First Metatarsal Head Osteochondral Defect Treatment with Particulated Juvenile Cartilage Allograft Transplantation

Transcription

1 First Metatarsal Head Osteochondral Defect Treatment with Particulated Juvenile Cartilage Allograft Transplantation Bryan Van Dyke, DO Gregory C. Berlet, MD Justin L. Daigre, MD Christopher F. Hyer, DPM, MS Terrence M. Philbin, DO Columbus, Ohio orthofootankle.com

2 Disclosures First Metatarsal Head Osteochondral Defect Treatment with Particulated Juvenile Cartilage Allograft Transplantation Our disclosures are in the final AOFAS Mobile App. There is a potential conflict with this presentation due to: Consultant, Zimmer Biomet (GCB)

3 Introduction Osteochondral Defect (OCD): pothole Focal area articular damage Pain, decreased motion Can progress to more generalized arthritis Cartilage Restoring Procedures: filling in the pothole Microfracture Forms fibrocartilage Osteochondral Autograft Require harvest from other site Autologous Chondrocyte Implantation Two stage procedure Particulated Juvenile Cartilage Allograft Columbus, Ohio orthofootankle.com

4 Particulated Juvenile Cartilage Allograft Particulated minced cartilage pieces Juvenile greater healing potential more metabolically active denser concentration of chondrocytes less immune response Single stage procedure Produces hyaline cartilage

5 Methodology Limited consecutive case series three foot and ankle surgeons Identified nine patients 2010 to Reviewed patients charts F/u office visit and XR AOFAS questionnaire FFI questionnaire VAS pain level patient satisfaction survey

6 Participants Patient Demographics 9 patients underwent procedure Age 41 (21-65) 5 females, 4 males Preoperative VAS Score 5.75 (3-8) out of 10 OCD Characteristics Location: 4 central, 2 plantar, 1 dorsal Mean Size: 30 mm 2 (16-49) Columbus, Ohio orthofootankle.com

7 Follow Up Exam Mean 3.3 years ( ) XR showed mild to moderate joint degeneration No patients had first MTP joint tenderness, swelling, clicking, locking, or crepitus on exam Mean DF 41.8º (6-70) Mean PF 19.9º (10-30)

8 Patient Outcomes No postoperative infections or revision surgery. No patients reported any limitations with activities of daily living (ADLs) 7 of 9 patients felt no recreational activity limitations 8 of 9 patients would repeat procedure 7 of 9 very satisfied Columbus, Ohio orthofootankle.com

9 Foot Function Index (FFI) Outcome Scores mean score 8.0 (0-30.6) out of 100. Zero is best score. AOFAS Scores Perfect 100 point scale broken down into: Pain (40), Function (45), and Alignment (15) Pain Score 35.6 Function 40.1 Alignment 12.3 Overall 88 out of 100 VAS decreased 5.75 to 1.2

10 Discussion No prior published data on first MTP OCDs treated with particulated juvenile cartilage allograft 2012, Kim et al retrospectively compared microfracture with OATS for first metatarsal OCDs Group A: 14 pts, microfx VAS from 6.9 to 3.9, post op AOFAS 73.2 Group B: 10 pts, OATS, VAS from 7.4 to 3.4, post op AOFAS 81.5 Large defect size >50mm 2 and subchondral cyst were significant predictors of poor outcomes with microfracture group Our average postop VAS score was 1.2 and AOFAS Score was 88. None of our lesions were over 50mm 2.

11 Conclusion OCDs of metatarsal head Focal articular defect Early detection ideal Prevent progression Particulated juvenile cartilage allograft transplantation Viable treatment option with promising patient results At three year follow up, patients satisfied with little pain or activity limitation No clinical or radiographic evidence of disease progression

12 References Shurnas PS. Hallux Rigidus: Etiology, Biomechanics, and Nonoperative Treatment. 2009;14:1-8 Safran et al. Evidence for Surgical Repair Articular Cartilage in the Knee. JAAOS. 2010;18: Easley et al. Osteochondral Lesions of the Talus. JAAOS. 2010;18: McNeil DS, Baumhauer JF, Glazebrook MA. Evidence-Based Analysis of the Efficacy for Operative Treatment of Hallux Rigidus. Foot Ankle Int. 2013;34:15 Luciano SK, Sammarco JV, Sammarco GJ. Surgical Treatment of the Hallux Rigidus. Foot Ankle Clin N Am. 2005;10:75-96 Adkisson et al. The Potential of Human Allogenic Juvenile Chondrocytes For Restoration of Articular Cartilage. Am J Sports Med. 2010;38(7): Stone et al. Articular Cartilage Paste Grafting to Full-Thickness Articular Cartilage Knee Joint Lesions: A 2 to 12 Year Follow Up. Arthroscopy Apr;22(4):A16. Adams et al. Particulated Juvenile Cartilage Allograft Transplantation for the Treatment of Osteochondral Lesions of the Talus. Oper Tech Orthop : Coughlin MJ, Shurnas PS. Hallux Rigidus. Grading and long-term results of operative treatment. J Bone Joint Surg Am. 2003;85: Bussewitz BW, Macaira MD, Hyer CF. Intermediate-Term Results Following First Metatarsal Cheilectomy. Foot Ankle Spec. 2013;6:191 Coetzee JC, Giza E, Schon LC, Berlet GC, Neufeld S, Stone RM, Wilson EL. Treatment of osteochondral lesions of the talus with particulated juvenile cartilage. Foot Ankle Int Sep;34(9): Kim et al. Clinical comparison of the osteochondral autograft transfer system and subchondral drilling in osteochondral defects of the first metatarsal head. Am J Sports Med Aug;40(8): Wunschel et al. Osteochondritis Dissecans of Both Knees, Both Elbows, and the First Metatarsophalangeal Joint in a Female Soccer Player. Clin J Sport Med. 2012;22(4): IMAGES: Medscape, STAR Physical Therapy, Northwood Foot and Ankle, brucelashleydpm.com, democratandchonicle.com, Choose Home Now, Ski Caraibes, VAS Pain Scale, yoursightmatters.com, South Florida Sports Medicine, Oni Design, My Foot Clinic