Comparison of autologous osteoperiosteal cylinder and osteochondral graft transplantation in the treatment of large cystic osteochondral lesions of the talus (OLTs): a protocol for a non-inferiority randomised controlled trial

Abstract

IntroductionLarge cystic osteochondral lesions of the talus (OLTs) have been shown to have inferior clinical outcomes after reparative techniques such as bone marrow stimulation. Autologous osteochondral transplantation has been viewed as an alternative choice for treating these lesions, but donor-site morbidity has limited its application. Excellent clinical outcomes have been shown in repairing these types of lesions with autologous osteoperiosteal grafts, and these outcomes are achieved at a low cost and without donor-site morbidity in the normal knee joint. This will be the first randomised controlled trial to compare the two surgical techniques, and recommendations for the treatment of patients with large cystic OLTs will be provided.Methods and analysisA non-inferiority randomised controlled trial will be conducted. A total of 70 participants with clinically diagnosed large cystic OLTs will be randomly allocated to either the experimental group or the control group at a ratio of 1:1. The experimental group will be treated with autologous osteoperiosteal cylinder graft transplantation, while the control group will be treated with autologous osteochondral transplantation. The primary outcome measure will be the American Orthopaedic Foot & Ankle Society Ankle-Hindfoot Score and the Short Form 12 (SF-12) questionnaire. Secondary outcome measures will include the secondary arthroscopy International Cartilage Repair Society score, the Magnetic Resonance Observation of Cartilage Repair Tissue score, the Tegner activity level score, the visual analogue scale, routine X-rays, CT and complications. These parameters will be evaluated preoperatively, as well as at 3, 6, 12, 24, 36 and 60 months postoperatively. In this trial, we hypothesised that both procedures offer good results for the treatment of patients with large cystic OLTs, and occurrence of donor-site morbidity in autologous osteoperiosteal cylinder graft transplantation group is less than that in autologous osteochondral transplantation group.Ethics and disseminationThe current study was approved by the board of research ethics of Peking University Third Hospital Medical Science Research Ethics Committee. The results of this study will be presented at national and international conferences and published in peer-reviewed journals.Trial registration numberNCT03347877.

Effect analysis of iliac bone autografting for Hepple V osteochondral lesions of the talus

“…Autologous osteochondral grafts are usually taken from the osteochondral column of the ipsilateral knee, producing hyaline cartilage with excellent biomechanical properties, but potentially leading to irreversible knee damage. However, iliac bone grafts have fewer complications in the treatment of talar cartilage injuries, and the iliac periosteum has multifunctional stem cells with the ability to differentiate into chondrocytes and fibrocartilage [ 8 , 9 , 18 ].…”

Comparative Analysis of Short-term Efficacy between Robot- assisted Retrograde Drilling and Arthroscopic Microfracture for Osteochondral Lesions of the Talus

“…Osteochondral allograft transplantation can also be used, but widespread adoption is unlikely due to its susceptibility to rejection. Periosteal bone grafting was rst proposed as an option for the repair of OCLT by Prof. Qinwei Guo and team and they reported that this procedure had no signi cant disadvantages compared with traditional osteochondral grafting, and satisfactory outcomes were achieved during the 5-year postoperative followup period [17], while similar conclusions were reached by a team in China in a subsequent study.…”

Comparative analysis of short-term efficacy between robot-assisted retrograde drilling and arthroscopic microfracture for osteochondral lesions of the talus

“…Osteochondral allograft transplantation can also be used, but widespread adoption is unlikely due to its susceptibility to rejection. Periosteal bone grafting was first proposed as an option for the repair of OCLT by Prof. Qinwei Guo and team and they reported that this procedure had no significant disadvantages compared with traditional osteochondral grafting, and satisfactory outcomes were achieved during the 5-year postoperative follow-up period ( 17 ), while similar conclusions were reached by a team in China in a subsequent study. However, it is considered that there is still a lack of large-scale clinical evidence to support this approach.…”