The clinical effect of autologous osteochondral transplantation via biplanar osteotomy for osteochondral lesions of the talus combined with subchondral cysts

Abstract

Objective: To examine the clinical effect of autologous osteochondral transplantation via biplanar osteotomy for osteochondral lesions of the talus combined with subchondral cysts. Methods: A retrospective analysis of 25 patients who underwent autogenous osteochondral transplantation via biplanar osteotomy for treatment of talus osteochondral injury combined with subchondral cysts at Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University from December 2015 to December 2018 were conducted.There were 21 males and 4 females, aged 35.5 years(range: 21 to 47 years).The extent and depth of cartilage damage of patients were evaluated under arthroscopy.The Outerbridge classification of patients were stage Ⅱ-Ⅳ. Through the anterior and medial incision of the medial malleolus, bilateral osteotomy of the medial malleolus was performed. The osteotomy block was turned down to reveal the cartilage damage site. The abnormal cartilage was completely removed and the sclerotic wall of cyst was completely removed with a spatula.Then the healthy cartilage from the same knee joint was transplanted to the talus cartilage damage area. The preoperative and postoperative visual analogue scale(VAS), American Orthopedic Foot Andankle Society-Ankle Hindfoot Scale (AOFAS-AH) and Karlsson-Peterson score and Lysholm score of knee joint were recorded. Data were analyzed by paired-samples t-test. Results: All of patients were followed up for 25.6 months (range: 12 to 48 months) .The VAS decreased from 6.5±1.3 to 1.9±1.3 (t=8.13, P=0.00) .AOFAS-AH increased from 62.4±3.3 to 88.0±2.4 (t=-31.51, P=0.00) .Karlsson-Peterson scores increased from 59.8±2.7 to 85.2±3.5 (t=-25.50, P=0.00) . While there was no statistical different in Lysholm score of knee joint (92.5±1.3 vs. 92.0±1.3, t=1.93, P=0.065) . No complications like infection, translated cartilage necrosis, cycst residual, nonunion, persistent pain in donor site. Conclusion: Autologous osteochondral transplantation via biplanar osteotomy has satisfactory effect for patients with osteochondral lesions of the talus combined with subchondral cysts.