Traumatology and Orthopedics of RussiaTraumatology and Orthopedics of RussiaТравматология и ортопедия России2311-29052542-0933Vreden National Medical Research Center of Traumatology and Orthopedics160610.21823/2311-2905-2021-27-3-149-161ReviewsОбзорыReviewsReview ArticleSurgical Treatment of Osteochondral Lesions of the Talar Dome: ReviewХирургические методы лечения остеохондральных повреждений блока таранной кости: обзор литературыhttps://orcid.org/0000-0003-3198-9985PashkovaEkaterina A.ПашковаЕкатерина Анатольевна
Russian Federation

аспирант

caterinapashkova@yandex.ruhttps://orcid.org/0000-0002-9948-9015SorokinEvgenii P.СорокинЕвгений Петрович
Russian Federation

Cand. Sci. (Med.)

канд. мед. наук, научный сотрудник

sorokinortoped@gmail.comhttps://orcid.org/0000-0002-0864-0171FomichevViktor A.ФомичевВиктор Андреевич
Russian Federation

врач травматолог-ортопед

fomichef@mail.ruhttps://orcid.org/0000-0002-2762-816XKonovalchukNikita S.КоновальчукНикита Сергеевич
Russian Federation

Cand. Sci. (Med.)

канд. мед. наук, лаборант-исследователь

konovalchuk91@gmail.comhttps://orcid.org/0000-0002-2239-2792DemyanovaKsenia A.ДемьяноваКсения Андреевна
Russian Federation

ординатор

ksunyablack@yandex.ruVreden National Medical Research Center of Traumatology and OrthopedicsФГБУ «Национальный медицинский исследовательский центр травматологии и ортопедии им. Р.Р. Вредена» Минздрава России281020212731491612903202107072021Copyright ©; 2021, Pashkova E.A., Sorokin E.P., Fomichev V.A., Konovalchuk N.S., Demyanova K.A.Copyright ©; 2021, Пашкова Е.А., Сорокин Е.П., Фомичев В.А., Коновальчук Н.С., Демьянова К.А.2021Pashkova E.A., Sorokin E.P., Fomichev V.A., Konovalchuk N.S., Demyanova K.A.Пашкова Е.А., Сорокин Е.П., Фомичев В.А., Коновальчук Н.С., Демьянова К.А.https://creativecommons.org/licenses/by/4.0https://journal.rniito.org/jour/article/view/1606

Background. The relevance of the talar dome osteochondral lesions problem is assosiated with the difficulties of diagnosis, the lack of unified treatment algorythm and the great number of unsatisfactory clinical and functional results. In the last decade, there has been increasing interest in this topic in the literature, which is demonstrated by a great number of publications with series of observations or clinical cases. However, attempts to create the universal algorithm for this group of patients treatment are limited by the low level of existing studies evidence, high frequency of the new data publications, as well as the impossibility of using a number of surgical methods in different countries for legislative or other reasons.

The aim is to determine the current state of the problem of the talar dome osteochondral lesions surgical treatment and to identify types of surgical interventions in patients with the studied pathology. Material and methods. 120 international articles published from 2000 to 2021, as well as 18 domestic publications for the period from 2007 to 2021 were selected for the literature analysis. The search for publications was carried out in the PubMed/MedLine and eLibrary databases.

Results. The most widespread are surgical interventions aimed at stimulation of the bone marrow, and plastic surgery using osteochondral auto - and allografts. Currently, there is no consensus on the indications for different types of surgical methods, and the previously used indications are being questioned. This determines the need to improve diagnostic and treatment concepts.

Conclusions. The studied literature cannot fully answer a number of questions related to the methods of surgical treatment of patients with symptomatic osteochondral lesions of the talar dome and indications for them. A more detailed assessment of the medium- and long-term clinical outcomes of various surgical methods and the development of algorithms for this group of patients treatment, specific for different countries, are needed.

Введение. Актуальность проблемы остеохондральных повреждений блока таранной кости обусловлена трудностями диагностики, отсутствием единой схемы лечения и большим количеством неудовлетворительных результатов. В последнее десятилетие отмечается повышение интереса к этой теме в литературе, что проявляется большим количеством публикаций, представленных сериями наблюдений или клиническими случаями. Однако попытки создания универсального алгоритма лечения этой группы пациентов ограничены низким уровнем доказательности имеющихся исследований, быстротой появления новых данных, а также невозможностью применения ряда хирургических методов в разных странах по законодательным или иным причинам. Цель — оценить современное состояние проблемы хирургического лечения остеохондральных повреждений блока таранной кости и выявить спектр оперативных вмешательств у пациентов с изучаемой патологией. Материал и методы. Для анализа литературы было отобрано 120 иностранных статей, опубликованных с 2000 по 2021 г., а также 18 отечественных публикаций за период с 2007 по 2021 г. Поиск публикаций проводился в базах данных PubMed/MedLine и eLIBRARY. Результаты. Наибольшее распространение получили вмешательства, направленные на стимуляцию костного мозга, и пластические операции с использованием остеохондральных ауто- и аллотрансплантатов. В настоящее время нет единого мнения о показаниях к разным хирургическим методам, а используемые ранее показания ставятся под сомнение. Это определяет необходимость совершенствования диагностических и лечебных концепций. Заключение. Изученная литература не может в полной мере ответить на ряд вопросов, связанных со способами оперативного лечения пациентов с симптомными остеохондральными повреждениями блока таранной кости и показаниями к ним. Необходима более детальная оценка среднесрочных и отдаленных клинических исходов различных хирургических методов и разработка алгоритмов лечения этой группы пациентов, специфичных для разных стран.

osteochondral lesions of the talar domemosaic osteochondroplastyosteochondral defecttalusankle arthroscopyостеохондральные повреждения блока таранной костимозаичная остеохондропластикакостно-хрящевой дефекттаранная костьартроскопия голеностопного суставаVreden National Medical Research Center of Traumatology and Orthopedics, St. Petersburg, Russia.ФГБУ «Национальный медицинский исследовательский центр травматологии и ортопедии им. Р.Р. Вредена» Минздрава России, Санкт-Петербург, Россия.Dahmen J., Lambers K.T.A., Reilingh M.L., van Bergen C.J.A., Stufkens S.A.S., Kerkhoffs G.M.M.J. No superior treatment for primary osteochondral defects of the talus. Knee Surg Sports Traumatol Arthrosc. 2018;26(7):2142-2157. doi: 10.1007/s00167-017-4616-5.Кузнецов В.В., Пахомов И.А. Остеохондральные поражения блока таранной кости, современные подходы к хирургическому лечению (обзор литературы). Сибирский научный медицинский журнал. 2016;(2):56-61. Kuznetsov V.V., Pakhomov I.A. [Osteochondral lesions of the trochlea tali: modern approaches to surgical treatment (review)]. Sibirskii nauchnyi meditsinskii zhurnal [The Siberian Scientific Medical Journal]. 2016;(2):56-61. (In Russian).Pinski J.M., Boakye L.A., Murawski C.D., Hannon C.P., Ross K.A., Kennedy J.G. Low Level of Evidence and Methodologic Quality of Clinical Outcome Studies on Cartilage Repair of the Ankle. Arthroscopy. 2016;32(1): 214-222.e1. doi: 10.1016/j.arthro.2015.06.050.Younce N. Osteochondral Lesions of the Talus: Literature Review. Northern Ohio Foot Ankle J. 2016;5(1):1-7. Available from: NOFA Journal OLT April 2016, revised (nofafoundation.org).Looze C.A., Capo J., Ryan M.K., Begly J.P., Chapman C., Swanson D., Singh B.C., Strauss E.J. Evaluation and Management of Osteochondral Lesions of the Talus. Cartilage. 2017;8(1):19-30. doi: 10.1177/1947603516670708.Lomax A., Miller R.J., Fogg Q.A., Jane Madeley N., Senthil Kumar C. Quantitative assessment of the subchondral vascularity of the talar dome: a cadaveric study. Foot Ankle Surg. 2014;20(1):57-60. doi: 10.1016/j.fas.2013.10.005.Sorrentino R., Carlson K.J., Bortolini E., Minghetti C., Feletti F., Fiorenza L. et al. Morphometric analysis of the hominin talus: Evolutionary and functional implications. J Hum Evol. 2020;142:102747. doi: 10.1016/j.jhevol.2020.102747.Dekker T.J., Dekker P.K., Tainter D.M., Easley M.E., Adams S.B. Treatment of Osteochondral Lesions of the Talus: A Critical Analysis Review. JBJS Rev. 2017;5(3):01874474-201703000-00001. doi: 10.2106/JBJS.RVW.16.00065.Зейналов В.Т., Шкуро К.В. Методы лечения остеохондральных повреждений таранной кости (рассекающий остеохондрит) на современном этапе (обзор литературы). Кафедра травматологии и ортопедии. 2018;4(34):24-36. doi: 10.17238/issn2226-2016.2018.4.24-36. Zeinalov V.T., Shkuro K.V. [Recent methods of treatment of osteochondral lesions (osteochondritis dessicans) of the talus (literature review)]. Kafedra travmatologii i ortopedii [Department of Traumatology and Orthopedics]. 2018;4(34):24-36. doi: 10.17238/issn2226-2016.2018.4.24-36. (In Russian).Konig F. Uber freie korper in den gelenken. Dtsch Z Chir. 1887;27;90-109.Prado M.P., Kennedy J.G., Raduan F., Nery C. Diagnosis and treatment of osteochondral lesions of the ankle: current concepts. Rev Bras Ortop. 2016;51(5):489-500. doi: 10.1016/j.rboe.2016.08.007.van Bergen C.J.A., Baur O.L., Murawski C.D., Spennacchio P., Carreira D.S., Kearns S.R. et al. International Consensus Group on Cartilage Repair of the Ankle. Diagnosis: History, Physical Examination, Imaging, and Arthroscopy: Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle. Foot Ankle Int. 2018 Jul;39(1_suppl):3S-8S. doi: 10.1177/1071100718779393Gianakos A.L., Yasui Y., Hannon C.P., Kennedy J.G. Current management of talar osteochondral lesions. World J Orthop. 2017;8(1):12-20. doi: 10.5312/wjo.v8.i1.12.Скороглядов А.В., Науменко М.В., Зинченко А.В., Коробушкин Г.В. Костно-хрящевые поражения таранной кости. Вестник Российского государственного медицинского университета. 2012;(5):40-45. Skoroglyadov A.V., Naumenko M.V., Zinchenko A.V., Korobushkin G.V. [Osteochonral lesions of the talus]. Vestnik Rossiiskogo gosudarstvennogo meditsinskogo universiteta [Bulletin of Russian State Medical University]. 2012;(5):40-45. (In Russian).Coughlin M.J., Saltzman C.L., Anderson R.B. Mann’s Surgery of the Foot and Ankle, 2-Volume Set: 9th Ed. Mosby; 2013. рp. 1748-1759.Hepple S., Winson I.G., Glew D. Osteochondral lesions of the talus: a revised classification. Foot Ankle Int. 1999;20(12):789-793. doi: 10.1177/107110079902001206.Ramponi L., Yasui Y., Murawski C.D., Ferkel R.D., DiGiovanni C.W., Kerkhoffs G.M.M.J. et al. Lesion Size Is a Predictor of Clinical Outcomes After Bone Marrow Stimulation for Osteochondral Lesions of the Talus: A Systematic Review. Am J Sports Med. 2017;45(7):1698-1705. doi: 10.1177/0363546516668292.Van Dijk C.N. Ankle arthroscopy: Techniques developed by the Amsterdam foot and ankle school. Springer-Verlag Berlin Heidelberg, 2014. рp. 149-184.Elias I., Jung J.W., Raikin S.M., Schweitzer M.W., Carrino J.A., Morrison W.B. Osteochondral lesions of the talus: change in MRI findings over time in talar lesions without operative intervention and implications for staging systems. Foot Ankle Int. 2006;27(3):157-166. doi: 10.1177/107110070602700301.van Diepen P.R., Dahmen J., Altink J.N., Stufkens S.A.S., Kerkhoffs G.M.M.J. Location Distribution of 2,087 Osteochondral Lesions of the Talus. Cartilage. 2020:1947603520954510. doi: 10.1177/1947603520954510.Berndt A., Harty M. Transchondral fractures (osteochondritis dissecans) of the talus. J Bone Joint Surg Am. 1959;41-A:988-1020.Scranton P.E. Jr., McDermott J.E. Treatment of type V osteochondral lesions of the talus with ipsilateral knee osteochondral autografts. Foot Ankle Int. 2001;22(5):380-384. doi: 10.1177/107110070102200504.Ferkel R.D., Sgaglione N.A., Del Pizzo W. Arthroscopic treatment of osteochondral lesions of the talus: technique and results. Orthop Trans. 1990;(14): 172-175.Cheng M.S., Ferkel R.D., Applegate G.R. Osteochondral lesions of the talus: a radiologic and surgical comparison. Oral presentation presented at: Annual Meeting of the American Academy of Orthopaedic Surgeons. New Orleans, 1995.Mintz D.N., Tashjian G.S., Connell D.A., Deland J.T., O’Malley M., Potter H.G. Osteochondral lesions of the talus: a new magnetic resonance grading system with arthroscopic correlation. Arthroscopy. 2003;19(4):353-359. doi: 10.1053/jars.2003.50041.Hannon C.P., Bayer S., Murawski C.D., Canata G.L., Clanton T.O., Haverkamp D. et al. International Consensus Group on Cartilage Repair of the Ankle. Debridement, Curettage, and Bone Marrow Stimulation: Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle. Foot Ankle Int. 2018;39 (1_suppl):16S-22S. doi: 10.1177/1071100718779392.Polat G., Erşen A., Erdil M.E., Kızılkurt T., Kılıçoğlu Ö., Aşık M. Long-term results of microfracture in the treatment of talus osteochondral lesions. Knee Surg Sports Traumatol Arthrosc. 2016;24(4):1299-1303. doi: 10.1007/s00167-016-3990-8.Hunt K.J., Lee A.T., Lindsey D.P., Slikker W., Chou L.B. Osteochondral lesions of the talus: effect of defect size and plantarflexion angle on ankle joint stresses. Am J Sports Med. 2012;40(4):895-901. doi: 10.1177/0363546511434404.Choi J.I., Lee K.B. Comparison of clinical outcomes between arthroscopic subchondral drilling and microfracture for osteochondral lesions of the talus. Knee Surg Sports Traumatol Arthrosc. 2016;24(7):2140-2147. doi: 10.1007/s00167-015-3511-1.Shimozono Y., Brown A.J., Batista J.P., Murawski C.D., Gomaa M., Kong S.W. et al. International Consensus Group on Cartilage Repair of the Ankle. Subchondral Pathology: Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle. Foot Ankle Int. 2018;39(1_suppl):48S-53S. doi: 10.1177/1071100718781866.Chuckpaiwong B., Berkson E.M., Theodore G.H. Microfracture for osteochondral lesions of the ankle: outcome analysis and outcome predictors of 105 cases. Arthroscopy. 2008;24(1):106-112. doi: 10.1016/j.arthro.2007.07.022.Reilingh M.L., Murawski C.D., DiGiovanni C.W., Dahmen J., Ferrao P.N.F., Lambers K.T.A. et al. International Consensus Group on Cartilage Repair of the Ankle. Fixation Techniques: Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle. Foot Ankle Int. 2018;39(1_suppl):23S-27S. doi: 10.1177/1071100718781096.Kerkhoffs G.M., Reilingh M.L., Gerards R.M., de Leeuw P.A. Lift, drill, fill and fix (LDFF): a new arthroscopic treatment for talar osteochondral defects. Knee Surg Sports Traumatol Arthrosc. 2016;24(4):1265-1271. doi: 10.1007/s00167-014-3057-7.Kraeutler M.J., Chahla J., Dean C.S., Mitchell J.J., Santini-Araujo M.G., Pinney S.J. et al. Current concepts review update: osteochondral lesions of the talus. Foot Ankle Int. 2017;38(3):331-342. doi: 10.1177/1071100716677746.Van Bergen C.J., Kox L.S., Maas M., Sierevelt I.N., Kerkhoffs G.M., van Dijk C.N. Arthroscopic treatment of osteochondral defects of the talus: outcomes at eight to twenty years of follow-up. J Bone Joint Surg Am. 2013;95(6):519-525. doi: 10.2106/JBJS.L.00675.Hurley E.T., Murawski C.D., Paul J., Marangon A., Prado M.P., Xu X. et al. International Consensus Group on Cartilage Repair of the Ankle. Osteochondral Autograft: Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle. Foot Ankle Int. 2018;39 (1_suppl):28S-34S. doi: 10.1177/1071100718781098.Корышков Н.А., Хапилин А.П., Ходжиев А.С., Воронкевич И.А., Огарёв Е.В., Симонов А.Б. и др. Мозаичная аутологичная остеохондропластика в лечении локального асептического некроза блока таранной кости. Травматология и ортопедия России. 2014;4(74):90-98. doi: 10.21823/2311-2905-2014-0-4-90-98. Koryshkov N.A., Khapilin A.P., Khodzhiyev A.S., Voronkevich I.A., Ogarev E.V., Simonov A.B. et al. [Treatment of local talus osteochondral defects using mosaic autogenous osteochondral plasty]. Travmatologiya i ortopediya Rossii [Traumatology and Orthopedics of Russia]. 2014;(4):90-98. (In Russian). doi: 10.21823/2311-2905-2014-0-4-90-98.Shimozono Y., Hurley E.T., Myerson C.L., Kennedy J.G. Good clinical and functional outcomes at mid-term following autologous osteochondral transplantation for osteochondral lesions of the talus. Knee Surg Sports Traumatol Arthrosc. 2018;26(10):3055-3062. doi: 10.1007/s00167-018-4917-3.Latt L.D., Glisson R.R., Montijo H.E., Usuelli F.G., Easley M.E. Effect of graft height mismatch on contact pressures with osteochondral grafting of the talus. Am J Sports Med. 2011;39(12):2662-2669. doi: 10.1177/0363546511422987.Fansa A.M., Murawski C.D., Imhauser C.W., Nguyen J.T., Kennedy J.G. Autologous osteochondral transplantation of the talus partially restores contact mechanics of the ankle joint. Am J Sports Med. 2011;39(11):2457-2465. doi: 10.1177/0363546511419811.Kock N.B., Van Susante J.L., Buma P., Van Kampen A., Verdonschot N. Press-fit stability of an osteochondral autograft: influence of different plug length and perfect depth alignment. Acta Orthop. 2006;77(3):422-428. doi: 10.1080/17453670610046352.Savage-Elliott I., Smyth N.A., Deyer T.W., Murawski C.D., Ross K.A., Hannon C.P. et al. Magnetic resonance imaging evidence of postoperative cyst formation does not appear to affect clinical outcomes after autologous osteochondral transplantation of the talus. Arthroscopy. 2016;32(9):1846-1854. doi: 10.1016/j.arthro.2016.04.018.Hangody L., Dobos J., Baló E., Pánics G., Hangody L.R., Berkes I. Clinical experiences with autologous osteochondral mosaicplasty in an athletic population: a 17-year prospective multicenter study. Am J Sports Med. 2010;38(6):1125-1133. doi: 10.1177/0363546509360405.Smyth N.A., Murawski C.D., Adams S.B.Jr, Berlet G.C., Buda R., Labib S.A. et al. International Consensus Group on Cartilage Repair of the Ankle. Osteochondral Allograft: Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle. Foot Ankle Int. 2018;39(1_suppl):35S-40S. doi: 10.1177/1071100718781097.Fraser E.J., Savage-Elliott I., Yasui Y., Ackermann J., Watson G., Ross K.A. et al. Clinical and MRI donor site outcomes following autologous osteochondral transplantation for talar osteochondral lesions. Foot Ankle Int. 2016;37(9):968-976. doi: 10.1177/1071100716649461.Johnson P., Lee D.K. Evidence-based rationale for ankle cartilage allograft replacement: a systematic review of clinical outcomes. J Foot Ankle Surg. 2015;54(5):940-943. doi: 10.1053/j.jfas.2014.12.008.Gross C.E., Adams S.B., Easley M.E., Nunley J.A. II. Role of fresh osteochondral allografts for large talar osteochondral lesions. J Am Acad Orthop Surg. 2016;24(1):e9-e17. doi: 10.5435/JAAOS-D-15-00302.Haene R., Qamirani E., Story R.A., Pinsker E., Daniels T.R. Intermediate outcomes of fresh talar osteochondral allografts for treatment of large osteochondral lesions of the talus. J Bone Joint Surg Am. 2012;94(12):1105-1110. doi: 10.2106/JBJS.J.02010.Ahmad J., Jones K. Comparison of osteochondral autografts and allografts for treatment of recurrent or large talar osteochondral lesions. Foot Ankle Int. 2016;37(1):40-50. doi: 10.1177/1071100715603191.Henak C.R., Ross K.A., Bonnevie E.D., Fortier L.A., Cohen I., Kennedy J.G. et al. Human talar and femoral cartilage have distinct mechanical properties near the articular surface. J Biomech. 2016;49(14):3320-3327. doi: 10.1016/j.jbiomech.2016.08.016.Schmidt K.J., Tírico L.E., McCauley J.C., Bugbee W.D. Fresh osteochondral allograft transplantation: is graft storage time associated with clinical outcomes and graft survivorship? Am J Sports Med. 2017;45(10):2260-2266. doi: 10.1177/0363546517704846.Raikin S.M. Fresh osteochondral allografts for large-volume cystic osteochondral defects of the talus. J Bone Joint Surg Am. 2009;91(12):2818-2826. doi: 10.2106/JBJS.I.00398.Adams S.B. Jr, Viens N.A., Easley M.E., Stinnett S.S., Nunley J.A. 2nd. Midterm results of osteochondral lesions of the talar shoulder treated with fresh osteochondral allograft transplantation. J Bone Joint Surg Am. 2011;93(7):648-654. doi: 10.2106/JBJS.J.00141.Pereira G.F., Steele J.R., Fletcher A.N., Clement R.D., Arasa M.A., Adams S.B. Fresh Osteochondral Allograft Transplantation for Osteochondral Lesions of the Talus: A Systematic Review. J Foot Ankle Surg. 2021;60(3):585-591. doi: 10.1053/j.jfas.2021.02.001.Rothrauff B.B., Murawski C.D., Angthong C., Becher C., Nehrer S., Niemeyer P. et al. Scaffold-Based Therapies: Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle. Foot Ankle Int. 2018;39(1_suppl):41S-47S. doi: 10.1177/1071100718781864.Brittberg M., Lindahl A., Nilsson A., Ohlsson C., Isaksson O., Peterson L. Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation. N Engl J Med. 1994;331(14): 889-895.Gooding C., Bartlett W., Bentley G., Skinner J.A., Carrington R., Flanagan A. A prospective, randomised study comparing two techniques of autologous chondrocyte implantation for osteochondral defects in the knee: periosteum covered versus type I/III collagen covered. Knee. 2006;13(3):203-210. doi: 10.1016/j.knee.2006.02.011.Giannini S., Battaglia M., Buda R., Cavallo M., Ruffilli A., Vannini F. Surgical treatment of osteochondral lesions of the talus by open-field autologous chondrocyte implantation: a 10-year follow-up clinical and magnetic resonance imaging T2-mapping evaluation. Am J Sports Med. 2009;37 Suppl 1: 112S-118S. doi: 10.1177/0363546509349928.Battaglia M., Vannini F., Buda R., Cavallo M., Ruffilli A., Monti C. et al. Arthroscopic autologous chondrocyte implantation in osteochondral lesions of the talus: mid-term T2-mapping MRI evaluation. Knee Surg Sports Traumatol Arthrosc. 2011;19(8):1376-1384. doi: 10.1007/s00167-011-1509-x.Gao L., Orth P., Cucchiarini M., Madry H. Autologous matrix-induced chondrogenesis: a systematic review of the clinical evidence. Am J Sports Med. 2019;47(1):222-231. doi: 10.1177/0363546517740575.Magnan B., Samaila E., Bondi M., Vecchini E., Micheloni G.M., Bartolozzi P. Three-dimensional matrix-induced autologous chondrocytes implantation for osteochondral lesions of the talus: midterm results. Adv Orthop. 2012;2012:942174. doi: 10.1155/2012/942174.