Journal of Foot and Ankle Surgery
Volume 49, Issue 3 , Pages 224-231, May 2010

Effectiveness of Composite Bone Graft Substitute Plugs in the Treatment of Chondral and Osteochondral Lesions of the Talus

  • Jason S. Lin, MD

      Affiliations

    • Fellow, The Institute for Foot and Ankle Reconstruction at Mercy Medical Center, Baltimore, MD
    • ,
  • Lucille B. Andersen, MD

      Affiliations

    • Assistant Professor, Department of Orthopaedics and Rehabilitation, Penn State Milton S. Hershey Medical Center and College of Medicine, Hershey, PA
    • ,
  • Paul J. Juliano, MD

      Affiliations

    • Professor, Vice Chairman, Residency Director, Chief of Foot and Ankle Division, Foot and Ankle Fellowship Director, Department of Orthopaedics and Rehabilitation, Penn State Milton S. Hershey Medical Center and College of Medicine, Hershey, PA
    • Corresponding Author InformationAddress correspondence to: Paul J. Juliano, MD, Chief Resident, Department of Orthopaedics and Rehabilitation, Penn State Milton S. Hershey Medical Center and College of Medicine, PO Box 850, Hershey, PA 17033.

published online 01 April 2010.

Abstract 

A review of outcomes in 13 patients with talar dome osteochondral or chondral lesions treated with a bone graft substitute plug was undertaken in an effort to evaluate its effectiveness in comparison with other reported surgical techniques. Mean patient age was 36.4 (range 16 to 57) years. Mean follow-up was 30.1 (range 7 to 43) months. Medial malleolar osteotomy was performed in 9 (69.23%) cases. Average defect diameter was 9.8 (range 5 to 20) mm. Pain decreased significantly from 6.2 (range 3 to 9) to 4.0 (range 0 to 9) (P = .009). Postoperative American Orthopaedic Foot and Ankle Society Ankle-Hindfoot scores averaged 67.3 (range 26 to 100). Younger age, smaller defect size, and avoidance of medial malleolar osteotomy resulted in better outcomes. Mean Short Form-36 scores for the study group fell below US norms in all categories, and 12 (92.31%) ankles demonstrated persistent lesions radiographically. Postoperative magnetic resonance imaging in 2 (15.39%) patients demonstrated enlarged lesions, and 4 (30.77%) patients underwent revision surgery that revealed abnormal cartilage around the implant site. Complications included 1 (7.69%) deep venous thrombosis, 1 (7.69%) arthrofibrosis, and 1 (7.69%) superficial neuritis. Despite some improvement in pain, comparison of functional outcome showed bone graft substitute plug implantation to be less effective overall than other operative interventions. Future investigations with more specific selection criteria are warranted to gain further insight into the efficacy of these bone graft substitute plugs.

Level of Clinical Evidence: 4

Keywords: ankle, cartilage, outcomes, surgery

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 Financial Disclosure: None reported.

 Conflict of Interest: None reported.

PII: S1067-2516(10)00048-7

doi:10.1053/j.jfas.2010.02.008

Journal of Foot and Ankle Surgery
Volume 49, Issue 3 , Pages 224-231, May 2010

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