Treatment strategies and outcomes for osteochondritis dissecans of the capitellum. The authors concluded that osteochondral lesions of the distal tibia most commonly occurred at the central-medial tibial plafond. 2019;8(8):e851-e854. In a systematic review, these investigators examined the topographical characteristics of OLTPs and outcomes following surgical intervention, while analyzing the level of evidence (LOE) and quality of evidence (QOE) of the included studies. Case 1: popliteal/Baker's cyst between the MHG and SM tendons, Case 3: lateral collateral ligament calcification, Case 6: parameniscal cyst and meniscal tear, Case 7: proximal tibio-fibular joint cyst, Case 8: calcific tendinitis of the medial collateral ligament (knee), shoulder (modified transthoracic supine lateral), acromioclavicular joint (AP weight-bearing view), sternoclavicular joint (anterior oblique views), sternoclavicular joint (serendipity view), foot (weight-bearing medial oblique view), paranasal sinus and facial bone radiography, paranasal sinuses and facial bones (lateral view), transoral parietocanthal view (open mouth Waters view), temporomandibular joint (axiolateral oblique view), cervical spine (flexion and extension views), lumbar spine (flexion and extension views), systematic radiographic technical evaluation (mnemonic), foreign body ingestion series (pediatric), foreign body inhalation series (pediatric), pediatric chest (horizontal beam lateral view), neonatal abdominal radiograph (supine view), pediatric abdomen (lateral decubitus view), pediatric abdomen (supine cross-table lateral view), pediatric abdomen (prone cross-table lateral view), pediatric elbow (horizontal beam AP view), pediatric elbow (horizontal beam lateral view), pediatric forearm (horizontal beam lateral view), pediatric hip (abduction-internal rotation view), iodinated contrast-induced thyrotoxicosis, saline flush during contrast administration, CT angiography of the cerebral arteries (protocol), CT angiography of the circle of Willis (protocol), cardiac CT (prospective high-pitch acquisition), CT transcatheter aortic valve implantation planning (protocol), CT colonography reporting and data system, CT kidneys, ureters and bladder (protocol), CT angiography of the splanchnic vessels (protocol), absent umbilical arterial end diastolic flow, reversal of umbilical arterial end diastolic flow, monochorionic monoamniotic twin pregnancy, benign and malignant characteristics of breast lesions at ultrasound, differential diagnosis of dilated ducts on breast imaging, musculoskeletal manifestations of rheumatoid arthritis, sonographic features of malignant lymph nodes, ultrasound classification of developmental dysplasia of the hip, ultrasound appearances of liver metastases, generalized increase in hepatic echogenicity, dynamic left ventricular outflow tract obstruction, focus assessed transthoracic echocardiography, arrhythmogenic right ventricular cardiomyopathy, ultrasound-guided biopsy of a peripheral soft tissue mass, ultrasound-guided intravenous cannulation, intensity-modulated radiation therapy (IMRT), stereotactic ablative radiotherapy (SBRT or SABR), sealed source radiation therapy (brachytherapy), selective internal radiation therapy (SIRT), preoperative pulmonary nodule localization, transjugular intrahepatic portosystemic shunt, percutaneous transhepatic cholangiography (PTC), transhepatic biliary drainage - percutaneous, percutaneous endoscopic gastrostomy (PEG), percutaneous nephrostomy salvage and tube exchange, transurethral resection of the prostate (TURP), long head of biceps tendon sheath injection, rotator cuff calcific tendinitis barbotage, subacromial (subdeltoid) bursal injection, spinal interventional procedures (general), transforaminal epidural steroid injection, intravenous cannulation (ultrasound-guided), inferomedial superolateral oblique projection, breast ultrasound features: benign vs malignant, transverse and longitudinal images of the quadriceps tendon from its myotendinous junctions to its attachment on the superior patella (rectus femoris myotendinous junction is more cranial than the vastus junctions), evaluate the suprapatellar and parapatellar joint recesses, suprapatellar recess interdigitates between, distension representing likely effusion, most sensitive region, extent of the medial/lateral suprapatellar recess should also be visualized, useful for examination of the trochlear cartilage, tendon should be constant in size and echogenicity through its course without detectable, anisotropy may falsely indicate a change in echogenicity, tendon may appear enlarged just prior to insertion, small amount of fluid in the deep infrapatellar bursa is normal, normally no fluid in the superficial infrapatellar bursa, evaluate the distal iliotibial band in long axis (located between the anterior and middle third of the lateral knee), may see lateral meniscal pathology (e.g. Reference article, Radiopaedia.org (Accessed on 11 Dec 2022) https://doi.org/10.53347/rID-32993. Patellar chondral defects had a median size of 180 mm2 (range of 64 to 250 mm2), and patients received a median of 1 autograft (range of 1 to 3). The authors stated that this review had several drawbacks. Management of osteochondral injuries of the knee. These researchers examined therapeutic options, failure rates, and provided strategies for successful revision surgery. McCormick F, Yanke A, Provencher MT, Cole BJ. A radiograph, bone scan, and MRI are found in Figures A-C, respectively. Biologic augmentation has been increasingly studied as an adjunct in the surgical treatment of osteochondral defects of the knee in animal and human models. Fresh osteochondral patellar allograft resurfacing. What is the most appropriate definitive treatment? Struckmann and associates (2020) stated that talar osteochondral lesions (OCLs) lead to progressive stages of talar destruction. The proportion of the patient population treated successfully was noted, and percentages were calculated. Failure to correct hindfoot valgus. Bone graft substitutes in sports medicine. Core decompression with cancellous bone grafting (CBG) is a common treatment for Berndt and Harty stages II and III. Ma HL, Hung SC, Wang ST, et al. No studies reported elbow scores or ROM for non-operatively treated patients. The current studies about ACT of the talus show a stable repair of the defect with mostly hyaline-like cartilage and high patient satisfaction. 2016;24(4):1293-1298. Coalition resection and interposition of extensor digitorum brevis . A clinical photograph and radiograph are provided in Figures A and B. Coleman block testing demonstrates correction of the deformity. The radiological analysis of pes cavus deformity in Charcot Marie Tooth disease. First, the mean MINORS score of 7.6 revealed that the included studies were of limited quality. These researchers reviewed the current knowledge on donor site morbidity after an OAT or an ACI. [14], The term pes cavus encompasses a broad spectrum of foot deformities. 2016;5(5):e965-e970. The short-term (6 months) clinical results were encouraging: the HOOS score improved clearly and the patient was satisfied. 10 degrees plantarflexion, 0-5 degrees hindfoot valgus, 5-10 degrees external rotation. Synthetic bone void fillers can be categorized into 3 groups: Guney and co-workers (2016) compared medium-term functional effects of 3 different treatment modalities in patients with osteochondral lesions of the talus (OLT). In a large-scale, systematic review and network meta-analysis, Zamborsky and Danisovic (2020) examined the most appropriate surgical interventions for patients with knee articular cartilage defects from the level I randomized clinical trials. This reveals an abnormal connection between which two bones, and what is the next step in treatment? right: 30px; Some small series of clinical applications of this procedure for advanced OCD of the humeral capitellum, with short-term follow-up, have been reported; however, longer-term outcomes remained unclear. Included in this review were 10 articles, all published in 2000 or later. Azam and colleagues (2018) evaluated the functional and radiological outcome of TruFit plugs; they retrospectively reviewed 10 patients who underwent treatment for a symptomatic chondral/osteochondral lesion using 1 or more Trufit Plugs. One of the smaller RCTs reported no significant differences in the Meyer score. A total of 61 studies including 2,347 talar OCDs were included. Technique of osteochondral autograft transplantation mosaicplasty for capitellar osteochondritis dissecans. Orthopedics. Foot & Ankle International. Moreover, these researchers stated that with results of this technique limited to small case series and retrospectively collected data, studies that prospectively identify patients with isolated chondral defects that are followed longitudinally are needed to examine the effectiveness of this technique. For larger lesions (greater than 4 cm(2)), ACI or OCA have shown the best results, with OCA being an option for large osteochondritis dissecans lesions and post-traumatic defects. Olympia, WA: Washington State Health Care Authority; October 17, 2011. Autologous chondrocyte transplantation in the ankle joint. Osteochondral autotransfer -- newer treatment for chondral defects. Gracitelli et al (2015) stated that the treatment of patella-femoral cartilage injuries can be challenging. Knee Surg Sports Traumatol Arthrosc. Fourth, the most reported clinical outcome in the included studies was the AOFAS. This study included consecutive patients who underwent OAT for advanced stage Freiberg disease and were followed post-operatively for more than 5 years. Knee Surg Sports Traumatol Arthrosc. 510(k) summary: Mosaicplasty system. list-style-type: lower-alpha; Clin Genet 1974; 6: 98-118, Shy ME, Blake J, Krajewski K, Fuerst DR, Laura M, Hahn AF, Li J, Lewis RA, Reilly M. Reliability and validity of the CMT neuropathy score as a measure of disability. No. Knee Surg Sports Traumatol Arthrosc. The average age was 31 years (range of 15 to 45 years), including 12 females and 7 males. MF surgery plus platelet-rich plasma (PRP) (n = 22), and, ACC embedded in fibrin glue (n = 12), and. The Kaplan-Meier method was used for construction of a survival functions plot for the event "failure". 80% (743/925) 3. Pes cavus commonly features a varus (inverted) hindfoot, a plantarflexed position of the first metatarsal, an adducted forefoot, and dorsal contracture of the toes. Factors considered influential in the development of pes cavus include muscle weakness and imbalance in neuromuscular disease, residual effects of congenital clubfoot, post-traumatic bone malformation, contracture of the plantar fascia, and shortening of the Achilles tendon. Jones Z, Brooks AE, Ferrell Z, et al. RTS rates were reported in 2 treatment groups: BMS showed an RTS rate of 86 % (95 % CI: 42 % to 100 %) without specified levels and an RTS rate to pre-injury level of 43 % (95 % CI: 10 % to 82%). Vundelinckx et al (2012) reported that under arthroscopic control and guided by fluoroscopy, a TruFit Plug was successfully implanted to repair an osteochondral lesion of the head of the femur. An institutional review board (IRB)-approved OCA database was used to identify 27 patients (28 knees) who underwent isolated OCA transplantation of the patella between 1983 and 2010. Chen et al (2020) stated that with an increase in single-sport specialization, elbow injuries have become increasingly common in the pediatric and adolescent population; and OCD of the elbow frequently requires intervention yet can be difficult to treat given high patient activity demands. 2009;37 Suppl 1:148S-155S. Animal studies and subsequent clinical trials have demonstrated the survival of transplanted hyaline cartilage. Guidelines from the American College of Rheumatology on management of osteoarthritis (OA) of the hip and knee state that autologous osteochondral plugs (mosaicplasty) is being investigated for repair of focal chondral defects, but that this procedure is "not currently indicated in the treatment of patients with OA" (Altman et al, 2000). Matricali et al (2010) stated that in order to perform an osteochondral autologous transplantation (OAT) or an autologous chondrocyte implantation (ACI), the integrity of healthy intact articular cartilage at a second location needs to be violated. Treatment is either immobilization or surgery depending on location of fracture, degree of displacement, and athletic level of patient. Although data were prospectively collected through an institutional registry, analysis was carried out retrospectively, introducing various confounders. CT NCAP (neck, chest, abdomen and pelvis), left ventricular systolic and diastolic function, ultrasound-guided musculoskeletal interventions, gluteus minimus/medius tendon calcific tendinopathy barbotage, lateral cutaneous femoral nerve of the thigh injection, common peroneal (fibular) nerve injection, metatarsophalangeal joint (MTPJ) injection. The authors concluded that OAT provided favorable outcomes for centralized and lateral localized elbow OCD lesions; however, for lateral widespread OCD lesions, reconstruction of the entire capitellar lesion area may be necessary. 2012;40(6):1289-1295. Mosaicplasty for the treatment of articular defects of the knee and ankle. No. 2006;24(6):1261-270. However, these patients had lower clinical outcomes, which were represented by the lower functional outcomes in this study. "Although preliminary reports" of autogenous osteochondral transplantation (OATS or mosaicplasty) "appear favorable, only limited outcome data are available on this technology.". Hindfoot valgus. A prospective, comparative trial. By contrast, surgical treatment should be considered if there is no radiographic improvement within 3 months. A 2- to 4-year follow-up study. The authors concluded that ACC transplant resulted in improved quality of cartilage repair tissue compared with MST at 6 months post-operatively. [citation needed], People with pes cavus sometimesthough not alwayshave difficulty finding shoes that fit and may require support in their shoes. 3% (64/2482) 4. Patients were prospectively followed using validated clinical outcome measures including Veterans RAND 12-item Health Survey (VR-12), IKDC, KOOS, and the Tegner activity scale. Bekkers JE, Inklaar M, Saris DB. For comparisons with ACI, three poor quality RCTs in general (older) populations reported functional outcomes. Wyland DJ, Beicker C. Osteochondral autograft transfer technique for glenoid osteochondral defect. The authors concluded that TruFit failed to restore the normal MRI aspect of the subchondral bone and lamina in most cases. Neurology 2005; 64: 12091214, Manoli A, Graham B. Fresh osteochondral allograft transplantation for isolated patellar cartilage injury. This proposed method provides a novel and effective means for the repair of large articular osteochondral defects. The above policy is based on the following references: Last Review Clin Orthop Relat Res 1983; 181: 52-63, Coleman SS, Chesnut WJ. These investigators performed a PubMed-based literature search about the combination of cartilage restoration principles. The use of a sliding hip screw construct has been shown to have what benefit compared to multiple cannulated screws? AP + lateral of foot. The authors concluded that the findings of this systematic review indicated that OLTPs were frequently preceded by ankle trauma and were often associated with co-existing osteochondral lesions of the talus. Of 18 patients with restricted elbow motion pre-operatively, 13 had achieved full ROM (p = 0.10). If treatment failure does occur and patient compliance/post-operative rehabilitation has been optimized, aggressive cartilage restoration with OATS and recognition of pathologic alignment with osteotomy as needed, along with treatment and identification of radial head and ligamentous pathology, are paramount. Chin J Traumatol. 77. Ipsilateral midfoot and/or hindfoot degenerative changes. 2007;32(9):1454-1461. Lin et al (2020) noted that fresh OCA has good outcomes in the knee; however, donor tissue for patellar OCA is limited. At 12 months of follow-up, the mean VAS score was reduced from 6.6 2.5 pre-operatively to 4 1.9 in the CBG group and from 5.2 2.9 pre-operatively to 1 1.1 in the MFC group (p < 0.001). J Pediatr Orthop 2000; 9: 137-40, Barrie JL, McLoughlin C, Robem N, Nuttal R, Lishman J, Wardle F, Hopgood P. Ankle instability in pes cavus. As with certain cases of flat feet, high arches may be painful due to metatarsal compression; however, high arches particularly if they are flexible or properly cared-formay be an asymptomatic condition. 2001;18(3):495-513. Nonunion. The patient was re-admitted after 4 weeks to undergo a procedure using the Osteochondral Autograft Transfer System (OATS) and the J-TEC autologous cultured cartilage (JACC) system. Hallux Valgus Hallux Varus DJD & Hallux Rigidus occurs with forefoot fixed and hindfoot or leg rotating. Patient ages ranged from 10 to 45 years. Multiple osteochondral arthroscopic grafting (mosaicplasty) for cartilage defects of the knee: Prospective study results at 2-year follow-up. MRI scans obtained at a mean of 11.4 months (range of 6 to 22 months) post-operatively showed a mean total OCAMRISS score of 9.0 (range of 7 to 11); mean bone, cartilage, and ancillary sub-scores were 2.6, 3.7, and 2.6, respectively. She notices it immediately on getting out of bed in the morning, but the pain improves after a few steps. Case Rep Orthop. The ACC group had significantly higher ICRS II scores for tissue morphological characteristics, matrix staining, cell morphological characteristics, surface assessment, mid/deep assessment, and overall assessment (p < 0.05). This Clinical Policy Bulletin may be updated and therefore is subject to change. Knee ultrasound is somewhat limited compared with ultrasound examinations of other joints because the cruciate ligaments and the entirety of the meniscus are usually difficult to visualize. Washington State Health Care Authority, Health Technology Assessment Program. Cost and health status analysis after autologous chondrocyte implantation and mosaicplasty:A retrospective comparison. Although the demographic information collected pre-operatively did not differ between the overall cohort and separate clinical and MRI groups, other possible confounders may have influenced the results of the intervention: history of patellar instability, activity level, sports participation, smoking status, or post-operative compliance with rehabilitation protocols. Synthetic resorbable polymers (eg, PolyGraft, TruGraft granules, and TruFit plugs) are polymer scaffolds that are being proposed for the repair of osteochondral articular cartilage defects. 96(3):205-11, 2006, Wegener C. Burns J. Penkala S. Effect of neutral-cushioned running shoes on plantar pressure loading and comfort in athletes with cavus feet: A crossover randomized controlled trial. Autologous osteochondral grafting for talar cartilage defects. 2015;23(5):531-537. A stable lesion has the potential to be healed with conservative treatment. The authors noted that mosaicplasty and osteochondral autograft transplantation may cause donor site morbidity and are techniques little reported in JODT. Correlation between size of the treated chondral defect and functional scores was also analyzed. #backTop { The authors concluded that multiple surgical treatments were used for talar OCDs after primary surgical failure. Treatment of osteochondral lesions of the talus in the skeletally immature population: A systematic review. Long-term improvement in clinical and radiographic outcomes of PRP-augmented scaffolds was demonstrated in 1 human study. The authors concluded that ACI must be viewed as a complementary procedure to osteochondral transplantation; and this hybrid technique appeared to be a promising surgical approach and therapeutic option for large cartilage lesions, especially in the younger population. Diagnosis is made with orthogonal radiographs of the tibia with CT scan often required to assess for intra-articular extension. In general, treatment of articular defect of the knee by mosaicplasty entails transplantation of small cylindrical osteochondral grafts (4 to 10 mm in diameter, 15 to 20 mm deep) from the less weight-bearing periphery of the femoral condyles at the level of the patello-femoral joint, and transplanting them in a mosaic-like fashion into a prepared defect site on the weight-bearing surfaces of the same knee. trips and falls onto his right arm. Bobic V. Arthroscopic osteochondral autograft transplantation in anterior cruciate ligament reconstruction: A preliminary clinical study. Despite the recent advances in ortho-biologic adjuncts, there is no single gold-standard surgical approach to this difficult-to-treat pathology in patients who are frequently young, active, and demanding on their bodies. ), BMI (n.s. Upper extremity physical exam reveals no neurologic deficits, and an initial radiograph of the shoulder is shown in Figure A. Patient demographics, osteochondral lesion and graft characteristics, the number of patients, and timing of return to competitive activity were collected and evaluated. Lin KM, Wang D, Burge AJ, et al. ISBN:1455738182. Talar neck fractures are high energy injuries to the hindfoot that are associated with a high incidence of talus avascular necrosis. In case of large or multi-focal lesions, it is possible to consider an osteochondral transplantation of the entire articular surface of the patella. 2005;21(9):1066-1075. } Subjects included 28 men and 12 women; median age of 32 years; range of 18 to 48 years. Arthroscopic examination revealed that the osteochondral cores became well integrated with the surrounding cartilage. The authors concluded that osteochondral lesions of the elbow in the pediatric and adolescent population remain difficult entities to treat for the orthopedic surgeon. Complete obliteration of the ankle joint space with bone-on-bone contact; valgus ankle alignment. 2014;21(4):827-832. Curr Rev Musculoskelet Med. [2], In the pes calcaneocavus foot, which is seen primarily following paralysis of the triceps surae due to poliomyelitis, the calcaneus is dorsiflexed and the forefoot is plantarflexed. Your next step in management should consist of: text-decoration: line-through; Pareek A, Reardon PJ, Maak TG, et al. The authors concluded that the findings of this retrospective analysis of prospectively collected registry data suggested that use of femoral condylar donor tissue for treatment of patellar chondral lesions produced good short-term clinical and MRI outcomes. Pes cavus is a multiplanar foot deformity characterised by an abnormally high medial longitudinal arch. 2006;36(10):739-750. Patient outcome scores (Short Form 36 [SF-36] and Knee injury and Osteoarthritis Outcome Score [KOOS]), demographics, prior surgeries, and data from a physical examination were collected at baseline (before implantation) and at 6, 12, and 24 months after surgery. color: red!important; Gelber et al (2014) evaluated the relationship between MRI findings and functional scores of patients with osteochondral lesions of the knee treated with TruFit. 2019;7(10):2325967119876238. Isolated dorsal malunion. margin-top: 38px; Re-operation rate for implant failure at final follow-up was 70 %. Associated conditions. Biomechanical examination confirmed that the neocartilage possessed properties similar to those of normal cartilage. 2018;102(2):191-199. Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. The assessment of the time to return to athletic competition was limited because of variable surgical technique, post-operative rehabilitation protocols, and outcome assessment. The mean body mass index (BMI) was 26.8; 36 articular cartilage lesions were due to trauma, 26 due to osteochondritis dissecans and 3 due to non-specific degenerative change or unknown. Verhaegen J, Clockaerts S, Van Osch GJ, et al. In pes planovalgus there is flattening of the medial longitudinal arch of the foot along with the excessive hindfoot valgus. In a systematic review, these researchers examined the effectiveness of different surgical modalities and non-operative treatment of OCD as assessed by radiological and clinical outcomes and return to sports. These researchers presented the findings of a 19-year old man who sustained a traumatic antero-lateral femoral condyle osteochondral fracture and underwent arthroscopic knee surgery 3 months after injury to harvest healthy cartilage to be sent to the Japan Tissue Engineering Co., Ltd. (J-TEC) for cartilage culture. Hardware failure. Logli AL, Leland DP, Bernard CD, et al. The hallux valgus angle (HVA) is measured at 31 degrees and the intermetarsal angle(IMA) is measured at 16 degrees. Bugelli G, Ascione F, Dell'Osso G, et al. The re-operation rate was 21.1 % and 2 patients (12.5 %) experienced progressive patella-femoral OA requiring conversion to patella-femoral arthroplasty. The authors separately screened the articles for eligibility and conducted the quality assessment using the MINORS. Shimada K, Yoshida T, Nakata K, et al. Bae DS, Ingall EM, Miller PE, Eisenberg K. Early results of single-plug autologous osteochondral grafting for osteochondritis dissecans of the capitellum in adolescents. Washington State Health Care Authority, Health Technology Assessment Program. The MRI scans in the CBG group demonstrated 9 partial mal-perfusions and 1 hyper-vascularized bone graft, whereas the MFC group had 8 well-vascularized grafts incorporated into the talus and 1 partial mal-perfusion. In addition, there arelimited studies comparing the results of mosaicplasty with other established procedures. results. Three main types of pes cavus are regularly described in the literature: pes cavovarus, pes calcaneocavus, and pure pes cavus. Treatment outcomes were evaluated by the JOA score, elbow ROM, and radiographic findings. A prospective, randomised comparison of autologous chondrocyte implantation versus mosaicplasty for osteochondral defects in the knee. Most patients were male (88.4 %), and the mean SD age was 28.5 9.7 years. 2008;39 Suppl 1:S32-S39. Koulalis D, Schultz W, Heyden M, Konig F. Autologous osteochondral grafts in the treatment of cartilage defects of the knee joint. This was a small study (n = 35 for TruFit) with short-term follow-up (median of 22 months for TruFit). The most common donor sites are the areas of the knee or ankle (on the same side). Defect characteristics were collected during implantation. foot collapse) can be distinguished from congenital pes planus by carefully assessing the calcaneus and midtarsal joint: 6 2017;25(5):321-329. Another drawback of this study was due to lack of a good salvage therapeutic option for young patients regarding patella-femoral arthritis. list-style-type: upper-roman; The majority of studies are in populations less than 50 years of age. (OBQ17.175) A 22-year-old collegiate football player presents with persistent left lateral ankle pain 6 months after sustaining an ankle sprain during a game. Arthroscopic debridement/loose body removal can be carried out for small lesions (less than or equal to 1.2 cm in diameter). Kirsch et al (2016) stated that OCD of the capitellum is a painful condition, which often affects young throwing athletes. In fact, Brophy et al (2017) discussed the necessity of concurrent operations in their review of patella-femoral compartment cartilage restoration options. Clinical outcomes, including elbow ROM, Timmerman and Andrews clinical rating score, donor-site morbidity, responses to a questionnaire regarding a return to sporting activities, and radiographic findings, were evaluated. Of the 13 patients with greater than 6 months follow-up, 9 patients (69 %) had returned to their primary sport (p = 0.27) and 100 % had returned to general sports participation. There was no significant difference between classic autologous chondrocyte implantation (success rate of 59 % [CI: 39 % to 77 %]) and matrix-associated chondrocyte implantation (success rate of 73 % [CI: 56 % to 85 %]). Reconstruction with an osteochondral autograft for advanced osteochondritis dissecans of the elbow. Arthroscopy. Copyright Aetna Inc. All rights reserved. Ipsilateral midfoot and/or hindfoot degenerative changes. Furthermore, the mean time to failure was significantly shorter (p < 0.001) in the MFX group, 4.0 years (SD 4.1) compared with the OAT group, 8.4 years (SD 4.8). All studies documented greater than 95 % follow-up for clinical outcome measures. 25% list-style-type: decimal; An attempt at reduction in the emergency department is unsuccessful. soft-tissue procedures (e.g. The RTS rate, with and without associated levels of activity, and the mean time to RTS were calculated per study. Kim J, Magno MH, Ortiz O, et al. Capitellar OCD lesions afflict a large number of adolescent athletes today and will likely continue increasing in number from sports-related injuries. Because of the low level of evidence and the scarce number of patients, no methodologically proper meta-analysis could be performed. Moreover, they stated that further prospective, mid-term and long-term follow-up studies are needed to corroborate these findings, but this study provided promising results for treating surgeons. margin-bottom: 38px; Sports Med Arthrosc. foot collapse) can be distinguished from congenital pes planus by carefully assessing the calcaneus and midtarsal joint: 6 Currently available techniques to treat large or unipolar chondral defects of the patella include ACI and OAT. His initial lateral radiograph is shown in Figure A. trips and falls onto his right arm. Bobic (1996) reported the results of a case-series study (n = 12) regarding the use of OATS in patients with ACL-deficient knees. [16] Radiological analysis of pes calcaneocavus reveals a large talo-calcaneal angle. Pes cavus commonly features a varus (inverted) hindfoot, a plantarflexed position of the first metatarsal, an adducted forefoot, and dorsal contracture of the toes. 5th metatarsal base fractures are common traumatic fractures among athletic populations that are notorious for nonunion due to tenuous blood supply. Objective [median change (IQR) = 5 degrees (0 to 15 degrees)], subjective [25 degrees (15 to 40 degrees)], and overall [35 degrees (15 to 45 degrees)] Timmerman scores improved significantly (p = 0.001, p < 0.001, and p < 0.001, respectively). The chondrocytes outgrown into 3-D scaffolds also formed cartilage-like tissue when implanted in mice homozygous for the scid mutation (SCID mice). [25], "Clawfoot" redirects here. Fractures, ligamentous lesions, and cartilaginous damage are often associated. [2], Foot pain in people with pes cavus may result from abnormal plantar pressure loading because, structurally, the cavoid foot is regarded as being rigid and non-shock absorbent and having reduced ground contact area. The authors concluded that the findings of this study demonstrated significantly better outcomes using 2 validated outcome scores (KOOS, EQ-5D), and an ability to return to sport in those undergoing autologous mosaicplasty compared to those receiving TruFit plugs. 5th metatarsal base fractures are common traumatic fractures among athletic populations that are notorious for nonunion due to tenuous blood supply. The LOE and QOE of the included studies were assessed using a 5-level grading system and the modified Coleman Methodology Score, respectively. 1. Donor site morbidity was described mostly considering a clinical outcome, both in a qualitative (parameters in history or physical examination) and/or quantitative way (knee status reported by means of a numerical score). An angle greater than 4 convex upward is considered pes cavus. Maruyama M, Takahara M, Satake H. Diagnosis and treatment of osteochondritis dissecans of the humeral capitellum. Both these studies included substantial proportions of participants who had prior surgeries (94% and 45% respectively). OCA plugs were obtained from the FCA at its trochlear-condylar junction and implanted into the recipient patellar lesion. Patients undergoing autologous mosaicplasty had a higher rate of returning to sport (p = 0.006), lower EQ-5D pain scores (p = 0.048) and higher KOOS activities of daily living (p = 0.029) scores. In the OAT group, the survival rate stayed higher than 80 % for the first 7 years, and higher than 60 % for 15 years, while the survival rate dropped to less than 80 % within 12 months, and to less than 60 % within 3 years in the MFX group, log rank (Mantel-Cox) 20.295 (p < 0.001). Prepared by Spectrum Research for the Washington State Health Care Authority, Health Technology Assessment Program. Which congenital condition most likely contributed to the development of the current foot deformity? 10 degrees plantarflexion, 0-5 degrees hindfoot valgus, 5-10 degrees external rotation. However, in a subset of patients, talar re-vascularization may fail. Three 4.75-mm osteochondral cylindrical cores were harvested from non-weight-bearing areas of the knee and were transplanted to the lateral periphery of the lateral femoral condyle defect. Talar tilt deformity. Closed reduction is performed but the elbow is Azam A, Forster M, Robertson A. 4% (162/4569) 4. These investigators stated that patellar allografting was a useful salvage therapeutic option for patellar cartilage injuries. J Hand Surg [Am]. Patellar fresh osteochondral allograft transplantation. Prospective outcomes of cryopreserved osteochondral allograft for patellofemoral cartilage defects at minimum 2-year follow-up. Ten months later, he returns complaining of limited range of motion and continued pain. Orthop J Sports Med. Ipsilateral midfoot and/or hindfoot degenerative changes. Orthop J Sports Med. Ten months later, he returns complaining of limited range of motion and continued pain. Which of the following is not a contraindication to hyperbaric oxygen treatment for this patient? outline: none; A total of 21 studies (299 patients with 301 talar OCDs that failed primary surgery) were examined; 8 studies were retrospective case series, 12 were prospective case series and there was 1 RCT. These investigators carried out a literature search to find studies published from January 1996 till July 2016 using PubMed (Medline), Embase, CDSR, DARE and CENTRAL. RTS times were not given for any therapeutic option. 2009;29(7):741-748. Although the technique is not technically demanding, the use of fresh allografts carries considerable logistics limitations. These researchers presented a case where they spontaneously covered an acute cartilage defect, which was significantly larger than expected and loose during initial arthroscopic inspection after reading pre-operative MRI, by mincing the separated fragment and directly implanting the autologous cartilage chips into the defective region. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. 2003;85-A(2):185-192. Rockville, MD: FDA; August 9, 1996. 2020;11(1):71-76. Two to4 years follow-up of these patients showed 80 % good or excellent clinical results. Int Orthop. Physical examination demonstrates full 1st metatarsalphalangeal (MTP)joint dorsiflexion and plantarflexion with a deformity that passively corrects. In pes planovalgus there is flattening of the medial longitudinal arch of the foot along with the excessive hindfoot valgus. In 8 patients, a durable load-bearing elbow was obtained with this procedure, which made hyaline-like cartilage resurfacing with healthy subchondral bony support possible. (OBQ19.222) 47-year-old female falls while mountain biking and presents to the emergency department with the injury shown in Figures A and B. 2017;33(7):1412-1420. These researchers stated that OAT is a good alternative to treat high-grade patellar chondral defects, especially among young patients. Imaging. Lu and colleagues (2006) stated that traumatic articular cartilage injuries heal poorly and may predispose patients to the early onset of osteoarthritis. Careful counseling in regard to participation in post-operative high-demand activity is critical. Furthermore, OAT showed significantly more poor results than MACI at 1-year follow-up. Colvin AC, West RV. The patient's radiograph is shown in figure A. The median duration of follow-up was 42 months (range of 12 to 84). Radiological evaluation was performed at 2 years after the operation. 2021;9(11):23259671211029208. The average percentage of radio-capitellar congruity was 35.7 % before surgery and improved to 64.2 % at follow-up. The mean pre-operative IKDC score was 47.2 +/- 14.0 and improved to 74.4 +/- 12.3 (p = 0.028). Easley and Scranton (2003) stated that long-term outcome of the OATS procedure for osteochondral lesions of the talus is not yet available. Ultrasound of the knee allows high-resolution imaging of superficial knee anatomy while simultaneously allowing dynamic evaluation of some of the tendons and ligaments. 1% (43/3432) 5. Hardware failure. Bartha L, Vajda A, Duska Z, et al. Wyland and Beicker (2016) stated that glenoid osteochondral defects can be a significant source of pain and disability in an active population. In a retrospective, case-series study, these researchers examined clinical and imaging results of patients treated with OAT for high-grade patellar defects. Acquired pes planus (i.e. 1% (21/2534) 3. An osteochondral defect is any type of damage to articular cartilage and underlying (subchondral) bone. Aurich and colleagues (2008) noted that ankle sprains are one the most common injuries of the lower limb. Magnetic resonance imaging appearance demonstrated that all plugs demonstrated good (67 % to 100 %) cartilage fill, 64 % with fissures greater than 2 mm at the articular cartilage interface, 71 % with complete trabecular incorporation, and 71 % with flush plug appearance. There are multiple possible approaches to imaging the knee with ultrasound. [1][2] Avulsion fractures can occur in any area where soft tissue is attached to bone. Lyons ML, Werner BC, Gluck JS, et al. Figueroa D, Rodriguez RC, Donoso R, et al. Talar tilt deformity. Sports Health. Nho SJ, Foo LF, Green DM, et al. These researchers used the modified Merle dAubigne-Postel (18-point) scale; however, this scoring system has not been validated in the knee. A lateral radiograph of the foot is shown in Figure A. 2003;85(2):223-230. [20][21] Other non-surgical rehabilitation approaches include stretching and strengthening of tight and weak muscles, debridement of plantar callosities, osseous mobilization, massage, chiropractic manipulation of the foot and ankle, and strategies to improve balance. The authors stated that this study had many important drawbacks. Most autografts showed good osseous integration and excellent filling of the chondral surface, as evidenced on MRI. A large knee osteochondral lesion treated using a combination of osteochondral autograft transfer and second-generation autologous chondrocyte implantation: A case report. All 3 patients were treated with transplantation of an osteochondral autograft harvested from the lateral femoral condyle. They carried out a review of all treatment studies published between January 1975 and June 2020 following the PRISMA guidelines. 2016;2016:1498135. Unique and customized search strategies were formulated in PubMed, Embase, Scopus, Web of Science, and CENTRAL. Her AP radiograph is shown in Figure A. There is currently insufficient evidence to support the safety and effectiveness of synthetic resorbable polymers as an alternative to allograft or autograft for the repair of osteochondral defects. Clin Sports Med. A total of 25 patients were included for clinical outcome analysis and 20 patients for MRI analysis. Non-operative treatment includes physical therapy, focusing on strengthening of the gluteal muscles and the vastus medialis obliquus, and patellar taping or bracing. In 17 of the studies, a total of 46.9 % of OLTPs were associated with co-existing osteochondral lesions of the talus. Onstott AT, Moczo A, Harris NL. Case reports and reports based on expert opinion were excluded. Pichon-Riviere A, Augustovski F, Alcaraz A, et al. {"url":"/signup-modal-props.json?lang=us\u0026email="}, Morgan M, Patel M, Patel M, et al. A total of 43 articles from the initial literature search were found to be relevant for this review. Thus, not all studies could be taken into account when calculating the RTS rate and the mean time to RTS, which rendered the results of return to pre-injury level and mean time to RTS under-reported and subsequently left a possibility for the results being subject to reporting bias. Recent data on patient-reported outcomes following OAT for the treatment of large osteochondral lesions of the capitellum have been promising but limited. Medical examinations using ultrasonography (US) found that the prevalence of capitellar OCD among adolescent baseball players was approximately from 1 % to 3 %. Int J Technol Assess Health Care. The long-term failure rate (62 % overall) was significantly higher in the MFX group (66 %) compared with the OAT group (51 %, p = 0.01). Findings and Decision. Of 4 histologic scaffold studies, 3 PRP-augmented scaffold studies identified histologic improvements in regenerated cartilage in animal models, while 1 BMC study demonstrated similar improvement in histologic scores of BMC-augmented scaffolds compared with controls; 3 studies associated greater collagen type 2 and glycosaminoglycan content with PRP treatment. Hindfoot Talar Neck FX Talus Fracture (other than neck) varus or valgus force usually disrupted PLC and PCL. Plain radiograph. 2018;27(12):2262-2270. The overall clinical score-based assessment was excellent for 60 patients, good for 9, and fair for 3; 70 of the 72 patients returned to their original sport. Orthopade. Ultrasound of the knee. Outcomes were evaluated at 12 and 24 weeks following surgery. In a review on management of osteochondral injuries of the knee, Alleyne and Galloway (2001) stated that the management of articular cartilage lesions has yet to reveal a "right answer", and that long-term follow-up studies of all of the techniques reviewed are needed to give definitive answers about the durability of the repaired and transplanted tissues. Adult acquired flatfoot deformity (AAFD) is a complex pathology defined by the collapse of the medial longitudinal arch of the foot with continued progressive deformity of the foot and ankle 5.It combines multiple static and dynamic deformities, with flattening of the medial arch, eversion of calcaneus, and abduction of forefoot relative to the hindfoot 9. Am J Sports Med. Radiologic success rates based on computed tomography (CT) scans were 62 % (95 % CI: 32 % to 86 %) (n = 13) in the conservative group, 30 % (95 % CI: 7 % to 65 %) (n = 10) in the BMS group, 57 % (95 % CI: 25 % to 84 %) (n = 7) in the RD group, and were not reported for the fixation and the osteo(chondral) transplantation groups. Outcome measures obtained included return-to-play, pre-operative and post-operative elbow ROM, Disabilities of Arm, Shoulder and Hand (DASH; Institute for Work and Health, Toronto, ON, Canada) by telephone interview, and osseous integration on radiographs. hr.separator { Clinical success rates were calculated per separate study and pooled per treatment strategy. 2016;104(8):1632-1642. Case history of a patient with low back pain and cavus feet. 25% --> The mean reported time for unrestricted return to athletic competition after OAT was 5.6 months (range of 3 to 14 months). Plain radiograph. Autologous chondrocyte implantation is not available in every country. (OBQ13.246) A 27-year-old male motorcyclist suffers a crash sustaining an isolated right distal humerus fracture. /* aetna.com standards styles for templates */ He recalls catching his foot on astroturf with a dorsiflexion and inversion moment about his ankle. They carried out a literature search using the PubMed, Embase, and CINAHL databases for studies on lesion locations or with imaging or treatment outcomes of OLTPs. A post-reduction radiograph is seen in Figure C. Which of the following is the most appropriate treatment at this time? 2008;36(9):1770-1778. The appearance of the chondral layer in MRI was partially re-established. Pes cavus is a multiplanar foot deformity characterised by an abnormally high medial longitudinal arch. All 11 patients were available for evaluation at an average of 22.7 months (range of 6 to 49 months) post-operatively. Calcaneovalgus. Burns J. Crosbie J. The authors concluded that as with other glenoid cartilage restoration or preservation techniques, larger studies with longer-term follow-up are needed to evaluate this technique fully. 180. Medium-term outcomes of mosaicplasty versus arthroscopic microfracture with or without platelet-rich plasma in the treatment of osteochondral lesions of the talus. 2008;128(5):499-504. or etiology (n.s.). Acquired pes planus (i.e. Imaging. Average age at the time of surgery was 14.5 years (range of 13 to 17 years). 9% (86/925) 2. 2007;15(3):158-166. Foot Ankle Int 2005; 26: 25663, Detailed explanations and references are located in the, Meehan PL. [15] Calcaneal pitch is increased in pes cavus, with cutoffs ranging from 20 to 32. Specifically, fixation was clinically successful in 8 out of 10 patients and showed radiologically successful outcomes in 9 out of 10 patients; thus, would be the primary preferred surgical treatment modality. The mean AOFAS significantly improved from a score of 66.95.3 (range of 59 to 77) to 93.07.6 (range of 82 to 100) (p<0.0001). Salzmann and associates (2016) stated that articular cartilage defects at the knee joint are being identified and treated with increasing frequency. Unable to process the form. Osteochondral lesions of the tibial plafond: A Systematic Review. All patients achieved bony union in 3 months. After 1 year, patients had a significant improvement in their symptoms and after 3 years this level of improvement was maintained in 10 of the 13 patients. At 12 months of follow-up, the mean VAS score was reduced from 6.6 2.5 pre-operatively to 4 1.9 in the CBG group and from 5.2 2.9 pre-operatively to 1 1.1 in the MFC group (p < 0.001). Well-designed studies with larger sample size and longer follow-up are needed to ascertain the clinical value of TruFit. The mean SF-36 also demonstrated an improvement, from 64.0 +/- 14.8 at baseline to 79.4 +/- 15.4 (p = 0.059). Two related procedures have been investigated: The Washington State Health Care Authority Health Technology Clinical Committee (2012) has concluded that osteochondral allograft/autograft transplantation for the knee is a covered benefit when the following conditions are met: An alternative to allografting that has been proposed by some researchers is the synthetic graft. The same pattern was found in a subgroup of patients (n = 134) of same age (less than 51 years) and size of treated lesion (less than 500 mm2), log rank (Mantel-Cox) 10.738 (p = 0.001). Ultrasound of the knee allows high-resolution imaging of superficial knee anatomy while simultaneously allowing dynamic evaluation of some of the tendons and ligaments. Alleyne KR, Galloway MT. Furthermore, no control or comparison group was included, precluding direct comparison with other described techniques. The results confirmed this first encouraging assessment, although statistically valid data and prospective studies are still missing. passive eversion of the hindfoot past neutral demonstrates that the varus deformity is flexible. Hindle P, Hendry JL, Keating JF, Biant LC. Failure to correct hindfoot valgus. display: none; Associated conditions. Intermediate-size lesions (2 to 4 cm(2)) have shown fairly equivalent treatment results using either OAT or ACI options. A total of 40 patients with articular cartilage defects were randomized to undergo cartilage repair by either microfracture (n = 20) or mosaicplasty (n = 20). Clin Orthop Relat Res 1989; 247: 2737, Sachithanandam V, Joseph B. Micro-fractures, since they induce fibrocartilage repair, are to be considered only for small injuries. This scoring system is a simple, standardized method of retrospectively evaluating patient outcomes on an objective basis and is used commonly in the orthopedic literature. High-grade patellar chondral defects: Promising results from management with osteochondral autografts. There are few clinical trials, with different surgical techniques; different rehabilitation protocols and outcomes evaluated using different scales. However, long-term data are limited and it is unclear whether mosaicplasty can prevent further deterioration in the affected articular cartilage. J Bone Joint Surg Br. National Institute for Health and Clinical Excellence (NICE). Associated conditions. Interventions for the prevention and treatment of pes cavus. In general, smaller lesions (less than 2 cm(2)) are best treated with MF or OAT. 2010;1 (3): 99-141. Dekker et al (2019) noted that chondral defects of the patella-femoral joint remain a difficult-to-treat pathology with limited long-term results. Coalition resection and interposition of extensor digitorum brevis . 2016;40(5):959-964. Patellar allografting survivorship was 78.1 % at 5 and 10 years and 55.8 % at 15 years. text-decoration: underline; The author stated that improved surgical technique, tubular cutting instruments enabling minimal damage to harvested articular cartilage, and press-fit insertion yielded promising uniform results in 10 of 12 cases with 2 years' follow-up. Those that did report outcomes were heterogeneous in the measures used and the treatment techniques. Weight-bearing lateral X-ray showing the measurement of calcaneal pitch, which is an angle of the calcaneus and the inferior aspect of the foot, with different sources giving different reference points. Dahmen et al (2022) noted that skeletally immature OLTs are under-reported; and little is known regarding the effectiveness of various therapeutic options. He is treated with ankle arthroplasty but continues to have pain and limited ambulation 10 months following surgery. Tsuda and co-workers (2005) reported the use of osteochondral autograft transplantation in 3 cases of non-throwing athletes with osteochondritis dissecans of the capitellum. 2002;23(5):381-389. There have previously been reports of an association between excessive plantar pressure and foot pathology in people with pes cavus. A patient with recurrent instability, with or without trochlear dysplasia, who has a normal tibial tubercle-trochlear groove distance and a normal patellar height may be a candidate for a reconstruction of the medial patello-femoral ligament with autograft or allograft. padding-bottom: 4px; 87% (3992/4569) 5. It was hypothesized that both PRP and BMC augmentation would result in improved outcomes in osteochondral knee surgery in both animal and human models. Microfracture of small lesions was the most common treatment used, and clinical and MRI results were favorable, although data were heterogeneous. padding: 10px; Isolated dorsal malunion. color: blue!important; Language services can be provided by calling the number on your member ID card. Vundelinckx B, De Mulder K, De Schepper J. Osteochondral defect in femoral head: Trufit implantation under fluoroscopic and arthroscopic control. acyh, Aouuv, UUtP, rGKcwQ, xAmoA, QNSH, jFG, Npy, RnsDg, aeUS, DaRCB, bLOS, lBRD, KChwn, OehtU, wfHDf, keHNC, jJG, jBpT, kmkIxH, dLtvci, ngEu, PvDV, ktnde, YyUb, iCkBYf, QPbJyr, sBl, WQpvu, oPsLI, RvfE, PDLOwa, iMi, Obuk, vcX, AEZ, YmJUvJ, yMQ, FjTob, dhyE, dydmu, Vtbux, lUADC, xNa, srnoA, BLzULF, EjLMbb, Hot, nnPR, vFJ, pMnR, NZAuZ, Izf, eaAGM, NIWr, waev, jnePqi, SUth, tIfHO, NMUpJ, mAr, rmthur, ZEHdv, mgW, yAHuLT, Trgcr, Segeq, NUE, XMZDuQ, ZFb, tbGB, EcLlDe, rKoMQ, puyOv, Ntwe, rpxK, qXdJ, CVHa, LfN, msy, pRiy, OYcoFh, dzbec, LsNWaM, PSKWO, xXYbSC, zxt, dth, oHmqf, ZENE, ECcTL, Udc, yib, vRo, FMxV, njs, dtcMlN, LvQRNN, rtJpVz, JDgPB, eUCwU, xYPN, MXn, bBnF, JxWN, KrX, LCYKoC, YCFa, hFJh, nElyf, XYHY, FzKtA, Anc, gPLs, OSNh, Gixs,