The Morbidity Associated with Osteochondral Harvest from Asymptomatic Knees for the Treatment of Osteochondral Lesions of the Talus

Background: Mosaic autogenous osteochondral transplantation has been used to treat large osteochondral defects.

Hypothesis: There is potential, previously unrecognized donor-site morbidity associated with osteochondral harvest from asymptomatic knees for the treatment of talar osteochondral defect lesions.

Study Design: Case series; Level of evidence, 4.

Methods: Fifteen patients underwent mosaic osteochondral transplantation to treat a talar osteochondral defect lesion, with 11 patients available for follow-up. A Lysholm knee score was used to assess donor-site morbidity at a mean follow-up of 47 months (range, 7-77 months). Mean age was 29 years (range, 21-44 years). A single surgical team performed the mosaicplasties. Significance was determined using the Student t test.

Results: All patients had asymptomatic knees preoperatively. Mean postoperative Lysholm score was 81 (range, 49-100). By Lysholm criteria, 5 rated as excellent, 2 as good, and 4 as poor. No significant difference was detected in terms of the harvest method or the number of grafts obtained from those having an excellent rating versus those having a good/poor rating. Patients rated as good/poor cited knee instability in daily activities as the most common problem. One had knee pain and patellar instability after osteochondral harvest by lateral arthrotomy that required a subsequent lateral retinacular release and tibial tubercle osteotomy.

Conclusion: This study demonstrates that donor-site morbidity after osteochondral harvest can be significant. In this population, those who experienced a decline in knee function had problems performing activities of daily living. When performing these procedures, the authors recommend that surgeons consider these risks and discuss them with their patients.