1St Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy.
Department of Biomedical and Neuromotor Sciences, University of Bologna, 40123, Bologna, Italy.
Musculoskelet Surg. 2023 Sep;107(3):337-343. doi: 10.1007/s12306-022-00767-6. Epub 2022 Nov 14.
To describe a new surgical technique for osteochondral lesions of the ankle, using bone marrow concentrate on a scaffold and homologous bone graft positioned through a retrograde approach. Many surgical options for ankle osteochondral lesions have been described, and the ideal treatment is still debated. Bone marrow stimulating techniques are recommended for cystic lesions, with some concerns regarding the healing potential of the subchondral bone. In case of wide osteochondral defects, regenerative solutions are preferred but a massive chondral debridement is usually required. To overcome these problems, a novel technique is proposed.
The proposed technique was performed on patients affected by osteochondral lesions of the talus, either cysts with intact cartilage or wide osteochondral defects. A preoperative magnetic resonance imaging was obtained to localize the lesion. A 6-mm tarsal tunnel was retrogradely created toward the lesion, to allow a complete sub-endo-chondral debridement preserving the healthy cartilage. A hyaluronan scaffold soaked with a previously prepared bone marrow concentrate was retrogradely positioned under the cartilage surface and the tunnel was filled with homologous bone graft. Preoperative clinical scores and postoperative x-rays were registered.
Four patients were treated using this technique. No intraoperative and postoperative complications occurred. Good bone remodeling was observed at 12-week postoperative x-rays.
This technique combines the mini-invasiveness of retrograde drilling with the regenerative properties of biological scaffold soaked with bone marrow concentrate. Despite further research being needed, it seems a new viable solution to treat both subchondral cysts and large osteochondral defects of the ankle, whose management is still controversial.
描述一种新的踝关节骨软骨病变的手术技术，使用骨髓浓缩物作为支架，通过逆行方法定位同源骨移植物。已经描述了许多治疗踝关节骨软骨病变的手术方法，而理想的治疗方法仍存在争议。骨髓刺激技术推荐用于囊性病变，但对软骨下骨的愈合潜力存在一些担忧。对于广泛的骨软骨缺损，首选再生解决方案，但通常需要大量软骨清创。为了克服这些问题，提出了一种新的技术。
该技术用于治疗距骨骨软骨病变的患者，包括有完整软骨的囊肿或广泛的骨软骨缺损。术前进行磁共振成像以定位病变。逆行创建一个 6 毫米的跗骨隧道，向病变方向延伸，以允许在保留健康软骨的情况下进行完整的软骨下内清创。将预先制备的骨髓浓缩物浸泡的透明质酸支架逆行定位在软骨表面下方，并用同源骨移植物填充隧道。记录术前临床评分和术后 X 线片。
四名患者采用该技术进行治疗。术中及术后无并发症发生。术后 12 周 X 线片观察到良好的骨重塑。
该技术将逆行钻孔的微创性与骨髓浓缩物浸泡的生物支架的再生特性相结合。尽管需要进一步研究，但对于治疗踝关节的软骨下囊肿和大骨软骨缺损，这似乎是一种新的可行解决方案，其治疗方法仍存在争议。
