Mid-and-long term follow-up of autogenous tibial periosteum-bone complex transplantation for treatment of cystic osteochondral lesion of talus

Abstract

Objective: To further clarify the mid-and-long term follow-up results of self-designed tibial periosteum-bone complex transplantation in the treatment of Hepple V osteochondral lesion of the talus(OLTs). Methods: The clinical data of 30 patients with Hepple V OLTs who received treatment in the Sports Medicine Center of the First Affiliated Hospital of Army Military Medical University from October 2011 to January 2019 were analyzed. There were 19 males and 11 females with a mean age of (40±11) years. Patients were treated with autogenous tibial periosteum-bone complex transplantation and were followed up for at least 2 years. The Foot and Ankle Outcome Score (FAOS), American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, the visual analog scale score (VAS) of pain, the simplified symptomatology evaluation (SSE) and imaging results before the operation and at the follow-up were recorded and compared. Results: The cohort were followed-up for a mean of 63.9 months (range 24-110 months). Twenty-nine (96.7%) patients were satisfied with the curative effect. The FAOS score was improved from 53.5±6.2 preoperatively to 88.4±6.6 at the final follow-up (P<0.001). The AOFAS ankle-hindfoot scale improved from 61.6±8.2 preoperatively to 90.8±6.8 at the last follow-up (P<0.001). The VAS score decreased from 4.3±0.2 preoperative to 0.7±0.7 at the last follow-up (P<0.001). The SSE score was poor in 14 cases (46.7%), average in 16 cases (53.3%) before the operation; and it was excellent in 23 cases (76.7%), good in 6 cases (20%), average in 1 case (3.3%) at the last follow-up. Imaging examination showed cystic change cure rate was 83.3%, cartilage defects were completely infilled with repair tissue, which didn't show any signs of degeneration. However, repair tissue showed varying degrees of heterogeneous signal compared to the normal articular cartilage. Conclusion: The autograft of tibial periosteum-bone complex transplantation is a safe and feasible method for the treatment of osteochondral lesion of the talus in Hepple V type, with good mid-and-long term clinical effect.