Outcomes of autologous osteo-periosteal cylinder graft transplantation for Hepple V osteochondral lesions of the talus

Abstract

Objective To study the outcomes of autologous osteo-periosteal cylinder graft transplan- tation for Hepple V osteochondral lesions of the talus （OLT） with large subchondral cyst. Methods The da- ta of 27 consecutive patients of OLT with subchondral cyst was retrospectively analyzed who were treated by autologous osteo-periosteal cylinder graft transplantation from October 2007 to September 2011. There were 26 males and 1 female with an average age of 35.8 years （range, 22-53 years）. Visual analogue score （VAS） for pain during daily activities, the American Orthopaedic Foot and Ankle Society （AOFAS） ankle and hind- foot score, and subjective satisfaction were investigated. The plain radiographs, magnetic resonance imaging （MRI） of the ankle, and second look arthroscopy were analyzed. Results All the 26 patients were followed up for 22.4 months. At the last follow-up, the VAS score decreased from 5.4±1.0 points preoperatively to 0.8±0.8 points postoperatively, and the mean （50%） AOFAS score improved from 73.9±3.1 points preopera- tively to 93.0±6.5 points postoperatively. In 26 cases, the radiolucent area of cysts disappeared on plain ra- diographs. The mean magnetic resonance observation of cartilage repair tissue （MOCART） score was 57.2, though small subchondral bone cyst was still found in 3 cases on postoperative MRI. The mean （50%） ICRS arthroscopic score of cartilage repair was 9.2 points according to second look arthroscopy of 18 cases. There were 16 cases receiving excellent effect, 8 good and 2 fair. The excellent and good rate was 92.3%（24/26）. There were no major complications. Conclusion Autologous osteo-periosteal cylinder graft transplantation could repair the osteochondral defects. It yields satisfactory results, and is suitable for treating OLT with large subchondral cyst. Key words: Talus; Osteochondritis; Transplantation, autologous; Bone cysts