Abstract
Osteochondral lesions of the talus (OLTs) continue to be a challenge for the treating
surgeon, especially when lesions are refractory to marrow stimulation techniques.
The purpose of this study is to evaluate the outcomes of lesions treated with osteochondral
allograft transplantation. A review was performed of 30 athletes with 31 OLTs that
were refractory to marrow stimulation or predicted to be refractory based on size
and location of the lesion. Results were evaluated in terms of occupational outcomes
and numeric pain scales. Lesions treated had a mean area of 1.37 (range 0.36 to 3.3)
cm2. Overall excellent outcomes were achieved in 11 (35%) ankles. Nineteen (61%) ankles
achieved good or excellent occupational outcomes, and 12 (39%) ankles demonstrated
poor occupational outcomes and the patients were unable to continue their previous
active occupations. Patients were found to have a mean pain scale score of 3 (range
0 to 7) of 10 at a mean of 21 (range 10 to 24) months after operative management.
Osteochondral allograft transplantation is an option for the treatment of selected
athletes with large OLTs, as well as lesions that are refractory to marrow stimulation
techniques. The results of this study may help active young patients and their surgeons
to better understand outcomes and options in their shared decision-making process.
Level of Clinical Evidence
Keywords
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References
- Weitere beitrage zur traumatisch-mechanischen entstehung der “spontanen” knorpela biosungen.Dtsch Z Chir. 1922; 171: 13‒29
- Osteochondral lesion of the talus: prognostic factors affecting the clinical outcome after arthroscopic marrow stimulation technique.Foot Ankle Clin. 2013; 18: 67‒78
- Outcomes following microfracture in grade 3 and 4 articular cartilage lesions of the ankle.Foot Ankle Int. 2014; 35: 764‒770
- Osteochondral lesions of the talus: aspects of current management.Bone Joint J. 2014; 96-B: 164‒171
- Arthroscopic findings in acute fractures of the ankle.J Bone Joint Surg Br. 2000; 82: 345‒351
- Current concept review: osteochondral lesions of the talus.Foot Ankle Int. 2010; 31: 90‒101
- Osteochondritis dissecans of the talus: diagnosis and treatment in athletes.Clin Sports Med. 2014; 33: 267‒284
- Residual disability following acute ankle sprains.J Bone Joint Surg Am. 1955; 37: 1237‒1243
- Arthroscopically detected intra-articular lesions associated with acute ankle fractures.J Bone Joint Surg Am. 2009; 91: 333‒339
- Arthroscopic assessment for intra-articular disorders in residual ankle disability after sprain.Am J Sports Med. 2005; 33: 686‒692
- Osteochondritis dissecans of the talus (trans chondral fractures of the talus): review of the literature and new surgical approach for medial dome lesions.Foot Ankle. 1985; 5: 165‒185
- Dome fracture of the talus. A report of ten cases.J Bone Joint Surg Br. 1973; 55: 319‒326
- Treatment strategies in osteochondral defects of the talar dome: a systematic review.Foot Ankle Int. 2000; 21: 119‒126
- Low level of evidence and methodologic quality of clinical outcome studies on cartilage repair of the ankle.Arthroscopy. 2016; 32: 214‒222
- Treatment of osteochondral lesions of the talus: a systematic review.Knee Surg Sports Traumatol Arthrosc. 2010; 18: 238‒246
- Incidence of osteochondral lesions of the talus in the United States military.Foot Ankle Int. 2011; 32: 948‒954
- Interventions for treating osteochondral defects of the talus in adults.Cochrane Database Syst Rev. 2010; CD008104
- Results of microfracture in the treatment of articular cartilage defects of the talus.Foot Ankle Int. 2005; 26: 583‒589
- Osteochondral lesions of the talus: randomized controlled trial comparing chondroplasty, microfracture, and osteochondral autograft transplantation.Arthroscopy. 2006; 22: 1085‒1092
- Long-term results of microfracture in the treatment of talus osteochondral lesions.Knee Surg Sports Traumatol Arthrosc. 2016; 24: 1299‒1303
- Systematic review of treatment strategies for osteochondral defects of the talar dome.Foot Ankle Clin. 2003; 8: 233‒242
- Osteochondral lesion of the talus: is there a critical defect size for poor outcome?.Am J Sports Med. 2009; 37: 1974‒1980
- Microfracture for osteochondral lesions of the ankle: outcome analysis and outcome predictors of 105 cases.Arthroscopy. 2008; 24: 106‒112
- Operative treatment of osteochondral lesions of the talus.J Bone Joint Surg Am. 2013; 95: 1045‒1054
- Treatment of unstable osteochondritis dissecans lesions of the knee using autogenous osteochondral grafts (mosaicplasty).Arthroscopy. 1999; 15: 312‒316
- Arthroscopic osteochondral autograft transplantation in anterior cruciate ligament reconstruction: a preliminary clinical study.Knee Surg Sports Traumatol Arthrosc. 1996; 3: 262‒264
- The use of a lateral patellar autologous graft for the repair of a large osteochondral defect in the knee.J Bone Joint Surg Am. 1995; 77: 65‒72
- Osteochondral transplantation of the talus: long-term clinical and magnetic resonance imaging evaluation.Am J Sports Med. 2011; 39: 1487‒1493
- Outcome of osteochondral autograft transplantation for type-V cystic osteochondral lesions of the talus.J Bone Joint Surg Br. 2006; 88: 614‒619
- Autologous osteochondral grafting—technique and long-term results.Injury. 2008; 39: 32‒39
- The treatment of osteochondral lesions of the talus with autologous osteochondral transplantation and bone marrow aspirate concentrate: surgical technique.Cartilage. 2011; 2: 327‒336
- Sports activity after osteochondral transplantation of the talus.Am J Sports Med. 2012; 40: 870‒874
- [Operative therapy of osteochondral lesions of the talus with autologous cartilage-bone transplantation].Orthopade. 2001; 30: 53‒58
- Knee donor-site morbidity after mosaicplasty; a systematic review.J Exp Orthop. 2016; 3: 31
- Autologous chondrocyte transplantation of the ankle.Foot Ankle Clin. 2003; 8: 291‒303
- Autologous chondrocyte implantation for the treatment of chondral and osteochondral defects of the talus: a meta-analysis of available evidence.Knee Surg Sports Traumatol Arthrosc. 2012; 20: 1696‒1703
- Fresh osteochondral allograft for the treatment of cartilage defects of the talus: a retrospective review.J Bone Joint Surg Am. 2011; 93: 1634‒1640
- Fresh osteochondral allografting for osteochondral lesions of the talus.Foot Ankle Int. 2010; 31: 283‒290
- Osteochondral defects of the talus treated with fresh osteochondral allograft transplantation.Foot Ankle Int. 2001; 22: 385‒391
- Osteochondral lesions of the talus treated with fresh talar allografts.Foot Ankle Int. 2010; 31: 277‒282
- Fresh osteochondral total ankle allograft transplantation for the treatment of ankle arthritis.Foot Ankle Int. 2008; 29: 554‒560
- Fresh ankle osteochondral allograft transplantation for tibiotalar joint arthritis.Foot Ankle Int. 2005; 26: 793‒802
- Fresh osteochondral allografts for large-volume cystic osteochondral defects of the talus.J Bone Joint Surg Am. 2009; 91: 2818‒2826
Article info
Publication history
Published online: April 20, 2019
Footnotes
Financial Disclosure: None reported.
Conflict of Interest: None reported.
Identification
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© 2018 by the American College of Foot and Ankle Surgeons. All rights reserved.
