- Email: [email protected]
Evaluation of reproducibility of the magnetic resonance observation of cartilage repair tissue (MOCART)
Abstracts / Foot and Ankle Surgery 23(S1) (2017) 1–28
ipsilateral pelvic bone marrow and centrifuged (10 min, 1500 RPM). The supernatant was used to impregnate a collagen I/III matrix (Chondro-Gide). The matrix was fixed into the chondral defect with fibrin glue. Results: Sixty-six patients with 69 chondral defects were included in the study. The age of the patients was 35 years on average (range, 12–64 years). VAS FA before surgery was 48.9 on average (range, 16.5–75.9). The defects were located as follows, medial talar shoulder, n = 28; lateral talar shoulder, n = 28 (medial and lateral talar shoulder, n = 3), tibia, n = 3. The defect size was 1.4 cm2 on average (range, 0.6–6 cm2 ). 60 patients (91%) completed 5-year-follow-up. No patient was converted to fusion or total ankle replacement. The VAS FA improved to an average of 78.2 (range, 60.8–100; p = 0.01). Conclusions: MAST led to improved and high validated outcome scores at 5-year-followup. No method related complications were registered. Even though a control group is missing, we conclude that MAST is an effective method mid-term for the treatment of chondral defects of the ankle. http://dx.doi.org/10.1016/j.fas.2017.07.1096 53 IFFAS S11 03 Primary versus secondary osteochondral autograft transplantation in patients with large sized OLTs K.H. Park ∗ , Y.G. Hwang, S.H. Han, J.W. Lee Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, South Korea Purpose: We compared clinical outcomes between patients receiving primary transplantation and patients receiving secondary transplantation after failure of prior marrow stimulation for large sized OLT and investigate prognostic factors affecting clinical failures. Methods: Between 2005 and 2014, 18 patients with large sized OLT (>50 mm2 ) underwent primary OAT as a primary surgery (primary OAT group) and 28 patients with large sized OLT underwent secondary OAT after failure of arthroscopic marrow stimulation (secondary OAT group). Clinical outcomes were assessed using VAS, AOFAS scores, FAOS and re-operation rate. Factors associated with clinical failure were evaluated using bivariate analysis and logistic regression analysis. Survival outcomes were compared using Kaplan–Meier analysis. Results: The mean follow-up time was 6.0 years (range 2.0–10.8) and the mean size of the lesion was 194.9 mm2 (range 151.7–296.3). There was no significant difference in patients’ demographics, preoperative findings, VAS, AOFAS score, FAOS, and re-operation rate. According to bivariate analysis, significant factor associated with clinical failure was not prior marrow stimulation but more than 225 mm2 of lesion size in preoperative MRI. Logistic regression analysis revealed that preoperative AOFAS score was significant predictor of clinical failure. The survival probabilities were not significantly different between primary and secondary OAT groups in Kaplan–Meier plots. Conclusion: Outcomes of secondary OAT were comparable to those of primary OAT in the large sized OLT. Therefore, we suggested that symptomatic patients with large sized OLT could be initially treated by either marrow stimulation or OAT and if failed with marrow stimulation, secondary OAT could be considered. http://dx.doi.org/10.1016/j.fas.2017.07.1097
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54 IFFAS S11 04 Magnetic resonance t1rho mapping of articular cartilage grafts after autologous osteochondral transplantation for osteochondral lesions of the talus: A longitudinal evaluation N. Haraguchi ∗ , K. Ota, T. Ozeki, N. Nishida, T. Yoshida, A. Tsutaya Tokyo Metropolitan Police Hospital, Japan Introduction: We used T1rho imaging to quantitatively monitor changes over time in the biochemical health of grafted cartilage after autologous osteochondral transplantation (AOT) for osteochondral lesions of the talus. Methods: T1rho mapping was performed 1 and 2 years postoperatively in 9 patients treated by AOT for an osteochondral lesion of the talus. T1rho maps were constructed with the use of PRIDE software. Coronal images were analyzed with ImageJ software. The mean T1rho value of full-thickness cartilage at the repair site and that of full-thickness cartilage elsewhere in the same image (control cartilage) were determined. Correlation between the T1rho ratios (grafted-to-control cartilage T1rho values) and clinical outcomes (AOFAS scale) was examined. Results: At 1 year, a significant difference existed between the mean T1rho value of the grafted cartilage (57.0 ± 7.7 ms) and that of the control cartilage (41.8 ± 4.6 ms) (p = 0.0002). At 2 years, the mean T1rho value of the grafted cartilage (49.1 ± 6.4 ms) was significantly lower than that at 1 year (p = 0.006). Moderate negative correlation was found between the T1rho ratio and the 1- and 2year AOFAS scores (r =− 0.60 and r =− 0.50, respectively). Conclusions: Although grafted cartilage appears to degenerate at the repair site during the first year after AOT, the proteoglycan content increases thereafter. The cartilage reparation process after AOT is slower than previously believed, and this has implications for the postoperative rehabilitation protocol and timing of the patient’s return to sports. http://dx.doi.org/10.1016/j.fas.2017.07.1098 55 IFFAS S11 05 Evaluation of reproducibility of the magnetic resonance observation of cartilage repair tissue (MOCART) N. Martinelli, D. Albano, T. Giacalone, A. Bianchi ∗ , G. Romeo, F. Malerba, L. Sconfienza IRCCS Galeazzi, Milan, Italy Introduction: The Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score is a scale used for monitoring cartilage repair surgeries. The aim of this study is to evaluate the applicability and reproducibility of the MOCART score for evaluation of osteochondral lesions of the talus (OLT) repaired using the autologous matrix-induced chondrogenesis (AMIC) technique. Methods: Two radiologists (R1–R2) and two orthopaedic surgeons (O1–O2) independently reviewed 26 MRI scans performed on 13 patients with OLT repaired using the AMIC technique. The MRI scans were performed at 6 and 12 months after treatment. For inter- and intra-observer agreement evaluation for each variable of the MOCART score we used Cohen’s kappa coefficient. Progression of MOCART score between 6 and 12 months evaluation was assessed using the Wilcoxon test.
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Abstracts / Foot and Ankle Surgery 23(S1) (2017) 1–28
Results: The inter-observer agreement between R1–R2 ranged from poor (adhesions, k = 0.124) to almost perfect (subchondral bone, k = 0.866), while between O1–O2 ranged from absent (effusion, k = −0.190) to poor (surface, k = 0.172). The intra-observer agreement of R1 ranged from poor (signal intensity, k = 0.031) to substantial (subchondral lamina, k = 0.677), while that of O1 ranged from absent (subchondral bone, k = −0.061) to substantial (surface, k = 0.663). There was a statistically significant increase of MOCART score between 6-month and 12-month evaluation of R1 (Z = −2.672; P = 0.008), R2 (Z = −2.721; P = 0.007) and O1 (Z = −3.034; P = 0.002). Conversely, the increase of MOCART score between the 6-months and 12-months evaluation of O2 was not statistically significant (Z = −1.665; P = 0.096). Conclusions: The MOCART score does not seem to be sufficiently reliable and reproducible to be applied for repaired OLT. http://dx.doi.org/10.1016/j.fas.2017.07.1099 56 IFFAS S12 01 Antinociceptive effect of hyaluronic acid sodium on ankle osteoarthritis model S. Jimbo 1,∗ , Y. Terashima 1 , A. Teramoto 1 , K. Watanabe 1 , Y. Sakakibara 1 , H. Shoji 1 , N. Tohse 2 , Y. Yamashita 1 1 Department of Orthopedic Surgery, Sapporo Medical University School of Medicine, Japan 2 Department of Cellular Physiology and Signal Transduction, Sapporo Medical University School of Medicine, Japan
Introduction: There are many people who suffer from pain caused by ankle osteoarthritis. We developed a new animal model of ankle osteoarthritis to research the mechanisms of pain in osteoarthritis, and examined the effect of hyaluronic acid (HA) on pain in ankle osteoarthritis. Materials and methods: We used 45 Sprague–Dawley rats. These rats were divided into three experimental groups (OA rats, HA rats, and Control rats). OA rats were induced by injecting MIA (1 mg/30 l) into the tibiotarsal joint of the right hind paw on two consecutive days. Control rats were induced by saline. HA rats were injected HA on 7, 14, 21 days after injection of MIA. The pain behavior was assessed by mechanical and thermal withdrawal responses on the day before MIA/saline injection, and 7, 14, 21, 28 days after injection. We observed histopathological changes of each ankle joint on 28 days. Results: In OA rats, the responses to mechanical stimulations were increased compared with those in control rats. The HA application improved mechanical hypersensitivity. But HA did not have effect on thermal hypersensitivity. Histological changes were observed in OA rats and HA rats on 21 days, such as disorganization of chondrocytes, erosion and fibrillation of cartilage surface and subchondral bone exposure. HA did not improve the width of the joint space. Discussion: We found that HA had antinociceptive effect on pain in ankle osteoarthritis, and delayed the cartilage denaturation, although HA did not repair ankle osteoarthritis. Conclusion: We established a new ankle osteoarthritis model. HA is effect on the cartilage and mechanical hypersensitivity. http://dx.doi.org/10.1016/j.fas.2017.07.1100
57 IFFAS S12 02 Preoperative patient-reported outcome measures predict success in patients with ankle arthritis F. Waly ∗ , K. Wing, M. Penner, A. Veljkovic, H. Qian, A. Younger University of British Columbia, Canada Background: Ankle arthritis is a leading cause of pain and disability. Despite the effectiveness of the current treatments for Ankle OA, a subset of patients remains with persistent pain and functional limitations. Aim: To use preoperative patient-reported outcome measures to predict which patients with Ankle OA are most likely to experience postoperative improvements in functional outcomes at an average follow-up of five years. Methods: A prospective cohort design used to evaluate 427 patients with end-stage ankle arthritis. Data on demographics, comorbidities, AOS score, and SF-36 PCS were collected. MCID was then calculated. A multivariable logistic regression analysis was performed. Receiver operating characteristic (ROC) analysis was used to calculate threshold values. Results: Patients who scored worst at preoperative baseline made the greatest gains in function and pain relief following surgical treatment. ROC curves demonstrated that preoperative AOS, SF-36 PCS physical function scores were predictive of postoperative improvements in physical function. Patients with preoperative AOS score above 45.7 had an 83% probability of achieving a clinically meaningful improvement in function as defined by MCID (area under the curve [AUC] 0.67). Patients with preoperative SF-36 PCS score below 31 had a 62% probability of achieving MCID (area under the curve [AUC] 0.64). MCIDs for AOS and SF3-36 PCS score changes were 12.35 and 6.43, respectively. Conclusion: We identified PROM threshold values that predict postoperative improvement in patients with end-stage ankle OA. The results of this study may be used to facilitate discussion between physicians and patients regarding the expected functional benefit after surgery. http://dx.doi.org/10.1016/j.fas.2017.07.1101 58 IFFAS S12 03 Relationship between isokinetic muscle strength and functional test in chronic ankle instability Y.H. Park 1,∗ , G.W. Choi 2 , H.J. Kim 1 1 2
Korea University Guro Hospital, Republic of Korea Korea University Ansan Hospital, Republic of Korea
Objective: Isokinetic muscle strength measurement and functional test are usually performed to evaluate ankle condition in chronic ankle instability (CAI), yet there is no clear demonstration for the relationship between isokinetic muscle strength and functional test. The purpose of this study is evaluation of the relationship between isokinetic muscle strength and functional test in CAI. Methods: Between April 2015 and august 2016, a total of 103 chronic ankle instability patients were involved. Single leg balance test, single heel raise test, single leg squat test for static balancing
ipsilateral pelvic bone marrow and centrifuged (10 min, 1500 RPM). The supernatant was used to impregnate a collagen I/III matrix (Chondro-Gide). The matrix was fixed into the chondral defect with fibrin glue. Results: Sixty-six patients with 69 chondral defects were included in the study. The age of the patients was 35 years on average (range, 12–64 years). VAS FA before surgery was 48.9 on average (range, 16.5–75.9). The defects were located as follows, medial talar shoulder, n = 28; lateral talar shoulder, n = 28 (medial and lateral talar shoulder, n = 3), tibia, n = 3. The defect size was 1.4 cm2 on average (range, 0.6–6 cm2 ). 60 patients (91%) completed 5-year-follow-up. No patient was converted to fusion or total ankle replacement. The VAS FA improved to an average of 78.2 (range, 60.8–100; p = 0.01). Conclusions: MAST led to improved and high validated outcome scores at 5-year-followup. No method related complications were registered. Even though a control group is missing, we conclude that MAST is an effective method mid-term for the treatment of chondral defects of the ankle. http://dx.doi.org/10.1016/j.fas.2017.07.1096 53 IFFAS S11 03 Primary versus secondary osteochondral autograft transplantation in patients with large sized OLTs K.H. Park ∗ , Y.G. Hwang, S.H. Han, J.W. Lee Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, South Korea Purpose: We compared clinical outcomes between patients receiving primary transplantation and patients receiving secondary transplantation after failure of prior marrow stimulation for large sized OLT and investigate prognostic factors affecting clinical failures. Methods: Between 2005 and 2014, 18 patients with large sized OLT (>50 mm2 ) underwent primary OAT as a primary surgery (primary OAT group) and 28 patients with large sized OLT underwent secondary OAT after failure of arthroscopic marrow stimulation (secondary OAT group). Clinical outcomes were assessed using VAS, AOFAS scores, FAOS and re-operation rate. Factors associated with clinical failure were evaluated using bivariate analysis and logistic regression analysis. Survival outcomes were compared using Kaplan–Meier analysis. Results: The mean follow-up time was 6.0 years (range 2.0–10.8) and the mean size of the lesion was 194.9 mm2 (range 151.7–296.3). There was no significant difference in patients’ demographics, preoperative findings, VAS, AOFAS score, FAOS, and re-operation rate. According to bivariate analysis, significant factor associated with clinical failure was not prior marrow stimulation but more than 225 mm2 of lesion size in preoperative MRI. Logistic regression analysis revealed that preoperative AOFAS score was significant predictor of clinical failure. The survival probabilities were not significantly different between primary and secondary OAT groups in Kaplan–Meier plots. Conclusion: Outcomes of secondary OAT were comparable to those of primary OAT in the large sized OLT. Therefore, we suggested that symptomatic patients with large sized OLT could be initially treated by either marrow stimulation or OAT and if failed with marrow stimulation, secondary OAT could be considered. http://dx.doi.org/10.1016/j.fas.2017.07.1097
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54 IFFAS S11 04 Magnetic resonance t1rho mapping of articular cartilage grafts after autologous osteochondral transplantation for osteochondral lesions of the talus: A longitudinal evaluation N. Haraguchi ∗ , K. Ota, T. Ozeki, N. Nishida, T. Yoshida, A. Tsutaya Tokyo Metropolitan Police Hospital, Japan Introduction: We used T1rho imaging to quantitatively monitor changes over time in the biochemical health of grafted cartilage after autologous osteochondral transplantation (AOT) for osteochondral lesions of the talus. Methods: T1rho mapping was performed 1 and 2 years postoperatively in 9 patients treated by AOT for an osteochondral lesion of the talus. T1rho maps were constructed with the use of PRIDE software. Coronal images were analyzed with ImageJ software. The mean T1rho value of full-thickness cartilage at the repair site and that of full-thickness cartilage elsewhere in the same image (control cartilage) were determined. Correlation between the T1rho ratios (grafted-to-control cartilage T1rho values) and clinical outcomes (AOFAS scale) was examined. Results: At 1 year, a significant difference existed between the mean T1rho value of the grafted cartilage (57.0 ± 7.7 ms) and that of the control cartilage (41.8 ± 4.6 ms) (p = 0.0002). At 2 years, the mean T1rho value of the grafted cartilage (49.1 ± 6.4 ms) was significantly lower than that at 1 year (p = 0.006). Moderate negative correlation was found between the T1rho ratio and the 1- and 2year AOFAS scores (r =− 0.60 and r =− 0.50, respectively). Conclusions: Although grafted cartilage appears to degenerate at the repair site during the first year after AOT, the proteoglycan content increases thereafter. The cartilage reparation process after AOT is slower than previously believed, and this has implications for the postoperative rehabilitation protocol and timing of the patient’s return to sports. http://dx.doi.org/10.1016/j.fas.2017.07.1098 55 IFFAS S11 05 Evaluation of reproducibility of the magnetic resonance observation of cartilage repair tissue (MOCART) N. Martinelli, D. Albano, T. Giacalone, A. Bianchi ∗ , G. Romeo, F. Malerba, L. Sconfienza IRCCS Galeazzi, Milan, Italy Introduction: The Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score is a scale used for monitoring cartilage repair surgeries. The aim of this study is to evaluate the applicability and reproducibility of the MOCART score for evaluation of osteochondral lesions of the talus (OLT) repaired using the autologous matrix-induced chondrogenesis (AMIC) technique. Methods: Two radiologists (R1–R2) and two orthopaedic surgeons (O1–O2) independently reviewed 26 MRI scans performed on 13 patients with OLT repaired using the AMIC technique. The MRI scans were performed at 6 and 12 months after treatment. For inter- and intra-observer agreement evaluation for each variable of the MOCART score we used Cohen’s kappa coefficient. Progression of MOCART score between 6 and 12 months evaluation was assessed using the Wilcoxon test.
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Abstracts / Foot and Ankle Surgery 23(S1) (2017) 1–28
Results: The inter-observer agreement between R1–R2 ranged from poor (adhesions, k = 0.124) to almost perfect (subchondral bone, k = 0.866), while between O1–O2 ranged from absent (effusion, k = −0.190) to poor (surface, k = 0.172). The intra-observer agreement of R1 ranged from poor (signal intensity, k = 0.031) to substantial (subchondral lamina, k = 0.677), while that of O1 ranged from absent (subchondral bone, k = −0.061) to substantial (surface, k = 0.663). There was a statistically significant increase of MOCART score between 6-month and 12-month evaluation of R1 (Z = −2.672; P = 0.008), R2 (Z = −2.721; P = 0.007) and O1 (Z = −3.034; P = 0.002). Conversely, the increase of MOCART score between the 6-months and 12-months evaluation of O2 was not statistically significant (Z = −1.665; P = 0.096). Conclusions: The MOCART score does not seem to be sufficiently reliable and reproducible to be applied for repaired OLT. http://dx.doi.org/10.1016/j.fas.2017.07.1099 56 IFFAS S12 01 Antinociceptive effect of hyaluronic acid sodium on ankle osteoarthritis model S. Jimbo 1,∗ , Y. Terashima 1 , A. Teramoto 1 , K. Watanabe 1 , Y. Sakakibara 1 , H. Shoji 1 , N. Tohse 2 , Y. Yamashita 1 1 Department of Orthopedic Surgery, Sapporo Medical University School of Medicine, Japan 2 Department of Cellular Physiology and Signal Transduction, Sapporo Medical University School of Medicine, Japan
Introduction: There are many people who suffer from pain caused by ankle osteoarthritis. We developed a new animal model of ankle osteoarthritis to research the mechanisms of pain in osteoarthritis, and examined the effect of hyaluronic acid (HA) on pain in ankle osteoarthritis. Materials and methods: We used 45 Sprague–Dawley rats. These rats were divided into three experimental groups (OA rats, HA rats, and Control rats). OA rats were induced by injecting MIA (1 mg/30 l) into the tibiotarsal joint of the right hind paw on two consecutive days. Control rats were induced by saline. HA rats were injected HA on 7, 14, 21 days after injection of MIA. The pain behavior was assessed by mechanical and thermal withdrawal responses on the day before MIA/saline injection, and 7, 14, 21, 28 days after injection. We observed histopathological changes of each ankle joint on 28 days. Results: In OA rats, the responses to mechanical stimulations were increased compared with those in control rats. The HA application improved mechanical hypersensitivity. But HA did not have effect on thermal hypersensitivity. Histological changes were observed in OA rats and HA rats on 21 days, such as disorganization of chondrocytes, erosion and fibrillation of cartilage surface and subchondral bone exposure. HA did not improve the width of the joint space. Discussion: We found that HA had antinociceptive effect on pain in ankle osteoarthritis, and delayed the cartilage denaturation, although HA did not repair ankle osteoarthritis. Conclusion: We established a new ankle osteoarthritis model. HA is effect on the cartilage and mechanical hypersensitivity. http://dx.doi.org/10.1016/j.fas.2017.07.1100
57 IFFAS S12 02 Preoperative patient-reported outcome measures predict success in patients with ankle arthritis F. Waly ∗ , K. Wing, M. Penner, A. Veljkovic, H. Qian, A. Younger University of British Columbia, Canada Background: Ankle arthritis is a leading cause of pain and disability. Despite the effectiveness of the current treatments for Ankle OA, a subset of patients remains with persistent pain and functional limitations. Aim: To use preoperative patient-reported outcome measures to predict which patients with Ankle OA are most likely to experience postoperative improvements in functional outcomes at an average follow-up of five years. Methods: A prospective cohort design used to evaluate 427 patients with end-stage ankle arthritis. Data on demographics, comorbidities, AOS score, and SF-36 PCS were collected. MCID was then calculated. A multivariable logistic regression analysis was performed. Receiver operating characteristic (ROC) analysis was used to calculate threshold values. Results: Patients who scored worst at preoperative baseline made the greatest gains in function and pain relief following surgical treatment. ROC curves demonstrated that preoperative AOS, SF-36 PCS physical function scores were predictive of postoperative improvements in physical function. Patients with preoperative AOS score above 45.7 had an 83% probability of achieving a clinically meaningful improvement in function as defined by MCID (area under the curve [AUC] 0.67). Patients with preoperative SF-36 PCS score below 31 had a 62% probability of achieving MCID (area under the curve [AUC] 0.64). MCIDs for AOS and SF3-36 PCS score changes were 12.35 and 6.43, respectively. Conclusion: We identified PROM threshold values that predict postoperative improvement in patients with end-stage ankle OA. The results of this study may be used to facilitate discussion between physicians and patients regarding the expected functional benefit after surgery. http://dx.doi.org/10.1016/j.fas.2017.07.1101 58 IFFAS S12 03 Relationship between isokinetic muscle strength and functional test in chronic ankle instability Y.H. Park 1,∗ , G.W. Choi 2 , H.J. Kim 1 1 2
Korea University Guro Hospital, Republic of Korea Korea University Ansan Hospital, Republic of Korea
Objective: Isokinetic muscle strength measurement and functional test are usually performed to evaluate ankle condition in chronic ankle instability (CAI), yet there is no clear demonstration for the relationship between isokinetic muscle strength and functional test. The purpose of this study is evaluation of the relationship between isokinetic muscle strength and functional test in CAI. Methods: Between April 2015 and august 2016, a total of 103 chronic ankle instability patients were involved. Single leg balance test, single heel raise test, single leg squat test for static balancing