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Stem cell therapy in early post-traumatic talus osteonecrosis

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Abstract

Purpose

Avascular necrosis of the talus is one of the most notable complications associated with talar neck fractures with frequent evolution of the osteonecrosis into a difficult arthrodesis. We tested whether the injection of bone marrow mesenchymal stem cells (MSCs) could improve the repair process of the osteonecrosis.

Material and methods

Forty-five early (without collapse) post-traumatic talus osteonecroses (group 1; study group) were treated between 1995 and 2012 with percutaneous injection of progenitor cells (autologous bone marrow concentrate from the iliac crest). The number of MSCs transplanted in each ankle of group 1 was 124 × 103 cells (range 101 × 103 to 164 × 103 cells). The evolution of these osteonecroses treated with autologous bone marrow implantation was compared with the evolution of a control group of 34 talar osteonecroses without collapse and treated with only core decompression (group 2; control group) between 1985 and 1995. The outcome was determined by progression in radiographic stages to collapse, by the need of arthrodesis, and by the time to successfully achieve fusion for patients who needed arthrodesis.

Results

For the 45 ankles with autologous concentrate bone marrow grafting, collapse frequency was lower (27%, 12 among 45 versus 71%, 24 among 34; odds ratio 0.1515, 95% CI 0.0563–0.4079; P = 0.0002) and follow-up showed longer duration of survival before collapse or arthrodesis, compared to 34 ankles of the control patients with core decompression alone. Furthermore, the time to successfully achieve fusion after arthrodesis was significantly shorter in patients treated with bone marrow progenitors as compared with the other ankles, which had core decompression alone.

Conclusion

In our study the early conservative surgical treatment with autologous bone marrow grafting improved the natural course of the disease as compared with core decompression alone.

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References

  1. Ahmad J, Raikin SM (2006) Current concepts review: talar fractures. Foot Ankle Int 27:475–482

    Article  PubMed  Google Scholar 

  2. Fortin PT, Balazsy JE (2001) Talus fractures: evaluation and treatment. J Am Acad Orthop Surg 9:114–127

    Article  CAS  PubMed  Google Scholar 

  3. Haliburton RA, Sullivan CR, Kelly PJ, Peterson LFA (1958) The extra-osseous and intraosseous blood supply of the talus. J Bone Joint Surg Am 40-A:1115–1120

    Article  CAS  PubMed  Google Scholar 

  4. Coltart WD (1952) Aviator’s astragalus. J Bone Joint Surg Br 34-B:545–566

    Article  CAS  PubMed  Google Scholar 

  5. Halvorson JJ, Winter SB, Teasdall RD, Scott AT (2013) Talar neck fractures: a systematic review of the literature. J Foot Ankle Surg 52(1):56–61

    Article  PubMed  Google Scholar 

  6. Shakked RJ, Tejwani NC (2013) Surgical treatment of talus fractures. Orthop Clin North Am 44(4):521–528

    Article  PubMed  Google Scholar 

  7. Hernigou P, Poignard A, Beaujean F, Rouard H (2005) Percutaneous autologous bonemarrow grafting for nonunions. Influence of the number and concentration of progenitor cells. J Bone Joint Surg Am 87(7):1430–1437

    PubMed  Google Scholar 

  8. Hernigou P, Beaujean F (2002) Treatment of osteonecrosis with autologous bone marrow grafting. Clin Orthop Relat Res 405:14–23

    Article  Google Scholar 

  9. Hawkins LG (1970) Fractures of the neck of the talus. J Bone Joint Surg Am 52:991–1002

    Article  CAS  PubMed  Google Scholar 

  10. Hernigou P, Flouzat-Lachaniette CH, Daltro G, Galacteros F (2016) Talar osteonecrosis related to adult sickle cell disease: natural evolution from early to late stages. J Bone Joint Surg Am 98(13):1113–1121

    Article  PubMed  Google Scholar 

  11. Mazur JM, Schwartz E, Simon SR (1979) Ankle arthrodesis. Long-term follow-up with gait analysis. J Bone Joint Surg Am 61:964–975

    Article  CAS  PubMed  Google Scholar 

  12. Mont MA, Schon LC, Hungerford MW, Hungerford DS (1996) Avascular necrosis of the talus treated by core decompression. J Bone Joint Surg (Br) 78-B:827–830

    Article  Google Scholar 

  13. Canale ST, Kelly FB (1978) Fractures of the neck of the talus: long-term evaluation of seventy-one cases. J Bone Joint Surg Am 60:143–156

    Article  CAS  PubMed  Google Scholar 

  14. Frawley PA, Hart JA, Young DA (1995) Treatment outcome of major fractures of the talus. Foot Ankle Int 16:339–345

    Article  CAS  PubMed  Google Scholar 

  15. Inokuchi S, Ogawa K, Usami N, Hashimoto T (1996) Long-term follow up of talus fractures. Orthopedics 19:477–481

    CAS  PubMed  Google Scholar 

  16. Lindvall E, Haidukewych G, DiPasquale T, Herscovici D, Sanders R (2004) Open reduction and stable fixation of isolated, displaced talar neck and body fractures. J Bone Joint Surg Am 86-A:2229–2234

    Article  PubMed  Google Scholar 

  17. Sanders DW, Busam M, Hattwick E, Edwards JR, McAndrew MP, Johnson KD (2004) Functional outcomes following displaced talar neck fractures. J Orthop Trauma 18:265–270

    Article  PubMed  Google Scholar 

  18. Schulze W, Richter J, Russe O, Ingelfinger P, Muhr G (2002) Surgical treatment of talus fractures: a retrospective study of 80 cases followed for 1–15 years. Acta Orthop Scand 73:344–351

    Article  PubMed  Google Scholar 

  19. Szyszkowitz R, Reschauer R, Seggl W (1985) Eighty-five talus fractures treated by ORIF with five to eight years of follow-up study of 69 patients. Clin Orthop Relat Res 199:97–107

    Google Scholar 

  20. Vallier HA, Nork SE, Barei DP, Benirschke SK, Sangeorzan BJ (2004) Talar neck fractures: results and outcomes. J Bone Joint Surg Am 86-A:1616–1624

    Article  PubMed  Google Scholar 

  21. Mulfinger GL, Trueta J (1970) The blood supply of the talus. J Bone Joint Surg Br 52:160–167

    Article  CAS  PubMed  Google Scholar 

  22. Giebel GD, Meyer C, Koebke J, Giebel G (1997) The arterial supply of the ankle joint and its importance for the operative fracture treatment. Surg Radiol Anat 19:231–235

    Article  CAS  PubMed  Google Scholar 

  23. Prasarn ML, Miller AN, Dyke JP, Helfet DL, Lorich DG (2010) Arterial anatomy of the talus: a cadaver and gadolinium-enhanced MRI study. Foot Ankle Int 31:987–993

    Article  PubMed  Google Scholar 

  24. Yajima H, Kobata Y, Tomita Y et al (2004) Ankle and pantalar arthrodeses using vascularized fibular grafts. Foot Ankle Int 25:3–7

    Article  PubMed  Google Scholar 

  25. Soldado F, Barrera-Ochoa S, Fontecha CG et al (2013) Vascularized periosteal graft from the first metatarsal bone: a new technique to prevent collapse of osteonecrosis of the talus in children. A case report. Microsurgery 33:56–59

    Article  PubMed  Google Scholar 

  26. Kodama N, Takemura Y, Ueba H, Imai S, Matsusue Y (2015) A new form of surgical treatment for patients with avascular necrosis of the talus and secondary osteoarthritis of the ankle. Bone Joint J 97-B(6):802–808

    Article  CAS  PubMed  Google Scholar 

  27. Tanaka Y, Omokawa S, Fujii T et al (2006) Vascularized bone graft from the medial calcaneus for treatment of large osteochondral lesions of the medial talus. Foot Ankle Int 27:1143–1147

    Article  PubMed  Google Scholar 

  28. Haddock NT, Wapner K, Levin LS (2013) Vascular bone transfer options in the foot and ankle: a retrospective review and update on strategies. Plast Reconstr Surg 132:685–693

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

We thank Richard Suzuki and Meghana Malur of Celling Biosciences for the review of the final manuscript and their help in translation.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, University Paris East (UPEC), Hôpital Henri Mondor, 94010, Creteil, France

    Philippe Hernigou, Arnaud Dubory, Charles Henri Flouzat Lachaniette, Issam Khaled, Nathalie Chevallier & Helene Rouard

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  1. Philippe Hernigou
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  2. Arnaud Dubory
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  3. Charles Henri Flouzat Lachaniette
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  4. Issam Khaled
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  5. Nathalie Chevallier
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  6. Helene Rouard
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Corresponding author

Correspondence to Philippe Hernigou.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Hernigou, P., Dubory, A., Flouzat Lachaniette, C.H. et al. Stem cell therapy in early post-traumatic talus osteonecrosis. International Orthopaedics (SICOT) 42, 2949–2956 (2018). https://doi.org/10.1007/s00264-017-3716-7

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  • DOI: https://doi.org/10.1007/s00264-017-3716-7

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