A novel retrograde technique for ankle osteochodral lesions: the sub-endo-chondral regenerative treatment (secret).
Ankle arthroscopy
Biological scaffold
Cartilage
Osteochondral lesions
Retrograde drilling
Journal
Musculoskeletal surgery
ISSN: 2035-5114
Titre abrégé: Musculoskelet Surg
Pays: Italy
ID NLM: 101498346
Informations de publication
Date de publication:
Sep 2023
Sep 2023
Historique:
received:
20
09
2022
accepted:
21
10
2022
medline:
18
8
2023
pubmed:
16
11
2022
entrez:
15
11
2022
Statut:
ppublish
Résumé
To describe a new surgical technique for osteochondral lesions of the ankle, using bone marrow concentrate on a scaffold and homologous bone graft positioned through a retrograde approach. Many surgical options for ankle osteochondral lesions have been described, and the ideal treatment is still debated. Bone marrow stimulating techniques are recommended for cystic lesions, with some concerns regarding the healing potential of the subchondral bone. In case of wide osteochondral defects, regenerative solutions are preferred but a massive chondral debridement is usually required. To overcome these problems, a novel technique is proposed. The proposed technique was performed on patients affected by osteochondral lesions of the talus, either cysts with intact cartilage or wide osteochondral defects. A preoperative magnetic resonance imaging was obtained to localize the lesion. A 6-mm tarsal tunnel was retrogradely created toward the lesion, to allow a complete sub-endo-chondral debridement preserving the healthy cartilage. A hyaluronan scaffold soaked with a previously prepared bone marrow concentrate was retrogradely positioned under the cartilage surface and the tunnel was filled with homologous bone graft. Preoperative clinical scores and postoperative x-rays were registered. Four patients were treated using this technique. No intraoperative and postoperative complications occurred. Good bone remodeling was observed at 12-week postoperative x-rays. This technique combines the mini-invasiveness of retrograde drilling with the regenerative properties of biological scaffold soaked with bone marrow concentrate. Despite further research being needed, it seems a new viable solution to treat both subchondral cysts and large osteochondral defects of the ankle, whose management is still controversial.
Identifiants
pubmed: 36376751
doi: 10.1007/s12306-022-00767-6
pii: 10.1007/s12306-022-00767-6
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
337-343Informations de copyright
© 2022. The Author(s), under exclusive licence to Istituto Ortopedico Rizzoli.
Références
Wodicka R, Ferkel E, Ferkel R (2016) Osteochondral lesions of the ankle. Foot Ankle Int 37:1023–1034. https://doi.org/10.1177/1071100716654691
doi: 10.1177/1071100716654691
pubmed: 27480500
Dahmen J, Lambers KTA, Reilingh ML et al (2018) No superior treatment for primary osteochondral defects of the talus. Knee Surg Sports Traumatol Arthrosc 26:2142–2157. https://doi.org/10.1007/S00167-017-4616-5
doi: 10.1007/S00167-017-4616-5
pubmed: 28656457
Giannini S, Buda R, Battaglia M et al (2013) One-step repair in talar osteochondral lesions: 4-year clinical results and t2-mapping capability in outcome prediction. Am J Sports Med 41:511–518. https://doi.org/10.1177/0363546512467622
doi: 10.1177/0363546512467622
pubmed: 23221772
Jeong S-Y, Kim J-K, Lee K-B (2016) Is retrograde drilling really useful for osteochondral lesion of talus with subchondral cyst?: a case report. Medicine (Baltimore) 95:e5418. https://doi.org/10.1097/MD.0000000000005418
doi: 10.1097/MD.0000000000005418
pubmed: 27930520
Ikuta Y, Nakasa T, Ota Y et al (2020) Retrograde drilling for osteochondral lesion of the talus in juvenile patients. Foot ankle Orthop 5:2473011420916139. https://doi.org/10.1177/2473011420916139
doi: 10.1177/2473011420916139
pubmed: 35097373
pmcid: 8697134
Dekker TJ, Dekker PK, Tainter DM et al (2017) Treatment of osteochondral lesions of the talus: a critical analysis review. JBJS Rev. https://doi.org/10.2106/JBJS.RVW.16.00065LK
doi: 10.2106/JBJS.RVW.16.00065LK
pubmed: 28359070
Geerling J, Zech S, Kendoff D et al (2009) Initial outcomes of 3-dimensional imaging-based computer-assisted retrograde drilling of talar osteochondral lesions. Am J Sports Med 37:1351–1357. https://doi.org/10.1177/0363546509332499
doi: 10.1177/0363546509332499
pubmed: 19357106
Kono M, Takao M, Naito K et al (2006) Retrograde drilling for osteochondral lesions of the talar dome. Am J Sports Med 34:1450–1456. https://doi.org/10.1177/0363546506287300
doi: 10.1177/0363546506287300
pubmed: 16636347
Lahm A, Erggelet C, Steinwachs M, Reichelt A (2000) Arthroscopic management of osteochondral lesions of the talus: results of drilling and usefulness of magnetic resonance imaging before and after treatment. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc North Am Int Arthrosc Assoc 16:299–304. https://doi.org/10.1016/s0749-8063(00)90054-9
doi: 10.1016/s0749-8063(00)90054-9
Takao M, Innami K, Komatsu F, Matsushita T (2010) Retrograde cancellous bone plug transplantation for the treatment of advanced osteochondral lesions with large subchondral lesions of the ankle. Am J Sports Med 38:1653–1660. https://doi.org/10.1177/0363546510364839
doi: 10.1177/0363546510364839
pubmed: 20522829
Kerimaa P, Ojala R, Sinikumpu J-J et al (2014) MRI-guided percutaneous retrograde drilling of osteochondritis dissecans of the talus: a feasibility study. Eur Radiol 24:1572–1576. https://doi.org/10.1007/s00330-014-3161-6
doi: 10.1007/s00330-014-3161-6
pubmed: 24740345
Saxena A, Maffulli N, Jin A et al (2022) Outcomes of talar osteochondral and transchondral lesions using an algorithmic approach based on size, location, and subchondral plate integrity: a 10-year study on 204 lesions. J Foot Ankle Surg 61:442–447. https://doi.org/10.1053/j.jfas.2021.06.011LK
doi: 10.1053/j.jfas.2021.06.011LK
pubmed: 35249808
Giannini S, Buda R, Vannini F et al (2009) One-step bone marrow-derived cell transplantation in talar osteochondral lesions. Clin Orthop Relat Res 467:3307–3320. https://doi.org/10.1007/S11999-009-0885-8
doi: 10.1007/S11999-009-0885-8
pubmed: 19449082
pmcid: 2772930
Badekas T, Takvorian M, Souras N (2013) Treatment principles for osteochondral lesions in foot and ankle. Int Orthop 37:1697–1706. https://doi.org/10.1007/s00264-013-2076-1
doi: 10.1007/s00264-013-2076-1
pubmed: 23982639
pmcid: 3764304
Ramponi L, Yasui Y, Murawski CD et al (2017) Lesion size is a predictor of clinical outcomes after bone marrow stimulation for osteochondral lesions of the talus: a systematic review. Am J Sports Med 45:1698–1705. https://doi.org/10.1177/0363546516668292
doi: 10.1177/0363546516668292
pubmed: 27852595
Beck S, Claßen T, Haversath M et al (2016) Operative technique and clinical outcome in endoscopic core decompression of osteochondral lesions of the talus: a pilot study. Med Sci Monit Int Med J Exp Clin Res 22:2278–2283. https://doi.org/10.12659/msm.896522
doi: 10.12659/msm.896522
Nairn LN, Subramaniam M, Ekhtiari S et al (2021) Safety and early results of Subchondroplasty® for the treatment of bone marrow lesions in osteoarthritis: a systematic review. Knee Surgery, Sport Traumatol Arthrosc 29:3599–3607. https://doi.org/10.1007/s00167-020-06294-w
doi: 10.1007/s00167-020-06294-w
Hanselman AE, Cody EA, Easley ME et al (2021) Avascular necrosis of the talus after subchondroplasty. Foot ankle Int 42:1138–1143. https://doi.org/10.1177/10711007211005435
doi: 10.1177/10711007211005435
pubmed: 34024148
Krause F, Anwander H (2022) Osteochondral lesion of the talus: still a problem? EFORT open Rev 7:337–343. https://doi.org/10.1530/EOR-22-0024
doi: 10.1530/EOR-22-0024
pubmed: 35638600
pmcid: 9257727
Anders S, Lechler P, Rackl W et al (2012) Fluoroscopy-guided retrograde core drilling and cancellous bone grafting in osteochondral defects of the talus. Int Orthop 36:1635–1640. https://doi.org/10.1007/s00264-012-1530-9
doi: 10.1007/s00264-012-1530-9
pubmed: 22491802
pmcid: 3535023