Clinical efficacy of osteochondral lesion of talus treated by autogenous knee osteocartilage transplantation

doi:10.3877/cma.j.issn.1674-134X.2023.04.021

Abstract

Abstract:

Objective

To investigate the clinical effect of 20 patients with osthondral lesion of the talus (OLT) of Hepple type Ⅴ treated with autogenous knee osteochondral autograft transplantation (OAT).

Methods

A retrospective case series study was used to analyze the clinical data of 20 patients with OLT of Hepple type Ⅴ admitted to the Foot and Ankle Surgery Department of Chongqing Orthopaedic Hospital of Traditional Chinese Medicine from September 2018 to September 2021. Visual analogue scale (VAS), American Association of Foot and Ankle Surgery (AOFAS) ankle-posterior foot score and knee Lysholm score were recorded before surgery, six months after surgery and at the last visit (≥12 months). Preoperative and postoperative scores such as VAS, AOFAS and Lysholm were used to evaluate ankle and knee pain and function. CT or MRI findings were used to evaluate the healing of the osteotomy area and the osteochondral graft area, and to record the complications. Repeated measure ANOVA, LSD-t test, Friedman test and Wilcoxon rank sum test were used for analysis.

Results

Twenty patients with OLT of Hepple type Ⅴ were followed up, and CT/MRI at the last follow-up showed that the bone graft was well integrated with the surrounding bone. VAS score decreased from 6.5 (6.0, 8.0) before surgery to 2.0 (2.0, 3.0) at six months after surgery and 2.0 (2.0, 3.0) at the last follow-up, respectively. AOFAS ankle-posterior foot score increased from 59.0 (48.0, 64.0) before surgery to 88.5(87.0, 90.0) at six months after surgery and 90.0(88.0, 90.0) at the last follow-up (χ²=33.78, 33.56, both P<0.05). There was no statistically significant difference in VAS score and AOFAS score between the last follow-up and six months after surgery (all P>0.05). There was no statistically significant difference in Lysholm score between six months after surgery and the last follow-up or between the data before operation and after operation (all P>0.05). The excellent rate of AOFAS ankle-posterior foot score at six months after operation was 95%, and no postoperative complication was observed.

Conclusion

Autologous osteochondral transplantation (OAT) for OLT of Hepple type Ⅴcan significantly reduce ankle pain, improve function, achieve satisfactory results, and control the risk of knee joint donor site, which has certain clinical practical value.

Key words: Cartilage, Talus, Transplantation, autologous

Zejun Yu, Songchuan Su, Yan Fu, Wenping Huang. Clinical efficacy of osteochondral lesion of talus treated by autogenous knee osteocartilage transplantation[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2023, 17(04): 592-596.

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URL: https://zhgjwkzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-134X.2023.04.021

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Figures/Tables 4

Figure 1 Surgical images of OLT (osthondral lesion of the talus) treated by OAT(osteochondral autograft transplantation) and X ray images after operation. A is operation process, showing obvious exfoliation of cartilage of the medial talar lesion; B is operation process, showing yellowish jelly-like fluid was removed from the capsular cavity by vascular forceps; C is sclerotic bone tissues containing capsular fluid removed from the talar capsule cavity; D is the anteroposterior and lateral X ray view of right ankle after surgery, showing internal fixation with hollow screws after left medial ankle osteotomy

Table 1 Comparison of VAS, AOFAS ankle-hind foot score and Lysholm score before and after surgery in OLT patients

时间点Time point	VAS	AOFAS	Lysholm评分(±s) Lysholm score
术前Before operation	6.5(6.0，8.0)	59.0(48.0，64.0)	90.5±2.9
术后6个月Six months after operation	2.0(2.0，3.0)	88.5(87.0，90.0)	90.3±3.0
末次随访Last time follow-up	2.0(2.0，3.0)^a	90.0(88.0，90.0)^b	89.5±3.0
统计值	χ²＝33.78	χ²＝33.56	F＝0.70
P值	<0.001	<0.001	>0.05

Figure 2 Pre- and postoperative CT images of OLT(osthondral lesion of the talus) of Hepple type Ⅴ in left ankle. A to C are preoperative CT images of the left ankle joint, showing the medial aspect of the talus, complete destruction of the subchondral bone plate, elliptical shape, sclerotic edges, no periosteal reaction, obvious cystic changes; D is CT image at 12 months after surgery, showing that the cartilage column was well integrated with the surrounding bone, and the cystic area was reduced compared with the previous one

Figure 3 Preoperative CT and postoperative MRI of OLT(osthondral lesion of the talus) of Hepple type Ⅴ in left ankle. A to B are preoperative CT images of the left ankle, showing obvious cystic phase change in the anteromedial aspect of the talus with cartilage facet defects; C to D are postoperative MRI at 17 months after the operation, showing that the cartilage was well repaired, and the area of necrotic foci had been reduced

References 15

[1]	Choi JI, Lee KB. Comparison of clinical outcomes between arthroscopic subchondral drilling and microfracture for osteochondral lesions of the talus[J]. Knee Surg Sports Traumatol Arthrosc, 2016, 24(7): 2140-2147.
[2]	O'Loughlin PF, Heyworth BE, Kennedy JG. Current concepts in the diagnosis and treatment of osteochondral lesions of the ankle[J]. Am J Sports Med, 2010, 38(2): 392-404.
[3]	Natsuhara M K, Sarcon A, Kreulen C, et al. Treatment of osteochondral lesions of talus with extracellular matrix cartilage allografts[J]. Techniques in Foot & Ankle Surgery，2018，18(18): 61-67.
[4]	Thompson MJ, Roukis TS. Osteochondral lesions of the talar dome[J]. Clin Podiatr Med Surg, 2020, 37(3): 533-551.
[5]	尼加提·阿不力米提，周开磊，李纲，等. 双平面截骨加自体骨软骨移植治疗距骨骨软骨损伤合并距骨囊肿的临床效果[J]. 中华外科杂志，2020, 58(3): 220-224.
[6]	唐尧，袁成松，陈万，等. 自体胫骨骨膜－骨复合体移植治疗Hepple Ⅴ期距骨骨软骨损伤的中长期随访结果[J]. 中华医学杂志，2021, 101(37): 2968-2974.
[7]	Baltzer AWA, Arnold JP. Bone-cartilage transplantation from the ipsilateral knee for chondral lesions of the talus[J]. Arthroscopy, 2005, 21(2): 159-166.
[8]	McGahan PJ, Pinney SJ. Current concept review: osteochondral lesions of the talus[J]. Foot Ankle Int, 2010, 31(1): 90-101.
[9]	Rungprai C, Tennant JN, Gentry RD, et al. Management of osteochondral lesions of the talar dome[J]. Open Orthop J, 2017, 11: 743-761.
[10]	Gu W, Li T, Shi Z, et al. Management of hepple stage V osteochondral lesion of the talus with a platelet-rich plasma scaffold[J/OL]. Biomed Res Int, 2017, 2017: 6525373. DOI: 10.1155/2017/6525373.
[11]	Toale J, Shimozono Y, Mulvin C, et al. Midterm outcomes of bone marrow stimulation for primary osteochondral lesions of the talus: a systematic review[J/OL]. Orthop J Sports Med, 2019, 7(10): 2325967119879127. DOI: 10.1177/2325967119879127.
[12]	Guo C, Li X, Zhu Y, et al. Clinical and MRI donor-site outcomes after autograft harvesting from the medial trochlea for talar osteochondral lesions: minimum 5-year clinical follow-up[J/OL]. Orthop J Sports Med, 2022, 10(9): 23259671221120075. DOI: 10.1177/23259671221120075.
[13]	Hu Y, Guo Q, Jiao C, et al. Treatment of large cystic medial osteochondral lesions of the talus with autologous osteoperiosteal cylinder grafts[J]. Arthroscopy, 2013, 29(8): 1372-1379.
[14]	张成昌，杨柳，段小军. 距骨骨软骨损伤的治疗研究进展[J/CD]. 中华关节外科杂志(电子版), 2019, 13(4): 466-472.
[15]	Cao Y, Xu Y, Huang Q, et al. Characteristics of osteochondral lesions of the talus in different age groups[J]. Int J Sports Med, 2020, 41(12): 873-878.

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