Abstract
Purpose
Bone marrow stimulation procedures (microfractures/drilling) are considered the gold standard for the primary treatment of osteochondral talar lesions. In the literature, there is lack of evidence about the appropriate treatment in cases of failure of these procedures. A technique of osteochondral autologous transplantation of talar graft was used. It was hypothesized that this is a successful method with good results and low complication rates. Additionally, a technique of anterior ankle approach with temporary removal of a bone block from the distal tibia that gives adequate access to posterior talar dome lesions is demonstrated.
Methods
Between 2004 and 2007, 46 patients (37 males, 9 females), with OLT for which arthroscopic treatment with curettage and drilling or microfracture had failed, underwent osteochondral transplantation with an osteochondral graft harvested from the ipsilateral talar articular facet. A medial malleolar osteotomy or a distal tibial wedge osteotomy was used to access the talar dome defect.
Results
The median follow-up time was 5.5 years (range 52–75 m). Thirty-four lesions (70.8 %) were located in the central talar dome in the coronal plane, while 26 (54.1 %) and 19 (39.5 %) lesions were located in the lateral and medial aspect of talar dome in saggital plane, respectively. The overall improvement between the preoperative and post-operative AOFAS and VAS FA score was 35 points (p < 0.001) and 39 points (p < 0.001), respectively. Clinical results were considered as good in 43 patients (93.4 %) and fair in three patients (6.5 %). All the transplanted grafts were observed to incorporate fully into the recipient bed. No complications occurred at the site of the malleolus osteotomy or tibial osteotomy and the donor site at the talus.
Conclusions
The midterm results suggest that the technique of osteochondral transplantation of autologous talar graft for osteochondral lesions of talus after failure of primary treatment with bone marrow stimulation can be safely and successfully used. It demonstrates excellent post-operative scores including improvement of pain and function. This procedure is combined with removal of a tibial bone block and its subsequent replacement and does not yield complications experienced with other procedures.
Level of evidence
Retrospective case series, Level IV.
Similar content being viewed by others
References
Al Shaikh RA, Chou LB, Mann JA, Dreeben SM, Prieskorn D (2002) Autologous osteochondral grafting for talar cartilage defects. Foot Ankle Int 23(5):381–389
Barnes CJ, Ferkel RD (2003) Arthroscopic debridement and drilling of osteochondral lesions of the talus. Foot Ankle Clin 8(2):243–257
Bartlett W, Skinner JA, Gooding CR, Carrington RW, Flanagan AM, Briggs TWR, Bentley G (2005) Autologous chondrocyte implantation versus matrix—induced autologous chondrocyte implantation for osteochondral defects of the knee: a prospective, randomised study. J Bone Joint Surg Br 87(5):640–645
Becher C, Thermann H (2005) Results of microfracture in the treatment of articular cartilage defects of the talus. Foot Ankle Int 26(8):583–589
Berndt AL, Harty M (1959) Transchondral fractures (osteochondritis dissecans) of the talus. J Bone Joint Surg Am 41-A:988–1020
Canale ST, Belding RH (1980) Osteochondral lesions of the talus. J Bone Joint Surg Am 62(1):97–102
Draper SD, Fallat LM (2000) Autogenous bone grafting for the treatment of talar dome lesions. J Foot Ankle Surg 39(1):15–23
Easley M, Latt LD, Santangelo J, Merian-Genast M, Nunley J (2010) Osteochondral lesions of the talus. J Am Acad Orthop Surg 18:616–630
El-Rashidy H, Villacis D, Omar I, Kelikian AS (2011) Fresh osteochondral allograft for the treatment of cartilage defects of the talus: a retrospective review. J Bone Joint Surg Am 93(17):1634–4160
Flick AB, Gould N (1985) Osteochondritis dissecans of the talus (transchondral fractures of the talus): review of the literature and new surgical approach for medial dome lesions. Foot Ankle 5(4):165–185
Gautier E, Kolker D, Jakob RP (2002) Treatment of cartilage defects of the talus by autologous osteochondral grafts. J Bone Joint Surg Br 84-B:237–244
Gobbi A, Francisco R, Lubowitz J, Allegra F, Canata G (2006) Osteochondral lesions of the talus: randomized controlled trial comparing chondroplasty, microfracture, and osteochondral autograft transplantation. Arthroscopy 22(10):1085–1092
Hangody L (2003) The mosaicplasty technique for osteochondral lesions of the talus. Foot Ankle Clin N Am 8:259–273
Hangody L, Kish G, Módis L, Szerb I, Gáspár L, Diószegi Z, Kendik Z (2001) Mosaicplasty for the treatment of osteochondritis dissecans of the talus: two to seven year results in 36 patients. Foot Ankle Int 22(7):552–558
Hahn DB, Aanstoos ME, Wilkins RM (2010) Osteochondral lesions of the talus treated with fresh talar allografts. Foot Ankle Int 31(4):277–282
Hembree WC, Wittstein JR, Vinson EN, Queen RM, Larose CR, Singh K, Easley ME (2012) Magnetic resonance imaging features of osteochondral lesions of the talus. Foot Ankle Int 33(7):591–597
Hepple S, Winson IG, Glew D (1999) Osteochondral lesions of the talus: a revised classification. Foot Ankle Int 20(12):789–793
Huntley JS, Bush PG, McBirnie JM, Simpson AH, Hall AC (2005) Chondrocyte death associated with human femoral osteochondral harvest as performed for mosaicplasty. J Bone Joint Surg Am 87(2):351–360
Kitaoka HB, Alexander IJ, Adelaar RS et al (1994) Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int 15(7):349–353
Kolker D, Murray M, Wilson M (2004) Osteochondral defects of the talus treated with autologous bone grafting. J Bone Joint Surg Br 86:521–526
Koulalis D, Schultz W, Heyden M (2002) Autologous chondrocyte transplantation for osteochondritis dissecans of the talus. Clin Orthop Relat Res 395:186–192
Kreuz PC, Steinwachs M, Erggelet C, Lahm A, Henle P, Niemeyer P (2006) Mosaicplasty with autogenous talar autograft for osteochondral lesions of the talus after failed primary arthroscopic management. Am J Sports Med 34(1):55–63
Kreuz PC, Steinwachs M, Edlich M, Kaiser T, Mika J, Lahm A, Südkamp N (2006) The anterior approach for the treatment of posterior osteochondral lesions of the talus: comparison of different surgical techniques. Arch Orthop Trauma Surg 126(4):241–246
Kumai T, Takakura Y, Higashiyama I, Tamai S (1999) Arthroscopic drilling for the treatment of osteochondral lesions of the talus. J Bone Joint Surg Am 81(9):1229–1235
LaPrade RF, Botker JC (2004) Donor-site morbidity after osteochondral autograft transfer procedures. Arthroscopy 20:e69–e73
Mendicino RW, Catanzariti AR, Hallivis R (2001) Mosaicplasty for the treatment of osteochondral defects of the ankle joint. Clin Podiatr Med Surg 18(3):495–513
Mendicino RW, Lee MS, Grossman JP, Shromoff PJ (1998) Oblique medial malleolar osteotomy for the management of talar dome lesions. J Foot Ankle Surg 37(6):516–523
Mitchell ME, Giza E, Sullivan MR (2009) Cartilage transplantation techniques for talar cartilage lesions. J Am Acad Orthop Surg 17(7):407–414
Orr JD, Dutton JR, Fowler JT (2012) Anatomic location and morphology of symptomatic, operatively treated osteochondral lesions of the talus. Foot Ankle Int 33(12):1051–1057
Raikin S, Elias I, Zoga A, Morrison W, Besser M (2007) Osteochondral lesions of the talus: localization and morphologic data from 424 patients using a novel anatomical grid scheme. Foot Ankle Int 28(2):154–161
Reddy S, Pedowitz DI, Parekh SG, Sennett BJ, Okereke E (2007) The morbidity associated with osteochondral harvest from asymptomatic knees for the treatment of osteochondral lesions of the talus. Am J Sports Med 35(1):80–85
Richter M, Zech S, Geerling J, Frink M, Knobloch K, Krettek C (2006) A new foot and ankle outcome score: questionnaire based, subjective, visual-analogue-scale, validated and computerized. Foot Ankle Surg 12:191–199
Robinson DE, Winson IG, Harries WJ, Kelly AJ (2003) Arthroscopic treatment of osteochondral lesions of the talus. J Bone Joint Surg Br 85(7):989–993
Sammarco GJ, Makwana NK (2002) Treatment of talar osteochondral lesions using local osteochondral graft. Foot Ankle Int 23(8):693–698
Scranton PE Jr, Frey CC, Feder KS (2006) Outcome of osteochondral autograft transplantation for type-V cystic osteochondral lesions of the talus. J Bone Joint Surg Br 88(5):614–619
Valderrabano V, Leumann A, Rasch H, Egelhof T, Hintermann B, Pagenstert G (2009) Knee-to-ankle mosaicplasty for the treatment of osteochondral lesions of the ankle joint. Am J Sports Med 37(Suppl. 1):105S–111S
Verhagen RA, Struijs PA, Bossuyt PM, van Dijk CN (2003) Systematic review of treatment strategies for osteochondral defects of the talar dome. Foot Ankle Clin 8(2):233–242
Zengerink M, Struijs PA, Tol JL, van Dijk CN (2010) Treatment of osteochondral lesions of the talus: a systematic review. Knee Surg Sports Traumatol Arthrosc 18(2):238–246
Conflict of interest
The authors declared that they have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Georgiannos, D., Bisbinas, I. & Badekas, A. Osteochondral transplantation of autologous graft for the treatment of osteochondral lesions of talus: 5- to 7-year follow-up. Knee Surg Sports Traumatol Arthrosc 24, 3722–3729 (2016). https://doi.org/10.1007/s00167-014-3389-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00167-014-3389-3