Q. Rikken (Amsterdam, NL)

Amsterdam UMC, Locatie AMC Orthopaedic Surgery

Presenter Of 3 Presentations

Poster Cartilage Imaging and Functional Testing

P021 - Incidence of (Osteo)Chondral Lesions Concomitant to Chronic Lateral Ankle Instability: Systematic Review and Meta-analysis

Presentation Topic
Cartilage Imaging and Functional Testing
Date
13.04.2022
Lecture Time
09:30 - 09:30
Room
Exhibition Foyer
Session Name
7.3 - Poster Viewing / Coffee Break / Exhibition
Session Type
Poster Session
Disclosure
No Significant Commercial Relationship

Abstract

Purpose

To determine the incidence of (osteo)chondral lesions ((O)CLs) in patients with chronic lateral ankle instability (CLAI).

Methods and Materials

A literature search was conducted in the PubMed (MEDLINE), EMBASE (Ovid), and the Cochrane Library databases for articles published from January 2000 until December 2020. Two authors independently screened the search results and conducted the quality assessment using the MINORS criteria. Clinical studies that reported findings on (O)CLs of the ankle as per preoperative or intraoperative diagnostic measures in patients with CLAI (> 6 months of symptoms) were included. Chondral and osteochondral lesions were analyzed altogether for the primary outcome, namely, the incidence of (O)CLs in ankles with CLAI. Additionally, a subgroup analysis for the incidence of (O)CLs located on the talus. Secondary outcomes included the study-, patient, and lesion characteristics. Lesions characteristics included lesion localization and chondral- or osteochondral involvement. A random effects model with 95% confidence intervals (95% CI) was used to analyze the primary outcome and subgroup analysis. Secondary outcomes were pooled using a simplified pooling method.

Results

afbeelding1.png12 studies with a total of 2145 patients with 2170 ankles with CLAI were included. The overall pooled incidence of (O)CLs in ankles with CLAI was 32.2% (95% CI 22.7 – 41.7). The pooled incidence of talar (O)CLs was 26.5% (95% CI 19.0 – 34.0). Overall the most common location of OCLs in patients with CLAI is the talus with 85%, of which 68% of (O)CLs are located on the medial talus and 32% are located laterally. 43% of lesions were chondral lesions and 57% of lesions were osteochondral in nature.

Conclusion

(O)CLs were found in up to 32% of ankles with CLAI. Furthermore, most lesions are located on the medial talar dome. These findings will aid physicians in the early recognition and treatment of ankle (O)CLs in the context of CLAI.

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Poster Joint Specific Cartilage Repair

P091 - Arthroscopic Bone Marrow Stimulation or Non-Operative Treatment for Osteochondral Lesions of the Tibial Plafond

Presentation Topic
Joint Specific Cartilage Repair
Date
13.04.2022
Lecture Time
09:30 - 09:30
Room
Exhibition Foyer
Session Name
7.3 - Poster Viewing / Coffee Break / Exhibition
Session Type
Poster Session
Disclosure
No Significant Commercial Relationship

Abstract

Purpose

The primary purpose of this study was therefore to compare the patient reported outcomes of OLTPs treated with arthroscopic bone marrow stimulation (BMS) and non-operative treatment. The secondary purpose was to compare the reintervention- and complication rates.

Methods and Materials

Patients treated either with BMS (BMS group) or any form of non-operative treatment (Non-operative group) at a minimum follow-up of 12 months were selected from a retrospective database query of patients treated between 1990 and 2020. Patients lost to follow-up/unwilling to participate were excluded for the final analysis. Eligible patients were contacted by phone and cross-sectionally included. The primary outcome was the Numeric Rating Scale (NRS) during weightbearing. Secondary outcomes included; the NRS in rest and the Foot and Ankle Outcome Score (FAOS) Additionally, the reintervention- and complication rates were collected.

Results

table 1.pngA total of 48 patients were included, which consisted of 15 patients for the non-operative group and 33 Patients for the BMS group. See Table 1 for the patient- and lesion baseline characteristics. The median NRS during weightbearing at final follow-up was 2 (IQR: 1-3) for the non-operative group and 1 (IQR: 0-3) for the BMS group (P= 0.17). The NRS in rest, during running, or when climbing stairs was, similarly, not significantly different between groups. None of the FAOS subscales were found to be significantly different between treatment groups. 3 Reoperations in the BMS group were recorded, none for the OLTP, however. No major complications were recorded.

Conclusion

Clinical outcomes following arthroscopic BMS and non-operative treatment yield moderate to good clinical results in this cross-sectional cohort of OLTP patients. This study was the first to report outcomes of non-operative treatment of OLTPs and to compare these to BMS, prospective studies are therefore highly needed for these understudied lesions.

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Poster Joint Specific Cartilage Repair

P099 - Long-Term Clinical Results of Arthroscopic Lift-Drill-Fill and Fixation (LDFF) Treatment for Osteochondral Lesions of The Talus

Presentation Topic
Joint Specific Cartilage Repair
Date
13.04.2022
Lecture Time
09:30 - 09:30
Room
Exhibition Foyer
Session Name
7.3 - Poster Viewing / Coffee Break / Exhibition
Session Type
Poster Session
Disclosure
No Significant Commercial Relationship

Abstract

Purpose

The purpose of this study was to describe the long-term (> 5 year) clinical results of a novel arthroscopic fixation technique for osteochondral lesions of the talus (OLT), named the Lift, Drill, Fill and Fix (LDFF) technique.

Methods and Materials

19 ankles (21 patients) underwent an arthroscopic LDFF procedure for a primary OLT. The mean follow-up was 6.9 years (range: 71.4 - 90.8 months). Pre- and postoperative clinical assessment was prospectively performed by measuring the Numeric Rating Scale (NRS) of pain at rest, during walking and when running. Additionally, the Foot and Ankle Outcome Score (FAOS) including its sub-scores of pain, symptoms, activities of daily living, sports and quality.

Results

The median NRS during weightbearing significantly improved from 7 (IQR: 5 - 8) pre-operatively to 0 (IQR: 0 - 2) post-operatively (p = <0.001), and remained stable from 1-year postoperatively, see Figure 1. The NRS during running significantly improved from 8 (IQR: 6 - 10) to 2 (IQR: 0 - 5) (p < 0.001) and the NRS in rest from 2.5 (IQR: 1 - 3) to 0 (IQR: 0 - 0) (p = <0.001). The median FAOS at final follow-up was 94.4 out of 100 for pain, 71.4 for other symptoms, 98.5 for activities of daily living, 80 for sport and 56.3 for quality of life. The FOAS improved significantly post-operatively on all subscales, expect for the symptoms subscale.ldff.png

Conclusion

Arthroscopic LDFF of a fixable primary OLTs results in excellent pain reduction and improvement of functional outcomes, with sustained results at long-term follow-up. These results indicate surgeons should consider fixation for a fixable OLT.

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Presenter Of 3 Presentations

Cartilage Imaging and Functional Testing

P021 - Incidence of (Osteo)Chondral Lesions Concomitant to Chronic Lateral Ankle Instability: Systematic Review and Meta-analysis

Abstract

Purpose

To determine the incidence of (osteo)chondral lesions ((O)CLs) in patients with chronic lateral ankle instability (CLAI).

Methods and Materials

A literature search was conducted in the PubMed (MEDLINE), EMBASE (Ovid), and the Cochrane Library databases for articles published from January 2000 until December 2020. Two authors independently screened the search results and conducted the quality assessment using the MINORS criteria. Clinical studies that reported findings on (O)CLs of the ankle as per preoperative or intraoperative diagnostic measures in patients with CLAI (> 6 months of symptoms) were included. Chondral and osteochondral lesions were analyzed altogether for the primary outcome, namely, the incidence of (O)CLs in ankles with CLAI. Additionally, a subgroup analysis for the incidence of (O)CLs located on the talus. Secondary outcomes included the study-, patient, and lesion characteristics. Lesions characteristics included lesion localization and chondral- or osteochondral involvement. A random effects model with 95% confidence intervals (95% CI) was used to analyze the primary outcome and subgroup analysis. Secondary outcomes were pooled using a simplified pooling method.

Results

afbeelding1.png12 studies with a total of 2145 patients with 2170 ankles with CLAI were included. The overall pooled incidence of (O)CLs in ankles with CLAI was 32.2% (95% CI 22.7 – 41.7). The pooled incidence of talar (O)CLs was 26.5% (95% CI 19.0 – 34.0). Overall the most common location of OCLs in patients with CLAI is the talus with 85%, of which 68% of (O)CLs are located on the medial talus and 32% are located laterally. 43% of lesions were chondral lesions and 57% of lesions were osteochondral in nature.

Conclusion

(O)CLs were found in up to 32% of ankles with CLAI. Furthermore, most lesions are located on the medial talar dome. These findings will aid physicians in the early recognition and treatment of ankle (O)CLs in the context of CLAI.

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Joint Specific Cartilage Repair

P091 - Arthroscopic Bone Marrow Stimulation or Non-Operative Treatment for Osteochondral Lesions of the Tibial Plafond

Abstract

Purpose

The primary purpose of this study was therefore to compare the patient reported outcomes of OLTPs treated with arthroscopic bone marrow stimulation (BMS) and non-operative treatment. The secondary purpose was to compare the reintervention- and complication rates.

Methods and Materials

Patients treated either with BMS (BMS group) or any form of non-operative treatment (Non-operative group) at a minimum follow-up of 12 months were selected from a retrospective database query of patients treated between 1990 and 2020. Patients lost to follow-up/unwilling to participate were excluded for the final analysis. Eligible patients were contacted by phone and cross-sectionally included. The primary outcome was the Numeric Rating Scale (NRS) during weightbearing. Secondary outcomes included; the NRS in rest and the Foot and Ankle Outcome Score (FAOS) Additionally, the reintervention- and complication rates were collected.

Results

table 1.pngA total of 48 patients were included, which consisted of 15 patients for the non-operative group and 33 Patients for the BMS group. See Table 1 for the patient- and lesion baseline characteristics. The median NRS during weightbearing at final follow-up was 2 (IQR: 1-3) for the non-operative group and 1 (IQR: 0-3) for the BMS group (P= 0.17). The NRS in rest, during running, or when climbing stairs was, similarly, not significantly different between groups. None of the FAOS subscales were found to be significantly different between treatment groups. 3 Reoperations in the BMS group were recorded, none for the OLTP, however. No major complications were recorded.

Conclusion

Clinical outcomes following arthroscopic BMS and non-operative treatment yield moderate to good clinical results in this cross-sectional cohort of OLTP patients. This study was the first to report outcomes of non-operative treatment of OLTPs and to compare these to BMS, prospective studies are therefore highly needed for these understudied lesions.

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Joint Specific Cartilage Repair

P099 - Long-Term Clinical Results of Arthroscopic Lift-Drill-Fill and Fixation (LDFF) Treatment for Osteochondral Lesions of The Talus

Abstract

Purpose

The purpose of this study was to describe the long-term (> 5 year) clinical results of a novel arthroscopic fixation technique for osteochondral lesions of the talus (OLT), named the Lift, Drill, Fill and Fix (LDFF) technique.

Methods and Materials

19 ankles (21 patients) underwent an arthroscopic LDFF procedure for a primary OLT. The mean follow-up was 6.9 years (range: 71.4 - 90.8 months). Pre- and postoperative clinical assessment was prospectively performed by measuring the Numeric Rating Scale (NRS) of pain at rest, during walking and when running. Additionally, the Foot and Ankle Outcome Score (FAOS) including its sub-scores of pain, symptoms, activities of daily living, sports and quality.

Results

The median NRS during weightbearing significantly improved from 7 (IQR: 5 - 8) pre-operatively to 0 (IQR: 0 - 2) post-operatively (p = <0.001), and remained stable from 1-year postoperatively, see Figure 1. The NRS during running significantly improved from 8 (IQR: 6 - 10) to 2 (IQR: 0 - 5) (p < 0.001) and the NRS in rest from 2.5 (IQR: 1 - 3) to 0 (IQR: 0 - 0) (p = <0.001). The median FAOS at final follow-up was 94.4 out of 100 for pain, 71.4 for other symptoms, 98.5 for activities of daily living, 80 for sport and 56.3 for quality of life. The FOAS improved significantly post-operatively on all subscales, expect for the symptoms subscale.ldff.png

Conclusion

Arthroscopic LDFF of a fixable primary OLTs results in excellent pain reduction and improvement of functional outcomes, with sustained results at long-term follow-up. These results indicate surgeons should consider fixation for a fixable OLT.

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