Past research has indicated the size of an OLT is a predictive factor correlating with successful surgical outcomes. Microfracture or arthroscopic marrow stimulation has demonstrated less success when treating larger OLTs (greater than 150mm), whereas Osteochondral Autograft Transplantation (OAT) has been successful in treating larger lesions.

A new retrospective study from Hospital for Special Surgery (HSS) compared clinical outcomes after treatment of medium-sized OLTs using a microfracture technique augmented with extracellular matrix and bone marrow aspirate concentrate (MFX) versus OAT to determine which option is superior for treating medium-sized lesions. Fifty patients were evaluated, 27 of whom were treated with MFX, and 23 who were treated with OAT for an OLT (sized 80-165mm) between 2015-2018, at a minimum of 12 months follow up. Patient-reported functional outcomes were collected through the HSS prospective registry database. Postoperative MRIs were assessed using a modified magnetic resonance observation of cartilage repair tissue (MOCART) score.

The OAT group had a higher MOCART score indicating that the use of a single osteochondral autograft plug may result in better structural repair. Higher average FAOS scores, better than average PROMIS scores and greater pre-to-postoperative change in the OAT group also suggest functional results may be better in this group as well. Patients treated with OAT reported significantly less pain and depression and better psychological benefits than those who were treated with MFX.

“The key takeaways from this research are the open procedure more closely replicates the normal anatomy than the arthroscopic procedure - they are not equal,” said Mark C. Drakos, MD, HSS foot and ankle surgeon and senior study author. “The findings validate the need to perform additional research to ensure the less invasive arthroscopic procedure has better outcomes similar to those of the open procedure.”

This study is available online as part of the AAOS 2020 Virtual Education Experience.

Abstract Title: A Comparison of Functional and Radiographic Outcomes following Microfracture with Extracellular Matrix Augmentation versus Osteochondral Autograft Transplantation for the Treatment of Medium-Sized Osteochondral Lesions of the Talus

Authors: Taylor Cabe, Carolyn M. Sofka, MD, Jonathan T. Deland, MD, Mark C. Drakos, MD

This year, the gala will be hosted by Al Roker, weatherman and co-host of NBC’s Today Show and CEO of Al Roker Entertainment, with special guest Saquon Barkley, running back of the New York Giants, on Monday, June 3, 2019 at the American Museum of Natural History in New York City.

“We are delighted to commemorate the extraordinary successes of Steve Tisch who has excelled in various disciplines of business, media and entertainment,” said Louis A. Shapiro, president and CEO at HSS. “Through his entrepreneurial spirit, artful storytelling and purposeful philanthropy, Steve inspires others to meet the greatest challenges with courage and perseverance.”

“Dr. Deland’s devotion to patient care and steadfast commitment to advancing the science and techniques to improve surgical treatment of foot and ankle conditions are living proof of the mission of HSS,” said Todd J. Albert, MD, surgeon-in-chief and medical director at HSS. “His foot and ankle registry, [the Rose Registry] is the largest in the nation supporting clinical studies and national publications that have, and will continue to, enhance foot and ankle care for patients in years to come.”

The event will begin at 6:15 p.m. with a dinner to follow at 7:15 p.m. Guests will include leaders from the worlds of business, health, finance, media, sports, the arts and government.

Jonathan T. Deland, MD

Jonathan T. Deland, MD is a foot and ankle surgeon at HSS and the Susan W. Rose and Jonathan T. Deland Chair for Research in Foot and Ankle Surgery. He serves as the Director of Quality and Innovation for the Foot and Ankle Service, having been its Chief and oversees the Aim Laboratory at HSS.

In addition to his devotion to foot and ankle surgery, Dr. Deland is an avid researcher. He presents his research nationally and internationally and has authored over 100 journal articles and 12 book chapters. His research focuses on improving the surgical treatment of foot deformities and total ankle replacements. Mrs. Susan W. Rose and Dr. Deland established the Rose Registry, one of the largest foot and ankle registries for clinical research in the nation. The registry supports clinical studies and national publications to advance foot and ankle care.

Dr. Deland’s interest in biomedical engineering has led him to co-invent a total ankle replacement and an Achilles tendon repair device. He and co-inventors are currently designing a new total ankle replacement as well as an ankle joint spacer for young patients with ankle arthritis.

Mr. Herbert Black and Dr. Deland teamed up to have the most advanced robotic gait simulator constructed at HSS in the Aim Laboratory, funded by Mr. Black. The gait simulator makes the most advanced biomechanical research in foot and ankle possible. Mr. Black and other supporters provide funding for its ongoing projects.

Steve Tisch

Steve Tisch is an Academy Award-winning producer, partner at Escape Artists Productions, Chairman, Executive Vice President and Co-Owner of the New York Football Giants, and a committed philanthropist. He is the only person with both an Oscar and a Super Bowl ring, winning Best Picture for “Forrest Gump” in 1994, and receiving two Super Bowl rings as Chairman of the Giants for Super Bowls XLII and XLVI.

For more than four decades, Steve has successfully produced compelling stories in film and television, from the critically acclaimed television movie, “The Burning Bed” starring Farrah Fawcett, to "Risky Business" and "The Pursuit of Happyness." Steve has been involved with the New York Giants since his father, Preston Robert Tisch, purchased 50 percent of the franchise in 1991. Steve worked closely with John Mara, President and CEO of the Giants, on the planning and construction of MetLife Stadium, which was completed in the spring of 2010 and ranked as the number one grossing stadium in the world in 2012. Tisch and Mara were named Best NFL Owners by Forbes in 2011.

Tisch also generously contributes his time and resources to a variety of organizations in arts, health and education. Steve is currently on the Board of Trustees of the Los Angeles County Museum of Art, is a founding Trustee of The Geffen Theatre in Los Angeles, is on the Board of Advisors of the Tisch School of the Arts at New York University and The Preston Robert Tisch Brain Tumor Center at Duke University, and previously served on the board of the Sundance Institute.

For more information, please visit https://www.hss.edu/36th-tribute-dinner.asp.

He interviews Jonathan T. Deland, MD, foot and ankle surgeon at HSS, as well as his patient, Frosty Blakeslee, who underwent the procedure a few years ago.

"My ankle hurt 24/7. I had to think about how I walked up the stairs and down the stairs from the kitchen to the living room," said Blakeslee, who is a certified professional ski instructor.

Blakeslee found Dr. Deland who recommended an ankle replacement over a fusion. He showed her a new generation prostheses that restores nearly normal function.

"Patients get good relief of pain, they can have little discomfort," said Dr. Deland. "It's like a 'wow operation'. They go 'wow, this is terrific!'"

Blakeslee regained 100 percent mobility and is able to get back on the slopes.

This coverage originally appeared in NewYork.CBSLocal.com. The original article is no longer available online.

The group, led by Constantine Demetracopoulos, MD, foot and ankle surgeon at HSS, received the honor for their paper, "Influence of Tibial Component Position on Altered Kinematics Following Total Ankle Arthroplasty During Simulated Gait." The article describes experiments to determine how surgical replacement of the joint can affect patient mobility after the procedure.

The surgeon team consisted of Drs. Jonathan Deland, Scott Ellis, and Guilherme Saito, who performed the study in conjunction with Daniel Sturnick in the Biomechanics Department at HSS. The research team utilized a unique robotic gait simulator, which is able to reproduce normal walking gait using human cadavers. The simulator was developed through a generous donation by Herbert Black, owner and CEO of American Iron and Metal Company, under the leadership of Dr. Jonathan Deland, foot and ankle surgeon at HSS.

The findings from the study could help surgeons fine-tune their techniques during ankle replacement to reduce the risk that patients experience complications later on, said Dr. Demetracopoulos. It may also help companies that make artificial joints design implants that are more anatomically friendly and less prone to wear.

"For patients who have ankle arthritis and have an ankle replacement, how we do the replacement and how we position the replacement device is critical to matching the kinematics of normal gait and the success of the procedure," Dr. Demetracopoulos said.

Total ankle arthroscopy (TAA), or ankle replacement surgery, is an option for patients with severe arthritis of the joint. For the procedure, surgeons replace the patient’s diseased ankle with a prosthetic joint composed of metal and plastic. Although the procedure is becoming more common, it is much less so than knee or hip replacement procedures, which number in the hundreds of thousands per year each. As a result, relatively little is known about the best ways to perform the procedure, particularly when it comes to positioning the replacement parts in the bone, or how variations in surgical techniques may affect outcomes.

Ankle replacement surgery is thought to provide patients greater flexibility and motion in the joint than an alternative procedure, ankle fusion. However, despite the significant improvement in pain and mobility following ankle replacement, whether an ankle prosthesis can restore normal walking gait remains unclear. 

For the new study, Dr. Demetracopoulos and his colleagues sought to learn how placement of the ankle implants during TAA affects range of motion. To do so, they implanted artificial ankles (Salto Talaris, Integra LifeSciences) into eight leg sections obtained from cadavers. (The use of cadavers allowed the researchers to more accurately assess ankle motion before and after implant surgery, and also avoided having to expose living patients to excessive radiation from imaging tests.)

To monitor motion, Dr. Demetracopoulos’ group surgically grafted ligaments and tendons from the original joint to sensors. The legs were mounted on a robotic platform with computer software that tracked movement of the ankle in three dimensions: up/down bending of the ankle, side-to-side tilting, and rotation of the bones. "As you bend your ankle up and down, the bone is doing a little bit of all three: From the very top to the very bottom, it’s bending down, it’s tilting and it’s rotating. It doesn’t move like a hinge," Dr. Demetracopoulos explained.

Using the robotic platform to simulate a walking gait, the HSS team found that ankle motion appeared to be restored in two degrees of movement--up/down and side to side tilting. However, rotational motion was significantly greater than before the procedure.  

"We were able to show that the technique of how the replacement is positioned is what drives that rotation," Dr. Demetracopoulos said.

The HSS researchers say the asymmetrical design of the implant used in the study—one of the oldest devices to reach the market that is currently still in use— may play a role in their findings. Newer implant designs may be less prone to such rotational motion, and the group is in the process of trying to evaluate those devices.