Osteochondral defects

 

OC defectOC defect

 

Definition

 

Defect of cartilage +/bone

Typically on talus

 

Options

 

Marrow stimulation - microfracture / microdrilling

 

Cartilage restoration

- Matrix autologous cartilage implantation (MACI)

- Autologous membrane induced chondrogenesis (AMIC)

- Autologous minced cartilage implantation (AutoCart)

- Allogenic minced juvenile cartilage implantation (DeNovo)

- Osteochondral autograft (Mosaicplasty / OAT)

- Osteochondral allograft (OCA)

 

Location

 

Issue

- guides approach

- open versus arthroscopic

- need for osteotomy

 

van Diepen et al Cartilage 2021

- systematic review of 2000 OC lesions of the talus

- 9 grid system

- 28% posteromedial

- 31% centromedial

 

Talus OCL

 

Approaches

 

Vumedi approaches to talus OCL

 

Arthroscopy Approaches

 

Anterolateral / anteromedial

- anterior 50 - 60% lesions

 

Posterolateral / posteromedial

- prone

- posterior lesions

 

Open approaches

 

Lateral lesion

- more anterior lesions accessible with anterolateral approach

- ± Anterior plafond osteotomy ± Chaput anterolateral osteotomy if large

 

Medial lesion

- often more posterior

- may require medial malleolar osteotomy

 

Medial Malleolar osteotomy

 

Predrill for screws

Arthrotomy / image guidance

Posterior homan to protect tibialis posterior

Initial osteotomy with saw / complete with osteotome

 

Surgical technique PDF

 

Vumedi surgical technique video

 

MM osteotMM osteotMM osteotomy

 

Microfracture

 

Indications

 

Chondral lesion < 1 cm diameter

 

Technique

 

Youtube surgical technique video microfracture

 

Arthroscopy techniques microfracture talus

 

mfxmfxm#

 

Talus Chondral LesionTalus OCD Bleeding

 

Results

 

Outcome

 

Fu et al Orthop J Sports Med 2022

- 5 year follow up of talus microfracture in 355 patients

- reoperation rate 9%

 

Size

 

Ramponi et al AJSM 2017

- systematic review of microfracture for talus lesions

- better results with diameter < 1 cm

 

PRP / HA

 

Huang et al Foot Ankle Surg 2024

- systematic review of PRP + microfracture for ostechondral lesions talus

- evidence that use of PRP improves outcomes

 

Dilley et al BMC Musculoskeletal Disorder 2022

- systematic review evaluating hyaluronic acid + microfracture for ostechondral lesions talus

- evidence that use of HA improves outcomes

 

Weight bearing

 

Song et al J Foot Ankle Surg 2021

- systematic review of early v delayed weightbearing after microfracture talus

- no evidence of improved outcomes with delayed weightbearing

 

Ankle Scope OCD Grade 4Ankle Scope OCD Abrasion

 

Matrix autologous cartilage implantation (MACI)

 

Technique

 

Vumedi surgical technique video MACI

 

Autologous chondrocytes on collagen scaffold

2 step procedure

 

Results

 

Hu et al Arch Orthop Trauma Surg 2023

- meta-analysis of 23 studies and 460 patients undergoing MACI

- success rate 89%

 

Autologous membrane induced chondrogenesis (AMIC)

 

Technique

 

Autologous Membrane Induced Chondrogenesis (AMIC)

- microfracture with collagen patch (Chondrogide) secured with fibrin glue

 

Vumedi surgical technique AMIC talus

 

Arthroscopy techniques AMIC talus

 

Results

 

Wen et al J Foot Ankle Surg 2021

- systematic review of microfracture v augmented microfracture

- 10 studies and 500 patients with talar cartilage defects

- evidence of superior results of augemented microfracture

 

Minced Juvenile Allograft Cartilage Transplantation

 

Technique

 

Vumedi surgical technique minced cartilage talus

 

Arthroscopic techniques minced cartilage talus

 

Minced autograft or allograft cartilage fragments

Secure with fibrin glue

 

Results

 

Coetzee et al Foot Ankle Int 2013

- 24 ankles

- 78% good or excellent results

 

Osteochondral autograft transplantation (OATS / mosaicoplasty)

 

Technique

 

Vudmedi arthroscopic mosaicplasty video

Donor cartilage taken from knee NWB surface

 

Results

 

Shimozono et al KSSTA 2018

- systematic review of OATS

- 11 studies and 500 ankles

- 5/500 (1%) deemed failures

- donor site complication 4%

- reoperation rate 6%

 

Osteochondral Allograft

 

Technique

 

Vumedi surgical technique osteochondral allograft video

 

Arthroscopic techniques osteochondral allograft

 

Talus MosaicplastyTalus Mosaicplasty 1Talus Mosaicplasty 2

 

Results

 

Pereira et al J Foot Ankle Surg 2021

- systematic review of 191 patients

- graft survival 87%

- reoperation rate (arthroscopic debridement / hardware removal) 22%