Osteochondral cylinders are harvested from lesser marginal weight-bearing areas of the knee joint and press-fitted into the prepared defect. Lesions with large cystic areas, diffuse arthritic changes, ankle malalignment, and prior history of infections are contraindications to this procedure. [37] Morphological evaluation post-retrograde drilling using second look arthroscopy showed no worsening of overlying cartilage at 1-year follow-up. The mosaicplasty technique for osteochondral lesions of the talus. [5] The sole indication for operative treatment at presentation is an acute lesion with displacement. Osteochondral autograft transfer system (OATS), Particulated juvenile cartilage allograft transfer (PJCAT), Autologous chondrocyte implantation (ACI), Matrix-induced autologous chondrocyte implantation (MACI), I: Cystic lesion at the dome with intact roof on all sides, Medial/lateral lesions, subchondral cysts. 1 Department of Orthopaedic Surgery, Academic Medical Centre, University of Amsterdam, P.O. By the mosaicplasly technique, osteochondral grafts are transplanted from areas of little weight bearing at the outer limits of the trochlca to the focal lesion in the same knee. The purpose of this study is to evaluate the outcomes of lesions treated with osteochondral allograft transplantation. This is possible due to less damage to the surrounding skin, ligaments and tendons. They are most commonly … Patients present with spectrum of non-specific complaints including of pain on weight-bearing, swelling, stiffness, and occasionally locking sensation at the ankle joint. Further sufficiently powered, randomized clinical trials with uniform methodology and validated outcome measures should be initiated to compare the outcome of surgical strategies for OCD of the talus. [19] Commonly used classifications are summarized in [Table 1]. One randomized clinical trial was identified. Osteochondral lesions are caused by trauma, osteochondritis dissecans (OCD), or osteonecrosis. These authors evaluate the effectiveness of procedures such as microfracture and arthroscopy, and recent innovations such as … Availability of fresh donor allografts and the associated cost is also a concern in developing countries. The diagnosis of cartilage damage (osteochondral lesion, also known as talar dome) is often done with x-rays and/or an MRI. High-impact activities, such as running and jumping, should be avoided until 6 to 12 months after surgery. With an MRI, the ligament structures, tendons and cartilage of the ankle can be examined and analyzed. Knee Surg Sports Traumatol Arthrosc. Clinical examination may reveal effusion at the ankle, tenderness over the talus on palpation, decreased range of motion, and pain on ankle dorsiflexion and inversion. Osteochondral lesions of the talus (OLT) are those that affect the chondral and subchondral areas of the talus. of the talus but at the cost of a hi gh rate of. Outcome. Malays Orthop J. Prognostic factors determining success of microfracture. 2016. [44] A systematic review by Richard et al. They reported favorable outcomes with 86% of patients having no pain or only mild pain, no advancement of MRI staging in 84% of patients, and no significant ankle arthritis at final follow-up, though many patients reported minor discomfort on activities of daily living and sporting activities. 2013 Jun 5;95(11):1045-54. doi: 10.2106/JBJS.L.00773. Once the piece has broken off, surgery is almost always necessary. In some rare cases, osteochondral lesions can occur for no apparent reason. [49], This is a second-generation technique that employs a collagen matrix instead of a periosteal sleeve to secure the chondrocytes. J Bone Joint Surg Am. Autologous osteochondral grafting for talar cartilage defects. -. HA is known to reduce inflammation in the joint while simultaneously substituting joint fluid. Because of the relatively high cost of ACI and the knee morbidity seen in OATS, we conclude that BMS is the treatment of choice for primary osteochondral talar lesions. Awareness of current national guidelines is important in the appropriate consenting of patients undergoing surgery. transplantation surgery fo r osteochondral lesions. [46] As cartilage tissue is immune deprived, it is also not associated with immune reactions. [3] Conservative treatment mainly consists of rest, avoiding sporting activities, cast immobilization with or without NSAIDs, and intraarticular injection of platelet-rich plasma (PRP) and hyaluronic acid (HA). Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. However, due to great diversity in the articles and variability in treatment results, no definitive conclusions can be drawn. found PRP as an adjunct to arthroscopic microfracture for the treatment of OLT resulted in improved functional score status at an average follow-up of 16.2 months. Anders et al. INTRODUCTION. Patient’s consent not required as patients identity is not disclosed or compromised. The proportion of the patient population treated successfully was noted, and percentages were calculated. Limited, Coimbatore, Tamil Nadu, Department of Orthopedics and Spine surgery. Finite Element Analysis of the Effect of Talar Osteochondral Defects of Different Depths on Ankle Joint Stability. Most of the talus is covered by cartilage. There are only a few recent studies that have reported the outcomes following non-operative management. Recommended indications include a symptomatic patient with size of the lesion at least 1.5 cm in one dimension or a patient who had a failed marrow stimulation technique. If you continue to use this site we will assume that you are happy with it. If structured rehabilitation is unsuccessful, then … Series shows the case of a 25-years-old man, a sports and physically active patient, with chronic ankle pain, a lateral talus osteochondral lesion (OCL), and chronic ankle instability. Osteochondral lesions of the talus encompass important clinical conditions encountered in day-to-day practice. [5] In 1959, Berndt and Harty were the first to describe the pathogenesis of osteochondral lesions post-trauma. [27] Toale et al. eCollection 2020 Jul. This is an US FDA approved allograft technique and was first made available in 2007 by DeNovo NT, Natural Tissue Graft (Zimmer, Inc., Warsaw. Rationale of conservative treatment is to offload the affected area for resolution of bone marrow edema and to facilitate healing of the detached cartilage. [2] Decision-making depends mainly on the stability of the overlying cartilage, size, and the containment of the lesion (shoulder and non-shoulder type lesion). [53], In summary, outcomes following surgery are variable and thus treatment strategy has to be tailored to every patient depending on specific factors. [31] The reported incidence of complication rate varies from 0 to 14% with superficial peroneal neuropathy and portal site pain cited as the most common complications. Plain radiography is the initial investigation of choice in a clinically suspected case of OLT. Background: The incidence of osteochondral lesions (OCLs) in association with displaced ankle fractures has only been examined in two previous studies. At this point the doctors in Portugal suggest surgery to fraguemento extraction and treatment of osteochondral lesion of about 12mm in size with the … There was a significantly lower cost for return to play in athletes after OAT versus microfracture at 1 year ($11,428 vs $16,953, respectively), 3 years ($12,856 vs $38,000, respectively), and 10 years ($32,141 vs $60,799, respectively). Although it still remains a 2-staged procedure, using a collagen matrix reduces the operative time and also helps in even distribution of chondrocytes. [40] A retrospective analysis of 131 patients suggested that though all patients returned to sporting activity, they engaged in fewer, less frequent sporting activities post-OATS treatment.[41]. Growth factors contained in PRP can facilitate cartilage repair by stimulating matrix formation and increasing chondrocyte proliferation. This tissue is mechanically inferior, but the results of the procedure in the short term are generally good with smaller lesion (<1.5 cm 2) [16, 22]. A history of ankle trauma/recurrent instability is to be elicited as OLT are associated with ankle instability. studied the factors influencing the results of ACI in OLT and concluded that size >137 mm2 and age <26 years to be significantly associated with better MOCART (modified magnetic resonance observation of cartilage repair tissue) scores while patients sex, depth of the lesion, and presence or absence of accompanied procedure did not affect the results of ACI in OLT. That none of the up ( dorsiflexion ) and down ( plantarflexion motion! Cartilage of the talus ( OLT ) are a well-established osteochondral lesion surgery cost within ankle... 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