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

doi:10.1007/s12204-021-2303-7

Abstract

Abstract: 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.

Key words: osteochondral lesion of the talus (OLT), 3D-printed guide plate, osteochondral autograft, joint
surface fitting

摘要： 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.

关键词: osteochondral lesion of the talus (OLT), 3D-printed guide plate, osteochondral autograft, joint
surface fitting

CLC Number:

R 684.3

YAO Xiangyun (姚湘云), GAN Yaokai (干耀恺), SHI Dingwei(史定伟), XU Chen (徐辰), ZHAO Jie(赵杰), DAI Kerong(戴尅戎). 3D-Printed Guide Plate Assisted Osteochondral Transplantation for the Treatment of Large Talar Defect:#br# Case Report and Literature Analysis[J]. J Shanghai Jiaotong Univ Sci, 2021, 26(3): 346-351.

References 12

	[1]
	MICHAEL J W P, WURTH A, EYSEL P, et al. Longterm results after operative
	treatment of osteochondritis dissecans of the knee joint—30 year results [J]. International
	Orthopaedics, 2008, 32(2): 217-221.
	[2]
	BERNDT A L, HARTY M. Transchondral fractures (osteochondritis dissecans) of the
	talus [J]. The Journal of Bone & Joint Surgery, 1959, 41(6): 988-1020.
	[3]
	HINTERMANN B, WAGENER J, KNUPP M, et al. Treatment of extended osteochondral
	lesions of the talus with a free vascularised bone graft from the medial condyle
	of the femur [J]. The Bone & Joint Journal, 2015, 97-B(9): 1242-1249.
	[4]
	HEPPLE S, WINSON I G, GLEW D. Osteochondral lesions of the talus: A revised
	classification [J]. Foot & Ankle International, 1999, 20(12): 789-793.
	[5]
	MINTZ D N, TASHJIAN G S, CONNELL D A, et al. Osteochondral lesions of the
	talus: A new magnetic resonance grading system with arthroscopic correlation [J].
	Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2003, 19(4):
35	3-359.
	[6]
	LOOZE C A, CAPO J, RYAN M K, et al. Evaluation and management of osteochondral
	lesions of the talus [J]. Cartilage, 2017, 8(1): 19-30.
	[7]
	ZENGERINK M, STRUIJS P A A, TOL J L, et al. Treatment of osteochondral lesions
	of the talus: A systematic review [J]. Knee Surgery, Sports Traumatology, Arthroscopy,
20	10, 18(2): 238-246.
	[8]
	VERHAGEN R A W, STRUIJS P A A, BOSSUYT P M M, et al. Systematic review of
	treatment strategies for osteochondral defects of the talar dome [J]. Foot and
	Ankle Clinics, 2003, 8(2): 233-242.
	[9]
	LIEBERTHAL J, SAMBAMURTHY N, SCANZELLO C R. Inflammation in joint injury and
	post-traumatic osteoarthritis [J]. Osteoarthritis and Cartilage, 2015, 23(11):
18	25-1834.
	[10]
	ANDERSON A F, RICHARDS D B, PAGNANI M J, et al. Antegrade drilling for
	osteochondritis dissecans of the knee [J]. Arthroscopy: The Journal of
	Arthroscopic & Related Surgery, 1997, 13(3): 319-324.
	[11]
	JEONG S Y, KIM J K, LEE K B. Is retrograde drilling really useful for osteochondral
	lesion of talus with subchondral cyst? [J]. Medicine, 2016, 95(49): e5418.
	[12]
	AHMAD FUAD A N B, DEEP K, YAO W, et al. On the development of a new flexible
	drill for orthopedic surgery and the forces experienced on drilling bovine bone
[J]	Proceedings of the Institution of Mechanical Engineers, Part H: Journal of
	Engineering in Medicine, 2018, 232(5): 502-507.
	[13]
	GOYMANN V. Abrasionsarthroplastik [J]. Der Orthop ¨ade,
19	99, 28: 11-18 (in German).
	[14]
	JOHNSON L L. Arthroscopic abrasion arthroplasty: A review [J]. Clinical
	Orthopaedics and Related Research, 2001, 391S: S306-S317.
	[15]
	HANGODY L. The mosaicplasty technique for osteochondral lesions of the talus
[J]	Foot and Ankle Clinics, 2003, 8(2): 259-273.
	[16]
	FREITAG J, NORSWORTHY C, WICKHAM J, et al. High tibial osteotomy in combination
	with arthroscopic abrasion arthroplasty and autologous adiposederived mesenchymal
	stem cell therapy in the treatment of advanced knee osteoarthritis [J]. BMJ
	Case Reports, 2019, 12(2): e228003.
[17]	MIN
	B H, CHOI W H, LEE Y S, et al. Effect of different bone marrow stimulation
	techniques (BSTs) on MSCs mobilization [J]. Journal of Orthopaedic Research, 2013,
31	(11): 1814-1819.
	[18]
	ARMIENTO A R, ALINI M, STODDART M J. Articular fibrocartilage - Why does hyaline
	cartilage fail to repair? [J]. Advanced Drug Delivery Reviews, 2019, 146:
28	9-305.
	[19]
	SOLHEIM E, HEGNA J, INDERHAUG E. Longterm survival after microfracture and
	mosaicplasty for knee articular cartilage repair: A comparative study between
	two treatments cohorts [J]. Cartilage, 2020, 11(1): 71-76.
	[20]
	KUMTA S, WARRIER S, JAIN L, et al. Medial femoral condyle vascularised
	corticoperiosteal graft: A suitable choice for scaphoid non-union [J]. Indian
	Journal of Plastic Surgery, 2017, 50(2): 138-147.
	[21]
	BERNSTEIN D T, O’NEILL C A, KIM R S, et al. Osteochondral allograft donor-host
	matching by the femoral condyle radius of curvature [J]. The American Journal
	of Sports Medicine, 2017, 45(2): 403-409.
	[22]
	SABAGHZADEH A, MIRZAEE F, SHAHRIARI RAD H, et al. Osteochondral autograft
	transfer (mosaicplasty) for treatment of patients with osteochondral lesions of
	talus [J]. Chinese Journal of Traumatology, 2020, 23(1): 60-62.
	[23]
	NAKAGAWA Y, SUZUKI T, MATSUSUE Y, et al. Bony lesion recurrence after mosaicplasty
	for osteochondritis dissecans of the talus [J]. Arthroscopy: The Journal of
	Arthroscopic & Related Surgery, 2005, 21(5): 630.e1-630.e5.
	[24]
	AL-SHAIKH R A, CHOU L B, MANN J A, et al. Autologous osteochondral grafting for
	talar cartilage defects [J]. Foot & Ankle International, 2002, 23(5): 381-389.
	[25]
	CHINZEI N, KANZAKI N, FUJISHIRO T, et al. Arthroscopic debridement of a talar
	cyst and bone grafting with the osteochondral autograft transfer system [J].
	Journal of the American Podiatric Medical Association, 2017, 107(6): 541-547.
	[26]
	SPARKS D S, WAGELS M, TAYLOR G I. Bone reconstruction: A history of
	vascularized bone transfer [J]. Microsurgery, 2018, 38(1): 7-13.
	[27]
	STRUCKMANN V F, HARHAUS L, SIMON R, et al. Vascularized medial femoral condyle
	autografts for osteochondral lesions of the talus: A preliminary prospective
	randomized controlled trial [J]. The Journal of Foot and Ankle Surgery, 2020,
59	(2): 307-313.
	[28]
	MISTRY H, METCALFE A, SMITH N, et al. The cost-effectiveness of osteochondral
	allograft transplantation in the knee [J]. Knee Surgery, Sports Traumatology, Arthroscopy,
20	19, 27(6): 1739-1753.
	[29]
	SHIMOZONO Y, HURLEY E T, NGUYEN J T, et al. Allograft compared with autograft
	in osteochondral transplantation for the treatment of osteochondral lesions of
	the talus [J]. The Journal of Bone and Joint Surgery -American Volume, 2018,
10	0(21): 1838-1844.
	[30]
	KRETTEK C, CLAUSEN J D, BRUNS N, et al. Partielle und komplette
	Gelenktransplantation mit frischen osteochondralen Allografts – das
	FLOCSATKonzept [J]. Der Unfallchirurg, 2017, 120(11): 932- 949.
	[31]
	TOMPKINS M, ADKISSON H D, BONNER K F. De- Novo NT allograft [J]. Operative
	Techniques in Sports Medicine, 2013, 21(2): 82-89.
	[32]
	TOWER D E, WOOD R W, VAARDAHL M D. Talocalcaneal joint middle facet coalition
	resection with interposition of a juvenile hyaline cartilage graft [J]. The Journal
	of Foot and Ankle Surgery, 2015, 54(6): 1178- 1182.
	[33]
	GUGLIELMOTTI M B, OLMEDO D G, CABRINI R L. Research on implants and
	osseointegration [J]. Periodontology 2000, 2019, 79(1): 178-189.
	[34]
	WANG H, ZHANG X R, WANG H C, et al. Enhancing the osteogenic differentiation
	and rapid osseointegration of 3D printed Ti6Al4V implants via nanotopographic modification
[J]	Journal of Biomedical Nanotechnology, 2018, 14(4): 707-715.
	[35]
	GULATI K, PRIDEAUX M, KOGAWA M, et al. Anodized 3D-printed titanium implants
	with dual microand nano-scale topography promote interaction with human
	osteoblasts and osteocyte-like cells [J]. Journal of Tissue Engineering and
	Regenerative Medicine, 2017, 11(12): 3313-3325.
	[36]
	DALY A C, FREEMAN F E, GONZALEZFERNANDEZ T, et al. 3D bioprinting for cartilage
	and osteochondral tissue engineering [J]. Advanced Healthcare Materials, 2017,
6(	22): 1700298.
	[37]
	MOUSER V H M, LEVATO R, BONASSAR L J, et al. Three-dimensional bioprinting and
	its potential in the field of articular cartilage regeneration [J]. Cartilage, 2017,
8(	4): 327-340. [38] SHI W L, SUN M Y, HU X Q, et al. Structurally and functionally
	optimized silk-fibroin-gelatin scaffold using 3D printing to repair cartilage
	injury in vitro and in vivo [J]. Advanced Materials, 2017, 29(29): 1701089.
	[39]
	WANG J H, YANG Q, CHENG N M, et al. Collagen/ silk fibroin composite scaffold
	incorporated with PLGA microsphere for cartilage repair [J]. Materials Science
	and Engineering: C, 2016, 61: 705-711.
[40]	KIM
	H N, LIU X N, NOH K C. Use of a real-size 3D-printed model as a preoperative
	and intraoperative tool for minimally invasive plating of comminuted midshaft
	clavicle fractures [J]. Journal of Orthopaedic Surgery and Research, 2015,
10	(1): 1-6.
[41]	YOU
	W, LIU L J, CHEN H X, et al. Application of 3D printing technology on the treatment
	of complex proximal humeral fractures (Neer3-part and 4-part) in old people
[J]	Orthopaedics & Traumatology: Surgery & Research, 2016, 102(7):
89	7-903.
[42]	SHI
	J H, LV W, WANG Y, et al. Three dimensional patient-specific printed cutting
	guides for closingwedge distal femoral osteotomy [J]. International
	Orthopaedics, 2019, 43(3): 619-624.
	[43]
	TURNBULL G, CLARKE J, PICARD F, et al. 3D bioactive composite scaffolds for
	bone tissue engineering [J]. Bioactive Materials, 2018, 3(3): 278-314.
[44]	HOLZAPFEL
	B M, RUDERT M, HUTMACHER D W. Ger¨usttr¨agerbasiertes
	knochen-tissue-engineering [J]. Der Orthop¨ade, 2017, 46(8): 701-710 (in
	German).
	[45]
	CARR L W, BROOKE S M, JOHNSON T S, et al. Reexploring the anatomy of the distal
	humerus for its role in providing vascularized bone [J]. Plastic and
	Reconstructive Surgery Global Open, 2018, 6(1): e1636.
	[46]
	TAYLOR J W, FRAMPTON C, ROTHWELL A G. Long-term survival of total hip
	arthroplasty using implants from different manufacturers [J]. The Journal of Arthroplasty,
20	18, 33(2): 491-495.
[47]	SEPP¨ANEN M, LAAKSONEN I, PULKKINEN P, et al.
	High revision rate for large-head metal-on-metal THA at a mean of 7.1 years: A
	registry study [J]. Clinical Orthopaedics & Related Research, 2018, 476(6):
12	23-1230.

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

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

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