J Korean Foot Ankle Soc.  2017 Dec;21(4):139-143. 10.14193/jkfas.2017.21.4.139.

Results of Autologous Osteochondral Transplantation of the Ostochondral Lesion on the Talus: A Comparison Study between Medial Malleolar Osteotomy Approach and Anterior Arthrotomy Approach

• Lee YS
• Ahn GY
• Nam IH
• Lee YH
• Lee TH
• Kim DG
• Lee DH

• KMID: 2398011
• DOI: http://doi.org/10.14193/jkfas.2017.21.4.139

Abstract

PURPOSE
Osteochondral lesion of the talus (OLT) has traditionally been treated using an autologous osteochondral graft via the medial malleolar approach. Here, we compare the traditional method with the anterior arthrotomy approach.
MATERIALS AND METHODS
Between January 2005 and June 2015, 24 cases of patients who received autologus osteochondral graft for OLT and with at least 2 years of follow-up were evaluated. They were divided into two groups; one group receiving autologous osteochondral graft via the medial malleolar osteotomy approach (group 1, n=9) and another group via the anterior arthrotomy approach (group 2, n=15). The clinical outcomes were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) score.
RESULTS
In all cases, the size of the subchondral cyst of the talus decreased, if not disappeared on the final follow-up radiograph. All osteochondral grafts were united. The mean AOFAS score increased from 61.5 preoperatively to 84.9 at the final follow-up. The mean AOFAS score of group 1 increased from 60.3 preoperatively to 78.0 (p=0.007) at the final follow-up, and the mean AOFAS score of group 2 also increased from 62.2 to 89.1 (p=0.006). The AOFAS score was statistically better in group 2 than in group 1 (p=0.034) at the final follow-up.
CONCLUSION
Autologous osteochondral graft of the OLT yields satisfactory radiologic and clinical outcomes. Especially, better clinical outcome was observed in the group using the anterior arthrotomy approach (group 2) than in the group using the medial malleolar osteotomy approach (group 1).

Keyword

Talus; Osteochondral lesion; Autologous osteochondral graft; Medial malleolar osteotomy

MeSH Terms

Ankle
Bone Cysts
Follow-Up Studies
Foot
Humans
Methods
Osteotomy*
Talus*
Transplants

Figure

• 

  Figure 1. A case with medial malleolar osteotomy approach in group 1. (A, B) T2-weighted coronal and sagittal magnetic resonance images show medial osteochondral lesion with subchondral cyst. (C) Osteochondral lesion of talus after medial malleolar osteotomy. (D) Osteochondral autograft was transplanted into the lesion. (E) Final radiograph shows loss of subchondral cyst and union of graft and osteotomy site.

• 

  Figure 2. A case with anterior arthrotomy approach in group 2. (A) T2-weighted coronal magnetic resonance image shows medial osteochondral lesion with subchondral cyst. (B) Sagittal image shows cystic lesion within 15。 posterior of talar dome apex. (C) Osteochondral lesion of talus after anterior arthrotomy approach. (D) Osteochondral autograft was transplanting into the lesion with 90。 to the articular surface. (E) Final radiograph shows loss of subchondral cyst and good union of osteochondral graft.

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