Outcomes of Osteochondral Autologous Transplantation with Ipsilateral Lateral Talar Autograft for Medial Osteochondral Lesions of the Talus

Overview

Journal Clin Orthop Surg

Specialty Orthopedics

Date 2024 Aug 2

PMID 39092295

Authors

Jae Wan Suh

Joo Han Kwon

Dae Hee Lee

Jae Uk Jung

Hyun-Woo Park

Affiliations

Soon will be listed here.

Abstract

Background: Osteochondral autologous transplantation (OAT) has been widely used in the treatment of osteochondral lesion of the talus (OLT). Previous studies have reported successful outcomes following the use of osteochondral autogenous grafts from the intercondylar notch of the knee or a non-weight-bearing region of the femoral condyle. However, donor-site morbidity of the knee joint has been observed in several cases. This study aimed to investigate the outcomes and safety of OAT with autografts from the ipsilateral lateral talar articular facet as an alternative donor site for medial OLT.

Methods: Among 40 patients who underwent OAT, 29 patients were excluded. Eleven patients who underwent OAT with an osteochondral graft harvested from the ipsilateral lateral talar articular facet from 2011 to 2022 were retrospectively analyzed. The size of OLT was measured on ankle magnetic resonance imaging, including coronal length, sagittal length, depth, and area. Clinical outcomes were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale and a visual analog scale (VAS). Weight-bearing ankle radiographs were obtained postoperatively and at 1 year after surgery.

Results: The average follow-up time after surgery was 64.7 months (range, 14-137 months). The average diameter of lesions was 8.8 mm (range, 8-9.9 mm). The average size of lesions was 51.2 mm (range, 33.6-71.3 mm) , and all lesions included subchondral cysts. The average depth of lesions was 7.3 mm (range, 6.2-9.1 mm). Graft sizes ranged from 8 to 10 mm in diameter (8 mm, n = 1; 10 mm, n = 10) All measured clinical outcomes improved postoperatively, including the AOFAS scores (preoperative, 55.4 ± 9.0; 1-year follow-up, 92.1 ± 7.6; = 0.001) and VAS scores (preoperative, 5.5 ± 0.7; 1-year follow-up, 1.9 ± 0.8; = 0.001). All weight-bearing ankle radiographs of the graft and donor sites did not reveal arthritic change in the ankle joint, lateral talar dome collapse, and graft-site delayed union or nonunion at 1 year after surgery.

Conclusions: For a single medial OLT, harvesting autografts from the ipsilateral lateral talar articular facet without knee donor-site morbidities can be a good alternative in OAT for OLT.

References

Gautier E, Kolker D, Jakob R . Treatment of cartilage defects of the talus by autologous osteochondral grafts. J Bone Joint Surg Br. 2002; 84(2):237-44. DOI: 10.1302/0301-620x.84b2.11735. View

BERNDT A, Harty M . Transchondral fractures (osteochondritis dissecans) of the talus. J Bone Joint Surg Am. 1959; 41-A:988-1020. View

Reddy S, Pedowitz D, Parekh S, Sennett B, Okereke E . The morbidity associated with osteochondral harvest from asymptomatic knees for the treatment of osteochondral lesions of the talus. Am J Sports Med. 2006; 35(1):80-5. DOI: 10.1177/0363546506290986. View

Valderrabano V, Leumann A, Rasch H, Egelhof T, Hintermann B, Pagenstert G . Knee-to-ankle mosaicplasty for the treatment of osteochondral lesions of the ankle joint. Am J Sports Med. 2009; 37 Suppl 1:105S-111S. DOI: 10.1177/0363546509351481. View

Barnes C, Ferkel R . Arthroscopic debridement and drilling of osteochondral lesions of the talus. Foot Ankle Clin. 2003; 8(2):243-57. DOI: 10.1016/s1083-7515(03)00016-0. View

El-Rashidy H, Villacis D, Omar I, Kelikian A . Fresh osteochondral allograft for the treatment of cartilage defects of the talus: a retrospective review. J Bone Joint Surg Am. 2011; 93(17):1634-40. DOI: 10.2106/JBJS.J.00900. View

Wan D, Huang H, Hu M, Dong Q . Results of the osteochondral autologous transplantation for treatment of osteochondral lesions of the talus with harvesting from the ipsilateral talar articular facets. Int Orthop. 2022; 46(7):1547-1555. DOI: 10.1007/s00264-022-05380-7. View

Kreuz P, Steinwachs M, Erggelet C, Lahm A, Henle P, Niemeyer P . 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. 2005; 34(1):55-63. DOI: 10.1177/0363546505278299. View

Robinson D, Winson I, Harries W, Kelly A . Arthroscopic treatment of osteochondral lesions of the talus. J Bone Joint Surg Br. 2003; 85(7):989-93. DOI: 10.1302/0301-620x.85b7.13959. View

10.

Bartlett W, Skinner J, Gooding C, Carrington R, Flanagan A, Briggs T . Autologous chondrocyte implantation versus matrix-induced autologous chondrocyte implantation for osteochondral defects of the knee: a prospective, randomised study. J Bone Joint Surg Br. 2005; 87(5):640-5. DOI: 10.1302/0301-620X.87B5.15905. View

11.

Sammarco G, Makwana N . Treatment of talar osteochondral lesions using local osteochondral graft. Foot Ankle Int. 2002; 23(8):693-8. DOI: 10.1177/107110070202300803. View

12.

Georgiannos D, Bisbinas I, Badekas A . Osteochondral transplantation of autologous graft for the treatment of osteochondral lesions of talus: 5- to 7-year follow-up. Knee Surg Sports Traumatol Arthrosc. 2014; 24(12):3722-3729. DOI: 10.1007/s00167-014-3389-3. View

13.

Hannon C, Bayer S, Murawski C, Canata G, Clanton T, Haverkamp D . Debridement, Curettage, and Bone Marrow Stimulation: Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle. Foot Ankle Int. 2018; 39(1_suppl):16S-22S. DOI: 10.1177/1071100718779392. View

14.

LaPrade R, Botker J . Donor-site morbidity after osteochondral autograft transfer procedures. Arthroscopy. 2004; 20(7):e69-73. DOI: 10.1016/j.arthro.2004.06.022. View

15.

Becher C, Thermann H . Results of microfracture in the treatment of articular cartilage defects of the talus. Foot Ankle Int. 2005; 26(8):583-9. DOI: 10.1177/107110070502600801. View

16.

Henderson I, Tuy B, Connell D, Oakes B, Hettwer W . Prospective clinical study of autologous chondrocyte implantation and correlation with MRI at three and 12 months. J Bone Joint Surg Br. 2003; 85(7):1060-6. DOI: 10.1302/0301-620x.85b7.13782. View

17.

Scranton Jr P, Frey C, Feder K . Outcome of osteochondral autograft transplantation for type-V cystic osteochondral lesions of the talus. J Bone Joint Surg Br. 2006; 88(5):614-9. DOI: 10.1302/0301-620X.88B5.17306. View

18.

Zengerink M, Struijs P, Tol J, van Dijk C . Treatment of osteochondral lesions of the talus: a systematic review. Knee Surg Sports Traumatol Arthrosc. 2009; 18(2):238-46. PMC: 2809940. DOI: 10.1007/s00167-009-0942-6. View

19.

Flynn S, Ross K, Hannon C, Yasui Y, Newman H, Murawski C . Autologous Osteochondral Transplantation for Osteochondral Lesions of the Talus. Foot Ankle Int. 2015; 37(4):363-72. DOI: 10.1177/1071100715620423. View

20.

Hangody L . The mosaicplasty technique for osteochondral lesions of the talus. Foot Ankle Clin. 2003; 8(2):259-73. DOI: 10.1016/s1083-7515(03)00017-2. View