Matrix-induced autologous osteochondral transplantation for osteochondral lesions of the talus

Abstract

Objective To evaluate mid-term clinical outcomes of autologous osteochondral transplantation(AOT)for the treatment of osteochondral lesions of the talus(OLT)(Hepple types Ⅳ and V). Methods From October 2011 to September 2013, AOT procedure was performed in 13 patients with OLT(Hepple types Ⅳ and V). They were 9 men 4 women, with a mean age of 31. 7 years(range, from 19 to 46 years). There were 5 cases of type Ⅳ and 8 ones of type V. The diameters of defective areas ranged from 0. 5 to 2. 0 cm(average, 1. 1 cm). Osteochondral plugs were harvested from the non-weight bearing area at the ipsilateral femoral lateral condyle. The arthroscopic single-plug or double-plug AOT procedure was conducted with a supplementary arthrotomy if necessary. Visual analogue scale(VAS), American Orthopedic Foot and Ankle Society(AOFAS)score, Magnetic Resonance Observation of Cartilage Repair Tissue(MOCART)score, and the International Knee Documentation Committee Knee Evaluation Form(IKDC)score were measured pre- and post-operatively for assessment of clinical outcomes. Results After successful surgery, all the patients were followed up for 28 to 52 months(average, 38. 2 months). The VAS(0. 7 ±0. 8), AOFAS(95. 2 ±2. 9)and MOCART(6. 6 ±0. 9)scores at the final follow-up were significantly improved compared with preoperation(7.9±1.3, 63.5 ±7. 4, 3.2±1. 1, respectively)(P 0. 05). Post-operative MRI showed complete hypertrophic cartilage layer filling in 3 cases, complete filling of the defect at the level of surrounding cartilage in 8 cases, and incomplete atrophic cartilage layer filling in 2 cases. Normal signal intensity of the repair tissue compared with the adjacent native cartilage was seen in 4 cases, and nearly normal activity in 9 cases. All the patients recovered normal walking and daily life. Conclusions In the treatment of Hepple types IV and V OLT, AOT proves to be reliable and can lead to fine mid-term clinical outcomes. Key words: Ankle joint; Cartilage; Wounds and injuries; Bone transplantation