SLR - August 2016 - Zeno Pfau
Reference: Pagliazzi G, Baldassarri M, Perazzo L, Vannini F, Castagnini F, Buda R. Tissue Bioengineering in the Treatment of Osteochondritis Dissecans of the Talus in Children With Open Physis: Preliminary Results. J Pediatr Orthop. 2016 Jul 2.
Scientific Literature Review
Reviewed By: Zeno Pfau, DPM
Residency Program: North Colorado Podiatric Medicine and Surgery Residency
Podiatric Relevance: Many treatment options have been discussed in regards to osteochondritis dissecans (OCD) of the talus in adults. Common treatment options include anterograde and retrograde drilling as well as microfracture techniques. Procedural selection is influenced by size, depth and type of the lesion. However, limited research has been performed on OCD in the juvenile population. This paper discussed a 1-step arthroscopic treatment for juvenile OCD of the talus (JOCDT) with the use of a collagen scaffold, autologous platelet-rich fibrin and bone marrow aspirate concentrate (BMAC).
Methods: Seven patients with JOCDT met inclusion criteria and were retrospectively reviewed. Exclusion criteria was closed growth plates, malalignment of ankle or hindfoot, rheumatic disease or prior ankle surgery. Ankle radiographs and MRI were used to evaluate and stage lesions according to Berndt and Harty classification. Healing was monitored with postoperative radiographs and MRI. Pain assessment was assessed via VAS score. Outcomes were also evaluated with the assistance of AOFAS score.
Results: Seven patients were followed retrospectively with a mean age of 12.8 at time of surgery. Average follow-up time was 48.1 months. Six of the lesions were classified as a stage III and 1 lesion as a stage IV, according to the Berndt and Harty classification. The average preoperative and postoperative AOFAS scores were 58.8 and 95.7 points, respectively. VAS score improved from an average of 6.3 to 0.4. Complete radiographic healing was observed in 3 out of the 7.
Conclusions: The results of the study showed good mid-term outcomes with a 1-step arthroscopic BMAC transplantation for JOCDT treatment. As such, juvenile patients with late-stage OCD of the talus who have failed conservative care may be appropriate beneficiaries for the described procedure.