J Korean Foot Ankle Soc.  2023 Dec;27(4):137-143. 10.14193/jkfas.2023.27.4.137.

Intermediate-Term Clinical Outcomes after Autologous Osteochondral Transplantation for Lateral Osteochondral Lesions of the Talus

• Kim SH
• Cho BK

• KMID: 2552993
• DOI: http://doi.org/10.14193/jkfas.2023.27.4.137

Abstract

Purpose
Autologous osteochondral transplantation (AOT) is indicated for patients with a large osteochondral lesion of the talus (OLT), accompanying subchondral cyst, and the failure of bone marrow stimulation (BMS) procedures. Despite the many reports on the clinical results of surgical treatment for medial osteochondral lesions, those of lateral lesions are rare. This paper reports the intermediate-term clinical outcomes after AOT for lateral OLTs.
Materials and Methods
Twenty-one patients with lateral OLTs were followed up for at least three years after AOT. The clinical evaluations comprised the Foot and Ankle Outcome Score (FAOS) and Foot and Ankle Ability Measure (FAAM). The radiographic assessment included the irregularity of the articular surface (subchondral plate), the progression of degenerative arthritis, and the changes in talar tilt angle and anterior talar translation.
Results
The mean FAOS and FAAM scores improved significantly from 42.1 to 89.5 and 39.5 to 90.6 points, respectively, at the final follow-up (p<0.001). The radiological evaluation revealed two cases (9.5%) of articular step-off ≥2 mm and 1 case (4.8%) of progressive arthritis. The mean talar tilt angle and anterior talar translation improved significantly. As postoperative complications, there was one case of a local wound problem, one case of superficial peroneal nerve injury, and one case of donor site morbidity. At a mean follow-up of 62.3 months, no patient showed a recurrence of instability or required reoperation for OLT.
Conclusion
AOT for the lateral OLTs demonstrated satisfactory intermediate-term clinical outcomes, including daily and sports activity abilities. Most OLT could be accessed through lateral ligament division and capsulotomy, and the incidence of iatrogenic complications, such as recurrent sprains or chronic instability, was minimal. AOT appears to be an effective and relatively safe treatment for patients with large lateral osteochondral lesions unresponsive to conservative therapy, with subchondral cysts, or with failed primary BMS.

Keyword

Talus; Osteochondral lesion; Autologous osteochondral transplantation; Clinical outcome

Figure

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  Figure 1 (A~C) Preoperative ankle radiographs showing a lateral osteochondral lesion (arrows) of the talus in a 48-year-old male patient.

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  Figure 2 (A~C) Preoperative T1-weighted magnetic resonance images show a large-sized lateral osteochondral lesion with multiple subchondral cysts of the talus.

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  Figure 3 Articular surface incongruence of the osteochondral graft with step-off >1 mm on computed tomography at 6 months postoperatively.

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  Figure 4 (A) Intraoperative photograph showing a full-thickness cartilage defect on the lateral talar dome, (B) unstable cartilage rim, underlying necrotic and sclerotic bone, and subchondral cysts are removed.

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  Figure 5 (A, B) Intraoperative photographs showing the transplantation with press-fit fixation technique of an autologous osteochondral graft harvested from the ipsilateral knee joint.

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  Figure 6 (A~C) Follow-up ankle radiographs show the well-maintained articular surface congruence and bony integration.

Reference

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