Autologous Osteochondral Grafting for Talar Cartilage Defects

Abstract

The purpose of this study was to evaluate the clinical results of Osteochondral Autograft Transfer System (OATS) for the treatment of symptomatic osteochondral defects of the talus using standardized outcome analysis. Nineteen patients with symptomatic osteochondral defect (OCD) of the talus were treated with autologous osteochondral grafting. There were six men and 13 women. The average age was 32 years (range, 18 to 48 years). The average duration of symptoms prior to surgery was 4.2 years (range, three months to 12 years). All patients had failed nonoperative treatment, and 13 (68%) patients had failed prior excision, curettage and/or drilling of the lesion. The average size of the lesion prior to autografting was 12 mm x 10 mm (range, 10 x 5 mm to 20 x 20 mm). Donor plugs were harvested from the trochlear border of the ipsilateral femoral condyle. Ankle exposure was obtained with a medial malleolar osteotomy in 13 patients, arthrotomy in five patients and lateral malleolar osteotomy in one patient. Clinical evaluations were performed for both the recipient ankle and donor knee using the AOFAS Ankle/Hindfoot Scale and Lysholm knee scale, respectively. The average follow-up time was 16 months (range, 12 to 30 months). The average postoperative AOFAS ankle score was 88 (range, 60 to 100). Most patients had occasional mild pain, but excellent function, range of motion, stability and alignment. The average postoperative ankle score for the 13 patients who failed prior surgery was 91 (range, 84 to 100). The average postoperative Lysholm knee score was 97 (range, 87 to 100). Only two patients had mild knee pain. Postoperative radiographs were available for 13 patients. There was no evidence of graft subsidence and all grafts healed. All malleolar osteotomies united. Seventeen (89%) patients said that they would undergo the procedure again. The results of osteochondral autograft transplant for OCD lesions of the talus demonstrate excellent postoperative ankle scores including improvement of pain and function with minimal knee donor site morbidity. Also, our results indicate that this is an effective salvage procedure following failed previous procedures and for patients with longstanding symptoms.

Autologous osteochondral transplantation for osteochondral lesions of the talus in an athletic population

“…Our findings agree with those of previous AOT and mosaicplasty studies [1,12,13,16,17,20,26,36] and highlight that at midterm follow-up AOT procedure is able to achieve good clinical outcomes in an entirely athletic cohort.…”

Long-term outcome after traumatic anterior dislocation of the hip

“…This technique achieved good clinical and radiological results according to the Epstein criteria at 2 years and prevented early joint degeneration [22]. Although osteochondral transplantation is a well-described technique for the treatment of osteochondral defects in joints [23][24][25][26], the treatment of osteochondral defects in the hip joint has not been extensively described in the literature. Based on our results in this particular case, we recommend this technique as a salvage procedure for femoral head impaction fractures also after posterior hip dislocation and we confirm nonoperative treatment recommendations in cases of superficial femoral head impaction defects.…”

Treatment of Talar Osteochondral Lesions Using Local Osteochondral Talar Autograft – Long Term Results

“…The result of non-operative treatment of stage III and IV osteochondral lesions of the talus have been poor 1,3 7 reported their results in 11 patients treated with mosaicplasty autogenous osteochondral grafting for talar dome lesions using the knee as a donor site with a high success rate. However donor site morbidity can occur in up to 15% -16% of cases in an asymptomatic joint 8 .…”