There are no cures or effective courses of treatment to halt the progression of any form of Charcot-Marie-Tooth disease at this time. This reveals an abnormal connection between which two bones, and what is the next step in treatment? Knee Surg Sports Traumatol Arthrosc. American Journal of Sports Medicine. Imaging. Prospective evaluation of concurrent meniscus transplantation and articular cartilage repair: Minimum 2-year follow-up. Nho et al (2008) stated that autologous osteochondral transplantation (AOT) has been successfully used in the femoral condyle and trochlea and is an attractive treatment option for full-thickness patellar cartilage lesions. list-style-type: decimal; 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. subtalar stiffness is a common complication. Two to4 years follow-up of these patients showed 80 % good or excellent clinical results. In the absence of neurological, congenital, or traumatic causes of pes cavus, the remaining cases are classified as being idiopathic because their aetiology is unknown. The mean AOFAS score improved from a pre-operative score of 47.2 10.7 to 84.4 8 (p < 0.05). The methodological quality of the studies was poor. These researchers hypothesize that single-plug OATS is safe and effective in alleviating pain and restoring function in unstable OCD. (See CMT Association website) There are many different types and subtypes of CMT, and as a result, it can present from infancy through to adulthood. recommended views. 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. That is, there is a fixed plantar flexion of the foot. A lateral radiograph of the foot is shown in Figure A. Those that did report outcomes were heterogeneous in the measures used and the treatment techniques. Although the technique is not technically demanding, the use of fresh allografts carries considerable logistics limitations. Interventions for the prevention and treatment of pes cavus. Mean MOCART score for the 6 patients with follow-up MRI was 62.5 (range of 25 to 85). Skelly AC, Ecker ED, Schenk-Kisser JM, et al. Physical examination demonstrates full 1st metatarsalphalangeal (MTP)joint dorsiflexion and plantarflexion with a deformity that passively corrects. A typical overall protocol is as follows 1: The knee is flexed 20-30 (flexion of the knee tightens the extensor tendons, decreasing the chance of anisotropy occurring in a lax tendon): The knee is flexed 20-30, with external rotation: Often examined with the patient prone and the knee extended, thereby gaining access to the dynamic fat-filled popliteal fossa: A number of knee abnormalities can be identified on ultrasound, including: ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Solheim E, Hegna J, Strand T, et al. She has no other injuries besides superficial abrasions. background: url('https://www.aetna.com/cpb/medical/data/assets/images/purplearrow.jpg') no-repeat; [16] Radiological analysis of pes calcaneocavus reveals a large talo-calcaneal angle. In a review on mosaicplasty for the treatment of osteochondral defects of the ankle joint, Mendicino and associates (2001) stated that this procedure shows excellent promise for use in the ankle and warrants larger investigational studies to assess outcomes. [1][2] Avulsion fractures can occur in any area where soft tissue is attached to bone. J Foot Ankle Surg. The patient is then evaluated by a keen orthopedic resident in the emergency room who describes the zookeeper's injuries to his chief. 2005;21(8):1008. Level of Evidence = III. Osteochondral autologous transplantation for the treatment of full-thickness articular cartilage defects of the shoulder. 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. stress radiographs. [citation needed], Individuals with pes cavus frequently report foot pain, which can lead to a significant limitation in function. The three types of pes cavus can be distinguished by their aetiology, clinical signs and radiological appearance. BMJ 1963; 2: 659-661. The systematic evidence review prepared for the Washington State Health Care Authority(Skelly et al,2011)reported thattwo small randomized controlled trials (RCTs)(level of evidenceIIb) in younger populations compared OAT with microfracture and three RCTs (or quasi RCTs,level of evidenceIIb) compared OAT/mosaicplasty with ACI in general (older)populations. Magnetic resonance imaging revealed good osseo-integration of the osteochondral plugs and congruent articular cartilage at the transplantation site in all but 1 patient. Osteochondral autotransfer -- newer treatment for chondral defects. [22] There are also numerous surgical approaches described in the literature that are aimed at correcting the deformity and rebalancing the foot. 2008;466(4):952-962. Nonunion. However, the regeneration of defects filled with TruFit implants took more than 2 years. color: blue!important; They returned fully to their sports activities within 6 months of surgery. Arthroscopic options for regenerative treatment of cartilage defects in the shoulder. 2007;32(9):1454-1461. Arch Orthop Trauma Surg. The authors concluded that non-operative treatment was similar in outcomes to surgical treatment for low-grade lesions, whereas surgical treatment was superior for higher grade lesions. The failure of bone most commonly results from an acute event with the application of usually sudden, tensile force to the bone through the soft These researchers stated that OAT is a good alternative to treat high-grade patellar chondral defects, especially among young patients. TruFit plug for repair of osteochondral defects-where is the evidence? 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. The authors concluded that to their knowledge, this was the largest series to-date regarding isolated patellar OAT. These authors concluded that this technique can be considered as rather novel besides previous publication effort and thus several pearls/advantages as well as pitfalls/disadvantages have to be considered. Radiological evaluation indicated favorable MRI findings regarding filling of the defect and incorporation with adjacent cartilage at 24 months follow-up, but conflicting evidence existed on the properties of the newly formed overlying cartilage surface. Pes cavus is a multiplanar foot deformity characterised by an abnormally high medial longitudinal arch. The use of a sliding hip screw construct has been shown to have what benefit compared to multiple cannulated screws? A duplicate search of PubMed, Embase, Scopus, Web of Science, and CENTRAL databases was performed, beginning from the database inception dates through July 2016, for all articles evaluating the return-to-play after OAT for OCD lesions of the capitellum. Gardiner A, Weitzel PP. Return to play after osteochondral autograft transplantation of the capitellum: A systematic review. RD showed an RTS rate of 100 % (95 % CI: 63 % to 100 %) without specified levels, an RTS rate to pre-injury level was not given. 2018;100(11):903-913. Li Z, Zhu T, Fan W. Osteochondral autograft transplantation or autologous chondrocyte implantation for large cartilage defects of the knee: A meta-analysis. The mean pre-operative ADL score was 60.1 +/- 16.9 and increased to 84.7 +/- 8.3 (p = 0.022). Sometimes children are born with flat feet (congenital). Bugelli and co-workers (2018) followed morphological imaging characteristics and osteo-integration of TruFit bone graft substitute (BGS) plugs in cases of chondral and osteochondral defects of the articular surface of the knee joint, using high-quality cartilage-sensitive 3-T MRI, linked to clinical outcomes. Salzmann and colleagues (2017) presented a surgical technique where the surgeon can apply autologous chondrocytes in a 1-step procedure to treat articular cartilage defects at the knee joint. Level of evidence = III. Although data were prospectively collected through an institutional registry, analysis was carried out retrospectively, introducing various confounders. QID Resection of coalition at the middle facet if <20 hindfoot valgus is present. Fate of large donor site defects in osteochondral transfer procedures in the knee joint with and without TruFit plugs. In a case-series study, these researchers examined functional outcomes and survivorship of the grafts among patients who underwent OCA for patellar cartilage injuries. 2006;14(3):163-168. 2001;(391 Suppl):S328-S336. These investigators stated that more studies are needed on OLTPs and co-existing OLTPs and OLTs to understand algorithms in and outcomes of management. The scientific evidence supporting the use of osteochondral autografts to repair the elbow and shoulder consists mainly of single case reports. A total of 61 studies including 2,347 talar OCDs were included. Easley ME, Scranton PE Jr. Osteochondral autologous transfer system. Current concepts: Osteochondritis dissecans of the capitellum and the role of osteochondral autograft transplantation. 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. Treatment of juvenile osteochondritis dissecans of the talus: Current concepts review. Similarly, weak dorsiflexors are overpowered by stronger plantarflexors, causing a plantarflexed first metatarsal and anterior pes cavus. Sometimes children are born with flat feet (congenital). A review illustrated by a case report. Joshi et al (2012) evaluated prospectively short- and medium-term results in patients with osteochondral patellar defects treated with synthetic re-absorbable scaffolds. The proposed improvement relies on mechanical fragmentation of cartilage tissue sufficient to mobilize embedded chondrocytes via increased tissue surface area. li.bullet { The OATS procedure focuses on chondral defects that are associated with chronic tears of the anterior cruciate ligament (ACL), using an arthroscopic approach that can provide access to both the ACL for reconstruction and performance of the autograft. In a case-series study, patients with focal patellar cartilage lesions treated with AOT were prospectively followed. (SBQ06TR.62) A 35-year-old zookeeper fell 10 feet while preparing an exhibit for a grand reopening, landing on his left arm. Arthroscopy. ADSCs were transduced with BMP4 (B-ADSCs). Patient inclusion criteria are not well settled in the literature, and there is no uniform consensus on the procedure's indication. 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. Acquired pes planus (i.e. The cultured cartilage was implanted to the remaining defect with a periosteal cover harvested from the antero-lateral ridge of the lateral femoral condyle. Scheibel M, Bartl C, Magosch P, et al. Otherwise, high arches may be handled with care and proper treatment. 4. 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. The chondrocytes outgrown into 3-D scaffolds also formed cartilage-like tissue when implanted in mice homozygous for the scid mutation (SCID mice). There are multiple possible approaches to imaging the knee with ultrasound. No significant difference in fibro-cartilage content was found (54.7 % for ACC versus 50.8 % for MST). There was no control group; and the patients were not randomized. Osteochondral allograft transplant of the patella using femoral condylar allografts: Magnetic resonance imaging and clinical outcomes at minimum 2-year follow-up. Foot Ankle Int 2005; 26: 256-63, McCluskey WP, Lovell WW, Cummings RJ. The mean age at the time of surgery was 30 years. The authors concluded that the current technique is a valid option and perhaps the most appropriate non-metal alternative for invalidating anterior knee pain due to a large cartilage defect of the patella in young patients. Functional outcomes were quantified using the Timmerman instrument. A clinical image is shown in Figure A and a radiograph is shown in Figure B. The authors described a technique for OAT to the patella for an isolated patellar chondral lesion (unipolar). Treatment selection in articular cartilage lesions of the knee: A systematic review. Subjects included all patients who received OAT for high-grade symptomatic patellar chondral defects between 2010 and 2018 at the authors institution. The majority of studies are in populations less than 50 years of age. Level of Evidence = IV. Treatment is either immobilization or surgery depending on location of fracture, degree of displacement, and athletic level of patient. The authors concluded that this study showed that for skeletally immature patients presenting with symptomatic OLTs, conservative treatment was clinically successful in 4 out of 10 children, whereas the various surgical therapeutic options were found to be successful in 7 to 10 out of 10 children. Clin Sports Med. There was an inverse linear relationship between the size of the lesion and the functional scores. [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. This also underscores the need for further research to identify safe donor sites or to develop techniques that eliminate the need for a formal biopsy completely. single focal full-thickness articular cartilage defect. bottom: 20px; He was treated with physical therapy and a controlled ankle motion boot for several weeks following the injury with minimal relief. Olympia, WA: Washington State Health Care Authority; October 17, 2011. PubMed was searched for treatment articles using the keywords knee, articular cartilage, and osteochondral defect, with a focus on articles published in the past 5 years. Defects with a median size of 3.5 cm2 (range of 2 to 5 cm2) were treated. Arthroscopy. The literature search was performed using the terms: "mosaicplasty'' or "osteochondral transplantation'' or "OATS'' and "autologous chondrocyte implantation'' or "autologous chondrocyte transplantation'' or "ACI'' or "matrix-associated autologous chondrocyte implantation'' or "MACI'' and "combination''. passive eversion of the hindfoot past neutral demonstrates that the varus deformity is flexible. [8], Pes cavus may be hereditary or acquired, and the underlying cause may be neurological, orthopedic, or neuromuscular. findings. angle formed by tibial plafond & talar dome is measured as inversion force is applied to hindfoot (5 deg is normal for most ankles) Hallux valgus deformity. Autologous osteochondral grafting for talar cartilage defects. Fundamentals of Musculoskeletal Ultrasound: Expert Consult-Online and Print, 2e (Fundamentals of Radiology). Am J Sports Med. 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. The JOA score significantly improved in patients with centralized, lateral localized, and lateral widespread types of OCD; ROM significantly improved in patients with centralized and lateral localized, and they returned to playing sports within 6 months. 2% (40/2555) 5. The authors concluded that the treatment of patellar cartilage injuries remains a difficult clinical challenge regardless of the surgical intervention chosen, with relatively high re-operation and revision rates. 2020;23(1):60-62. The mean allograft area was 10.1 cm(2) (range of 4.0 to 18.0 cm(2)). Sharpe et al (2005) reported their 3-year post-operative findings on the use of a combination of autologous chondrocyte implantation (ACI) and the OATS procedure as a treatment option for the repair of large areas of degenerative articular cartilage. (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. No studies reported elbow scores or ROM for non-operatively treated patients. There was a single OCA study eligible for inclusion. Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. Calculated success percentages varied widely and ranged from 17 % to 100 %. 180. J Orthop Res. Maruyama et al (2018) noted that OCD of the humeral capitellum is a critical elbow injury in adolescent overhead throwing athletes; however, its etiology remains unknown. 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. Semi-quantitative evaluation was performed by means of the International Cartilage Repair Society (ICRS) II score. The member is skeletally mature with documented closure of growth plates (e.g., 15 years or older); The member is not considered a candidate for total knee replacement (i.e., member is under 55 years of age); The member has disabling symptoms limiting ambulation that have not been relieved by appropriate non-surgical therapies (e.g., medication, physical therapy); The member has focal, full thickness (grade III or IV) unipolar lesions on the weight bearing surface of the femoral condyles or trochlea; The member has minimal to absent degenerative changes in the surrounding articular cartilage (Outerbridge grade II or less) and normal appearing hyaline cartilage surrounding the border of the defect; Stable and aligned knee with intact meniscus and normal joint space on X-ray (a corrective procedure in combination with, or prior to, chondrocyte implantation may be necessary to ensure stability, alignment and normal weight distribution within the joint); The opposing articular surface should be generally free of disease or injury. Outcome analysis was performed with VAS, AOFAS ankle-hindfoot score, Lower Extremity Functional Scale (LEFS), and contrast-enhanced MRI (CE-MRI) scans. 2020;8(10):2325967120960088. Although it is a relatively common disease, many doctors and laypersons are not familiar with it. Because of the poor methodological quality of the studies, it is not possible to make specific recommendations on its use, considering it as experimental.". list-style-type: lower-roman; Hindle et al (2014) stated that autologous osteochondral mosaicplasty and TruFit bone graft substitute plugs are methods used to repair symptomatic articular cartilage defects in the adult knee. 68% (1724/2534) 4. The authors concluded that there are no data available that support superiority or equality of TruFit compared to conservative treatment or mosaicplasty / micro-fracture (MF). [19], Despite various presentations and descriptions of pes cavus, not all incarnations are characterised by an abnormally high medial longitudinal arch, gait disturbances, and resultant foot pathology. IKDC, Knee Outcomes Survey-Activities of Daily Living (KOS-ADL), and pain VAS scores were collected pre-operatively and at minimum 2 years post-operatively, and outcomes were compared using the paired t-test. Partial weight-bearing was allowed 4 weeks following surgery, which was progressed to full weight-bearing after another 2 weeks. Non-operative treatment includes physical therapy, focusing on strengthening of the gluteal muscles and the vastus medialis obliquus, and patellar taping or bracing. Furthermore, clinical studies are limited in quantity but would likely be of substantial benefit, especially if comparisons could be made between PRP and BMC as forms of augmentation. This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. 2016;24(4):1293-1298. Treatment of osteochondral lesions of the talus in the skeletally immature population: A systematic review. Maruyama M, Takahara M, Satake H. Diagnosis and treatment of osteochondritis dissecans of the humeral capitellum. 1% (21/2534) 3. Effectiveness questions particularly center on whether the potential beneficial outcomes of long term pain and functional improvement, prevention of osteoarthritis or further joint deterioration occur with this surgical intervention.". Arch Orthop Trauma Surg. In addition, more than 50 % of the subjects had concomitant surgery to correct patellar instability, which may have influenced the results. While pes cavus has been reported in between 2 and 29% of the adult population, there are several limitations of the prevalence data reported in these studies. Any re-operation resulting in removal of the allograft was considered a failure of the OCA transplantation. Diagnosis is made with orthogonal radiographs of the tibia with CT scan often required to assess for intra-articular extension. A clinical image is shown in Figure A and a radiograph is shown in Figure B. Diagnosis can be made clinically with loss of medial arch of the foot which may progress to hindfoot valgus, forefoot abduction and subsequent development of midfoot osteoarthritis. background-color: #663399; These researchers examined the available literature on the etiology, diagnosis, and reported outcomes associated with OCD of the capitellum and the use of OAT for its treatment. At final follow-up, all donor knees were asymptomatic with full ROM and strength. Comparative studies found that both augmentations increased osteogenic proteins, including bone morphogenetic protein-2 (BMP-2) and osteoprotegerin; 2 of 3 studies on BMC-augmented osteochondral allografts reported no difference in radiographic features post-operatively. Improvements in patient-reported outcome scores and rate of complete osseous integration based on MRI were comparable with previously reported results after OCA for condylar defects. Washington State Health Care Authority, Health Technology Assessment Program. Health Technology Assessment. 2017;6(1):e127-e131. MTP joint arthrodesis with structural bone graft . The Washington State Health Care Authority Technology Assessment Program (2011) commissioned a technology assessment ofOsteochondral Allograft Transplantation and Autograft Transfer System (OATS/mosaicplasty). A significant improvement in Timmerman-Andrews scores from pre-operatively to post-operatively was reported in 9 of 10 studies. 2018;26(7):2158-2170. 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). Return-to-play rates to the pre-injury level of competitive play ranged from 62 % to 100 % across 16 studies. The diagnosis and treatment of osteochondritis dissecans. Hindfoot Talar Neck FX After closed reduction, the elbow is unstable with valgus stress at 40 degrees of flexion. 2018;27(12):2262-2270. Thus, delivery of chondrocytes in the form of cartilage tissue fragments in conjunction with appropriate polymeric scaffolds provides a novel intra-operative approach for cell-based cartilage repair. 2010;26(5):685-696. Rue JP, Yanke AB, Busam ML, et al. Treatment of focal articular cartilage defects in the knee: A systematic review. Knee injury and Osteoarthritis Outcome Score, SF-36 and visual analog scale (VAS) were used for clinical evaluation. Unique and customized search strategies were formulated in PubMed, Embase, Scopus, Web of Science, and CENTRAL. 2020;36(6):1747-1764. Graft incorporation was evaluated by MRI or 2nd-look arthroscopy. None of the included studies showed evidence for bone ingrowth. Flexible Pes Planovalgus, also known as Flexible Flatfoot, is a common idiopathic condition, caused by ligamentous laxity that presents with a decrease in the medial longitudinal arch, a valgus hindfoot and forefoot abduction with weight-bearing. Randomized study of long-term (15-17 years) outcome after microfracture versus mosaicplasty in knee articular cartilage defects. Standard radiographs, magnetic resonance imaging and second-look arthroscopy were used to evaluate the presence of glenohumeral osteoarthritis and the integrity of the grafts. This is a bi-phasic scaffold designed to stimulate cartilage and subchondral bone formation. Patellar allografting survivorship was 78.1 % at 5 and 10 years and 55.8 % at 15 years. Autologous osteochondral transplantation presents a new way to revisit these patellar defects. According to the p scores for interventions ranking, there was a disagreement concerning the best intervention; however, MF was always ranked as the last. 06/20/2022 ", More recently, an assessment of mosaicplasty for knee cartilage defects by the Institute for Clinical Effectiveness and Health Policy (Pichon-Riviere, et al., 2009) concluded:"At present, there is not good quality evidence that would allow the assessment of mosaicplasty versus other techniques. Clin Podiatr Med Surg. 3% (112/4198) 3. The number of studies on OLTPs were also limited, with even fewer reporting on outcomes of treatment. Biologic augmentation has been increasingly studied as an adjunct in the surgical treatment of osteochondral defects of the knee in animal and human models. 11% (136/1292) 3. However, there is currently insufficient evidence to support the use of non-autologous mosaicplasty for repair of osteochondral defects. A simplified pooling method resulted in a calculated mean success rate of 90 % confidence interval [CI]: 82 % to 95 %] for the osteochondral autograft transfer procedure, 65 % [CI: 46 % to 81 %] for mosaicplasty and 55 % [CI: 40 % to 70 %] for the osteochondral allograft transfer procedure. There were no significant differences between the 2 groups in terms of age, sex, BMI, defect location, or etiology. The lateral view is key to assessment, as the dorsoplantar view can sometimes appear normal, unless there an associated abnormality 2. The groups did not differ with regard to change in baseline AOFAS score; however, improvement in VAS pain scores was significantly better in the mosaicplasty group when compared to the MF group (change from baseline, -5.8 1.0 versus -3.2 2.9, p = 0.018). Additionally, the authors presented a case report of the combinatory use of 3 established techniques. [citation needed], The cause and deforming mechanism underlying pes cavus is complex and not well understood. Microfracture of small lesions (less than 150 mm2) was the most common treatment employed. Moreover, they stated that RCTs comparing TruFit Plug with an established treatment method are needed to improve synthetic bi-phasic implants as therapy for osteochondral lesions. Upper extremity physical exam reveals no neurologic deficits, and an initial radiograph of the shoulder is shown in Figure A. Patients requiring re-operation had lower outcome scores regardless of their initial procedure. MTP joint arthrodesis with structural bone graft . The authors concluded that osteochondral lesions of the elbow in the pediatric and adolescent population remain difficult entities to treat for the orthopedic surgeon. The in-vitro study showed that the osteogenic and chondrogenic activities of the B-ADSCs were enhanced compared with those of the control. Children with high arches who have difficulty walking may wear specially-designed insoles, which are available in various sizes and can be made to order. Compared with microfracture (MF), OAT was associated with better patient-reported (based on International Cartilage Repair Society (ICRS) cartilage repair assessment), and clinician-reported (based on the Hospital for Special Surgery (HSS) Score)functional outcomes in young athletes and children based on two small RCTs (total n = 104) (citing Gudas, et al., 2005; Gudas, et al., 2009). 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). These researchers stated that further investigation is needed to more accurately determine the true impact of biologics on the treatment outcomes for these injuries. Sports Health. 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. color: #FFF; forefoot adduction is seen on the AP radiograph. Quarch et al (2014) examined if the potential donor site morbidity for large defects could be reduced by means of TruFit plugs. } Gelber et al (2018) stated that the treatment of articular cartilage lesions in young patients is certainly a complex matter and subject of continuous research, especially for those located at the patella-femoral joint, given its peculiar biomechanical characteristics. Coalition resection and interposition of extensor digitorum brevis . Hallux MTP dorsiflexion. Last Review06/20/2022. A flat foot is a combination of foot deformities that includes a valgus hindfoot and an abducted and supinated forefoot. 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. The latter is well-known and being established as the treatment of choice for large cartilage defects in the knee. Figure A shows a lateral radiograph of the affected heel. Miyamoto W, Takao M, Miki S, Kawano H. Midterm clinical results of osteochondral autograft transplantation for advanced stage Freiberg disease. Of the 26 patients who reported pre-operative tenderness, 19 (73 %) patients had no tenderness at most recent clinical follow-up (p = 0.02). 68% (1724/2534) 4. Patients at high risk for the development of this condition are involved in high-demand upper extremity activity such as baseball or gymnastics. Arthroscopic debridement/loose body removal can be carried out for small lesions (less than or equal to 1.2 cm in diameter). Osteochondral allograft and autograft transplantation. The mean SF-36 also demonstrated an improvement, from 64.0 +/- 14.8 at baseline to 79.4 +/- 15.4 (p = 0.059). 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. Sharpe JR, Ahmed SU, Fleetcroft JP, Martin R. The treatment of osteochondral lesions using a combination of autologous chondrocyte implantation and autograft: Three-year follow-up. Pes cavus is sometimesbut not alwaysconnected through Hereditary Motor and Sensory Neuropathy Type 1 (Charcot-Marie-Tooth disease) and Friedreich's Ataxia; many other cases of pes cavus are natural. Level of Evidence = IV. Lambers KTA, Dahmen J, Reilingh ML, et al. Foot Ankle Int 2005; 26: 25663, Detailed explanations and references are located in the, Meehan PL. Osteochondral autograft transplantation for osteochondritis dissecans of the capitellum in nonthrowing athletes. Level of Evidence = IV. Upper extremity physical exam reveals no neurologic deficits, and an initial radiograph of the shoulder is shown in Figure A. [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. Magnussen RA, Dunn WR, Carey JL, Spindler KP. Radiographs. Sub-group analysis showed no difference related to the number of cases the surgeon performed. Baker and colleagues (2011) noted that the development of synthetic bone graft substitutes is an intense area of research due to the complications associated with the harvest of autogenous bone and concerns about the supply of allogeneic bone. J Bone Joint Surg Am. Nine patients underwent concomitant distal re-alignment and demonstrated improvement between pre-operative and post-operative outcomes scores, but these differences were not statistically significant. Meeting Materials. Patients with an open capitellar physis had superior ROM for stable and unstable lesions, but there was no correlation with lesion location and the outcomes of OATS versus fragment fixation for high-grade lesions. J Orthop Sports Phy Ther 1991; 14: 70-74, Williams DS, 3rd, McClay IS, Hamill J. Arch structure and injury patterns in runners. The authors concluded that cartilage repair techniques, rather than MF, provided higher quality repair of tissue and had lower failure and higher return-to-activity rates. 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). The authors concluded that these techniques may improve patient outcomes, though no single technique can reproduce normal hyaline cartilage. The mean MINORS score of the included study was 7.6 (range of 5 to 9). Significantly more hyaline cartilage was found in the ACC (17.1 %) compared with MST (2.9 %) group (p < 0.01). Jakob RP, Franz T, Gautier E, Mainil-Varlet P. Autologous osteochondral grafting in the knee: Indication, results, and reflections. 7% (90/1292) 4. Isolated valgus malunion. Although favorable treatment outcomes have been reported for centrally located OCD, treatment outcomes are generally questionable; and the choice of surgical method is controversial for laterally located OCD. The average final DASH was 1.4 (95 % CI: 0.6 to 2.1), and the average final sport-specific DASH was 1.7 (95 % CI: -1.8 to 5.2). Charcot-Marie-Tooth disease can cause painful foot deformities such as pes cavus. On post-operative MRI, 86 % (p < 0.001) of elbows had restoration of articular congruity and 93 % had complete graft incorporation. Pes cavus commonly features a varus (inverted) hindfoot, a plantarflexed position of the first metatarsal, an adducted forefoot, and dorsal contracture of the toes. (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. Although most studies included in this review were of Level IV evidence, the mean MINORS scores were reasonably good. Minas T, Nehrer S. Current concepts in the treatment of articular cartilage defects. Pes cavus is a multiplanar foot deformity characterised by an abnormally high medial longitudinal arch. Patient demographics, osteochondral lesion and graft characteristics, the number of patients, and timing of return to competitive activity were collected and evaluated. Buenos Aires, Argentina:Institute for Clinical Effectiveness and Health Policy (IECS); 2009. The TruFit plug is a bi-phasic scaffold designed to stimulate cartilage and subchondral bone formation. Evaluation of the cavus foot for orthopedic treatment. } Allahabadi et al (2021) noted that osteochondral lesions of the tibial plafond (OLTPs) remain less common than osteochondral lesions of the talus (OLTs); however, recognition of the condition has increased. Microfracture of small lesions was the most common treatment used, and clinical and MRI results were favorable, although data were heterogeneous. Overall, 86.7 % of OLTPs were associated with a traumatic history and/or previous ankle sprain. QID: 4540 FIGURES: A 20 degrees hindfoot valgus, 5-10 degrees external rotation. Talar neck fractures are high energy injuries to the hindfoot that are associated with a high incidence of talus avascular necrosis. When the remaining cartilage defect was large after fragment fixation, a large-sized osteochondral plug was transplanted to the defect. In contrast to the mosaicplasty, donor site morbidity is low and the size of the defect is not a limiting factor. However, 2 years of monitoring has shown its failure in restoring the subchondral bone despite the formation of predominant hyaline cartilage from synthetic resorbable scaffolds. 2003;85-A(2):185-192. stress radiographs. 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. Similarly, patients who underwent OAT had higher return-to-activity rates than those with MF. 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. Knee Surg Sports Traumatol Arthrosc. Osteochondral grafts can be of relatively small size when the defect is focal and in an area that allows good stability and consequently the graft's integration. Chin J Traumatol. 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). The authors stated that currently available published studies are small, non-randomized, and lack long-term follow-up. Gudas R, Kalesinskas RJ, Kimtys V, et al. No mid-term difference in mosaicplasty in previously treated versus previously untreated patients with osteochondral lesions of the talus. Cain EL, Clancy WG. The authors stated that this systematic review had several drawbacks. These 2 treatment strategies were directly compared via a prospective preliminary randomized trial including 20 subjects with talar core decompression followed by either cancellous (CBG group, n = 10) or vascularized MFC (MFC group, n = 10) bone grafting. This study suggested that patients with patellar mal-alignment may represent a subset of patients who have a poor prognostic outlook compared with patients with normal alignment. Inclusion criteria were as follows: age of 18 to 50 years at the time of surgery, 1 or 2 symptomatic focal full-thickness articular chondral defects on the femoral condyles or trochlea, and size 2 to 6 cm2. They stated that prospective and comparative long-term clinical trials with large patient cohorts (including the use of MRI) have to be performed to fully support the use of this technique. The few histological data available confirmed these results. In addition, these investigators examined RTS and radiologic outcomes for the various therapeutic options. 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. 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. The median duration of follow-up was 42 months (range of 12 to 84). The mean patient age was 14.3 years. A total of 72 patients with an osteochondral defect of the humeral capitellum were treated with costal osteochondral autograft and followed for a minimum of 3 years (mean follow-up of 57 months; range of 36 to 147 months). Olympia, WA: Washington State Health Care Authority; November 18, 2011. Long-term outcomes after osteochondral autograft transfer: A systematic review at mean follow-up of 10.2 years. Recommendations for the medical management of osteoarthrits of the hip and knee. Orthop J Sports Med. Pareek A, Reardon PJ, Maak TG, et al. ), defect location (n.s.) Arthroscopy. The remaining 2 patients had changed sporting activities before surgery and did not return to baseball, despite satisfactory clinical results. 2018;7(6):e617-e622. Autologous osteochondral transplantation for the treatment of chondral defects of the knee. J Am Acad Orthop Surg. Karataglis D, Learmonth DJ. Third, it must be noted that due to the low number of included patients per study, a well-powered novel prospective study could potentially adjust the findings of this review; however, this review provided clinicians the best current evidence. 2012;40(6):1289-1295. It should be noted that the KOOS was higher in patients who underwent characterized chondrocyte implantation or MACI compared to MF. Clin Orthop Relat Res. Logli AL, Leland DP, Bernard CD, et al. Autologous osteochondral grafting--technique and long-term results. 2008;36(9):1770-1778. Cost and health status analysis after autologous chondrocyte implantation and mosaicplasty:A retrospective comparison. J Pediatr Orthop. Electronic databases from January 1966 to December 2006 were systematically screened. Glenohumeral joint preservation: Current options for managing articular cartilage lesions in young, active patients. Hindfoot Talar Neck FX Valgus migration of the fracture. Level of Evidence = IV. Olympia, WA: Washington State Health Care Authority; August 10, 2011. A clinical photograph and radiograph are provided in Figures A and B. Coleman block testing demonstrates correction of the deformity. the talus and calcaneus are more parallel than in typical feet. Furthermore, determining the association of imaging findings with arthroscopic findings and each of these with functional outcomes would be beneficial to understand the use of the pre- and intra-operative evaluation. Pichon-Riviere A, Augustovski F, Alcaraz A, et al. Sometimes children are born with flat feet (congenital). display: block; He was treated with physical therapy and a controlled ankle motion boot for several weeks following the injury with minimal relief. Likewise, the mean VAS significantly improved from a score of 72.710.3 (range of 60 to 90) to 7.87.2 (range of 0 to 20) (p<0.0001). height:2px; Which of the following is not a contraindication to hyperbaric oxygen treatment for this patient? Etiology of OCD was presumed to be sports participation, including baseball (n = 5) and gymnastics (n = 11). They stated thatfurther 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. Core decompression with cancellous bone grafting (CBG) is a common treatment for Berndt and Harty stages II and III. CaAlg hydrogel containing bone morphogenetic protein 4-enhanced adipose-derived stem cells combined with osteochondral mosaicplasty facilitated the repair of large osteochondral defects. Polymers are osteo-conductive and when used with marrow could provide a biodegradable osteo-inductive implant for repairing large defects. /*margin-bottom: 43px;*/ 2008;90(12):2751-2762. Kirsch JM, Thomas JR, Khan M, et al. She notices it immediately on getting out of bed in the morning, but the pain improves after a few steps. A total of 54 patients undergoing arthroscopic surgery for OLT were included in this study. Vascularized MFC autografts provided superior pain relief along with improvement of physical function in patients with talar OCL stage II and III compared with CBG. Heterogeneity was also observed in the used outcome measures. Chona DV, Kha ST, Minetos PD, et al. 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. 2021;9(11):23259671211049756. The authors concluded that current evidence suggested that OAT may lead to better and more consistent outcomes than previously described methods for treating large OCD lesions of the capitellum; however, long-term follow-up is needed to better characterize OAT as a treatment strategy in OCD of the elbow. 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). A post-reduction radiograph is seen in Figure C. Which of the following is the most appropriate treatment at this time? Careful counseling in regard to participation in post-operative high-demand activity is critical. The short-term (6 months) clinical results were encouraging: the HOOS score improved clearly and the patient was satisfied. The pain is exacerbated throughout her workday to the point where she is unable to finish her work shift. [1][2] Avulsion fractures can occur in any area where soft tissue is attached to bone. The mean time to RTS ranged from 13 to 26 weeks, although no pooling was possible for this outcome measure. passive eversion of the hindfoot past neutral demonstrates that the varus deformity is flexible. Buenos Aires, Argentina: Institute for Clinical Effectiveness and Health Policy (IECS); 2006. All surgical modalities resulted in significantly increased post-operative ROM and elbow scores for stable (UGS grades 1 and 2) and unstable lesions (UGS grades 3 and 4). The authors concluded that the long-term results suggested that the technique of Trufit Plug for OLT was safe and demonstrated good post-operative scores including improvement of pain and function, with discordant MRI results. Swine models of large cartilage defects of the knee were constructed and received 1 of the 4 treatments: mosaicplasty only, mosaicplasty with the CaAlg hydrogel, mosaicplasty with the CaAlg hydrogel containing ADSCs, or mosaicplasty with the CaAlg hydrogel containing B-ADSCs injected into the defective cracks. On post-operative MRI follow-up beyond 2 years, a subset of patients had a worsening appearance on MRI scans due to worsening cartilage sub-scores. Rational or irrational? Continuous passive range of motion (ROM) exercises and gait re-training were immediately initiated, with strict no weight-bearing precaution on the operated limb. Verhaegen and associates (2015) stated that treatment of osteochondral defects remains a challenge in orthopedic surgery. Orthop J Sports Med. Autologous cultured chondrocytes were injected underneath a periosteal patch covering the cores. The subtle cavus foot, "the underpronator," a review. These researchers stated that areas for future research include the following: the effect of patient factors and additional pathologies on outcomes; larger or deeper lesion treatment; more direct comparisons of outcomes between kissing or co-existing lesions and isolated lesions; and direct comparison of treatments, such as microfracture, bone marrow-derived cell transplantation (BMDCT), and osteochondral autografts/allografts. It probably consists of aseptic bone necrosis whose spontaneous healing is impaired by micro-traumas, resulting in an osteochondral injury and, in some cases, in osteoarthritis. The TruFit plug has been examined as a potential therapy for osteochondral defects. 2006;34(1):55-63. 2011;40(1):85-92. 1% (43/3432) 5. : CD006154. The mean pre-operative IKDC score was 47.2 +/- 14.0 and improved to 74.4 +/- 12.3 (p = 0.028). Talar tilt deformity. 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. Foot Ankle Int. 3% (131/4569) L 2 A radiograph of the chest shows a small pneumothorax which is being observed and does not require a thoracostomy tube. 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. 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