Search Results (75)

Osteochondral lesions of the talus (OLTs) present a significant clinical challenge, often leading to pain, dysfunction, and joint degeneration. Traditional treatments, including microfracture and grafting, have limitations in their ability to fully restore osteochondral integrity. Recent advances in tissue engineering have introduced heparin-conjugated fibrin hydrogel (HCFH) as a promising scaffold for regenerative therapy. By supporting mesenchymal stem cell (MSC) proliferation and controlled growth factor release, HCFH enhances cartilage and bone repair. A 21-year-old female presented with chronic right ankle pain and instability following a sports injury, with MRI revealing an osteochondral lesion in the lateral dome of the talus and an anterior talofibular ligament injury. Treatment included autologous MSC isolation, HCFH synthesis, arthroscopic debridement, microfracture, and implantation of MSC-loaded HCFH, while postoperative rehabilitation involved four weeks of restricted weight-bearing- and physiotherapy. At 12 months, her visual analog scale (VAS) score decreased from 60 to 40, indicating clinical improvement, and her American Orthopaedic Foot and Ankle Society (AOFAS) score increased from 69 to 77. Serial MRI scans showed progressive cartilage regeneration with near-complete defect filling. This case highlights the potential of MSC-loaded HCFH in treating OLTs. The observed improvements in pain relief, function, and cartilage regeneration suggest that this technique may overcome the limitations of conventional treatments. Further studies with larger cohorts and long-term follow-up are necessary to confirm its clinical efficacy. Full article

Background/Objectives: Different patient-reported outcomes and radiological results are reported depending on whether microfracture, drilling, or nanofracture is utilized in the arthroscopic treatment of talus osteochondral lesions, but the first-line treatment is still controversial. The aim of this study is to evaluate the early patient-reported outcomes of microfracture, nanofracture, and antegrade drilling methods in talus anteromedial osteochondral lesions. Methods: A total of 77 patients who presented with ankle pain between October 2016 and June 2022, were diagnosed with talus osteochondral lesions, and underwent microfracture (n: 27), nanofracture (n: 25), and K-wire drilling (n: 25) were included. Demographic data of the patients were evaluated, such as age, gender, lesion side, dominant extremity, body mass index (BMI), smoking status, smoking (pack/day-year), and symptom duration. Patient-reported outcomes of the patients were evaluated with VAS (visual analog scale) and AOFAS (American Orthopedic Foot & Ankle Society) scores measured before surgery and at 6 and 12 months after surgery. The results were evaluated at the significance level of p < 0.05. Results: There were no statistically significant differences among the microfracture, nanofracture, and drilling groups in terms of age, gender, lesion side, dominant extremity, BMI, smoking, or daily cigarette use (p = 0.121, p = 0.852, p = 0.956, p = 0.731, p = 0.881, p = 0.769, p = 0.124). Similarly, the mean duration of symptoms did not differ significantly between the groups (p = 0.336). Although AOFAS and VAS scores significantly improved in all groups (p = 0.0001), there were no statistically significant differences between the microfracture, nanofracture, and drilling groups at preoperative, 6th-, and 12th-month measuring points. The microfracture group showed a significantly higher AOFAS improvement from preop to 6 months compared to the other groups (p = 0.012), though no differences were found between nanofracture and drilling or in 12-month changes. VAS percentage changes showed no significant differences among groups at either time point. Conclusions: All treatment groups had similar baseline characteristics and outcomes, with the microfracture group showing a greater functional improvement at 6 months. Full article

Background: Autologous osteochondral transplantation (AOT)—the transfer of hyaline cartilage with its underlying subchondral bone—is well established for focal osteochondral lesions, yet evidence for larger (>200 mm²) defects is limited. We assessed clinical and functional outcomes of AOT in patients with osteochondral knee lesions exceeding 200 mm². Methods: In this retrospective cohort study, 52 patients underwent AOT for full-thickness osteochondral defects of the femoral condyles or patellofemoral joint. All lesions were ≥200 mm² and treated with a standardized press-fit technique using one to four overlapping cylindrical grafts. Pain and knee function were evaluated preoperatively and at 3, 6, and 12 months postoperatively with the Visual Analogue Scale (VAS), Tegner–Lysholm Knee Score (TLKS), and Knee Society Score (KSS). Results: Mean defect size was 224.4 ± 84.5 mm². The VAS improved from 6.32 ± 1.1 preoperatively to 0.72 ± 0.6 at 12 months (p < 0.001). The TLKS rose from 58.6 ± 11.4 to 95.0 ± 6.8 and the KSS from 63.8 ± 12.2 to 97.4 ± 4.9 during the same period (both p < 0.001). Most gains occurred within the first 3–6 months and were sustained at 12 months. No major surgical complications were observed, and outcomes were unaffected by age, sex, or graft number/size. Conclusions: AOT is a safe, effective option for large osteochondral knee defects (>200 mm²), offering rapid, durable pain relief and excellent functional recovery while preserving native joint structures. Accurate donor site reconstruction and precise graft placement in the weight-bearing zone appear critical for optimal results. Longer-term prospective studies are needed to confirm durability and refine patient-selection criteria. Full article

Background: A trilayered collagen/collagen–magnesium–hydroxyapatite (Col/Col-Mg-HA) scaffold is used in clinical practice to treat osteochondral lesions, but the regeneration of the subchondral bone is still not satisfactory. Objective: The aim of this study was to test, in vitro, the osteoinductivity induced by the addition of bone morphogenetic protein-2 (BMP-2) or amorphous calcium phosphate granules with strontium ions (Sr-ACP), in order to improve the clinical regeneration of subchondral bone, still incomplete. Methodology: Normal human osteoblasts (NHOsts) were seeded on the scaffolds and grown for 14 days in the presence of human osteoclasts and conditioned medium of human endothelial cells. NHOst adhesion and morphology were observed with transmission electron microscopy, and metabolic activity was tested by Alamar blue assay. The expression of osteoblast- and osteoclast-typical markers was evaluated by RT-PCR on scaffolds modified by enrichment with BPM-2 or Sr-ACP, as well as on unmodified material used as a control. Results: NHOsts adhered well to all types of scaffolds, maintained their typical morphology, and secreted abundant extracellular matrix. On the modified materials, COL1A1, SPARC, SPP1, and BGLAP were more expressed than on the unmodified ones, showing the highest expression in the presence of BMP-2. On Sr-ACP-enriched scaffolds, NHOsts had a lower proliferation rate and a lower expression of RUNX2, SP7, and ALPL compared to the other materials. The modified scaffolds, particularly the one containing Sr-ACP, increased the expression of the osteoclasts’ typical markers and decreased the OPG/RANKL ratio. Both types of scaffold modification were able to increase the osteoinductivity with respect to the original scaffold used in clinical practice. BMP-2 modification seemed to be more slightly oriented to sustain NHOst activity, and Sr-ACP seemed to be more slightly oriented to sustain the osteoclast activity. These could provide a concerted action toward better regeneration of the entire osteochondral unit. Full article

As tissue engineering and regenerative medicine (TERM) continues to revolutionize medicine and surgery, there is also growing interest in applying these advancements to foot and ankle surgery. The purpose of this article is to provide a comprehensive review of the types of gel scaffolds and templates, their applications in foot and ankle surgery, the challenges with current utilization, and the future directions of TERM in foot and ankle surgery. With multiple compelling scaffold prospects across the numerous natural, synthetic, and hybrid polymers currently utilized in TERM, promising results have been described in the treatment of osteoarthritis (OA) and osteochondral lesions (OCLs). However, concerns with material biocompatibility, structural integrity, feasibility during surgery, and degradation still exist and limit the extent of utilization. As researchers continue to develop enhanced polymers and formulations that address current issues, there are many opportunities to increase applications across foot and ankle surgery. Full article

Background and Objectives: Chondral and osteochondral lesions can lead to osteoarthritis if untreated, making accurate assessment of cartilage repair outcomes essential for optimizing treatment strategies. The objective of this study was to compare MOCART and MOCART 2.0 and to evaluate the clinical utility of both across different surgical cartilage repair techniques and various time points. Material and Methods: This study included 111 patients (age: 35 ± 10, 35% female) who underwent cartilage repair surgery of the knee between September 2015 and March 2022. A total of 188 postoperative magnetic resonance images were evaluated using MOCART and MOCART 2.0. The correlations between both scores, as well as to the change in Patient-Reported Outcome Measures (PROMs), were determined. Results: MOCART 2.0 scores (66 ± 13) were significantly higher than MOCART scores (58 ± 13, p < 0.001). Positive correlation was observed between scoring systems (r = 0.837, p < 0.001). There was no significant correlation between MOCART or MOCART 2.0 scores and the change in PROMs. Noticeably, there was a statistically significant correlation between both MOCART and MOCART 2.0 in the AutoCart subgroup across multiple timepoints for the change in PROMs. Conclusions: Based on radiographic–clinical outcome discordance, clinicians should not rely solely on MOCART or MOCART 2.0 scores when evaluating cartilage repair success but instead prioritize patient-reported functional improvements while using imaging as a complementary assessment tool. Full article

Osteochondral defects, involving both articular cartilage and subchondral bone, pose significant challenges to joint function and health due to the lack of spontaneous healing and the risk of long-term degenerative diseases like osteoarthritis. Biomaterials have emerged as important components in the development of scaffolds, providing structural support that facilitates tissue growth, integration, and regeneration. This study aims to demonstrate the effectiveness of a tomographic assessment method for optimizing the evaluation of osteochondral regeneration, particularly using Hounsfield units, to enable the evaluation of scaffold integration and tissue regeneration. The sheep model was selected as a model study. Two distinct configurations of biomaterials were utilized in this study: Honey (HMG—Mg doped hydroxyapatite; HWS—wollastonite–hydroxyapatite) and Bi-layer (BWS—wollastonite–hydroxyapatite). The HMG scaffold demonstrated superior integration, reparative tissue quality, and regeneration potential compared to the HWS, BWS, and CTRL groups. The findings underscore the significance of CT assessment as a preliminary method for evaluating hard tissue, such as bone, employing Hounsfield units. Statistical evaluations validated the significant differences in performance, particularly favoring the HMG group. The results of this study underscore the importance of tomographic assessment in evaluation of osteochondral regeneration. Full article

Objective: Literature regarding osteochondral lesions in patients following elbow dislocation is scarce. The aim of this study was to examine osteochondral lesions on MRI in patients following simple elbow dislocations and evaluate inter-rater reliability between radiologists and orthopedic surgeons at different levels of experience. Methods: In this retrospective, single-center study, 72 MRIs of patients following simple elbow dislocations were evaluated. Ligamentous and osteochondral injuries were evaluated by a junior and senior radiologist and a junior and senior orthopedic surgeon. Osteochondral lesions were classified according to the Anderson classification, and their distribution was assessed. Inter-rater reliability was assessed using Cohen’s Kappa (95% CI) and Fleiss’ Kappa (95% CI). Results: The mean time from injury to MRI was 6.92 ± 4.3 days, and the mean patient age was 42.4 ± 16.0 years. A total of 84.5% of patients had a lateral collateral ligament tear, and 69.0% had a medial collateral ligament tear. Osteochondral lesions were found in 27.8% to 63.9% of cases. According to the senior orthopedic surgeon, 100% were first-grade lesions, whereas the senior radiologist classified 63.2% as first-grade, 26.3% as second-grade, and 5.3% as third- and fourth-grade lesions. Inter-rater reliability was fair to moderate for ligamentous injuries and fair for osteochondral lesions (Fleiss Kappa 0.25 [0.15–0.34]). Localization of the lesions differed depending on the examiner. For all examiners, osteochondral lesions of the lateral column (radial head and capitulum) were most common, with 57.8–66.7% of all lesions. Inter-rater reliability was moderate for lesions in the medial column (Fleiss Kappa 0.51 [0.41–0.6]) and fair for lesions in the lateral column (Fleiss Kappa 0.34 [0.24–0.43]). Conclusions: Osteochondral lesions following simple elbow dislocations are common; however, in contrast to the current literature, high-grade lesions seem to be relatively rare. Overall inter-rater reliability between radiologists and surgeons, as well as within surgeons, was only moderate to fair regarding ligament and osteochondral lesions. Full article

Background: Evidence on return to sport (RTS) criteria and timelines for pediatric patients with osteochondral (OCD) lesions of the foot and ankle is limited. Methods: This systematic review evaluated RTS criteria and outcomes in this population by querying PubMed, Embase, Web of Science, CINAHL, and SPORTDiscus up to 30 May 2024. Inclusion criteria were retrospective or prospective studies that examined pediatric patients with osteochondral lesions of the foot and ankle and gave outcomes or criteria regarding RTS. Results: Five observational studies (n = 168 patients; n = 180 OCD lesions; mean age: 14.19 ± 0.47 years; mean follow-up: 42 ± 174 months) were included. Two studies (40%) used time-based criteria for RTS, two studies (40%) used mixed criteria, and the final study (20%) used milestone-based criteria. Across the mixed and milestone criteria, physical therapy (n = 3) and minimal partial weight-bearing prior to RTS (n = 4) were most frequently seen as the milestones used for assessing RTS readiness. RTS from the postoperative period ranged from 3 months to 6 months. At the final follow-up, 61.45% of patients (n = 110) were available to provide information regarding their ability to RTS. Of these patients, 80% (n = 88) achieved RTS. Conclusions: Results showed variability in RTS criteria, ranging from three to six months, with no clear patterns. Most patients returned to sport, suggesting that such individualized criteria may be effective to an extent. Future research should focus on larger, high-quality studies to develop consistent RTS protocols. Full article

Scaffolds are widely used devices for the treatment of osteochondral lesions of the talus (OCLT), aimed at enhancing mechanical stability and fostering chondrogenic differentiation. A systematic review and meta-analysis were performed to evaluate the safety, and clinical and radiological results of scaffolds for OCLT management. On 2 January 2024, a search was performed in four databases (PubMed, Embase, Web of Science, and Scopus), according to PRISMA guidelines. The risk of bias in the included studies was also evaluated. Thirty clinical studies were included in the qualitative analysis: 12 retrospective case series, 3 retrospective comparative studies, 9 prospective case series, 1 prospective comparative study, and 1 Randomized Controlled Trial (RCT). Natural scaffolds, such as bilayer collagen (COLL)I/III and hyaluronic scaffolds, were the most employed. Only minor adverse events were observed, even if more serious complications were shown, especially after medial malleolar osteotomy. An overall clinical and radiological improvement was observed after a mean of 36.3 months of follow-up. Patient age and Body Mass Index (BMI), lesion size, and location were correlated with the clinical outcomes, while meta-analysis revealed significant improvement in clinical scores with hyaluronic scaffolds compared to microfracture alone. This study highlights the safety and positive clinical outcomes associated with the use of scaffolds for OCLT. In the few available comparative studies, scaffolds have also demonstrated superior clinical outcomes compared to microfractures alone. Nevertheless, the analysis has shown the limitations of the current literature, characterized by an overall low quality and scarcity of RCTs. Full article

Osteochondral lesions may be due to trauma or congenital conditions. In both cases, therapy is limited because of the difficulty of tissue repair. Tissue engineering is a promising approach that relies on designed scaffolds with variable mechanical attributes to favor cell attachment and differentiation. Human adipose-derived stem cells (hASCs) are a very promising cell source in regenerative medicine with osteochondrogenic potential. Based on the assumption that stiffness influences cell commitment, we investigated three different scaffolds: a semisynthetic animal-derived GelMA hydrogel, a combined scaffold made of rigid PEGDA coated with a thin GelMA layer and a decellularized plant-based scaffold. We investigated the role of different biomechanical stimulations in the scaffold-induced osteochondral differentiation of hASCs. We demonstrated that all scaffolds support cell viability and spontaneous osteochondral differentiation without any exogenous factors. In particular, we observed mainly osteogenic commitment in higher stiffness microenvironments, as in the plant-based one, whereas in a dense and softer matrix, such as in GelMA hydrogel or GelMA-coated-PEGDA scaffold, chondrogenesis prevailed. We can induce a specific cell commitment by combining hASCs and scaffolds with particular mechanical attributes. However, in vivo studies are needed to fully elucidate the regenerative process and to eventually suggest it as a potential approach for regenerative medicine. Full article

The treatment of osteochondritis dissecans of the knee has always been a challenge for orthopedic surgeons. We present a case report of a 38-year-old male with severe right knee pain after suffering from an indirect trauma and axial rotation of the knee, limiting knee functionality and impeding his ability to walk, with a diagnosis of osteochondritis dissecans in the trochlea of the knee, who underwent arthroscopic treatment with matrix-induced autologous chondrocyte implantation (MACI). After the surgery, a physical therapy protocol for MACI was implemented, and magnetic resonance images with cartilage mapping were used to evaluate the recovery of the lesion. A total recovery was observed and evaluated with the modified Cincinnati knee rating system (mCKRS). A discussion is provided with evidence and general recommendations for the use of MACI in the treatment of adult OCD of the knee as a possible alternative to conventional treatments. Our case shows a rapid improvement in pain and functionality 2 months after surgery that progressed to full recovery within 6 months. Full article

Weight-bearing computed tomography (WBCT) enables acquisition of three-dimensional bony structure images in a physiological weight-bearing position, which is fundamental in understanding the pathologic lesions and deformities of the ankle joint. Over the past decade, researchers have focused on validating and developing WBCT measurements, which has significantly enhanced our knowledge of common foot and ankle diseases. Consequently, understanding the application of WBCT in clinical practice is becoming more important to produce improved outcomes in the treatment of disease around the ankle joint. This review will describe an overview of what is currently being evaluated in foot and ankle surgery using WBCT and where the course of research will be heading in the future. Full article

Background: Retrograde Drilling (RD) is a surgical technique employed for osteochondral lesions of the talus (OCLTs) to reach the subchondral bone lesion from behind, thus preserving cartilage integrity. The aim of the present pilot study was to set up an in vitro model of OCLTs to evaluate the regenerative potential of biological approaches that could be associated with the RD technique. Methods: For this purpose, an OCLT was created in human osteochondral specimens, to try to mimic the RD technique, and to compare the regenerative potential of two biological treatments. For this purpose, three groups of treatments were performed in vitro: (1) no treatment (empty defect); (2) autologous bone graft (ABG); (3) hyaluronic membrane enriched with autologous bone marrow cells. Tissue viability; production of Collagen I and II, Vascular Endothelial Growth Factor, and Aggrecan; and histological and microCT evaluations were performed after 30 days of culture in normal culture conditions. Results: It was observed that Group 3 showed the highest viability, and Group 2 showed the highest protein production. From a histological and microtomographic point of view, it was possible to appreciate the structure of the morcellized bone with which the defect of Group 2 was filled, while it was not yet possible to observe the deposition of mineralized tissue in Group 3. Conclusions: To conclude, this pilot study shows the feasibility of an alternative in vitro model to evaluate and compare the regenerative potential of two biological scaffolds, trying to mimic the RD technique as much as possible. The tissues remained vital for up to 4 weeks and both ABG and hyaluronic acid-based scaffolds stimulated the release of proteins linked to regenerative processes in comparison to the empty defect group. Full article

Background: Managing osteochondral cartilage defects (OCDs) of the talus is a common daily challenge in orthopaedics as they predispose patients to further cartilage damage and progression to osteoarthritis. Therefore, the implementation of a reliable tool to quantify the amount of cartilage damage that is present is of the essence. Methods: We retrospectively identified 15 adult patients diagnosed with uncontained OCDs of the talus measuring <150 mm², which were treated arthroscopically with bone marrow stimulation. Five independent assessors evaluated the pre-operative MRI scans with the AMADEUS scoring system (i.e., MR-based pre-operative assessment system) and the intra-/inter-observer variability was then calculated by means of the intraclass correlation coefficients (ICC) and Kappa (κ) statistics, respectively. In addition, the correlation between the mean AMADEUS scores and pre-operative self-reported outcomes as measured by the Manchester–Oxford foot questionnaire (MOxFQ) was assessed. Results: The mean ICC and the κ statistic were 0.82 (95% CI [0.71, 0.94]) and 0.42 (95% CI [0.25, 0.59]). The Pearson correlation coefficient was found to be r = −0.618 (p = 0.014). Conclusions: The AMADEUS tool, which was originally designed to quantify knee osteochondral defect severity prior to cartilage repair surgery, demonstrated good reliability and moderate inter-observer variability for small OCDs of the talar shoulder. Given the strong negative correlation between the AMADEUS tool and pre-operative clinical scores, this tool could be implemented in clinical practise to reliably quantify the extent of the osteochondral defects of the talus. Full article