 33229961 DOI: 10.1097/bpo.0000000000001715] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE Factors that contribute to the development of juvenile osteochondritis dissecans (JOCD) of the talus are poorly understood. Some authors suggest that a higher loading of the affected zone may be a cofactor in osteochondral lesions. Therefore, the purpose of the study is to evaluate any association between ankle morphology and talus JOCD using morphologic parameters from magnetic resonance images. Our hypothesis is that ankles with JOCD lesions would have differences in the anatomy compared with age and sex-matched unaffected ankles. METHODS We evaluated a total of 75 extremities. There were 22 patients (25 ankles) with talus JOCD lesions, and 50 patients (50 ankles) sex and age-matched individuals with healthy ankles served as controls. Two examiners conducted independent measurements of 8 magnetic resonance images parameters: tibial anterior surface angle, tibial shaft both malleoli angle (TBM), tibial axis-medial malleolus angle, anterior opening angle of the talus, malleolar width, tibial lateral surface angle, Maximal tibial thickness, length of trochlea tali arc, and height of trochlea tali arc. Measurement reliability was assessed using intraclass correlation coefficients. Differences in parameters between JOCD patients and controls were evaluated using independent t test. The level of significance was taken to be P<0.05. RESULTS Intraclass correlation coefficients demonstrated good to excellent consistency for all measurements. Sagittal parameters demonstrated a significant length of trochlea tali arc increase in ankles with JOCD lesions compared with normal ankles (P=0.015). There was no statistical difference in any of the axial or coronal parameters. CONCLUSIONS Ankle morphology may have a relationship with JOCD lesions. Future larger studies will be useful for further clarifying our findings, and detecting other potential predisposing factors with clinical relevance and how they can be modified. STUDY DESIGN Cross-sectional study (Level of evidence III).
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Affiliation(s)
- J Javier Masquijo
- Department of Pediatric Orthopaedics, Sanatorio Allende,Nueva Córdoba, Córdoba, Argentina
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Chu CH, Chen IH, Yang KC, Wang CC. Midterm Results of Fresh-Frozen Osteochondral Allografting for Osteochondral Lesions of the Talus. Foot Ankle Int 2021; 42:8-16. [PMID: 33040601 DOI: 10.1177/1071100720949861] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Osteochondral lesions of the talus (OLT) are relatively common. Following the failure of conservative treatment, many operative options have yielded varied results. In this study, midterm outcomes after fresh-frozen osteochondral allograft transplantation for the treatment of OLT were evaluated. METHODS Twenty-five patients (12 women and 13 men) with a mean age 40.4 (range 18-70) years between 2009 and 2014 were enrolled. Of 25 ankles, 3, 13, 4, and 4 were involved with the talus at Raikin zone 3, 4, 6, and 7 as well as one coexisted with zone 4 and 6 lesion. The mean OLT area was 1.82 cm2 (range, 1.1-3.0). The mean follow-up period was 5.5 years (range, 4-9.3). Outcomes evaluation included the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, visual analog scale score, and 12-item Short Form Health Survey (SF-12). RESULT AOFAS ankle-hindfoot score increased from 74 preoperatively to 94 at 2 years postoperatively (P < .001) and the SF-12 physical health component scores increased from 32 to 46 points (P < .001). Incorporation was inspected in all patients in the latest follow-up, and graft subsidence and radiolucency were observed in 2 and 7 cases, respectively, whereas graft collapse and revision OLT graft were not observed. Bone sclerosis was found in 6 of 25 patients. CONCLUSION With respect to midterm results, fresh, frozen-stored allograft transplantation might be an option in the management of symptomatic OLT. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Chung-Hua Chu
- Department of Orthopedic Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Ing-Ho Chen
- Department of Orthopedic Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.,Department of Orthopedic Surgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, 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
| | - Chen-Chie Wang
- Department of Orthopedic Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.,Department of Orthopedics, School of Medicine, Tzu Chi University, Hualien, Taiwan
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Darwich A, Adam J, Dally FJ, Hetjens S, Jawhar A. Incidence of concomitant chondral/osteochondral lesions in acute ankle fractures and their effect on clinical outcome: a systematic review and meta-analysis. Arch Orthop Trauma Surg 2021; 141:63-74. [PMID: 33128607 PMCID: PMC8213566 DOI: 10.1007/s00402-020-03647-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 10/15/2020] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Despite successful osteosynthesis, some patients report residual symptoms after ankle fractures. One of the reasons behind the postoperative complaints might be traumatic concomitant chondral lesions (CL) and/or osteochondral lesions (OCL) within the ankle joint. The study aims to systematically review the incidence of CL and/or OCL in ankle fractures and to assess their effect on the clinical outcome. MATERIALS AND METHODS This work was conducted according to PRISMA checklists. A systematic literature search was performed using following keywords: "Ankle Fractures" OR "Trimalleolar Fracture" OR "Bimalleolar Fracture" OR "Maisonneuve fracture" OR "Malleolus Fracture" AND "Cartilage" OR "Cartilage Diseases" OR "Cartilage, Articular" OR "chondral" up to March 2020. The identified articles were analysed to determine the incidence of CL and/or OCL. Included studies in the meta-analysis assessed possible cartilage damage through arthroscopy or MRI immediately after traumatic ankle fractures and described the postoperative clinical outcome. RESULTS The search identified a total of 111 publications; 19 described the incidence of CL and/or OCL after ankle fractures; six met the criteria to be included in the meta-analysis: five (n = 293) diagnosed CL and/or OCL through arthroscopy during ORIF and one study (n = 153) used preoperative MRI. The clinical outcome was evaluated in four studies (n = 177) using AOFAS score and in two (n = 269) using FAOS score. The mean incidence of arthroscopically detected CL and/or OCL was 65 ± 21% [95% CI 53.9 to 76.72]. The cumulative meta-analysis sample size comprised a total of 400 Patients (170 with and 230 without CL and/or OCL) available for a mean follow-up of 23.9 ± 11.5 months [95% CI 11.79 to 36.07]. The average age was 44.3 ± 5.5 years [95% CI 38.57 to 50.13]. The meta-analysis revealed a mean AOFAS score of 91.2 ± 4.8 [95% CI 83.53 to 98.93] with versus 94.4 ± 4.7 [95% CI 86.81 to 102.07] without CL and/or OCL (p = 0.15) and a mean FAOS score of 73.2 ± 11.31 [95% CI - 28.44 to 174.85] with versus 79.0 ± 18.4 [95% CI - 86.77 to 244.87] without CL and/or OCL (p = 0.18). CONCLUSIONS CL and/or OCL appear very frequently after ankle fractures. A tendency towards a favourable short- to mid-term clinical outcome was noticed in ankle fractures without CL and/or OCL, however without reaching statistical significance. LEVEL OF EVIDENCE Level I.
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Affiliation(s)
- Ali Darwich
- grid.7700.00000 0001 2190 4373Department of Orthopaedics and Traumatology Surgery, University Medical Centre, Medical Faculty Mannheim of the University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Julia Adam
- grid.7700.00000 0001 2190 4373Department of Orthopaedics and Traumatology Surgery, University Medical Centre, Medical Faculty Mannheim of the University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Franz-Joseph Dally
- grid.7700.00000 0001 2190 4373Department of Orthopaedics and Traumatology Surgery, University Medical Centre, Medical Faculty Mannheim of the University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Svetlana Hetjens
- grid.7700.00000 0001 2190 4373Institute of Medical Statistics and Biomathematics, University Medical Centre, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | - Ahmed Jawhar
- grid.7700.00000 0001 2190 4373Department of Orthopaedics and Traumatology Surgery, University Medical Centre, Medical Faculty Mannheim of the University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany ,Department of Trauma, Hand and Reconstructive Surgery, Klinikum Worms, Academic Teaching Hospital of the University Mainz, Worms, Germany
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Treatment of Osteochondral Lesions of the Talus With Matrix-induced Autologous Chondrocyte Implantation (MACI). TECHNIQUES IN FOOT & ANKLE SURGERY 2020. [DOI: 10.1097/btf.0000000000000276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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40
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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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Fritz B, Parkar AP, Cerezal L, Storgaard M, Boesen M, Åström G, Fritz J. Sports Imaging of Team Handball Injuries. Semin Musculoskelet Radiol 2020; 24:227-245. [PMID: 32987422 DOI: 10.1055/s-0040-1710064] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Team handball is a fast high-scoring indoor contact sport with > 20 million registered players who are organized in > 150 federations worldwide. The combination of complex and unique biomechanics of handball throwing, permitted body tackles and blocks, and illegal fouls contribute to team handball ranging among the four athletic sports that carry the highest risks of injury. The categories include a broad range of acute and overuse injuries that most commonly occur in the shoulder, knee, and ankle. In concert with sports medicine, physicians, surgeons, physical therapists, and radiologists consult in the care of handball players through the appropriate use and expert interpretations of radiography, ultrasonography, CT, and MRI studies to facilitate diagnosis, characterization, and healing of a broad spectrum of acute, complex, concomitant, chronic, and overuse injuries. This article is based on published data and the author team's cumulative experience in playing and caring for handball players in Denmark, Sweden, Norway, Germany, Switzerland, and Spain. The article reviews and illustrates the spectrum of common handball injuries and highlights the contributions of sports imaging for diagnosis and management.
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Affiliation(s)
- Benjamin Fritz
- Department of Radiology, Balgrist University Hospital, Zurich, and Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Anagha P Parkar
- Department of Radiology, Haraldsplass Deaconess Hospital, Bergen, Norway.,Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - Luis Cerezal
- Department of Radiology, Diagnostico Médico Cantabria, Santander, Spain
| | - Morten Storgaard
- Institute of Sports Medicine Copenhagen, Copenhagen Area, Denmark
| | - Mikael Boesen
- Department of Radiology Copenhagen university hospital, Bispebjerg and Frederiksberg, Copenhagen NV, Denmark.,Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, Frederiksberg, Denmark
| | - Gunnar Åström
- Department of Immunology, Genetics and Pathology (Oncology) and department of Surgical Sciences (Radiology), Uppsala University, Uppsala, Sweden
| | - Jan Fritz
- Department of Radiology, New York University Grossman School of Medicine, New York University, New York, New York
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Deng E, Gao L, Shi W, Xie X, Jiang Y, Yuan H, Guo Q. Both Magnetic Resonance Imaging and Computed Tomography Are Reliable and Valid in Evaluating Cystic Osteochondral Lesions of the Talus. Orthop J Sports Med 2020; 8:2325967120946697. [PMID: 32995345 PMCID: PMC7503027 DOI: 10.1177/2325967120946697] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 03/26/2020] [Indexed: 11/16/2022] Open
Abstract
Background Compared with computed tomography (CT), magnetic resonance imaging (MRI) might overestimate the condition of osteochondral lesions of the talus (OLTs) owing to subchondral bone marrow edema and the overlying cartilage defect. However, no study has compared MRI and CT directly in evaluating OLTs with subchondral cysts. Purpose To compare the reliability and validity of MRI and CT in evaluating OLTs with subchondral cysts. Study Design Cohort study (diagnosis); Level of evidence, 2. Methods An institutional radiology database was queried for inpatients diagnosed with OLTs with subchondral cysts who had undergone surgical treatment between May 2015 and October 2019. A total of 48 patients met the inclusion criteria. Based on our measurement method, 2 experienced observers who were blinded to the study independently measured the length, width, and depth of the cysts using MRI and CT. The classification of cystic lesions was also performed based on MRI and CT findings. Results Interobserver reliability was almost perfect, with intraclass correlation coefficients (ICCs) ranging from 0.935 to 0.999. ICCs for intraobserver reliability ranged from 0.944 to 0.976. The mean size of cysts measured on MRI (length, 13.38 ± 4.23 mm; width, 9.28 ± 2.28 mm; depth, 11.54 ± 3.69 mm) was not significantly different to that evaluated on CT (length, 13.40 ± 4.08 mm; width, 9.25 ± 2.34 mm; depth, 11.32 ± 3.54 mm). The size of subchondral cysts was precisely estimated on both MRI and CT. The MRI classification and CT classification revealed almost perfect agreement (kappa = 0.831). Conclusion With our measurement method, both MRI and CT were deemed to be reliable and valid in evaluating the size of subchondral cysts of OLTs, and the MRI classification was well-correlated with the CT classification. The presented measurement method and classification systems could provide more accurate information before surgery.
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Affiliation(s)
- En Deng
- Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Lixiang Gao
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Weili Shi
- Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Xing Xie
- Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Yanfang Jiang
- Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Huishu Yuan
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Qinwei Guo
- Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
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Conti MS, Ellington JK, Behrens SB. Osteochondral Defects of the Talus: How to Treat Without an Osteotomy. Clin Sports Med 2020; 39:893-909. [PMID: 32892974 DOI: 10.1016/j.csm.2020.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Surgical management of osteochondral lesions of the talus without an osteotomy depends on the size, location, and chronicity of the lesion. Bone marrow stimulation techniques, such as microfracture, can be performed arthroscopically and have consistently good outcomes in lesions less than 1 cm in diameter. For lesions not amenable to bone marrow stimulation, one-stage techniques, such as allograft cartilage extracellular matrix and allograft juvenile hyaline cartilage, may be used. Arthroscopy may be used in many cases to address these lesions; however, an arthrotomy may be required to use osteochondral autograft and allograft transplantation techniques.
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Affiliation(s)
- Matthew S Conti
- Hospital for Special Surgery, Weill Cornell Medical College, 535 East 70th Street, New York, NY 10021, USA
| | - J Kent Ellington
- OrthoCarolina Foot & Ankle Institute, 2001 Vail Avenue, Charlotte, NC 28207, USA
| | - Steve B Behrens
- Hospital for Special Surgery, Weill Cornell Medical College, 535 East 70th Street, New York, NY 10021, USA.
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Kim T, Choi YR. Osteochondral lesion of talus with gout tophi deposition: A case report. World J Clin Cases 2020; 8:3814-3820. [PMID: 32953858 PMCID: PMC7479557 DOI: 10.12998/wjcc.v8.i17.3814] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 05/27/2020] [Accepted: 08/12/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Osteochondral lesion of talus is a broad term used to describe an injury or abnormality of the talar articular cartilage and adjacent bone. It arises from diverse causes, and although trauma is implicated in many cases, it does not account for the etiology of every lesion. Gout is a chronic arthritic disease caused by excess levels of uric acid in blood. Intraosseous deposition of monosodium urate in the clavicle, femur, patella and calcaneus was reported previously. Gout is common disease but rare at a young age, especially during teenage years. Osteochondral lesion caused by intra-articular gouty invasion is very rare.
CASE SUMMARY We encountered a rare case of a 16-year-old male who has osteochondral lesion of the talus (OLT) with gout. He had fluctuating pain for more than 2 years. We could see intra-articular tophi with magnetic resonance image (MRI) and arthroscopy. We performed arthroscopic exploration, debridement and microfracture. Symptoms were resolved after operation, and bony coverage at the lesion was seen on postoperative images. We had checked image and uric acid levels for 18 mo.
CONCLUSION It is rare to see OLT with gouty tophi in young adults. While it is challenging, the accuracy of diagnosis can be improved through history taking, MRI and arthroscopy.
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Affiliation(s)
- Taeho Kim
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University, Seongnam 13497, Gyeonggi-do, South Korea
| | - Young-Rak Choi
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, South Korea
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45
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Patel M, Francavilla ML, Lawrence JTR, Barrera CA, Nguyen MK, Longoria C, Nguyen JC. Osteochondral lesion of the talus in children: Are there MRI findings of instability? Skeletal Radiol 2020; 49:1305-1311. [PMID: 32306071 DOI: 10.1007/s00256-020-03436-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 03/23/2020] [Accepted: 03/30/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of our study was to investigate the performance of MRI findings to predict instability of osteochondral lesion of the talus (OLT) in children and the association between skeletal maturity and lesion stability. MATERIALS AND METHOD This retrospective IRB-approved and HIPPA-compliant study included children with OLT, who underwent an ankle MRI examination between March 1, 2011, and May 31, 2018. Blinded to the clinical outcome, 2 radiologists retrospectively assessed each MRI study for the presence or absence of various features on the articular side, along the interface, and on the subchondral side of each lesion. Regional skeletal maturity was recorded. Lesion stability was classified using clinical and surgical findings. Mann-Whitney U, Chi-square, Fisher's exact, and Cochran-Armitage tests were used to compare demographic and MRI findings between children with stable and unstable lesions. RESULTS Of the 48 ankles identified, 36 were stable (12.7 + 3.9 years) and 12 were unstable (14.2 + 1.6 years) lesions. None of the lesions presented as a detached fragment. Skeletal immaturity (p = 0.01) was significantly more common in stable than unstable lesions. No other MRI features were found to be significantly different between stable and unstable lesions, which included the presence of an effusion (p = 0.27), intra-articular body (p = 0.25), cartilage changes (p = 0.19), subchondral disruption (p = 0.51), T2-weighted signal intensity rim (p = 0.16), cysts (p = 0.48), marginal sclerosis (p = 0.70), and perilesional marrow edema (p = 0.17). CONCLUSION Results from our study suggest that previously published OCD criteria using conventional MRI are not sufficient for predicting stability of OLT in children. Regional skeletal maturity and older age were more predictive of unstable lesions.
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Affiliation(s)
- Maya Patel
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Michael L Francavilla
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - J Todd R Lawrence
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Divison of Orthopedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Christian A Barrera
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Michael K Nguyen
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | | | - Jie C Nguyen
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA. .,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
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Martin KD, McBride TJ, Horan DP, Haleem A, Huh J, Groth A, Dawson LK. Validation of 9-Grid Scheme for Localizing Osteochondral Lesions of the Talus. FOOT & ANKLE ORTHOPAEDICS 2020; 5:2473011420944925. [PMID: 35097402 PMCID: PMC8697075 DOI: 10.1177/2473011420944925] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND A 9-grid scheme has been integrated into the foot and ankle literature to help clinicians and researchers localize osteochondral lesions of the talus (OLTs). We hypothesized that fellowship-trained orthopedic foot and ankle surgeons would have a high rate of intra/inter-observer reliability when localizing OLTs, therefore validating the scheme. METHODS We queried our institution's foot and ankle radiographic database for magnetic resonance images with OLTs. Each MRI was reviewed by the senior author, and 2 key images (widest OLT diameter) from each tangential view were copied and combined onto one slide. Fifty consecutive deidentified images of ankles were then sent to 4 practicing fellowship-trained foot and ankle surgeons. Each was asked to identify which zone the OLT was localized within. A radiologist's report served as the control. Statistical analyses were performed using Cohen and Fleiss kappa tests. RESULTS The reviewers demonstrated majority consensus on 45/50 images with substantial agreement for zones 4 and 6. The interobserver reliability was moderate with a κ = 0.55. The mean intraobserver reliability was substantial, with a κ = 0.79. A musculoskeletal radiologist determined there were 3 lesions in zone 7, 18 lesions in zone 4, and 29 lesions in zone 6. CONCLUSION This study is the first to critically evaluate the 9-grid scheme and its reliability among orthopedic foot and ankle surgeons. Our study found that the 9-grid scheme is an accurate method of localization for OLTs with high intra- and moderate interobserver reliability between surgeons. LEVEL OF EVIDENCE Level IV, retrospective diagnostic study.
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Affiliation(s)
| | | | | | - Amgad Haleem
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | | | - Adam Groth
- The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Laura K. Dawson
- Colonel Florence A Blanchfield Army Community Hospital, Fort Campbell, KY, USA
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Yang J. [Micro-fracture therapy combined with intra-articular injection of platelet-rich plasma for small sized osteochondral lesion of the talus]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:53-56. [PMID: 31939235 PMCID: PMC8171839 DOI: 10.7507/1002-1892.201904093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 11/21/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To investigate the effectiveness of micro-fracture therapy combined with intra-articular injection of platelet-rich plasma (PRP) in the treatment of small sized osteochondral lesion of the talus (OLT). METHODS Between September 2014 and October 2017, 43 patients with small sized OLT met the inclusive criteria were admitted and randomly divided into micro-fracture group (21 cases) and combined group (22 cases). Patients in the micro-fracture group were treated with micro-fracture therapy, and patients in the combined group were treated with micro-fracture therapy combined with intra-articular injection of PRP. There was no significant difference in gender, age, disease duration, side of OLT, injured position, lesion area, Mintz classification, and preoperative American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hind foot score and visual analogue scale (VAS) score between the two groups ( P>0.05). After treatment, MRI, VAS score, and AOFAS ankle-hind foot score were used to evaluate the recovery of OLT and the ankle function. RESULTS All incisions healed by first intention, and no complications such as venous thrombosis and ankle joint infection occurred. All patients were followed up 12-18 months after operation, with an average of 15.6 months. The VAS scores and the AOFAS ankle-hind foot scores were significantly improved at 6 and 12 months after operation in the two groups ( P<0.05), and the scores at 12 months were significantly improved when compared with postoperative scores at 6 months ( P<0.05). Compared with the micro-fracture group, the VAS score and the AOFAS ankle-hind foot score were significantly improved in the combined group at 6 and 12 months after operation ( P<0.05). MRI showed that OLT was well filled in both groups at 12 months after operation. CONCLUSION Compared with micro- fracture therapy, micro-fracture therapy combined with intra-articular injection of PRP can effectively reduce pain, improve ankle function, and has a good effectiveness in the treatment of small sized OLT.
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Affiliation(s)
- Jinjie Yang
- Department of Orthopedics, the First Hospital of Handan, Handan Hebei, 056000,
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Song K, Wikstrom EA. Plausible mechanisms of and techniques to assess ankle joint degeneration following lateral ankle sprains: a narrative review. PHYSICIAN SPORTSMED 2019; 47:275-283. [PMID: 30739572 DOI: 10.1080/00913847.2019.1581511] [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: 12/26/2022]
Abstract
Lateral ankle sprain (LAS) is the most common lower extremity musculoskeletal injury sustained during daily life and sport. The cascade of events that starts with ligamentous trauma leads to clinical manifestations such as recurrent sprains and giving way episodes, hallmark characteristics of chronic ankle instability (CAI). The sequelae of lateral ankle sprains and CAI appear to contribute to aberrant biomechanics. Combined, joint trauma and aberrant biomechanics appear to directly and/or indirectly play a role in talar cartilage degeneration. Up to 80% of all cases of ankle osteoarthritis (OA) are post-traumatic in nature and common etiologies for ankle post-traumatic osteoarthritis (PTOA) are histories of a single and recurrent ankle sprains. Despite known links between LAS, CAI, and PTOA and evidence demonstrating the burden of LAS and its sequelae, early pathoetiological changes of ankle PTOA and how they can be assessed are poorly understood. Therefore, the purpose of this paper is to review the plausible mechanistic links among LAS and its sequelae of CAI and PTOA as well as review non-surgical techniques that can quantify talar cartilage health. Understanding the pathway from ligamentous ankle injury to ankle PTOA is vital to developing theoretically sound therapeutic interventions aimed at slowing ankle PTOA progression. Further, directly assessing talar cartilage health non-surgically provides opportunities to quantify if current and novel intervention strategies are able to slow the progression of ankle PTOA.
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Affiliation(s)
- Kyeongtak Song
- Department of Exercise & Sport Science, University of North Carolina at Chapel Hill , Chapel Hill , NC , USA.,Human Movement Science Curriculum, University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - Erik A Wikstrom
- Department of Exercise & Sport Science, University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
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Effects of Early Weightbearing on Microfracture Treatment of Osteochondral Lesions of Talus with Subchondral Bone Defects. Curr Med Sci 2019; 39:88-93. [DOI: 10.1007/s11596-019-2004-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 12/22/2018] [Indexed: 12/27/2022]
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50
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Lambers KTA, Saarig A, Turner H, Stufkens SAS, Doornberg JN, Kerkhoffs GMMJ, Jaarsma R. Prevalence of Osteochondral Lesions in Rotational Type Ankle Fractures With Syndesmotic Injury. Foot Ankle Int 2019; 40:159-166. [PMID: 30304961 DOI: 10.1177/1071100718804818] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND: The aim of this study was to report the incidence of associated osteochondral lesions (OCLs) on postop CTs, which may benefit from arthroscopic treatment, in patients with rotational type ankle fractures with syndesmotic injury. The diagnosis and treatment of associated OCLs may be an additional benefit of the use of arthroscopy in the management of rotational type ankle fractures with syndesmotic injury. METHODS: We retrospectively reviewed data of a prospective cohort study of patients who underwent open reduction and surgical fixation of an ankle fracture with syndesmotic injury. These patients underwent routine bilateral postoperative CT assessment. Two independent observers classified ankle fractures according to Weber and OCLs according to the classification system by Berndt and Harty. Fifty-nine patients were included. There were 19 (32%) Weber B type ankle fractures and 39 (66%) Weber C type fractures. One patient (2%) had fixation for a medial malleolus fracture and syndesmotic rupture without fibula fracture. RESULTS: Talar OCLs were present in 8 patients (14%). In one patient, 2 OCLs were found, which resulted in a total of 9 lesions. Two lesions were found on the medial side, both anterior. The other 7 were located laterally, of which 1 was anterior, 3 central, and 3 posterior on the talus. According to the Berndt and Harty classification, 1 was classified as stage I, 4 as stage III, and 4 as stage IV. CONCLUSION: The prevalence of OCLs in ankle fractures with syndesmotic instability was 14%. We believe that lesions were arthroscopically accessible in 6 patients (10%). Moreover, most lesions were located on the lateral dome, and thus also potentially approachable through an anterolateral arthrotomy during open reduction and internal fixation. The majority of OCLs found in this series were Berndt and Harty type III or IV, and so likely would preferably have been addressed during the index procedure. LEVEL OF EVIDENCE: Level III, diagnostic cohort study.
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Affiliation(s)
- Kaj T A Lambers
- 1 Department of Orthopaedic Surgery, Flinders University, Adelaide, Australia.,2 Department of Orthopaedic Surgery, Academic Medical Center (AMC), Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands
| | - Aimane Saarig
- 1 Department of Orthopaedic Surgery, Flinders University, Adelaide, Australia.,2 Department of Orthopaedic Surgery, Academic Medical Center (AMC), Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands
| | - Hayley Turner
- 3 Department of Radiology, Flinders University, Adelaide, Australia
| | - Sjoerd A S Stufkens
- 2 Department of Orthopaedic Surgery, Academic Medical Center (AMC), Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands
| | - Job N Doornberg
- 1 Department of Orthopaedic Surgery, Flinders University, Adelaide, Australia.,2 Department of Orthopaedic Surgery, Academic Medical Center (AMC), Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands
| | - Gino M M J Kerkhoffs
- 2 Department of Orthopaedic Surgery, Academic Medical Center (AMC), Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands
| | - Ruurd Jaarsma
- 1 Department of Orthopaedic Surgery, Flinders University, Adelaide, Australia
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