Open Treatment of Osteochondral Lesions of the Talus With Bone Grafting and Particulated Juvenile Cartilage Allografting

2021 ◽  
pp. 193864002110097
Author(s):  
Suhas P. Dasari ◽  
Thomas M. Langer ◽  
Derek Parshall ◽  
Brian Law
Keyword(s):  
Therapeutic Option ◽  
Symptomatic Improvement ◽  
Pain Scale ◽  
Osteochondral Lesions ◽  
Outcome Scores ◽  
Scale Scores ◽  
Open Treatment ◽  
Bone Autograft

Background: Large cystic osteochondral lesions of the talus (OLT) are challenging pathological conditions to treat, but particulated juvenile cartilage allografts (PJCAs) supplemented with bone grafts are a promising therapeutic option. The purpose of this project was to further elucidate the role of PJCA with concomitant bone autografts for treating large cystic OLTs with extensive subchondral bone involvement (greater than 150 mm2 in area and/or deeper than 5 mm). Methods: We identified 6 patients with a mean OLT area of 307.2 ± 252.4 mm2 and a mean lesion depth of 10.85 ± 6.10 mm who underwent DeNovo PJCA with bone autografting between 2013 and 2017. Postoperative outcomes were assessed with radiographs, Foot and Ankle Outcome Scores (FAOS), and visual pain scale scores. Results: At final follow-up (27.0 ± 12.59 weeks), all patients had symptomatic improvement and incorporation of the graft on radiographs. At an average of 62 ± 20.88 months postoperatively, no patients required a revision surgery. All patients contacted by phone in 2018 and 2020 reported they would do the procedure again in retrospect and reported an improvement in their symptoms relative to their preoperative state, especially with pain and in the FAOS activities of daily living subsection (91.93 ± 9.04 in 2018, 74.63 ± 26.86 in 2020). Conclusion: PJCA with concomitant bone autograft is a viable treatment option for patients with large cystic OLTs. Levels of Evidence: Level IV

scholarly journals Medial Patellofemoral Ligament Reconstruction with and without Tibial Tubercle Osteotomy

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0030
Author(s):  
Seth L. Sherman ◽  
John W. Welsh ◽  
Joseph M. Rund ◽  
Lasun O. Oladeji ◽  
John R. Worley ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Medial Patellofemoral Ligament ◽  
Mpfl Reconstruction ◽  
Tibial Tubercle ◽  
Subjective Outcome ◽  
Recurrent Instability ◽  
Outcome Scores ◽  
Tissue Stabilization

Objectives: The medial patellofemoral ligament (MPFL) is the primary soft-tissue restraint against lateral patellar displacement. Surgery to address MPFL incompetence is the current gold standard for recurrent patellofemoral instability. The role of tibial tubercle osteotomy (TTO) as an adjunct to MPFL reconstruction remains controversial. Our purpose was to evaluate a cohort of patella instability patients undergoing surgical soft tissue stabilization with or without concomitant TTO. Our hypothesis was that there would be no difference between cohorts in baseline values, subjective outcome scores at final follow-up, or complication profile. Methods: Following IRB approval, retrospective review of prospectively collected data identified a consecutive cohort of patients undergoing soft tissue stabilization for recurrent patella instability, with or without concomitant TTO. Indications for TTO were at the surgeon’s discretion, including elevated TT-TG, Caton-Deschamps ratio, and/or unloading chondral lesion(s). Surgery was performed by a single sports fellowship trained surgeon. Pre-surgical and post-surgical patient reported outcomes were collected including KOOS domains, PROMIS (global health, mental health, physical function, pain interference), IKDC, SANE, and Marx scores. Complications requiring re-operation (infection, stiffness, recurrent instability) were recorded. Results were analyzed statistically. Results: The cohort was comprised of 87 patients (95 knees), with 25 males (28.7%) and 62 females (71.3%). The MPFL-TTO cohort had 32 patients (38 knees) and the MPFL-Iso had 55 patients (57 knees). The average age of the MPFL-TTO cohort was 28.3 (range 19.5-44.6) and the average age of the MPFL-Iso group was 29.8 (18.7-55.3). There was no significant difference in pre-operation outcome scores between groups (p>.05). Significant improvements were seen for all KOOS domains in both patient cohorts with no significant differences detected between groups. SANE, IKDC, and PROMIS scores improved significantly with no differences detected between groups. Marx activity score at 6 months post-operatively was significantly different between the groups favoring the isolate MPFL reconstruction cohort. (MPFL-TTO 0.79 +/- 2.15 vs. 4.61 +/- 5.44 in the MPFL-Iso group (p=0.01)). In terms of complications, 4 knees in the MPFL-TTO group required further surgery (2 for stiffness, 1 for infection, and 1 for fracture) and 6 knees in the MPFL-Iso cohort required surgery (4 for stiffness, 1 for infection, and 1 for recurrent instability). Neither the overall complication rate of 4 vs. 6 (p=1) nor the recurrent instability rate of 0 vs. 1 (p=0.41) was significant. Conclusion: In a cohort of patients undergoing MPFL reconstruction, the addition of an appropriately indicated TTO appears to be both safe and effective. Both MPFL-TTO and MPFL-Iso groups demonstrated significant improvement in the majority of subjective outcome scores without major difference between groups. Marx activity scores were higher for the isolated MPFL reconstruction cohort at relatively short term follow-up. The surgical complication profile was similar between groups. Further work is needed to clearly define the role of TTO as an adjunct procedure to MPFL reconstruction.

scholarly journals Osteochondral Lesions of the Talus: Few Patients Require Surgery

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0005
Author(s):  
Seung-Hwan Park ◽  
Sang Gyo Seo ◽  
Ho Seong Lee
Keyword(s):  
Osteochondral Lesion ◽  
Lesion Size ◽  
Nonoperative Treatment ◽  
Osteochondral Lesions ◽  
Sports Activity ◽  
Sf 36 ◽  
Outcome Scores ◽  
The Mean ◽  
Analogue Scales

Category: Ankle, Ankle Arthritis Introduction/Purpose: The frequency of progression of osteoarthritis and persistence of symptoms in untreated osteochondral lesion of the talus (OCL) is not well known. We report the outcome of a nonoperative treatment for symptomatic OCL. Methods: This study included 142 patients with OCLs from 2003 to 2013. The patients did not undergo immobilization and had no restrictions of physical activities. The mean follow-up time was 6 (3–10) years. Initial MRI and CT confirmed OCL and showed lesion size, location, and stage of the lesion. Progression of osteoarthritis was evaluated by standing radiographs. In 83 patients, CT was performed at the final follow-up for analyses of the lesion size. We surveyed patients for limitations of sports activity, and Visual Analogue Scales (VAS), AOFAS, and SF-36 were assessed. Results: No patients had progression of osteoarthritis. The lesion size as determined by CT did not change in 69/83 patients, decreased in 5, and increased in 9. The mean VAS score of the 142 patients decreased from 3.8 to 0.9 (p < 0.001), the mean AOFAS ankle–hindfoot score increased from 86 to 93 (p < 0.001), and the mean SF-36 score increased from 52 to 72 (p < 0.001). Only 9 patients reported limitations of sports activity. The size and location of the lesion did not correlate with any of the outcome scores. Conclusion: Nonoperative treatment can be considered a good option for patients with OCL.

scholarly journals The role of bone marrow edema on autologous matrix induced chondrogenesis for the treatment of osteochondral lesions of the talus

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001
Author(s):  
Riccardo D’Ambrosi ◽  
Camilla Maccario ◽  
Federico Giuseppe Usuelli
Keyword(s):  
Bone Marrow ◽  
Repeated Measures ◽  
Bone Marrow Edema ◽  
Lesion Size ◽  
Osteochondral Lesions ◽  
Significant Difference ◽  
T1 And T2 ◽  
Marrow Edema

Category: Ankle, Arthroscopy, Basic Sciences/Biologics Introduction/Purpose: to assess the functional and radiological outcomes after AT-AMIC® (arthroscopic talus autologous matrix induced chondrogenesis) in 2 groups: patients with and without bone marrow edema (BME). Methods: Thirty-seven patients of which 24 without edema (GNE) and 13 with edema (GE) were evaluated. All patients were treated with AT-AMIC® repair for osteochondral talar lesion. MRI and CT-scan evaluations, as well as clinical evaluations measured by the VAS score for pain, AOFAS and SF-12 were performed preoperatively (T0) and at 6 (T1), 12 (T2), and 24 (T3) months postoperatively. Results: GNE consisted of 24 patients while GE consisted of 13 patients. In both groups we found a significant difference for clinical and radiological parameters with ANOVA for repeated measures through four time points(p<0.001). In GNE, AOFAS improved significantly at each follow-up(p<0.05); while CT and MRI showed a significant decrease between T1 and T2 and T2 and T3(p<0.05). In GE, AOFAS improved significantly between T0 and T1 and T2 and T3(p<0.05); CT decreased between T1 and T2(p<0.05), while MRI showed a reduction at each follow-up(p<0.05). Lesion size was significantly higher both in MRI and CT in GE in respect to GNE(p<0.05). In the GNE no patients presented edema at T3, while in GE only 23.08% of the patients presented edema at T3. Conclusion: The study revealed that osteochondral lesions of the talus were characterized by bigger size both in MRI and CT in patients with edema. We conclude that AT-AMIC® can be considered a safe and reliable procedure that allows effective healing, regardless of edema and more than half of patients did not present edema six months after surgery.

Definition of the Role of Contemporary Surgical Management in Cisternal and Parenchymatous Cysticercosis Cerebri

Neurosurgery ◽  
1991 ◽  
Vol 28 (2) ◽  
pp. 231-237 ◽  
Author(s):  
William T. Couldwell ◽  
Chi-Shing Zee ◽  
Michael L. J. Apuzzo
Keyword(s):  
Symptomatic Improvement ◽  
Brain Parenchyma ◽  
Cystic Mass ◽  
Increased Intracranial Pressure ◽  
Focal Neurological Deficit ◽  
Definition Of ◽  
Mass Lesions ◽  
The Brain

Abstract With increasing immigration from endemic regions, the incidence of neurocysticercosis in North America is rising. This retrospective study was undertaken to examine the role of surgery in those cases presenting with large cystic parenchymal and cisternal lesions in the current era of anthelminthic agents administered orally. A total of 237 patients presented with newly diagnosed neurocysticercosis to our institution over a recent 5-year period (mean age, 31.2 years). Among those who presented with cystic mass lesions predominantly affecting the brain parenchyma and cisternal spaces. 20 (8.4%; mean age, 40.2 years) with large cystic lesions subsequently underwent surgical intervention, either because of an emergent presentation or because they were refractory to medical management. Clinical presentation included increased intracranial pressure, focal neurological deficit, and seizure. Radiographic imaging (computed tomography and/or magnetic resonance imaging) demonstrated 12 cases with cisternal lesions, 7 with parenchymal lesions, and 1 involving both compartments. Based on imaging guidelines, 30 operative procedures (excluding shunt revisions) were performed (14 craniotomies, 8 cerebrospinal fluid diversions, 7 stereotactic procedures, and 1 burr hole drainage). Fifteen (75%) showed neurological or symptomatic improvement over a median follow-up period of 36.4 months. There were three surgery-related complications and no deaths.

scholarly journals The Role of Arthroscopic Debridement after Ankle Fractures Treated with ORIF

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001
Author(s):  
Paolo Ceccarini ◽  
Giuseppe Rinonapoli ◽  
Julien Teodori ◽  
Auro Caraffa
Keyword(s):  
Distal Tibia ◽  
Case Series ◽  
Activity Level ◽  
Ankle Arthroscopy ◽  
Ankle Fractures ◽  
Osteochondral Lesions ◽  
Operation Rate ◽  
Patient Reported

Category: Ankle, Ankle Arthritis, Arthroscopy Introduction/Purpose: The role of ankle arthroscopy in managing the consequences of ankle fractures is yet to be fully estab- lished. This study aims to assess this procedure in terms of the accuracy of preoperative diagnosis, re-operation rate and patient- reported outcomes. Methods: We compared two homogeneous groups of 16 patients (32 in total, average age 40.6 years) operated for a fracture of the distal tibia and/or fibula treated with ORIF. For all fractures the AO classification was used. The baseline was 6 months after surgery. Inclusion criteria were: patients aged between 19 and 50 a pre-trauma Tegner score >3, FAOS score <75 at the baseline, R.O.M. <20° vs contralateral; we included patients with well-aligned osteosynthesis and with radiographic union. Patients with open fractures, with osteochondral lesions and with previous were excluded. In the first group we planned an arthroscopy of the ankle from 6 to 12 months after trauma, in the second group, we continued with conservative rehabilitation treatment. All patients were then re-evaluated at 3,6 and 12 months with questionnaires (Tegner activity level, and FAOS). The mean follow-up was 18.2 months. For all data statistical analysis was performed. Results: The results of our case-series showed excellent patient satisfaction (12/14) with a FAOS Score and an improved R.O.M. statistically significant (p <.001) in patients treated with ankle arthroscopy. Eighty percent was able to return to previous activity. The average time until return to sport was 5.3 ± 2.4 months. Seventy percent of the athletes still had occasional pain with sport. Conclusion: The literature on arthroscopic treatment after fracture is still poor but results obtained, even with a limited number of cases, and with a short follow-up, are positive, especially in those patients where the functional demand is highest.

scholarly journals Kinetic Profiles of Inflammatory Mediators in the Conjunctival Sac Fluid of Patients upon Photorefractive Keratectomy

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Veronica Tisato ◽  
Paolo Perri ◽  
Erika Rimondi ◽  
Elisabetta Melloni ◽  
Giuseppe Lamberti ◽  
...  
Keyword(s):  
Therapeutic Option ◽  
Methodological Approach ◽  
Healing Process ◽  
Corneal Stroma ◽  
Systemic Circulation ◽  
Photorefractive Keratectomy ◽  
Ocular Surface Diseases ◽  
Serial Samples

Photorefractive keratectomy (PRK) represents a therapeutic option to remodel corneal stroma and to compensate refractive errors, which involves inflammatory and/or regenerative processes. In this context, the modulation of cytokines/chemokines in the conjunctival sac fluid and their role in the maintenance of the corneal microenvironment during the healing process upon refractive procedures has not been deeply investigated. In this study, serial samples of conjunctival sac fluid of patients (n=25) undergoing PRK were harvested before and at different time points after surgery. The levels of 29 cytokines/chemokines/growth factors involved in inflammatory/immune processes were measured with a multiplex array system. The results have firstly highlighted the different pattern of cytokine expression between the microenvironment at the anterior surface of the eye and the systemic circulation. More importantly, the kinetic of modulation of cytokines/chemokines at the conjunctival level following PRK revealed that while the majority of cytokines/chemokines showed a significant decrease, MCP-1 emerged in light of its pronounced and significant increase soon after PRK and during the follow-up. This methodological approach has highlighted the role of MCP-1 in the healing process following PRK and has shown a potential for the identification of expression/modulation of soluble factors for biomarker profiling in ocular surface diseases.

The Role of External Banding Valvuloplasty in the Surgical Management of Chronic Deep Venous Disease

1994 ◽  
Vol 9 (1) ◽  
pp. 8-12 ◽  
Author(s):  
H. Schanzer ◽  
M. Skladany ◽  
E. C. Peirce
Keyword(s):  
Venous Insufficiency ◽  
Clinical Symptoms ◽  
Tertiary Care ◽  
Symptomatic Improvement ◽  
Venous Stasis ◽  
Venous Disease ◽  
Muscle Pump ◽  
Lost To Follow Up

Objective: Correction of venous reflux by perivalvular banding in patients suffering from chronic venous stasis secondary to primary valvular incompetence. Design: Prospective study in a group of patients with severe venous insufficiency. One patient (one extremity) was lost to follow-up. Setting: Tertiary care teaching hospital. Patients: Twelve patients (13 extremities) with severe or moderate venous insufficiency. Interventions: Correction of valvular incompetence by narrowing a valvular ring with an external band. Twenty-seven bands were fitted to incompetent valves of 13 extremities. Main outcome measures: Abolition of reflux and improvement of muscle pump measured by clinical, plethysmographic and venographic criteria. Results: Symptomatic improvement was found in 10 extremities (77%) and complete correction of reflux on venography in eight extremities (67%). Plethysmographically measured reflux improved in 6 extremities (50%) and muscle pump function improved in 7 extremities (58%). No correlation was found between plethysmographic and clinical or venographic outcome. Conclusion: Perivalvular banding can correct reflux and alleviate clinical symptoms of chronic venous stasis in patients with primary valvular incompetence. Selection of patients, valves to be corrected, necessary degree of valvular ring narrowing and need for additional interventions should be further investigated.

scholarly journals Intratympanic corticosteroid perfusion in the therapy of Meniere’s disease

2014 ◽  
Vol 142 (5-6) ◽  
pp. 291-295 ◽  
Author(s):  
Snezana Sankovic-Babic ◽  
Rade Kosanovic ◽  
Zoran Ivankovic ◽  
Snezana Babac ◽  
Milica Tatovic
Keyword(s):  
Minimally Invasive ◽  
Action Potentials ◽  
Therapeutic Option ◽  
Experimental Studies ◽  
Hearing Threshold ◽  
Minimally Invasive Surgical ◽  
Hearing Function ◽  
One Year

Introduction. Over the last two decades the intratympanic perfusion of corticosteroids has been used as a minimally invasive surgical therapy of Meniere?s disease. According to experimental studies the antiinflammatory, immunoprotective, antioxidant and neuroprotective role of the locally perfused corticosteroids was noticed in the inner ear structures. The recovery of action potentials in the cells of the Corti organ was confirmed as well as a decreased expression of aquaporine-1, a glycoprotein responsible for labyrinth hydrops and N and K ions derangement. Objective. The study showed results of intratympanic perfusion therapy with dexamethasone in patients with retractable Meniere?s disease who are resistant to conservative treatment. Methods. Single doses of 4 mg/ml dexamethasone were given intratympanically in 19 patients with retractable Meniere?s disease. Six single successive doses of dexamethasone were administered in the posteroinferior quadrant of the tympanic membrane. Follow-up of the patients was conducted by using a clinical questionnaire a month after completed perfusion series as well as on every third month up to one year. Results. One month after completed first course of perfusions, in 78% of patients, vertigo problems completely ceased or were markedly reduced. The recovery of hearing function was recorded in 68% and marked tinnitus reduction in 84% of patients. After a year of follow-up, in 63% of patients the reduction of vertigo persisted, while hearing function was satisfactory in 52%. Tinitus reduction was present in 73% of patients. Conclusion. Intratympanic perfusion of dexamethasone in patients with Meniere?s disease is a minimally invasive therapeutic method that contributes to the reduction of the intensity of vertigo recurrent attacks, decrease of the intensity of tinnitus and improvement of the average hearing threshold. Patients with chronic diseases and Meniere?s disease who are contraindicted for systemic administration of cortocosteroids (hypertension, diabetes, glaucoma, peptic ulcer, etc.) have an additional therapeutic option by dexamethasone intratympanic perfusion.

scholarly journals EVAR and OPEN treatment of abdominal aortic aneurysm: What is the role of MMP-9 in the follow-up?

2017 ◽  
Vol 42 (1) ◽  
pp. 21-28 ◽  
Author(s):  
A. Ascoli Marchetti ◽  
G. Pratesi ◽  
L. Di Giulio ◽  
M. Battistini ◽  
R. Massoud ◽  
...  
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Abdominal Aortic ◽  
Open Treatment

Acute Zoster Pain (AZP) and Post-Herpetic Neuralgia (PHN) in the Course of Lymphoproliferative Disorders (LPD): Durable Pain Relief Provided by Oxycodone in Patients Unresponsive to Standard Therapy.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 5500-5500
Author(s):  
Pasquale Niscola ◽  
Claudio Romani ◽  
Alessio Pio Perrotti ◽  
Giovanni Del Poeta ◽  
Claudio Cartoni ◽  
...  
Keyword(s):  
Pain Relief ◽  
Case Series ◽  
Pain Scale ◽  
Pathological Process ◽  
Pain Syndromes ◽  
Topical Analgesics ◽  
Topical Capsaicin ◽  
Pain Rate

Abstract Background. PHN and AZP are significant neuropathic pain syndromes associated with LPD. Some pathways in the pathological process, including a peripheral nerve injury and a central sensitisation, suggest that an appropriate approach should include multiple agents having different mechanisms of action. Anticonvulsants, mainly gabapentin (GB) and pregabalin (PGB), are indicated for the AZP and PHN management, while the role of opioids and topical analgesics was not definitively established. Case series. There were 5 patients (2 NHL, 1 ALL, 1 CLL, 1 MM) with median age of 69 (52–83) years. Some clinical features concernig the patient’s pain histories are detailed in table 1. Patient 1 and 2 presented long lasting PHN unrelieved by GB and PGB, alone or associated with tramadol in the second case. The patient 1 kept under our attention complaining a constant deep, aching burning sensation, spontaneous shooting pain and a superficial dysesthetic sufferance evoked by light touch or wearing clothes. Oxycodone was administered at initial dose of 10 mg twice daily and the titrated until an acceptable pain relief was achieved. No remarkable side effects were recorded. However persisting allodynia was reported by the two PHN patients, for which the application of topical capsaicin 0.075 percent cream was started, obtaining after one week a complete resolution of allodynia. Burning was the main side effect, improving after the first week of capsaicin topical application. Patient 2 received oxycodone at initial doses 5 mg thrice achieving a rapid pain relief. Patients 3, 4 and 5 presented AZP unresponsive to GB or PGB alone. Overall, in all patients, the median reported pain rate was 7 (4 – 9), on a 0 to 10 pain scale. Two patients need a slight increase of the dosage. Conclusion. Although the short follow-up and the small size of the series, some suggestions do appear: an opioid should be taken into account in patients with AZP or PHN; in this light, oxycodone could represent a suitable potential option, although no randomised studies have claimed its superiority to others opioid; topical capsaicine cream can improve allodynia. However, from these anecdotic observations some questions, such as the opioid of choice in this setting, the best timing and duration of therapy, the choice of other drugs to be associated with oxycodone or other opiods, remain to explore and may represent the basis of further research on this specific topic. Table 1: outcome of the patient’s zoster-related pain syndromes Patient Primary Analgesic Therapy Basal pain rate Oxy initial doses (mg) Time to Response [Days] Mean Doses (Days of Treatment) Last Pain Rate Oxy: Oxycodone; PGB: Pregabalin; GB: Gabapentin; NSAIDs: Non-Steroidal Antinflammatory Drugs; AMP: Acetaminophen. ° Reduction of almost 50% of pain rate with respect to the baseline level. 1 PGB (1800 mg) 9 20 2 30 mg (240) 0–1 2 GB (1200 mg) 8 15 3 15 mg (95) 1–2 3 GB (900 mg)+ AMP (3000 mg) 7 15 1 15 mg (95) 0 4 PGB (300) 7 15 1 15 mg (95) 0 5 GB (1800) + NSAIDs 4 15 3 15 mg (95) 1

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