Skip to main content
Top
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 4/2016

Open Access 01-04-2016 | Ankle

A study to evaluate the safety of platelet-derived growth factor for treatment of osteochondral defects of the talus

Authors: Alastair Younger, Kevin Wing, Murray Penner, Mark Cresswell

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 4/2016

Login to get access

Abstract

Purpose

An arthroscopic procedure for the treatment of osteochondral defects using platelet-derived growth factor (PDGF) carried out in a matrix of tricalcium phosphate was developed. This prospective, case-series-based study was designed to evaluate the safety and clinical utility of this procedure.

Methods

Patients with an isolated osteochondral defect larger than 5 mm long, 3 mm wide, and 5 mm deep and smaller than 30 mm long, 25 mm wide, or 20 mm deep were considered for enrolment. Only patients with chronic lesions were enroled. Arthroscopic debridement was followed by the placement of recombinant human PDGF in a matrix of tricalcium phosphate. The Ankle Osteoarthritis Scale (AOS), visual analogue scale (VAS) for pain, and SF-36 questionnaires were administered at 0, 2, 6, 12, and 24 weeks. Magnetic resonance imaging (MRI) and computed tomography (CT) scans were taken before and after surgery.

Results

Five patients were ultimately enroled in this proof-of-concept trial. All outcome measures demonstrated marked improvement from baseline to final follow-up: The mean weight bearing VAS pain score improved by 49 %, and the mean AOS functional score improved by 28 %. Bone healing was seen on CT, and reduction in oedema signal was seen on MRI.

Conclusion

This new procedure may offer a promising alternative for the treatment of osteochondral defects. Further high-quality studies are needed to confirm these results and to analyse the long-term effects of the procedure. The clinical relevance of this study is that the procedure may provide a less invasive option with improved bone healing compared to standard techniques .

Level of evidence

IV.
Appendix
Available only for authorised users
Literature
1.
go back to reference Adams SB Jr, Viens NA, Easley ME, Stinnett SS, Nunley JA 2nd (2011) Midterm results of osteochondral lesions of the talar shoulder treated with fresh osteochondral allograft transplantation. J Bone Joint Surg Am 93(7):648–654CrossRefPubMed Adams SB Jr, Viens NA, Easley ME, Stinnett SS, Nunley JA 2nd (2011) Midterm results of osteochondral lesions of the talar shoulder treated with fresh osteochondral allograft transplantation. J Bone Joint Surg Am 93(7):648–654CrossRefPubMed
2.
go back to reference Agung M, Ochi M, Adachi N, Uchio Y, Takao M, Kawasaki K (2004) Osteochondritis dissecans of the talus treated by the transplantation of tissue-engineered cartilage. Arthroscopy 20(10):1075–1080CrossRefPubMed Agung M, Ochi M, Adachi N, Uchio Y, Takao M, Kawasaki K (2004) Osteochondritis dissecans of the talus treated by the transplantation of tissue-engineered cartilage. Arthroscopy 20(10):1075–1080CrossRefPubMed
3.
go back to reference Anders S, Goetz J, Schubert T, Grifka J, Schaumburger J (2012) Treatment of deep articular talus lesions by matrix associated autologous chondrocyte implantation—results at five years. Int Orthop 36(11):2279–2285CrossRefPubMedPubMedCentral Anders S, Goetz J, Schubert T, Grifka J, Schaumburger J (2012) Treatment of deep articular talus lesions by matrix associated autologous chondrocyte implantation—results at five years. Int Orthop 36(11):2279–2285CrossRefPubMedPubMedCentral
4.
go back to reference Beaton DE, Schemitsch E (2003) Measures of health-related quality of life and physical function. Clin Orthop Relat Res 413:90–105CrossRefPubMed Beaton DE, Schemitsch E (2003) Measures of health-related quality of life and physical function. Clin Orthop Relat Res 413:90–105CrossRefPubMed
5.
go back to reference Borazjani BH, Chen AC, Bae WC, Patil S, Sah RL, Firestein GS, Bugbee WD (2006) Effect of impact on chondrocyte viability during insertion of human osteochondral grafts. J Bone Joint Surg Am 88(9):1934–1943CrossRefPubMed Borazjani BH, Chen AC, Bae WC, Patil S, Sah RL, Firestein GS, Bugbee WD (2006) Effect of impact on chondrocyte viability during insertion of human osteochondral grafts. J Bone Joint Surg Am 88(9):1934–1943CrossRefPubMed
6.
go back to reference Brazier JE, Harper R, Jones NM, O’Cathain A, Thomas KJ, Usherwood T, Westlake L (1992) Validating the SF-36 health survey questionnaire: new outcome measure for primary care. BMJ 305(6846):160–164CrossRefPubMedPubMedCentral Brazier JE, Harper R, Jones NM, O’Cathain A, Thomas KJ, Usherwood T, Westlake L (1992) Validating the SF-36 health survey questionnaire: new outcome measure for primary care. BMJ 305(6846):160–164CrossRefPubMedPubMedCentral
7.
go back to reference Bugbee WD, Khanna G, Cavallo M, McCauley JC, Gortz S, Brage ME (2013) Bipolar fresh osteochondral allografting of the tibiotalar joint. J Bone Joint Surg Am 95(5):426–432CrossRefPubMed Bugbee WD, Khanna G, Cavallo M, McCauley JC, Gortz S, Brage ME (2013) Bipolar fresh osteochondral allografting of the tibiotalar joint. J Bone Joint Surg Am 95(5):426–432CrossRefPubMed
8.
go back to reference Buser D, Hoffmann B, Bernard JP, Lussi A, Mettler D, Schenk RK (1998) Evaluation of filling materials in membrane—protected bone defects. A comparative histomorphometric study in the mandible of miniature pigs. Clin Oral Implants Res 9(3):137–150CrossRefPubMed Buser D, Hoffmann B, Bernard JP, Lussi A, Mettler D, Schenk RK (1998) Evaluation of filling materials in membrane—protected bone defects. A comparative histomorphometric study in the mandible of miniature pigs. Clin Oral Implants Res 9(3):137–150CrossRefPubMed
9.
go back to reference Costa MA, Wu C, Pham BV, Chong AK, Pham HM, Chang J (2006) Tissue engineering of flexor tendons: optimization of tenocyte proliferation using growth factor supplementation. Tissue Eng 12(7):1937–1943CrossRefPubMed Costa MA, Wu C, Pham BV, Chong AK, Pham HM, Chang J (2006) Tissue engineering of flexor tendons: optimization of tenocyte proliferation using growth factor supplementation. Tissue Eng 12(7):1937–1943CrossRefPubMed
10.
go back to reference DiGiovanni CW, Lin SS, Baumhauer JF, Daniels T, Younger A, Glazebrook M, Anderson J, Anderson R, Evangelista P, Lynch SE (2013) Recombinant human platelet-derived growth factor-BB and beta-tricalcium phosphate (rhPDGF-BB/beta-TCP): an alternative to autogenous bone graft. J Bone Joint Surg Am 95(13):1184–1192CrossRefPubMed DiGiovanni CW, Lin SS, Baumhauer JF, Daniels T, Younger A, Glazebrook M, Anderson J, Anderson R, Evangelista P, Lynch SE (2013) Recombinant human platelet-derived growth factor-BB and beta-tricalcium phosphate (rhPDGF-BB/beta-TCP): an alternative to autogenous bone graft. J Bone Joint Surg Am 95(13):1184–1192CrossRefPubMed
11.
13.
go back to reference Emery P, Kavanaugh A, Bao Y, Ganguli A, Mulani P (2014) Comprehensive disease control (CDC): What does achieving CDC mean for patients with rheumatoid arthritis? Ann Rheum Dis. doi:10.1136/annrheumdis-2014-205302 Emery P, Kavanaugh A, Bao Y, Ganguli A, Mulani P (2014) Comprehensive disease control (CDC): What does achieving CDC mean for patients with rheumatoid arthritis? Ann Rheum Dis. doi:10.​1136/​annrheumdis-2014-205302
14.
go back to reference Giannini S, Buda R, Grigolo B, Vannini F (2001) Autologous chondrocyte transplantation in osteochondral lesions of the ankle joint. Foot Ankle Int 22(6):513–517PubMed Giannini S, Buda R, Grigolo B, Vannini F (2001) Autologous chondrocyte transplantation in osteochondral lesions of the ankle joint. Foot Ankle Int 22(6):513–517PubMed
15.
go back to reference Giannini S, Vannini F (2004) Operative treatment of osteochondral lesions of the talar dome: current concepts review. Foot Ankle Int 25(3):168–175PubMed Giannini S, Vannini F (2004) Operative treatment of osteochondral lesions of the talar dome: current concepts review. Foot Ankle Int 25(3):168–175PubMed
16.
go back to reference Hawker GA, Mian S, Kendzerska T, French M (2011) Measures of adult pain: visual analog scale for pain (VAS Pain), numeric rating scale for pain (NRS Pain), mcgill pain questionnaire (MPQ), short-form mcgill pain questionnaire (SF-MPQ), chronic pain grade scale (CPGS), short form-36 bodily pain scale (SF-36 BPS), and measure of intermittent and constant osteoarthritis pain (ICOAP). Arthritis Care Res 63(Suppl 11):S240–S252CrossRef Hawker GA, Mian S, Kendzerska T, French M (2011) Measures of adult pain: visual analog scale for pain (VAS Pain), numeric rating scale for pain (NRS Pain), mcgill pain questionnaire (MPQ), short-form mcgill pain questionnaire (SF-MPQ), chronic pain grade scale (CPGS), short form-36 bodily pain scale (SF-36 BPS), and measure of intermittent and constant osteoarthritis pain (ICOAP). Arthritis Care Res 63(Suppl 11):S240–S252CrossRef
17.
go back to reference Koulalis D, Schultz W, Heyden M (2002) Autologous chondrocyte transplantation for osteochondritis dissecans of the talus. Clin Orthop Relat Res 395:186–192CrossRefPubMed Koulalis D, Schultz W, Heyden M (2002) Autologous chondrocyte transplantation for osteochondritis dissecans of the talus. Clin Orthop Relat Res 395:186–192CrossRefPubMed
18.
go back to reference Kreuz PC, Steinwachs M, Erggelet C, Lahm A, Henle P, Niemeyer P (2006) Mosaicplasty with autogenous talar autograft for osteochondral lesions of the talus after failed primary arthroscopic management: a prospective study with a 4-year follow-up. Am J Sports Med 34(1):55–63CrossRefPubMed Kreuz PC, Steinwachs M, Erggelet C, Lahm A, Henle P, Niemeyer P (2006) Mosaicplasty with autogenous talar autograft for osteochondral lesions of the talus after failed primary arthroscopic management: a prospective study with a 4-year follow-up. Am J Sports Med 34(1):55–63CrossRefPubMed
19.
go back to reference LaPrade RF, Botker JC (2004) Donor-site morbidity after osteochondral autograft transfer procedures. Arthroscopy 20(7):e69–e73CrossRefPubMed LaPrade RF, Botker JC (2004) Donor-site morbidity after osteochondral autograft transfer procedures. Arthroscopy 20(7):e69–e73CrossRefPubMed
20.
go back to reference Madeley NJ, Wing KJ, Topliss C, Penner MJ, Glazebrook MA, Younger AS (2012) Responsiveness and validity of the SF-36, Ankle Osteoarthritis Scale, AOFAS Ankle Hindfoot Score, and Foot Function Index in end stage ankle arthritis. Foot Ankle Int 33(1):57–63CrossRefPubMed Madeley NJ, Wing KJ, Topliss C, Penner MJ, Glazebrook MA, Younger AS (2012) Responsiveness and validity of the SF-36, Ankle Osteoarthritis Scale, AOFAS Ankle Hindfoot Score, and Foot Function Index in end stage ankle arthritis. Foot Ankle Int 33(1):57–63CrossRefPubMed
21.
go back to reference McCormack HM, Horne DJ, Sheather S (1988) Clinical applications of visual analogue scales: a critical review. Psychol Med 18(4):1007–1019CrossRefPubMed McCormack HM, Horne DJ, Sheather S (1988) Clinical applications of visual analogue scales: a critical review. Psychol Med 18(4):1007–1019CrossRefPubMed
22.
go back to reference McGuire MK, Scheyer ET, Schupbach P (2009) Growth factor-mediated treatment of recession defects: a randomized controlled trial and histologic and microcomputed tomography examination. J Periodontol 80(4):550–564CrossRefPubMed McGuire MK, Scheyer ET, Schupbach P (2009) Growth factor-mediated treatment of recession defects: a randomized controlled trial and histologic and microcomputed tomography examination. J Periodontol 80(4):550–564CrossRefPubMed
23.
go back to reference Mellonig JT, Valderrama Mdel P, Cochran DL (2009) Histological and clinical evaluation of recombinant human platelet-derived growth factor combined with beta tricalcium phosphate for the treatment of human Class III furcation defects. Int J Periodontics Restorative Dent 29(2):169–177PubMed Mellonig JT, Valderrama Mdel P, Cochran DL (2009) Histological and clinical evaluation of recombinant human platelet-derived growth factor combined with beta tricalcium phosphate for the treatment of human Class III furcation defects. Int J Periodontics Restorative Dent 29(2):169–177PubMed
24.
go back to reference Nevins M, Giannobile WV, McGuire MK, Kao RT, Mellonig JT, Hinrichs JE, Mcallister BS, Murphy KS, McClain PK, Nevins ML, Paquette DW, Han TJ, Reddy MS, Lavin PT, Genco RJ, Lynch SE (2005) Platelet-derived growth factor stimulates bone fill and rate of attachment level gain: results of a large multicenter randomized controlled trial. J Periodontol 76:2205–2215CrossRefPubMed Nevins M, Giannobile WV, McGuire MK, Kao RT, Mellonig JT, Hinrichs JE, Mcallister BS, Murphy KS, McClain PK, Nevins ML, Paquette DW, Han TJ, Reddy MS, Lavin PT, Genco RJ, Lynch SE (2005) Platelet-derived growth factor stimulates bone fill and rate of attachment level gain: results of a large multicenter randomized controlled trial. J Periodontol 76:2205–2215CrossRefPubMed
25.
go back to reference Peterson L, Brittberg M, Lindahl A (2003) Autologous chondrocyte transplantation of the ankle. Foot Ankle Clin 8(2):291–303CrossRef Peterson L, Brittberg M, Lindahl A (2003) Autologous chondrocyte transplantation of the ankle. Foot Ankle Clin 8(2):291–303CrossRef
26.
go back to reference Ridgway HK, Mellonig JT, Cochran DL (2008) Human histologic and clinical evaluation of recombinant human platelet-derived growth factor and beta-tricalcium phosphate for the treatment of periodontal intraosseous defects. Int J Periodontics Restor Dent 28(2):171–179 Ridgway HK, Mellonig JT, Cochran DL (2008) Human histologic and clinical evaluation of recombinant human platelet-derived growth factor and beta-tricalcium phosphate for the treatment of periodontal intraosseous defects. Int J Periodontics Restor Dent 28(2):171–179
27.
go back to reference Sakiyama-Elbert SE, Das R, Gelberman RH, Harwood F, Amiel D, Thomopoulos S (2008) Controlled-release kinetics and biologic activity of platelet-derived growth factor-BB for use in flexor tendon repair. J Hand Surg Am 33(9):1548–1557CrossRefPubMedPubMedCentral Sakiyama-Elbert SE, Das R, Gelberman RH, Harwood F, Amiel D, Thomopoulos S (2008) Controlled-release kinetics and biologic activity of platelet-derived growth factor-BB for use in flexor tendon repair. J Hand Surg Am 33(9):1548–1557CrossRefPubMedPubMedCentral
28.
go back to reference Schmidt MA, Chen EH, Lynch S (2005) A review of the effects of insulin-like growth factor and platelet derived growth factor on in vivo cartilage healing and repair. Osteoarthr Cartil 14:403–412CrossRef Schmidt MA, Chen EH, Lynch S (2005) A review of the effects of insulin-like growth factor and platelet derived growth factor on in vivo cartilage healing and repair. Osteoarthr Cartil 14:403–412CrossRef
29.
go back to reference Shah P, Keppler L, Rutkowski J (2014) A review of platelet derived growth factor playing pivotal role in bone regeneration. J Oral Implantol 40(3):330–340CrossRefPubMed Shah P, Keppler L, Rutkowski J (2014) A review of platelet derived growth factor playing pivotal role in bone regeneration. J Oral Implantol 40(3):330–340CrossRefPubMed
30.
go back to reference Thomopoulos S, Das R, Sakiyama-Elbert S, Silva M, Charlton N, Gelberman R (2010) bFGF and PDGF-BB for tendon repair: controlled release and biologic activity by tendon fibroblasts in vitro. Ann Biomed Eng 38(2):225–234CrossRefPubMedPubMedCentral Thomopoulos S, Das R, Sakiyama-Elbert S, Silva M, Charlton N, Gelberman R (2010) bFGF and PDGF-BB for tendon repair: controlled release and biologic activity by tendon fibroblasts in vitro. Ann Biomed Eng 38(2):225–234CrossRefPubMedPubMedCentral
31.
go back to reference Thomopoulos S, Das R, Silva MJ, Sakiyama-Elbert S, Harwood FL, Zampiakis E, Kim HM, Amiel D, Gelberman RH (2009) Enhanced flexor tendon healing through controlled delivery of PDGF-BB. J Orthop Res 27(9):1209–1215CrossRefPubMedPubMedCentral Thomopoulos S, Das R, Silva MJ, Sakiyama-Elbert S, Harwood FL, Zampiakis E, Kim HM, Amiel D, Gelberman RH (2009) Enhanced flexor tendon healing through controlled delivery of PDGF-BB. J Orthop Res 27(9):1209–1215CrossRefPubMedPubMedCentral
32.
go back to reference Thomopoulos S, Harwood F, Silva M, Amiel D, Gelberman R (2005) Effect of several growth factors on canine flexor tendon fibroblast proliferation and collagen synthesis in vitro. J Hand Surg Am 30A(3):441–447CrossRef Thomopoulos S, Harwood F, Silva M, Amiel D, Gelberman R (2005) Effect of several growth factors on canine flexor tendon fibroblast proliferation and collagen synthesis in vitro. J Hand Surg Am 30A(3):441–447CrossRef
33.
go back to reference Thomopoulos S, Zaegel M, Das R, Harwood F, Silva M, Amiel D, Sakiyama-Elbert S, Gelberman R (2007) PDGF-BB released in tendon repair using a novel delivery system promotes cell proliferation and collagen remodeling. J Orthop Res 25(10):1358–1368CrossRefPubMed Thomopoulos S, Zaegel M, Das R, Harwood F, Silva M, Amiel D, Sakiyama-Elbert S, Gelberman R (2007) PDGF-BB released in tendon repair using a novel delivery system promotes cell proliferation and collagen remodeling. J Orthop Res 25(10):1358–1368CrossRefPubMed
34.
go back to reference Tol JL, Struijs PA, Bossuyt PM, Verhagen RA, van Dijk CN (2000) Treatment strategies in osteochondral defects of the talar dome: a systematic review. Foot Ankle Int 21(2):119–126PubMed Tol JL, Struijs PA, Bossuyt PM, Verhagen RA, van Dijk CN (2000) Treatment strategies in osteochondral defects of the talar dome: a systematic review. Foot Ankle Int 21(2):119–126PubMed
35.
go back to reference Weiler A, Forster C, Hunt P, Falk R, Jung T, Unterhauser FN, Bergmann V, Schmidmaier G, Haas NP (2004) The influence of locally applied platelet-derived growth factor-BB on free tendon graft remodeling after anterior cruciate ligament reconstruction. Am J Sports Med 32(4):881–891CrossRefPubMed Weiler A, Forster C, Hunt P, Falk R, Jung T, Unterhauser FN, Bergmann V, Schmidmaier G, Haas NP (2004) The influence of locally applied platelet-derived growth factor-BB on free tendon graft remodeling after anterior cruciate ligament reconstruction. Am J Sports Med 32(4):881–891CrossRefPubMed
36.
go back to reference Zengerink M, Struijs PA, Tol JL, van Dijk CN (2010) Treatment of osteochondral lesions of the talus: a systematic review. Knee Surg Sports Traumatol Arthrosc 18(2):238–246CrossRefPubMedPubMedCentral Zengerink M, Struijs PA, Tol JL, van Dijk CN (2010) Treatment of osteochondral lesions of the talus: a systematic review. Knee Surg Sports Traumatol Arthrosc 18(2):238–246CrossRefPubMedPubMedCentral
Metadata
Title
A study to evaluate the safety of platelet-derived growth factor for treatment of osteochondral defects of the talus
Authors
Alastair Younger
Kevin Wing
Murray Penner
Mark Cresswell
Publication date
01-04-2016
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 4/2016
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-015-3549-0

Other articles of this Issue 4/2016

Knee Surgery, Sports Traumatology, Arthroscopy 4/2016 Go to the issue