Paper #128 An optimal donor site for the weight bearing area of the femoral condyle in an autologous osteochondral transplantation

Abstract Background: Autologous osteochondral transplantation (AOT) is one of the most effective treatments for osteochondral lesions of the talus (OLTs). Normally, medial malleolar osteotomy is used to expose posteromedial lesions. However, medial malleolar osteotomy causes additional ankle injuries and a risk of persistent pain in the ankle joint. The purpose of the current study was to evaluate a new medial malleolar triplane osteotomy method and the functional outcomes of AOT from a non-weight-bearing area of the talus for OLTs.Methods: Twenty-three patients (23 ankles), including 14 males and 9 females, received AOT with triplane osteotomy of the medial malleolus for symptomatic OLTs between September 2015 and December 2017. The mean age was 35.6 years. The mean size of the lesion area was 141.5 mm2. The visual analog scale (VAS) for pain during walking and the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score were used for the pre- and postoperative evaluations. In addition, the incorporation of the grafts was assessed by computed tomography (CT).Results: All patients had a minimum follow-up of 22 months, with an average of 37.1 months. The mean time from osteotomy to full weight-bearing activity was 8.1±2.3 weeks (range, 5-12 weeks). The VAS score improved from 4.34 preoperatively to 0.53 postoperatively (P <0.01). The AOFAS ankle-hindfoot score improved significantly in all domains (P<0 .01). Twenty-one patients returned to sport at their previous level, and 2 returned at a lower level compared with preinjury (mean return to play, 7.4 months). According to CT, the medial malleolus recovered in all patients, and the graft was incorporated well. One patient suffered from flexor hallucis longus tendon discomfort due to internal fixation screw irritation posteromedial to the ankle. The general complication rate was 4.3% (1/23).Conclusions: AOT combined with medial malleolus triplane osteotomy is a viable option for OLTs. Patients could perform weight-bearing exercise and return to sport as early as possible, with few complications at the osteotomy site and donor site.

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Treatment of a Femur Nonunion with Microsurgical Corticoperiosteal Pedicled Flap from the Medial Femoral Condyle

Case Reports in Orthopedics ◽

10.1155/2016/5125861 ◽

2016 ◽

Vol 2016 ◽

pp. 1-5 ◽

Cited By ~ 4

Author(s):

Matteo Guzzini ◽

Cosma Calderaro ◽

Marco Guidi ◽

Carolina Civitenga ◽

Germano Ferri ◽

...

Keyword(s):

Distal Femur ◽

Femoral Condyle ◽

Weight Bearing ◽

Donor Site ◽

Pedicled Flap ◽

Medial Femoral Condyle ◽

Full Weight Bearing ◽

Genicular Artery ◽

Reconstruction Of Bone Defects

Introduction. The vascularized corticoperiosteal flap is harvested from the medial femoral condyle and it is nourished by the articular branch of the descending genicular artery and the superomedial genicular artery. This flap is usually harvested as a free flap for the reconstruction of bone defects at forearm, distal radius, carpus, hand, and recently at lower limb too.Case Report. A 50-year-old Caucasian man referred to our department for hypertrophic nonunion of the distal femur, refractory to the conservative treatments. The first surgical choice was the revision of the nail and the bone reconstruction with a corticoperiosteal pedicled flap from the medial femoral condyle. We considered union to have occurred 3.5 months after surgery when radiographs showed bridging of at least three of the four bony cortices and clinically the patient was able to walk with full weight bearing without any pain. At the last follow-up (25 months), the patient was completely satisfied with the procedure.Discussion. The corticoperiosteal flap allows a faster healing of fractures with a minimal morbidity at the donor site. We suggest that the corticoperiosteal pedicled flap graft is a reliable and effective treatment for distal femur nonunion.

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Fixation of chondral fracture of the weight-bearing area of the lateral femoral condyle in an adolescent

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-013-2833-0 ◽

2014 ◽

Vol 22 (6) ◽

pp. 1284-1287 ◽

Cited By ~ 9

Author(s):

Chung Ming Chan ◽

Joseph J. King ◽

Kevin W. Farmer

Keyword(s):

Femoral Condyle ◽

Weight Bearing ◽

Lateral Femoral Condyle ◽

Chondral Fracture ◽

Weight Bearing Area

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Clinical and MRI Donor Site Outcomes Following Autologous Osteochondral Transplantation for Talar Osteochondral Lesions

Foot & Ankle International ◽

10.1177/1071100716649461 ◽

2016 ◽

Vol 37 (9) ◽

pp. 968-976 ◽

Cited By ~ 21

Author(s):

Ethan J. Fraser ◽

Ian Savage-Elliott ◽

Youichi Yasui ◽

Jakob Ackermann ◽

Geoffrey Watson ◽

...

Keyword(s):

Donor Site ◽

Osteochondral Lesions ◽

Osteochondral Transplantation ◽

Autologous Osteochondral Transplantation

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Comparison of autologous osteoperiosteal cylinder and osteochondral graft transplantation in the treatment of large cystic osteochondral lesions of the talus (OLTs): a protocol for a non-inferiority randomised controlled trial

BMJ Open ◽

10.1136/bmjopen-2019-033850 ◽

2020 ◽

Vol 10 (2) ◽

pp. e033850 ◽

Cited By ~ 1

Author(s):

En Deng ◽

Weili Shi ◽

Yanfang Jiang ◽

Qinwei Guo

Keyword(s):

Randomised Controlled Trial ◽

Controlled Trial ◽

Donor Site ◽

Donor Site Morbidity ◽

Control Group ◽

Osteochondral Lesions ◽

Osteochondral Transplantation ◽

Autologous Osteochondral Transplantation ◽

Randomised Controlled ◽

Experimental Group

IntroductionLarge cystic osteochondral lesions of the talus (OLTs) have been shown to have inferior clinical outcomes after reparative techniques such as bone marrow stimulation. Autologous osteochondral transplantation has been viewed as an alternative choice for treating these lesions, but donor-site morbidity has limited its application. Excellent clinical outcomes have been shown in repairing these types of lesions with autologous osteoperiosteal grafts, and these outcomes are achieved at a low cost and without donor-site morbidity in the normal knee joint. This will be the first randomised controlled trial to compare the two surgical techniques, and recommendations for the treatment of patients with large cystic OLTs will be provided.Methods and analysisA non-inferiority randomised controlled trial will be conducted. A total of 70 participants with clinically diagnosed large cystic OLTs will be randomly allocated to either the experimental group or the control group at a ratio of 1:1. The experimental group will be treated with autologous osteoperiosteal cylinder graft transplantation, while the control group will be treated with autologous osteochondral transplantation. The primary outcome measure will be the American Orthopaedic Foot & Ankle Society Ankle-Hindfoot Score and the Short Form 12 (SF-12) questionnaire. Secondary outcome measures will include the secondary arthroscopy International Cartilage Repair Society score, the Magnetic Resonance Observation of Cartilage Repair Tissue score, the Tegner activity level score, the visual analogue scale, routine X-rays, CT and complications. These parameters will be evaluated preoperatively, as well as at 3, 6, 12, 24, 36 and 60 months postoperatively. In this trial, we hypothesised that both procedures offer good results for the treatment of patients with large cystic OLTs, and occurrence of donor-site morbidity in autologous osteoperiosteal cylinder graft transplantation group is less than that in autologous osteochondral transplantation group.Ethics and disseminationThe current study was approved by the board of research ethics of Peking University Third Hospital Medical Science Research Ethics Committee. The results of this study will be presented at national and international conferences and published in peer-reviewed journals.Trial registration numberNCT03347877.

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Plantar Flap for Foot Reconstruction

Operative Plastic Surgery ◽

10.1093/med/9780190499075.003.0088 ◽

2019 ◽

pp. 891-896

Author(s):

Benjamin T. Lemelman ◽

David W. Chang

Keyword(s):

Free Flap ◽

Weight Bearing ◽

Donor Site ◽

Sensory Function ◽

Medial Plantar Nerve ◽

Foot Reconstruction ◽

Donor Site Defect ◽

Weight Bearing Area ◽

Sole Of The Foot

The medial plantar flap is an axial pattern flap from the non–weight-bearing area of the sole of the foot between the heel and the metatarsal heads. The flap can be raised as a pedicle or a free flap, based on either the medial or lateral plantar arteries, or both. Sensory function is provided by branches of the medial plantar nerve. The donor site defect in the foot has caused no difficulty except for occasional marginal hyperkeratosis.

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