Autologous Osteochondral Transplantation for Focal Femoral Condyle Defects: Comparison of Mosaicplasty by Arthrotomy vs. Arthroscopy

Background: Uncontained-type osteochondral lesions of the talus (OLTs) have been shown to have inferior clinical outcomes after treatment with bone marrow stimulation. While autologous osteochondral transplantation (AOT) is indicated for larger lesions, no study has reported on the prognostic significance of the containment of OLTs treated with the AOT procedure. Purpose: To clarify the effect of the containment of OLTs on clinical and radiological outcomes in patients who underwent AOT for OLTs. Study Design: Case control study; Level of evidence, 3. Methods: A retrospective cohort study comparing patients with contained-type and uncontained-type OLTs was undertaken to include all patients who underwent AOT for the treatment of OLTs between 2006 and 2014. Analyses were performed by grouping the patients according to the containment type. Clinical outcomes were evaluated using the Foot and Ankle Outcome Score (FAOS) and the 12-Item Short Form Health Survey (SF-12) preoperatively and at final follow-up. Magnetic resonance imaging (MRI) at 2 years’ follow-up was evaluated with the modified magnetic resonance observation of cartilage repair tissue (MOCART) score. Multivariate regression models were used to evaluate factors affecting postoperative FAOS, SF-12, and MOCART scores. Results: Ninety-four patients were included: 31 patients with a contained-type OLT and 63 patients with an uncontained-type OLT. The median patient age was 34 years (interquartile range [IQR], 28-48 years) in the contained-type group and 36 years (IQR, 27-46 years) in the uncontained-type group. The median follow-up time was 45 months (IQR, 38-63 months) in the contained-type group and 52 months (IQR, 40-66 months) in the uncontained-type group. The median FAOS and SF-12 scores improved significantly after surgery in both contained-type and uncontained-type lesions ( P < .001). The median postoperative FAOS score of patients with contained-type OLTs was higher than that of patients with uncontained-type OLTs (91.7 vs 85.0, respectively; P = .009), but no significant differences were found between the contained-type and uncontained-type groups for postoperative SF-12 and MOCART scores. The multivariate regression models showed that patients with contained-type OLTs had an approximately 10-point better score on the FAOS compared with patients with uncontained-type OLTs ( P = .006). There was a nonsignificant trend for the rate of cystic occurrence in uncontained-type OLTs to be higher than that of contained-type OLTs (55.6% vs 38.7%, respectively; P = .125). Conclusion: Patients with contained-type OLTs experienced better clinical outcomes than those with uncontained-type OLTs after AOT for the treatment of OLTs. However, the AOT procedure still provided good clinical and MRI outcomes in both contained-type and uncontained-type OLTs at midterm follow-up.

Download Full-text

Autologous Osteochondral Transplantation as a Secondary Procedure after Failed Microfracture for Osteochondral Lesion of Talus

Journal of Korean Foot and Ankle Society ◽

10.14193/jkfas.2015.19.2.47 ◽

2015 ◽

Vol 19 (2) ◽

pp. 47 ◽

Cited By ~ 1

Author(s):

Su-Young Bae

Keyword(s):

Osteochondral Lesion ◽

Osteochondral Transplantation ◽

Autologous Osteochondral Transplantation ◽

Secondary Procedure ◽

Osteochondral Lesion Of Talus

Download Full-text

Mid-term Outcomes of Autologous Osteochondral Transplantation for Osteochondral Lesions of the Talus

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00444 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0044

Author(s):

Yoshiharu Shimozono ◽

Eoghan Hurley ◽

John Kennedy

Keyword(s):

Systematic Review ◽

Clinical Outcomes ◽

Osteochondral Transplantation ◽

Autologous Osteochondral Transplantation ◽

Short Term ◽

Level Of Evidence ◽

Quality Of Evidence ◽

Current Systematic Review

Category: Ankle Introduction/Purpose: Autologous osteochondral transplantation (AOT) is an established treatment for large-sized OLT, typically greater than 107mm2. Several studies have demonstrated favourable outcomes following AOT at short- and mid-term follow-up. However, the majority of the literature on AOT has short-term follow-up and little evidence exists on the mid-term and longer-term follow-up. Additionally, few studies include a large number of patients or have a high level of evidence, limiting the ability to draw broad and meaningful conclusions about the effectiveness of the AOT procedure for the treatment of OLT beyond short-term follow-up. The purpose of the current systematic review was to evaluate the clinical outcomes analysing level and quality of evidence of the AOT procedure in the treatment of OLT at mid-term and long-term follow-up. Methods: A systematic search of the MEDLINE, EMBASE and Cochrane Library databases was performed in October 2017 based on the PRISMA guidelines. Included studies were evaluated with regard to level of evidence (LOE) and quality of evidence (QOE) using the Coleman Methodology Score. Clinical outcomes, and complications were also evaluated. Results: Eleven studies, with 500 ankles were included at a mean 62.8 months follow-up. There were 3 studies of LOE III, and 8 studies of LOE IV. There were 3 studies of fair quality and 8 studies of poor quality. The weighted mean preoperative AOFAS score was 55.1 ± 6.1, and the postoperative score was 86.2 ± 4.5, with 87.4% of patients being reported as excellent or good results. In total, 54 of the 500 patients (10.8%) had complications. The most common complication was donor site morbidity with 18 patients (3.6%) at final follow-up. Thirty-one patients (6.2%) underwent reoperations, and the authors deemed a total of 5 ankles (1.0%) failures. Only 5 studies (45.5%) used MRI for follow-up evaluation. Conclusion: The current systematic review demonstrated that good clinical and functional outcomes can be expected following AOT procedure for the treatment of OLT, with a failure rate of only 1.0% at 63 months follow-up. MRI and radiographs showed restoration of articular surface as well as a minimal presence of osteoarthritis at mid-term follow-up. However, there is still lack of data from high LOE and QOE studies, and further high quality studies are necessary.

Download Full-text

Arthroscopically Assisted Autologous Osteochondral Transplantation for Osteochondral Lesions of the Talar Dome: An MRI and Clinical Follow-Up Study

Foot & Ankle International ◽

10.1177/107110070102200703 ◽

2001 ◽

Vol 22 (7) ◽

pp. 544-551 ◽

Cited By ~ 98

Author(s):

Joseph A. Assenmacher ◽

Armen S. Kelikian ◽

Charles Gottlob ◽

Steven Kodros

Keyword(s):

Osteochondral Lesions ◽

Osteochondral Transplantation ◽

Talar Dome ◽

Autologous Osteochondral Transplantation ◽

Follow Up Study ◽

Arthroscopically Assisted

Download Full-text

Influence of Intra-Articular Administration of Trichostatin A on Autologous Osteochondral Transplantation in a Rabbit Model

BioMed Research International ◽

10.1155/2015/470934 ◽

2015 ◽

Vol 2015 ◽

pp. 1-8 ◽

Cited By ~ 1

Author(s):

Huacheng Hou ◽

Ke Zheng ◽

Guanghu Wang ◽

Shiro Ikegawa ◽

Minghao Zheng ◽

...

Keyword(s):

Articular Cartilage ◽

Cartilage Repair ◽

Trichostatin A ◽

Interleukin 1 ◽

Rabbit Model ◽

Treated Group ◽

Control Group ◽

Osteochondral Transplantation ◽

Autologous Osteochondral Transplantation ◽

Significant Difference

Autologous osteochondral transplantation (AOT) is a method for articular cartilage repair. However, several disadvantages of this method have been reported, such as transplanted cartilage degeneration and the lack of a connection between the grafted and adjacent cartilage tissues. To evaluate the effect of intra-articular administration of trichostatin A (TSA) on AOT, we conducted a case control study in a rabbit model. International Cartilage Repair Society (ICRS) macroscopic scores, the modified O’Driscoll histology scores, and real-time PCR were utilized to evaluate the results. At 4 weeks, both macroscopic and histological assessments showed that there was no significant difference between the TSA and control groups. However, the mean macroscopic and histological scores for the TSA-treated group were significantly higher than the scores for the control group at 12 weeks. TSA was shown to directly reduce collagen type II (COL2), aggrecan, matrix metalloproteinase (MMP), and a disintegrin and metalloproteinase domain with thrombospondin motifs 5 (ADAMTS-5) expression and to simultaneously repress the upregulation of MMP-3, MMP-9, and MMP-13 levels induced by interleukin 1β(IL-1β) in chondrocytes. In conclusion, TSA protects AOT grafts from degeneration, which may provide a benefit in the repair of articular cartilage injury.

Download Full-text