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Athletic Performance in the National Basketball Association Following Arthroscopic Debridement of Osteochondral Lesions of the Talus
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2017 ISAKOS ABSTRACTS
SUMMARY Intramedullary screw fixation techniques remain as the most utilized construct for the treatment of Jones’ fractures despite reports of non-union and re-fracture. The authors are not aware of any other biomechanical studies comparing this plate construct to an intramedullary screw construct.
Methods: Twelve pairs of male cadaver feet (mean age 58) were separated into 2 groups (plate or screw) to conduct contralateral comparative testing of two devices with equally numbered right and left feet in each group. For each fifth metatarsal, an osteotomy was created 2.5cm distal to the proximal tuberosity aimed for the articulation between the fourth and fifth metatarsals to simulate a Jones fracture. The plate group underwent fixation with a 3.0mm 4-hole low profile titanium locking plate placed plantar-laterally. The screw group underwent fixation with a 40 or 45mm X 5.5mm partially-threaded solid titanium intramedullary screw. The osteotomy and fixation were performed leaving all ligamentous and tendinous attachments in place to simulate a surgical procedure. After fixation, the metatarsals were excised for biomechanical testing. Cyclic cantilever failure testing was conducted using a gradient-fatigue method (force applied at gradually increasing peak-loads). Sinusoidal loading forces at a constant frequency of 0.25Hz were applied to the metatarsal increasing by 2.5 pound-force (lbf) increments per 10 cycles. Testing was concluded once each specimen had completed the prescribed cycles or experienced mechanical failure of the implant or bone. Failure mode, number of cycles to failure (CTF), peak-failure load (PFL), gap width (GW), and video data were recorded. The T-test was used to compare the two groups with a P<.05 set for clinical significance. Results: The failure mode in both groups occurred at the bone-implant interface. No significant difference was found between the plate and screw groups with regard to CTF (21.5 vs 21 P¼0.49), PFL (18.5 lbf vs 9 lbf, P¼0.33), or GW (1.2mm vs 5.7mm, P¼0.13) respectively reported as means. Discussion: This biomechanical investigation suggests planter-lateral plating is a viable option for management of Jones fractures. Although not statistically significant, larger PFL and smaller GW were recognized in the plate group compared to the screw group. This may hold clinical importance in both primary and revision Jones fracture treatments. The authors are unaware of any prior biomechanical studies comparing plantar-lateral plating and screw fixation for the treatment Jones fractures. Significance: Intramedullary screw fixation techniques remain as the most utilized construct for the treatment of Jones’ fractures despite reports of non-union and re-fracture. The authors are not aware of any other biomechanical studies comparing this plate construct to an intramedullary screw construct.
ABSTRACT DATA Introduction: Fifth metatarsal base fractures of the metaphyseal-diaphyseal watershed junction (Jones fractures) are commonly treated with surgical fixation in athletes. Intramedullary screw fixation remains the most utilized construct despite reports of non-union and refractures. This paper compares the biomechanical strength of an intramedullary screw with a plantar-lateral plating construct applied to simulated Jones fractures in paired cadaver foot specimens.
Category: Ankle/Foot/Calf Paper #88: Athletic Performance in the National Basketball Association Following Arthroscopic Debridement of Osteochondral Lesions of the Talus RICHARD D. FERKEL, MD, UNITED STATES CHRISTOPHER LEE SHEU, MD, UNITED STATES Southern California Orthopedic Institute, Van Nuys, California, UNITED STATES
situated around the tip of tuberosity, with a mean surface area of 150.753.5 mm2. The PB insertion was involved in 100% (21/21) of the zone 1 PFMF and 29% (6/21) of the fractures in zone 2.The PF insertion was involved 100% (21/21) of the fractures in zone 1 and 43% (9/21) of the zone 2 fractures. Discussion: This study demonstrates that the insertion of both the PB and PF are involved in all zone 1 PFMF and a significant percentage of zone 2 PFMF. The location of tendon insertions affect forces exerted on the bone, which may indicate a relation of the insertions with the pathophysiology of many zone 1 and 2 PFMF. Moreover, in the treatment of these fractures, care should be taken to maintain or restore the anatomy of these insertions to maximize functional outcomes. Significance: With PFMF being one of the most common fractures in the foot, understanding of the pathophysiology and optimal treatment of PFMF is required. This study aids in understanding the fracture mechanism and creates a guide in the treatment of PFMF.
Category: Ankle/Foot/Calf Paper #87: A Biomechanical Comparison of Fifth Metatarsal Jones Fracture Fixation Methods - What is the Ideal Construct? JOSHUA DAVID HARRIS, MD, UNITED STATES NEIL LEON DUPLANTIER, MD RONALD JACOB MITCHELL, MD, UNITED STATES AARON STONE, MS, UNITED STATES STEVE ZAMBRANO, BS, UNITED STATES DOMENICA DELGADO BRADLEY S. LAMBERT, PHD, UNITED STATES MICHAEL R. MORENO, PHD, UNITED STATES PATRICK C. MCCULLOCH, UNITED STATES DAVID M. LINTNER, MD, UNITED STATES KEVIN E. VARNER, MD, UNITED STATES Houston Methodist Orthopedics & Sports Medicine, Houston, Texas, UNITED STATES
2017 ISAKOS ABSTRACTS
SUMMARY The results of arthroscopic debridement of osteochondral lesions of the talus, without microfracture or drilling, on performance and career longevity for National Basketball Association (NBA) players was studied. ABSTRACT DATA Background: Use of microfracture for osteochondral lesions of the talus in the National Basketball Association (NBA) is controversial. Hypothesis: NBA players would be able to return to pre-injury playing status by arthroscopic debridement alone without marrow stimulation techniques. Purpose: To determine results of arthroscopic debridement of osteochondral lesions of the talus on performance and career longevity for National Basketball Association (NBA) players. Methods: Between the 2000-2015 seasons, 10 NBA players were treated with arthroscopic debridement of an osteochondral lesion of the talus. Preoperative and postoperative outcomes including seasons played, games played, games started, minutes per game, points per game, field goals, 3-point shots, rebounds, assists, double doubles, triple doubles, steals, blocks, turnovers, personal fouls, assists per turnovers, steals per turnovers, NBA rating, scoring efficiency, and shooting efficiency were compared. In addition, these NBA players were compared to a match controlled group using mixed effects regression and Fisher’s least significance difference modeling. Results: Ten of the ten players (100%) returned to play in the NBA following arthroscopic debridement without microfracture or drilling of an osteochondral lesion of the talus. When compared to preoperative performance, postoperative mean points scored, assists made, and steals made increased by 2.86 (P¼.042), 0.61 (P¼.049), and 0.15 (P¼.027) respectively. Only field goal percentage decreased postoperatively when compared to matched controls; however, this normalized by the end of the 2nd season after surgery. There was no statistically significant change in any of the other performance factors when compared to matched controls. All patients returned to basketball either during the same season (1) or the following season (9) if the operation was performed during the off-season. The average length of career after surgery was 4.1 years with five players currently still playing in the league. Conclusions: Following arthroscopic debridement of an osteochondral lesion of the talus without drilling or microfracture, there is a high rate of return to sport in the NBA with improved points scored, assists and steals made after surgery when compared to preoperative performance. Furthermore, there is no statistically significant change in any performance factors when compared to healthy, uninjured matched controls. The size of the lesion did not affect the length of the players’ career. This data should be used to manage patients’ and team expectations regarding their abilities to return to elite levels of athletic performance following surgery of an OLT.
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Category: Ankle/Foot/Calf Paper #89: A Metal Resurfacing Implant in the Treatment of Osteochondral Defects of the Talus after Failed Previous Surgery: A Prospective Follow-Up GWENDOLYN VUURBERG, BACHELOR OF HEALTH, NETHERLANDS ROGIER GERARDS, MD, NETHERLANDS INGE VAN EEKEREN, MD, NETHERLANDS MIKEL L. REILINGH, MD, NETHERLANDS CHRISTIAAN J. A. VAN BERGEN, MD, NETHERLANDS C. NIEK VAN DIJK, MD, PHD, NETHERLANDS Academic Medical Center, Amsterdam, NETHERLANDS SUMMARY Using a metal resurfacing implant after failed previous surgical treatment of OCDs provided good results in lesions up to 20mm in diameter as measured by the NRS-scale, AOFAS, FAOS and SF-36. ABSTRACT DATA Introduction: In about 70% of ankle sprains an osteochondral ankle defects (OCDs) of the ankle may occur. Most often the medial talar dome is affected. Primary treatment mainly consists of arthroscopic debridement and microfracture in defects up to 15mm. Secondary treatment can consist of bone grafting techniques. To avoid donor site morbidity and to adequately treat patients with a secondary OCD of the medial talar dome a resurfacing implant was developed. The long term follow-up is not fully known yet. The aim of this study was to evaluate the clinical effectiveness of the metal implant in treatment of OCDs in patients with a follow-up period up of 1-8 years. Methods: We prospectively studied all patients with an OCD of the medial talar dome, with the largest diameter being between 12 mm and 20 mm as measured on CT scans who received the HemiCAP resurfacing prosthesis. Only patients with persistent complaints for more than a year after previous surgical treatment and a minimum follow-up of 1 year were included in this update. Exclusion criteria included an age < 18 years, ankle osteoarthritis grade III, other ankle pathology, and diabetes mellitus. The primary outcome measure pain as measured by the Numeric Rating Scale for pain (NRS) at rest and during walking, running, and stair climbing. The Foot Ankle Outcome Score (FAOS), American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and Short-Form 36 (SF-36) were used as secondary outcome measures. Approval for this study was received by the local ethics committee. All score changes were assessed using the ANOVA for repeated measurements including the Bonferroni correction for posthoc pairwise comparisons. All skewed data was presented with a median and range, and normally distributed data with a mean and standard deviation. Results: This study included 38 patients with a mean age of 38.6 years (SD13.2), 64.7% females, a median follow-up of 5 years (range 2-8), and a mean
2017 ISAKOS ABSTRACTS
SUMMARY Intramedullary screw fixation techniques remain as the most utilized construct for the treatment of Jones’ fractures despite reports of non-union and re-fracture. The authors are not aware of any other biomechanical studies comparing this plate construct to an intramedullary screw construct.
Methods: Twelve pairs of male cadaver feet (mean age 58) were separated into 2 groups (plate or screw) to conduct contralateral comparative testing of two devices with equally numbered right and left feet in each group. For each fifth metatarsal, an osteotomy was created 2.5cm distal to the proximal tuberosity aimed for the articulation between the fourth and fifth metatarsals to simulate a Jones fracture. The plate group underwent fixation with a 3.0mm 4-hole low profile titanium locking plate placed plantar-laterally. The screw group underwent fixation with a 40 or 45mm X 5.5mm partially-threaded solid titanium intramedullary screw. The osteotomy and fixation were performed leaving all ligamentous and tendinous attachments in place to simulate a surgical procedure. After fixation, the metatarsals were excised for biomechanical testing. Cyclic cantilever failure testing was conducted using a gradient-fatigue method (force applied at gradually increasing peak-loads). Sinusoidal loading forces at a constant frequency of 0.25Hz were applied to the metatarsal increasing by 2.5 pound-force (lbf) increments per 10 cycles. Testing was concluded once each specimen had completed the prescribed cycles or experienced mechanical failure of the implant or bone. Failure mode, number of cycles to failure (CTF), peak-failure load (PFL), gap width (GW), and video data were recorded. The T-test was used to compare the two groups with a P<.05 set for clinical significance. Results: The failure mode in both groups occurred at the bone-implant interface. No significant difference was found between the plate and screw groups with regard to CTF (21.5 vs 21 P¼0.49), PFL (18.5 lbf vs 9 lbf, P¼0.33), or GW (1.2mm vs 5.7mm, P¼0.13) respectively reported as means. Discussion: This biomechanical investigation suggests planter-lateral plating is a viable option for management of Jones fractures. Although not statistically significant, larger PFL and smaller GW were recognized in the plate group compared to the screw group. This may hold clinical importance in both primary and revision Jones fracture treatments. The authors are unaware of any prior biomechanical studies comparing plantar-lateral plating and screw fixation for the treatment Jones fractures. Significance: Intramedullary screw fixation techniques remain as the most utilized construct for the treatment of Jones’ fractures despite reports of non-union and re-fracture. The authors are not aware of any other biomechanical studies comparing this plate construct to an intramedullary screw construct.
ABSTRACT DATA Introduction: Fifth metatarsal base fractures of the metaphyseal-diaphyseal watershed junction (Jones fractures) are commonly treated with surgical fixation in athletes. Intramedullary screw fixation remains the most utilized construct despite reports of non-union and refractures. This paper compares the biomechanical strength of an intramedullary screw with a plantar-lateral plating construct applied to simulated Jones fractures in paired cadaver foot specimens.
Category: Ankle/Foot/Calf Paper #88: Athletic Performance in the National Basketball Association Following Arthroscopic Debridement of Osteochondral Lesions of the Talus RICHARD D. FERKEL, MD, UNITED STATES CHRISTOPHER LEE SHEU, MD, UNITED STATES Southern California Orthopedic Institute, Van Nuys, California, UNITED STATES
situated around the tip of tuberosity, with a mean surface area of 150.753.5 mm2. The PB insertion was involved in 100% (21/21) of the zone 1 PFMF and 29% (6/21) of the fractures in zone 2.The PF insertion was involved 100% (21/21) of the fractures in zone 1 and 43% (9/21) of the zone 2 fractures. Discussion: This study demonstrates that the insertion of both the PB and PF are involved in all zone 1 PFMF and a significant percentage of zone 2 PFMF. The location of tendon insertions affect forces exerted on the bone, which may indicate a relation of the insertions with the pathophysiology of many zone 1 and 2 PFMF. Moreover, in the treatment of these fractures, care should be taken to maintain or restore the anatomy of these insertions to maximize functional outcomes. Significance: With PFMF being one of the most common fractures in the foot, understanding of the pathophysiology and optimal treatment of PFMF is required. This study aids in understanding the fracture mechanism and creates a guide in the treatment of PFMF.
Category: Ankle/Foot/Calf Paper #87: A Biomechanical Comparison of Fifth Metatarsal Jones Fracture Fixation Methods - What is the Ideal Construct? JOSHUA DAVID HARRIS, MD, UNITED STATES NEIL LEON DUPLANTIER, MD RONALD JACOB MITCHELL, MD, UNITED STATES AARON STONE, MS, UNITED STATES STEVE ZAMBRANO, BS, UNITED STATES DOMENICA DELGADO BRADLEY S. LAMBERT, PHD, UNITED STATES MICHAEL R. MORENO, PHD, UNITED STATES PATRICK C. MCCULLOCH, UNITED STATES DAVID M. LINTNER, MD, UNITED STATES KEVIN E. VARNER, MD, UNITED STATES Houston Methodist Orthopedics & Sports Medicine, Houston, Texas, UNITED STATES
2017 ISAKOS ABSTRACTS
SUMMARY The results of arthroscopic debridement of osteochondral lesions of the talus, without microfracture or drilling, on performance and career longevity for National Basketball Association (NBA) players was studied. ABSTRACT DATA Background: Use of microfracture for osteochondral lesions of the talus in the National Basketball Association (NBA) is controversial. Hypothesis: NBA players would be able to return to pre-injury playing status by arthroscopic debridement alone without marrow stimulation techniques. Purpose: To determine results of arthroscopic debridement of osteochondral lesions of the talus on performance and career longevity for National Basketball Association (NBA) players. Methods: Between the 2000-2015 seasons, 10 NBA players were treated with arthroscopic debridement of an osteochondral lesion of the talus. Preoperative and postoperative outcomes including seasons played, games played, games started, minutes per game, points per game, field goals, 3-point shots, rebounds, assists, double doubles, triple doubles, steals, blocks, turnovers, personal fouls, assists per turnovers, steals per turnovers, NBA rating, scoring efficiency, and shooting efficiency were compared. In addition, these NBA players were compared to a match controlled group using mixed effects regression and Fisher’s least significance difference modeling. Results: Ten of the ten players (100%) returned to play in the NBA following arthroscopic debridement without microfracture or drilling of an osteochondral lesion of the talus. When compared to preoperative performance, postoperative mean points scored, assists made, and steals made increased by 2.86 (P¼.042), 0.61 (P¼.049), and 0.15 (P¼.027) respectively. Only field goal percentage decreased postoperatively when compared to matched controls; however, this normalized by the end of the 2nd season after surgery. There was no statistically significant change in any of the other performance factors when compared to matched controls. All patients returned to basketball either during the same season (1) or the following season (9) if the operation was performed during the off-season. The average length of career after surgery was 4.1 years with five players currently still playing in the league. Conclusions: Following arthroscopic debridement of an osteochondral lesion of the talus without drilling or microfracture, there is a high rate of return to sport in the NBA with improved points scored, assists and steals made after surgery when compared to preoperative performance. Furthermore, there is no statistically significant change in any performance factors when compared to healthy, uninjured matched controls. The size of the lesion did not affect the length of the players’ career. This data should be used to manage patients’ and team expectations regarding their abilities to return to elite levels of athletic performance following surgery of an OLT.
e83
Category: Ankle/Foot/Calf Paper #89: A Metal Resurfacing Implant in the Treatment of Osteochondral Defects of the Talus after Failed Previous Surgery: A Prospective Follow-Up GWENDOLYN VUURBERG, BACHELOR OF HEALTH, NETHERLANDS ROGIER GERARDS, MD, NETHERLANDS INGE VAN EEKEREN, MD, NETHERLANDS MIKEL L. REILINGH, MD, NETHERLANDS CHRISTIAAN J. A. VAN BERGEN, MD, NETHERLANDS C. NIEK VAN DIJK, MD, PHD, NETHERLANDS Academic Medical Center, Amsterdam, NETHERLANDS SUMMARY Using a metal resurfacing implant after failed previous surgical treatment of OCDs provided good results in lesions up to 20mm in diameter as measured by the NRS-scale, AOFAS, FAOS and SF-36. ABSTRACT DATA Introduction: In about 70% of ankle sprains an osteochondral ankle defects (OCDs) of the ankle may occur. Most often the medial talar dome is affected. Primary treatment mainly consists of arthroscopic debridement and microfracture in defects up to 15mm. Secondary treatment can consist of bone grafting techniques. To avoid donor site morbidity and to adequately treat patients with a secondary OCD of the medial talar dome a resurfacing implant was developed. The long term follow-up is not fully known yet. The aim of this study was to evaluate the clinical effectiveness of the metal implant in treatment of OCDs in patients with a follow-up period up of 1-8 years. Methods: We prospectively studied all patients with an OCD of the medial talar dome, with the largest diameter being between 12 mm and 20 mm as measured on CT scans who received the HemiCAP resurfacing prosthesis. Only patients with persistent complaints for more than a year after previous surgical treatment and a minimum follow-up of 1 year were included in this update. Exclusion criteria included an age < 18 years, ankle osteoarthritis grade III, other ankle pathology, and diabetes mellitus. The primary outcome measure pain as measured by the Numeric Rating Scale for pain (NRS) at rest and during walking, running, and stair climbing. The Foot Ankle Outcome Score (FAOS), American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and Short-Form 36 (SF-36) were used as secondary outcome measures. Approval for this study was received by the local ethics committee. All score changes were assessed using the ANOVA for repeated measurements including the Bonferroni correction for posthoc pairwise comparisons. All skewed data was presented with a median and range, and normally distributed data with a mean and standard deviation. Results: This study included 38 patients with a mean age of 38.6 years (SD13.2), 64.7% females, a median follow-up of 5 years (range 2-8), and a mean