A bibliometric analysis and visualization of osteochondral lesions of talus (2004-2021)

Background:Osteochondral lesions of the talus(OLTs)are a significant challenge for foot and ankle specialists,which could cause pain and decrease patient function.Researchers can use the findings of this study to shape future directions for research by exploring global trends and hotspots in OLT.Methods:Web of Science Core Collection was used to retrieve literature related to OLT between 2004 and 2021.This report covers the current state of OLTs,such as publications,journals,trends,hotspots,and the performances of relevant countries,institutions and authors.The co-citation analysis,the coauthorship analysis,the cooccurrence analysis,and the bibliographic coupling analysis were conducted with the Bibliometrix R package,VOSviewer v1.6.10.0,and CiteSpace 5.8.R3.Results:During an 18-year review,717 articles and 76 review articles on OLT published from 2004 to 2021 were reviewed.The USA has made the largest contribution to the OLT-related literature,and a significant contribution has been made by Kennedy JG(48/6.05%)and van Dijk CN(30/3.78%).In terms of total link strength,Foot&Ankle International was the leading journal.Analysis showed that the global research hotspots of OLTs focused on the pathogenesis,diagnosis,clinical research,and surgical treatment of OLT.It would be significant to pay close attention to future research on osteochondral autograft transplantation and management,surgery,multidisciplinary integration and mechanisms of OLT,and its related diseases.Conclusions:The study provides information about the current status and hotspots of research in the domain of OLT over the past 18 years that will assist researchers in identifying potential perspectives on hot topics and research frontiers.

Clinical efficacy of the Ankle Spacer for the treatment of multiple secondary osteochondral lesions of the talus

BACKGROUND The Ankle Spacer was developed as a joint-sparing alternative to invasive endstage surgeries.Currently,there are no clinical studies on the Ankle Spacer.AIM To describe the operative technique and the clinical efficacy of the Ankle Spacer for the treatment of multiple,cystic osteochondral lesions of the talus in patients with failed prior operative treatment.METHODS This is a prospective study during which patients were assessed preoperatively,at 2-and 6 wk,and at 3,6,12 and 24 mo postoperatively.Patients with multiple,cystic or large(≥15 mm)osteochondral lesions of the talus after failed prior surgery were included.The primary outcome measure was the numeric rating scale(NRS)for pain during walking at 2 years postoperatively.Secondary outcome measures included the NRS in rest and during stair climbing,the American Orthopaedic Foot and Ankle Society Hindfoot Score,the Foot and Ankle Outcome Score,the Short-Form 36 physical and mental component scale,and the Range of Motion(ROM).Radiographic evaluations were conducted to evaluate prosthetic loosening and subsidence.Revision rates and complications were also assessed.RESULTS Two patients underwent an Ankle Spacer implantation on the talus.The NRS during walking improved from 6 and 7 preoperatively to 2 and 2 points postoperatively at 2 years,in patient 1 and 2,respectively.The other patient-reported outcome measures also improved substantially.There were no re-operations nor complications.Radiological imaging showed no loosening of the implant and no change of implant position.CONCLUSION The Ankle Spacer showed clinically relevant pain reduction during walking,improvement in clinical outcomes as assessed with PROMs,and no complications or re-operations.This treatment option may evolve as a joint-sparing alternative to invasive end-stage surgeries.

Osteochondral lesion of talus with gout tophi deposition:A case report

BACKGROUND Osteochondral lesion of talus is a broad term used to describe an injury or abnormality of the talar articular cartilage and adjacent bone.It arises from diverse causes,and although trauma is implicated in many cases,it does not account for the etiology of every lesion.Gout is a chronic arthritic disease caused by excess levels of uric acid in blood.Intraosseous deposition of monosodium urate in the clavicle,femur,patella and calcaneus was reported previously.Gout is common disease but rare at a young age,especially during teenage years.Osteochondral lesion caused by intra-articular gouty invasion is very rare.CASE SUMMARY We encountered a rare case of a 16-year-old male who has osteochondral lesion of the talus(OLT)with gout.He had fluctuating pain for more than 2 years.We could see intra-articular tophi with magnetic resonance image(MRI)and arthroscopy.We performed arthroscopic exploration,debridement and microfracture.Symptoms were resolved after operation,and bony coverage at the lesion was seen on postoperative images.We had checked image and uric acid levels for 18 mo.CONCLUSION It is rare to see OLT with gouty tophi in young adults.While it is challenging,the accuracy of diagnosis can be improved through history taking,MRI and arthroscopy.

Clinical outcomes of early weight-bearing after arthroscopic microfracture during the treatment of osteochondral lesions of the talus

Background The time until weight-bearing after arthroscopic microfracture when treating osteochondral lesions of the talus （OLT） is very important to the clinical outcomes of the operation.However,there have been no consistent opinions regarding the optimal time to start weight-bearing postoperatively.Many opinions advocate that weight-bearing should begin not earlier than the sixth or eighth week postoperatively,whereas others point out that earlier weight-bearing could also obtain satisfactory outcomes.The purpose of our study was to evaluate the clinical outcomes of early weight-bearing after arthroscopic microfracture during the treatment of OLT.Methods Fifty-eight ankles in 58 patients with a single OLT ＜2 cm2 were retrospectively studied.All lesions were treated with arthroscopic debridement and microfracture under local anesthesia.After the operation,the patients were allowed to bear full weight under the protection of figure-8-shaped splints.The visual analog scale （VAS） for pain and the American Orthopaedic Foot and Ankle Society （AOFAS） ankle—hindfoot scale were evaluated preoperatively and at six postoperative timepoints （1st day,1st month,3rd month,6th month,12th month,and 24th month）.Patients were followed up for 24-52 months （mean （34.97±7.33） months）.Results All 58 patients achieved excellent recovery with significant relief of their symptoms.The VAS score decreased from 7.31±1.0 preoperatively to 0.95±0.76 at the 24th month follow-up （P=0.000）,whereas the AOFAS score improved from 53.53±8.57 preoperatively to 87.62±5.42 at the 24th month follow-up （P=0.000）.Conclusion The successful clinical outcomes of this study demonstrated that early weight-bearing after the treatment of OLT with arthroscopic microfracture can be allowed.

3D-Printed Guide Plate Assisted Osteochondral Transplantation for the Treatment of Large Talar Defect:Case Report and Literature Analysis

Osteochondral lesion of the talus(OLT)is a common cause of ankle pain that often occurs in the talar dome and leads to talar cartilage and subchondral bone damage.Osteochondral autograft transplantation is a logical treatment option.It is known that if the cartilage does not heal properly after injury,it degenerates,and osteoarthritis worsens.A three dimensional(3D)-printed guide plate can be used to find the curved articular surface from the donor site which optimally fits the defect in the talus.Herein,we present the case of a 28-year-old man who had an open injury from the crash of a tricycle in the right ankle at the age of 5.Radiographs revealed a large defect in the medial talar dome that affected nearly half of the talar dome.We performed the debridement of the ankle lesion.An osteochondral autograft was harvested from the medial femoral condyle(MFC)with the help of a personalised 3D-printed guide plate.This 3D-printed guide plate simulated the contour of a specific area in the talar dome,which involved the site of the defect.The autograft was then transplanted into the talus defect.The efficacy of this technique was evaluated at 2,4,and 7 months after surgery and proven to be reliable.