Regarding “Autologous Osteochondral Transplantation for Osteochondral Lesions of the Talus: Does Previous Bone Marrow Stimulation Negatively Affect Clinical Outcome?”

Abstract

We read with interest the discussion by Ross et al.1Ross A.W. Murawski C.D. Fraser E.J. et al.Autologous osteochondral transplantation for osteochondral lesions of the talus: Does previous bone marrow stimulation negatively affect clinical outcome?.Arthroscopy. 2016; 32: 1377-1383Abstract Full Text Full Text PDF PubMed Scopus (28) Google Scholar about autologous osteochondral transplantation (AOT) for osteochondral lesions of the talus (OLT) after failed microfractures. They show that after primary AOT functional outcomes were better than in secondary AOT after failed microfractures for patients with similar characteristics and lesion sizes. In our previous study about 37 cases of AOT with a mean follow-up at 76 months,2De L’Escalopier N. Barbier O. Mainard D. Mayer J. Ollat D. Versier G. Outcomes of talar dome osteochondral defect repair using osteocartilaginous autografts: 37 cases of Mosaicplasty®.Orthop Traumatol Surg Res. 2015; 101: 97-102Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar we noted that 81% of patients had good or excellent outcomes. Nevertheless, contrary to Ross et al., results after AOT were similar in patients with primary AOT and patients with a second-line AOT after failed palliative treatment. Moreover, we noted that OLT with a size between 0.5 and 1 cm2 were associated with significantly better functional outcomes. In the literature, most of the time, indications for AOT are OLT with a size more than 1.0 cm2 and microfractures for smaller lesions.3Verhagen R.A. Struijs P.A. Bossuyt P.M. van Dijk C.N. Systematic review of treatment strategies for osteochondral defects of the talar dome.Foot Ankle Clin. 2003; 8: 233-242Abstract Full Text Full Text PDF PubMed Scopus (238) Google Scholar, 4Stone J. Osteochondral lesions of the talar dome.J Am Acad Orthop Surg. 1996; 4: 63-73Crossref PubMed Google Scholar, 5Laffenêtre O. Osteochondral lesions of the talus: Current concept.Orthop Traumatol Surg Res. 2010; 96: 554-566Abstract Full Text Full Text PDF PubMed Scopus (45) Google Scholar, 6Christel P. Versier G. Les greffes ostéochondrales selon la technique de la mosaicplasty.Maîtrise Orthop. 1998; 76 ([in French]): 1-13Google Scholar, 7Versier G. Christel P. Bures C. Djian P. Serre Y. Traitement des lésions cartilagineuses du dôme de l’astragale par autogreffes ostéochondrales en mosaïque.e-mem Acad Chir. 2005; 4 ([in French]): 1-11Google Scholar In this study, AOT was most of the time directly performed in first line for OLT smaller than 1 cm2 with a one-plug procedure. We would like to know what the indications were of AOT for an OLT for the authors and if they recommended this procedure for small lesions in first line. For us, we consider that AOT is a valid option even for the first-line treatment of lesions less than 1 cm2 in size. Moreover, the depth of the lesion is another factor that should be considered to choose the more appropriate procedure. Autologous Osteochondral Transplantation for Osteochondral Lesions of the Talus: Does Previous Bone Marrow Stimulation Negatively Affect Clinical Outcome?ArthroscopyVol. 32Issue 7PreviewTo determine if functional outcomes and magnetic resonance imaging (MRI) outcomes were significantly different between patients receiving primary autologous osteochondral transplantation (AOT) and patients receiving secondary AOT surgery after failed microfracture. Full-Text PDF Authors' ReplyArthroscopyVol. 32Issue 8PreviewWe appreciate Dr. Barbier's interest in our work and look forward to continued discussion. It is generally accepted that lesion size is a major determinant of which surgical intervention is appropriate for osteochondral lesions of talus (OLT).1,2 Small lesions (<15 mm in diameter or <150 mm2) are frequently treated with reparative procedures such as bone marrow stimulation (BMS), whereas larger lesions are treated with the replacement procedure such as autologous osteochondral transplantation (AOT). Full-Text PDF