Effect analysis of iliac bone autografting for Hepple V osteochondral lesions of the talus

Background Talar cartilage injury is a kind of disease that causes long-term and chronic pain of ankle joint. Autologous osteochondral transplantation has been viewed as an alternative choice for treating these lesions, but donor-site morbidity has limited its application. This study aimed to analyze the efficacy of iliac bone autografting for Hepple V osteochondral lesions of the talus. Methods This retrospective study included 32 patients surgically treated for Hepple V osteochondral lesions of the talus from January 2015 to January 2020. All patients underwent open surgery. Ipsilateral iliac bone grafts were taken and filled with talar cartilage injury area. The improvement of postoperative ankle pain was evaluated by Visual Analogue Scale (VAS), and the improvement of ankle function was evaluated by the American Orthopaedic Foot & Ankle Society (AOFAS). During the postoperative follow-up, X-ray examination of the front and side of the ankle joint and CT of the ankle joint were performed to evaluate the bone cartilage healing in the graft area. Results Thirty-two patients (32 ankles) (100%) returned for clinical and radiologic follow-up at an average of 28 (range 24–36) months postoperatively. At 3 months postoperatively and at the last follow-up, the AOFAS scores were (80.4 ± 3.6) and (89.2 ± 6.4), respectively, which were significantly improved compared with the preoperative score (49.7 ± 8.1), and the difference was statistically significant (P < 0.05). The VAS scores were (2.1 ± 0.9) and (1.5 ± 0.8), respectively, which were significantly better than the preoperative score (6.2 ± 1.7), and the difference was statistically significant (P < 0.05). Re-examination of the front and side of the ankle joint X-rays and CT showed that the bone healing at the osteotomy of medial malleolus and osteochondral transplantation area. All patients had no pain at the donor site. No complications occurred in 32 patients at the last follow-up. Conclusions With iliac bone autografting for Hepple V osteochondral lesions of the talus can effectively relieve ankle joint pain and significantly improved ankle function. Level of evidence Level III, Retrospective series.

Outcomes of Autologous Osteochondral Transplantation With and Without Extracellular Matrix Cartilage Allograft Augmentation for Osteochondral Lesions of the Talus

Background: Autologous osteochondral transplantation (AOT) using a cylindrical graft in the treatment of osteochondral lesions of the talus (OLTs) is typically indicated for patients with larger lesions. However, with lesions that are irregular in shape, the AOT graft may not completely replace the lesion. For these lesions, we utilize extracellular matrix cartilage allograft (EMCA) augmentation in AOT to act as a physiologic grout at the host-graft interface. Purpose: To determine if the combination of EMCA with concentrated bone marrow aspirate (CBMA) would improve integration of the host-graft interface and subsequently reduce postoperative cyst formation after AOT. It was also hypothesized that EMCA in conjunction with CBMA would demonstrate improved MOCART (magnetic resonance observation of cartilage repair tissue) scores and functional outcome scores at a minimum 2 years after surgery. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective analysis was performed comparing patients treated with AOT/CBMA alone and AOT with CBMA/EMCA. Clinical outcomes were evaluated with the Foot and Ankle Outcome Score. Magnetic resonance imaging appearance was evaluated with the use of the MOCART (magnetic resonance observation of cartilage repair tissue) score. Cyst formation was also evaluated on postoperative magnetic resonance imaging. Results: A total of 26 patients were included in the AOT + CBMA/EMCA group (10 male, 16 female), and 34 patients were included in the AOT/CBMA group (17 male, 17 female). The mean Foot and Ankle Outcome Score significantly improved in both groups ( P < .001) across all subscales (symptoms, pain, activities of daily living, sports activities, and quality of life), but there was no significant difference between groups at final follow-up. There was no significant difference in mean MOCART scores between the groups ( P = .118). In the AOT/CBMA group, 3 patients (8.8%) complained of knee pain, and 1 (2.9%) required additional surgery (hardware removal). In the AOT + CBMA/EMCA group, 2 patients (7.7%) complained of knee pain, and 6 patients (23%) required additional surgery (3 hardware removals and 3 arthroscopic debridements of scar tissue in the ankle). Conclusion: We found that while EMCA with CBMA has benefit in regeneration and repair of OLT treated with bone marrow stimulation, there appears to be little benefit of EMCA over CBMA alone as a physiologic grout at the graft-host interface in OLT treated with AOT.

Autologous osteochondral transplantation method of treatment for recurrent anterior shoulder instability

BackgroundGenerally, the treatment of recurrent anterior shoulder instability is a challenge in the orthopedics with various treatment methods. There is a high recurrence rate for those patients with high activity and glenoid bone lesion less than 20% after Bankart procedure. The authors present a novel surgical technique using autologous osteochondral transplantation (AOT) method for recurrent anterior shoulder instability.MethodsBetween 2019 to 2021, 7 patients (five man and two women; mean age 35.1 years (range 17–55 years)) with recurrent anterior shoulder instability and glenoid bone lesion of 20% or less were treated with AOT method. All patients were available for follow-up at a mean of 25.4 months (range, 16 to 32 months), including Rowe score, Oxford Shoulder Score (OSS), Simple Shoulder Test (SST), and 3-dimensional computed tomography examination.ResultsThe mean preoperative and postoperative Rowe score were calculated to be 25.7 ± 6.7 (range, 20–35) and 90.6 ± 2.4 (range, 85–95), respectively (p < 0.01). The mean preoperative and postoperative Oxford score were 36.4 ± 5.6 (range, 30–40) and 54.6 ± 2.4 (range, 50–57), respectively (p < 0.01). The mean preoperative and postoperative SST score were 6.9 ± 0.7 (range, 6–8) and 11.5 ± 0.7 (range, 11–12), respectively (p < 0.01). The average final forward flexion was 176° (affected shoulder), compared with 177° on the non-affected shoulder (P = 0.81). The average final abduction in external rotation was 86.6° (affected shoulder), compared with 89° on the non-affected shoulder (P = 0.31). Analysis of Computed Tomography (CT) data at an average 1 years postoperative showed that a mean glenoid bony gain of 16.7% was observed (range, 11.2%-19%, SD 3.6).ConclusionThis technique can be a useful option, particularly in patients with glenoid bone defect less than 20%. In addition, AOT technique may be considered as alternative to the Latarjet procedure. Nonetheless, further biomechanical and clinical studies are needed to determine the effect of this procedure to more commonly utilized techniques.Level of EvidenceLevel IV; Case series

Single-incision Non-weight-bearing Area Autologous Osteochondral Transplantation for the Treatment of Osteochondral Lesions of the Talus

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.

Autologous Osteochondral Transplantation for Young Patients with Postcollapse Osteonecrosis of the Knee: A Retrospective Cohort Study with an Average 7-Year Follow-Up

Background Only a few studies exist that have assessed the efficacy of autologous osteochondral transplantation (AOT) treatment of osteonecrosis (ON) of the knee. The purpose of this study was to clarify the clinical and radiographic results of AOT performed on young patients with postcollapse ON of the knee. Methods This retrospective study included 14 young patients (6 men, 8 women, mean age 34.71 ± 5.41 years) with stage III knee ON undergoing AOT surgery. Mean follow-up time was 87 ± 10.23 months. The postoperative clinical and radiological evaluations were based on Hospital for Special Surgery (HSS) scores and plain x-rays. Paired t tests were used for the statistical analysis by SPSS software. Results Preoperative HSS (mean 66.86 ± 7.49 points) was significantly improved at mean 7 years to a postoperative HSS (mean 87.36 ± 8.63 points) ( P < 0.001). The postoperative rangeof motion (ROM; 125.71° ± 4.74°) was not significantly different from the preoperative ROM (126.86° ± 7.13°) ( P = 0.626). There was no progression of collapse observed in any knees at the last follow-up. No knees required any reoperations during the follow-up period. Conclusion Fourteen young patients with local ON of the knee were treated by AOT. No progression of bone collapse was seen and clinical improvement sustained at mean 7 years postsurgery. AOT seems to be a safe technique that can give long-term improvement and durability in young ON patients. However, large-sample and high-quality clinical trials are still needed in the future.

Autologous Osteochondral Transplantation for Osteochondral Lesions of the Talus: Does Gender Impact Outcomes?

Category: Ankle; Arthroscopy Introduction/Purpose: Autologous osteochondral transplantation (AOT) is commonly used in the treatment of osteochondral lesions (OCL) of the talus. There is limited data comparing gender differences in the incidence, presentation, and outcomes following AOT. The purpose of this study is to compare these differences between male and female patients. Methods: Eighty-five consecutive patients who underwent AOT were retrospectively reviewed. Patients were divided into two groups based on gender. Demographic data and OCL defect characteristic data were recorded. Functional outcomes were assessed pre- and post-operatively using the Foot and Ankle Outcome Score (FAOS). The Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score was used to assess cartilage incorporation. The mean clinical follow-up was 47.2 months, with mean MRI follow-up of 24.8 months. Results: Fifty-five (65%) males and 30 (35%) females were included. OCL defect size was significantly larger in men (112.8mm2) when compared with women (88.7mm2) (p<0.0001). Male patients had a significantly longer duration of symptoms (p<0.001) and OCLs were more likely traumatic in nature (p=0.0006) when compared with female patients. Mean FAOS improved pre- to postoperatively from 50 to 81(P < .001) with a statistically significant increase in men (p<0.0001). The mean MOCART score was 82.1 and 86.7 in male and female patients, respectively (p<0.0001). Lesion size was negatively correlated with MOCART score (r = -0.36,P = .004). No differences were found in knee donor site morbidity, complication rate, or revision surgery. Conclusion: Our study demonstrates that male patients typically present with talar OCLs that are larger in size, traumatic in nature, and with longer symptom duration when compared with female patients. In addition, male patients had greater improvement in FAOS scores following AOT. Therefore, understanding these differences may influence the management and treatment of talar OCLs in male and female patients.