Osteochondral autograft transplantation for rare case of osteochondral lesion of the tarsal navicular in an adolescent athlete: A case report

Abstract

Osteochondral lesions of the tarsal navicular bone are rare. The pathogenesis of osteochondral lesions of the tarsal navicular involves direct trauma to the tarsal navicular joint and repetitive trauma caused by excessive shear force, including a stress fracture. Osteochondral autograft transplantation (OAT) has emerged as a surgical treatment option for osteochondral lesions of the knee, ankle, and elbow joints. This report discusses the surgical treatment of an osteochondral lesion in the tarsal navicular bone of a 16-year-old track and field jumper. The patient was surgically treated with curettage of the osteochondral lesion at the center of the tarsal navicular and OAT. Computed tomography images 3 months postoperatively revealed adequate bone-to-bone healing of the graft and tarsal navicular joint surface. He returned to track and field competition without experiencing foot pain for 10 postoperative months. No symptom recurrence was observed during the 4-year follow-up. Based on the results of this case, we recommend OAT as a viable treatment option for patients with isolated cartilage lesion of the navicular bone (without fracture line) that does not respond to conservative treatment.

Reconstruction of Navicular Osteochondral Lesions: Two Case Reports With Short-term Follow-up

“…For large lesions or those that fail microfracture, other surgical options include osteochondral auto- or allografting, autologous chondrocyte implantation, matrix-based autologous chondrocyte implantation, and biological treatment with BMAC or platelet-rich plasma ( Figure 5 ). 1 , 4 , 5 , 7 …”

“…Like OCLs of the talus, navicular OCLs can be managed nonoperatively with arch supports, immobilization, limited weightbearing, nonsteroidal antiinflammatory drugs, activity modifications, and physical therapy. 1 , 3 Described operative interventions for navicular OCLs include transplantation of iliac crest bone graft, 3 micronized cartilage matrix, 6 osteochondral autograft transplantation (OATS), 5 and flowable collagen with iliac crest bone marrow aspirate concentrate (BMAC) and fibrin glue. 4 In this report, we present 2 cases of navicular OCLs: one primary lesion treated with autologous bone grafting and cartilage resurfacing with lyophilized collagen II (BioCartilage; Arthrex, Naples, FL) and BMAC, and a second revision lesion after failed microfracture treated with OATS.…”