Search Results (8)

Background: Complex hindfoot pathologies involving critical-sized bone defects of the talus are difficult to manage. The current management involves arthrodesis and bone grafting with the defective talus, which have limitations in restoring structural integrity and functional goals. The advancement of 3D-printed scaffolds has opened new avenues to address such complex hindfoot pathologies, which may potentially improve treatment outcomes. The addition of platelet-rich fibrin further enhances healing potential. Method: This is a retrospective study involving six patients with severe talar bone loss secondary to osteomyelitis or avascular necrosis, where 3D-printed scaffolds coated with PRF were implemented in salvage surgery performed from 2023 to 2024. We intended to investigate the clinical outcomes in terms of healing time and union rate. Additionally, we evaluated the degree of deformity corrections and the patients’ clinical outcomes. Results: This study reports six complex reconstructions which achieved CT-confirmed union after a mean duration of 20.2 weeks. All patients were able to ambulate with full weight bearing after an average duration of 23.3 weeks. The patients demonstrated improved radiological parameters, VAS scores from 7.5 ± 1.4 points to 2.3 ± 1.2, and functional scores in all domains for AOFAS, FFI and SF-36. Conclusion: This study demonstrates the benefits of PRF-coated 3D-printed scaffolds in managing complex hindfoot cases, especially in the presence of significant bony defects. This modality has the potential to achieve a good union rate, near-anatomical correction and good functional outcomes. Full article

Background: Talar neck fractures are complex injuries that become particularly challenging when accompanied by bone loss or comminution. This case report introduces the use of an allograft bone screw as a novel method for bridging lateral comminution at the talar neck, providing structural support and promoting bone regeneration. Methods: A 20-year-old male sustained a comminuted talar neck fracture with subtalar and tibiotalar dislocation after a bouldering fall. Urgent surgical intervention involved open reduction and internal fixation using a two-incision technique. The medial key fragment was stabilized with two conventional compression screws, revealing a significant lateral bony defect. This was bridged and stabilized with an allogeneic cortical bone screw (Shark Screw^®, Surgebright GmbH, Lichtenberg, Austria), supplemented by bone replacement material. Results: At three months, CT confirmed fracture healing, and weight-bearing was initiated. At six months, the AOFAS score was 85/100 and FAAM 69/84, with no significant pain or swelling. By one year, the patient demonstrated full weight-bearing with occasional pain (AOFAS 88/100, FAAM 79/84). At two years, the patient achieved a pain-free range of motion and full activity participation (AOFAS 100/100, FAAM 83/84). Conclusions: The successful application of this technique illustrates the potential of allograft bone screws for stabilizing and bridging defects in talar neck fractures. 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

Autologous matrix-induced chondrogenesis (AMIC) has been advocated for the management of talar osteochondral lesions (OCLs). This systematic review, which was conducted according to the PRISMA 2020 guidelines, investigated the clinical and imaging efficacy and safety of the AMIC technique in the management of OCLs of the talus. Only studies investigating AMIC for talar chondral defects that were published in peer-reviewed journals were considered. In September 2022, the following databases were accessed: PubMed, Web of Science, Google Scholar, and Embase. Data on the visual analogue scale (VAS), American Orthopaedic Foot and Ankle Score (AOFAS), Tegner activity scale, and Foot Function Index (FFI) were retrieved. To evaluate the morphological MRI findings, data obtained from the magnetic resonance observation of cartilage repair tissue (MOCART) scores were evaluated. Data on hypertrophy, failures, and revision surgeries were also collected. Data from 778 patients (39% women, 61% men) were collected. The mean length of the follow-up was 37.4 ± 16.1 months. The mean age of the patients was 36.4 ± 5.1 years, and the mean BMI was 26.1 ± 1.6 kg/m². The mean defect size was 2.1 ± 1.9 cm². Following the AMIC technique, patients demonstrated an improved VAS (p < 0.001), AOFAS (p < 0.001), and FFI (p = 0.02) score. The MOCART score also improved from the baseline (p = 0.03). No difference was observed in the Tegner score (p = 0.08). No graft delamination and hypertrophy were reported in 353 patients. 7.8% (44 of 564) of patients required revision surgeries, and 6.2% (32 of 515) of patients were considered failures. The AMIC technique could be effective in improving symptoms and the function of chondral defects of the talus. Full article

Introduction: Many procedures are available to manage cartilage defects of the talus, including microfracturing (MFx) and Autologous Matrix Induced Chondrogenesis (AMIC). Whether AMIC or MFx are equivalent for borderline sized defects of the talar shoulder is unclear. Thus, the present study compared the efficacy of primary isolated AMIC versus MFx for borderline sized focal unipolar chondral defects of the talar shoulder at midterm follow-up. Methods: Patients undergoing primary isolated AMIC or MFx for focal unipolar borderline sized chondral defects of the talar shoulder were recruited prospectively. For those patients who underwent AMIC, a type I/III collagen resorbable membrane was used. The outcomes of interest were: Visual Analogic Scale (VAS), Tegner Activity Scale, American Orthopedic Foot and Ankle Score (AOFAS). The Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) was assessed by a blinded radiologist, who had not been involved in the clinical management of the patients. Data concerning complication rate and additional procedures were also collected. Results: The mean follow-up was 43.5 months. The mean age of the 70 patients at operation was 32.0 years, with a mean defect size of 2.7 cm². The mean length of hospitalization was shorter in the MFx cohort (p = 0.01). No difference was found between the two cohorts in terms of length of prior surgery symptoms and follow-up, mean age and BMI, sex and side, and defect size. At a mean follow-up of 43.5 months, the AOFAS (p = 0.03), VAS (p = 0.003), and Tegner (p = 0.01) scores were greater in the AMIC group. No difference was found in the MOCART score (p = 0.08). The AMIC group evidenced lower rates of reoperation (p = 0.008) and failure (p = 0.003). Conclusion: At midterm follow-up, AMIC provides better results compared to MFx. Full article

Background: The management of a focal osteochondral lesion of the talus (OLT) is challenging. Evidence concerning the role of the autologous matrix-induced chondrogenesis (AMIC) procedure in patients with focal OLT is promising. The purpose of the present study was to investigate clinical outcomes and radiographic findings of the AMIC technique for focal unipolar OLT. Material and Methods: The present study was performed according to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Twenty-four patients who underwent AMIC for focal OLT were prospectively recruited at our institution. All the surgeries were performed by two experienced surgeons through malleolar osteotomy and autologous cancellous bone grafting. The outcomes of interest were the American orthopedic foot and ankle score (AOFAS), the foot-function index (FFI), and the magnetic resonance observation of cartilage repair tissue (MOCART). Surgical duration, hospitalization length, and complications were also collected. Results: 24 patients were included in the present study. The mean follow-up was 25.17 ± 13.1 months. The mean age of the patients at surgery was 46.75 ± 15.2 years, the mean BMI 26.92 ± 5.7 kg/m², and 50% (12 of 24) of patients were female. The right ankle was involved in 62.5% (15 of 24) of patients. The mean defect size was 6.95 ± 2.9 mm². The mean surgical duration was 112 ± 20 min while the mean hospitalization 5.58 ± 1.7 days. At last follow-up, the AOFAS increased by 27.8 points (p < 0.0001), while the FFI reduced by 25.3 points (p < 0.0001) and the MOCART score increased by 28.33 points (p < 0.0001). No complications were observed. Conclusion: The AMIC procedure for focal osteochondral defects of the talar shoulder is feasible and reliable at midterm follow-up. Full article

A rigid surface–volume registration scheme is presented in this study to register computed tomography (CT) and free-hand tracked ultrasound (US) images of the talocrural joint. Prior to registration, bone surfaces expected to be visible in US are extracted from the CT volume and bone contours in 2D US data are enhanced based on monogenic signal representation of 2D US images. A 3D monogenic signal data is reconstructed from the 2D data using the position of the US probe recorded with an optical tracking system. When registering the surface extracted from the CT scan to the monogenic signal feature volume, six transformation parameters are estimated so as to optimize the sum of monogenic signal features over the transformed surface. The robustness of the registration algorithm was tested on a dataset collected from 12 cadaveric ankles. The proposed method was used in a clinical case study to investigate the potential of US imaging for pre-operative planning of arthroscopic access to talar (osteo)chondral defects (OCDs). The results suggest that registrations with a registration error of 2 mm and less is achievable, and US has the potential to be used in assessment of an OCD’ arthroscopic accessibility, given the fact that 51% of the talar surface could be visualized. Full article

A completely extruded talus without any remaining soft tissue attachments is extremely rare. The present report describes treatment of a 45-year-old man who sustained a completely extruded talus injury following a rockclimbing fall. Upon admission, the extruded talus was deep-frozen in our bone bank. The open ankle joint underwent massive wound debridement and irrigation for 3 days. Four days later we performed a primary subtalar fusion between the extruded talus and the calcaneus, anticipating revascularization from the calcaneus. However, aseptic loosening and osteolysis developed around the screw and talus. At 12 months post-trauma we performed a tibiocalcaneal ankle fusion with a femoral head allograft to fill the talar defect. Follow-up at 24 months post-trauma showed the patient had midfoot motion, tibio-talar-calcaneal fusion, and was able partake in 4-hour physical activity twice per week. Full article