Evaluation and management of osteochondral lesions of the talus in skeletally immature patients / Evaluación y tratamiento de las lesiones osteocondrales del astrágalo en pacientes esqueléticamente inmaduros

Abstract: Osteochondral lesions of the talus (OLTs) are defined as damage to the talar cartilage, with pathological changes in the underlying bone. They include a group of injuries that involve juvenile osteochondritis dissecans (JOCD) and osteochondral fractures of the talus. The etiology of OLT remains not fully clarified but is more common in young and active patients. Treatment strategies for OLTs in skeletally immature populations depend on the magnitude of symptoms, lesion morphology (stability and overlying cartilage integrity), size, nature of the lesion (traumatic versus JOCD), ankle stability, lower extremity alignment, and previous treatment. The aim of this review is to provide an overview of the current evidence for the diagnosis and treatment of OLTs in skeletally immature patients.

Resumen: Las lesiones osteocondrales del astrágalo (OLT) se definen como lesiones del cartílago talar, con cambios patológicos en el hueso subyacente. Incluyen un grupo de lesiones que implican osteocondritis disecante juvenil (JOCD) y fracturas osteocondrales del astrágalo. La etiología de las OLT aún no está totalmente aclarada, pero son más frecuentes en pacientes jóvenes y activos. Las estrategias de tratamiento de las OLT en poblaciones esqueléticamente inmaduras dependen de la magnitud de los síntomas, la morfología de la lesión (estabilidad e integridad del cartílago suprayacente), el tamaño, la naturaleza de la lesión (traumática frente a JOCD), la estabilidad del tobillo, la alineación de la extremidad inferior y el tratamiento previo. El objetivo de esta revisión es proporcionar una visión general de las pruebas actuales para el diagnóstico y el tratamiento de los OLT en pacientes esqueléticamente inmaduros.

Tratamiento artroscópico en lesión osteocondral subtalar / Arthroscopic treatment of subtalar osteochondral lesion

Las lesiones osteocondrales de la articulación subtalar es una patología infrecuente y de incidencia variable, dado su reporte principalmente como hallazgo en el estudio de dolor crónico de tobillo y ya con cambios degenerativos articulares. La sospecha clínica y el estudio imagenológico dirigido, permiten investigar esas lesiones en estadios iniciales, evitando así el uso de técnicas que no preservan la articulación para su manejo. La artroscopía subtalar es una excelente herramienta tanto diagnóstica como terapéutica para la resolución de dichas lesiones. Dadas las características anatómicas y biomecánicas de la articulación, en estadios iniciales, el manejo mediante sinovectomía y microfracturas es una alternativa con excelentes resultados funcionales. Este trabajo incluye dos casos de lesiones osteocondrales de la faceta posterior de la articulación subtalar manejadas vía artroscópica mediante sinovectomía y microfracturas y su posterior evolución.

Osteochondral lesions in the subtalar joint are an uncommon pathology with a variable incidence, being mainly reported as a finding in chronic ankle pain studies and with already visible degenerative joint changes at time of diagnosis. Clinical suspicion and directed imaging study, allows to investigate these lesions during early stages, thus avoiding the use of invasive techniques with scarce joint preservation. Subtalar arthroscopy is an excellent diagnostic and therapeutic tool for the resolution of these lesions. Given the anatomical and biomechanical characteristics of the joint, in the early stages the management by synovectomy and microfractures is an alternative with excellent functional results. This study includes two cases of osteochondral lesions of the posterior facet of the subtalar joint managed through arthroscopically synovectomy and microfractures and their subsequent evolution.

Protocol for Harvest, Transport and Storage of Human Osteochondral Tissue / Protocolo para captação, transporte e preservação de tecido osteocondral humano

Abstract Objective To elaborate a protocol for the harvest, transport, and preservation of human osteochondral tissue for use in tissue banks (TBs). Methods Osteochondral fragments measuring 2 cm3 of 5 corpse donors aged between 15 and 45 years old were analyzed. The samples were stored in cell preservation medium containing: human albumin, Iscove's and vancomycin preserved at 4ºC. The concentration of proteoglycans in the extracellular medium was quantified by the use of Safranin-O, while tissue structural analysis was assessed by histological study with hematoxylin-eosin stained slides. The images obtained were analyzed according to the histological scores of Mankin and the score proposed by the OsteoArthritis Research Society International. The samples were analyzed with 0, 15, 30 and 45 days of preservation. Results The osteochondral fragments studied showed a progressive decrease in proteoglycan concentration with increased preservation time. After 30 days of preservation, structural changes were identified with discontinuity of the cartilage surface layer. According to the results obtained by the Mankin score, there was a statistically significant difference between 15 and 30 days of tissue preservation. Conclusion The protocol described defined knee transport immersed in Lactated Ringer at a controlled temperature of 10º C until its arrival at the TB. After processing, the preservation solution was composed of Iscove's serum-free cell culture medium supplemented with 10% human albumin and 100 µg/ml vancomycin. The tissue was preserved at a temperature of 4ºC until the moment of transplantation characterizing the fresh preservation.

Resumo Objetivo Elaborar um protocolo para a captação, transporte e preservação de tecido osteocondral humano para utilização em banco de tecidos (BT). Métodos Foram analisados fragmentos osteocondrais com dimensão de 2 cm3 de 5 doadores cadáveres com idades entre 15 e 45 anos. As amostras foram armazenadas em meio de preservação celular contendo: albumina humana, Iscove's e vancomicina preservados à temperatura de 4ºC. A concentração de proteoglicanos no meio extracelular foi quantificada pelo uso de Safranina-O, enquanto a análise estrutural do tecido foi avaliada através de estudo histológico com lâminas coradas em hematoxilina-eosina. As imagens obtidas foram analisadas segundo os escore histológicos de Mankin e o escore proposto pela OsteoArthritis Research Society International. As amostras foram analisadas com 0, 15, 30 e 45 dias de preservação. Resultados Os fragmentos osteocondrais estudados apresentaram diminuição progressiva na concentração de proteoglicanos com o aumento do tempo de preservação. Após 30 dias de preservação, foram identificadas alterações estruturais com descontinuidade da camada superficial da cartilagem. Segundo os resultados obtidos pelo escore de Mankin, houve diferença com significância estatística entre 15 e 30 dias de preservação do tecido. Conclusão O protocolo descrito definiu o transporte de joelho em bloco imerso em Ringer Lactato em temperatura controlada a 10ºC até sua chegada ao BT. Após o processamento, a solução de preservação foi composta por meio de cultura celular sem soro Iscove's suplementado com albumina humana a 10% e vancomicina 100 µg/mL. O tecido foi preservado à temperatura de 4ºC até o momento do transplante caracterizando a preservação a fresco.

Micro-fracture therapy combined with intra-articular injection of platelet-rich plasma for small sized osteochondral lesion of the talus / 中国修复重建外科杂志

Objective: To investigate the effectiveness of micro-fracture therapy combined with intra-articular injection of platelet-rich plasma (PRP) in the treatment of small sized osteochondral lesion of the talus (OLT). Methods: Between September 2014 and October 2017, 43 patients with small sized OLT met the inclusive criteria were admitted and randomly divided into micro-fracture group (21 cases) and combined group (22 cases). Patients in the micro-fracture group were treated with micro-fracture therapy, and patients in the combined group were treated with micro-fracture therapy combined with intra-articular injection of PRP. There was no significant difference in gender, age, disease duration, side of OLT, injured position, lesion area, Mintz classification, and preoperative American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hind foot score and visual analogue scale (VAS) score between the two groups ( P>0.05). After treatment, MRI, VAS score, and AOFAS ankle-hind foot score were used to evaluate the recovery of OLT and the ankle function. Results: All incisions healed by first intention, and no complications such as venous thrombosis and ankle joint infection occurred. All patients were followed up 12-18 months after operation, with an average of 15.6 months. The VAS scores and the AOFAS ankle-hind foot scores were significantly improved at 6 and 12 months after operation in the two groups ( P<0.05), and the scores at 12 months were significantly improved when compared with postoperative scores at 6 months ( P<0.05). Compared with the micro-fracture group, the VAS score and the AOFAS ankle-hind foot score were significantly improved in the combined group at 6 and 12 months after operation ( P<0.05). MRI showed that OLT was well filled in both groups at 12 months after operation. Conclusion: Compared with micro- fracture therapy, micro-fracture therapy combined with intra-articular injection of PRP can effectively reduce pain, improve ankle function, and has a good effectiveness in the treatment of small sized OLT.

Osteochondral Lesion of the Talus in Children and Adolescents / 대한정형외과학회잡지

Osteochondral lesion of the talus (OLT) is a disease affecting the subchondral bone and articular cartilage of the talus, which may cause fragmentation and displacement of the osteochondral lesion. The stability of the joint and the size of the lesion are important prognostic factors. Conservative treatment is preferred in the initial treatment of OLT in skeletal immature patients because it has a more favorable prognosis than adult OLT in terms of the healing potential and improvement of symptoms. Surgery is recommended when the conservative outcome is unsatisfactory and the fragment is large or displaced. Surgical procedures, including marrow stimulation technique, autologous osteochondral transplantation, and autologous chondrocyte implantation, were performed depending on the condition of the osteochondral lesion.

Autogenous Tibial Periosteum Bone Graft for Treating Medial Osteochondral Lesion of the Talus / 中国运动医学杂志

Objective To evaluate the clinical effect of treating the medial osteochondral lesions of the talus (OLTs) using the malleolar osteotomy and bone grafting with periosteum.Methods A total of 28 patients who underwent medial malleolar osteotomy,lesions debridement and bone grafting with periosteum between January 2014 and August 2015 were reviewed retrospectively.The oblique medial mal leolar osteotomy was performed to expose the talar lesion,followed by cyst debridement and bone grafting with periosteum,then the medial malleolus fracture was fixed.X-rays and MRI examination were conducted before and after the operation.MRI was used for the measurement of radiographic parameters such as the length,width and depth of the edema area.The patients were also evaluated using the American orthopaedic foot and ankle society (AOFAS)-ankle and hindfoot score questionnaires.Results Twenty-three subjects completed the follow-up over a mean period of 15 months (range,10～28 months).According to X-rays,the mean time for osseous union was 11 weeks (range,9-14 weeks).MRI results showed significant reduce in the bone marrow edema area after the operation,except for one case of fibrous cartilage higher than the surrounding articular cartilage,and two with the chondro cyst not disappearing completely.The arthroscopy of 6 patients revealed 5 good integrations with similar color and smoothness.The AOFAS ankle-hindfoot scores increased significantly after the surgery (P＜0.05).No wound pain,infection,and failure of internal fixation were observed during the follow-up period.Conclusions The combination of medial malleolar osteotomy,lesions debridement and bone grafting with periosteum can be used to treat patients with stage Ⅲ～Ⅴ OLTs,as this technique can effectively relieve pain and enhance the joint function.

Arthroscopic Treatment for an Osteochondral Lesion of the Talus / 대한정형외과학회잡지

Ankle injury is one of the most common injuries, and osteochondral lesions of the talus occur in up to 70% of acute ankle sprains or fractures. The number of sports injuries have increased due to the increase in leisure activities, and the development of diagnostic techniques to evaluate the cartilage status leads to a higher prevalence of osteochondral lesions of the talus. Although osteochondral lesions of the talus with no symptoms can be treated conservatively, adult patients are usually treated by surgery because they are more likely to fail after non-surgical management. Recovery to normal cartilage is important, but there has been no surgical treatment established for effective cartilage regeneration. Bone marrow stimulation, such as arthroscopic microfracture, is a commonly used surgical procedure and an effective treatment for lesions that are small or failed after non-operative treatment. In addition, there are treatments, such as osteochondral autograft transplantation, osteochondral allograft transplantation and autologous chondrocyte implantation. The selection of the methods depends on the size and location of the lesion, the presence of subchondral cysts, and the results of previous surgery. Many surgical procedures have shown good results in short and mid-term follow-up studies but the results of long-term follow-up have been unclear. Various treatment methods, such as hyaluronan, platelet-rich plasma, mesenchymal stem cells, and bone marrow aspirate concentrate, have been available recently due to the development of various biological agents.

Application of MR small FOV surface coil in talar osteochondral lesions imaging / 中国医学影像技术

Objective To compare the accuracy rate of talar osteochondral lesions between the small field of view (FOV) surface coil MR imaging and 2D FSE proton density weighted imaging (2D-FSE-PD),3D-SPACE sequences MR imaging with boot-shaped coil.Methods Totally 43 patients (45 ankles) underwent 3D-SPACE sequence after 2D-FSE-PD sequence scanning using the boot-shaped coil,then the PDWI sequence was scanning after the boot-shaped coil was replaced by the small FOV surface coil at 1.5T MRI.The results of the arthroscopic examinations was regarded as the standard for assessing the accuracy rate of the three methods.Results The accuracy rate of 2D-FSE-PD sequence with small FOV surface coil was 86.67％ (39/45),the accuracy rate of 2D-FSE-PD sequence with boot coil was 60.00％ (27/45),the accuracy rate of 3D-SPACE sequence with boot coil was 68.89％ (31/45).The accuracy rate of small FOV surface coil was higher than those of boot coil used 3D-SPACE sequence (x2 =4.114,P =0.002) and boot coil used 2D-FSE-PD sequence (x2 =8.182,P＜0.001).There was not significant difference between 3D-SPACE sequence using boot coil and 2D-FSE-PD sequence using boot coil (x2 =0.776,P=0.125).Conclusion Compared with the 2D-FSE-PD and 3D-SPACE sequences with boot-shaped coil,the small surface coil scanning with routine sequence can show talar osteochondral lesions better.

Clinical effects of arthroscopic microfracture on osteochondral lesions of the talus / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the clinical effects of arthroscopic microfracture on osteochondral lesions of the talus.</p><p><b>METHODS</b>Total 42 patients with osteochondral lesions of the talus, who were collected in our department from January 2011 to December 2013. The patients were 35.9 years old on average, including 28 males and 14 females. There were 34 patients who had injury histories. The debridement and microfracture were performed under arthroscopy. The function of ankle was assessed according to AOFAS Ankle Hindfoot Scale. MRI of ankle was checked 2 years postoperatively.</p><p><b>RESULTS</b>There were 23 cases in stage 3, 9 cases in stage 4 and 10 cases in stage 5 in MRI. There were 25 cases on the 4th district, 11 cases on the 6th district, 4 cases on the 1st district, 2 cases on the 3rd district according to 9 districts location and 8 cases of subchondral cyst found on the 4th district. AOFAS Ankle Hindfoot Scale of all patients on the 1st year postoperatively was 73.3±3.9 which was significantly better than 50.4±7.8 preoperatively, and 81.1±4.8 on the 2nd year postoperatively was also significantly better than that on the 1st year postoperatively.</p><p><b>CONCLUSIONS</b>Arthroscopic microfracture for the osteochondral lesions of the talus could have a good clinical effect.</p>

Non-Operative Treatment for Symptomatic Osteochondral Lesion of the Talus / 대한정형외과학회잡지

PURPOSE: Although reports on operative treatment of osteochondral lesion of the talus (OLT) are increasing, to the best of our knowledge, there have been only a few reports on non-operative treatment of OLT. The purpose of this study is to report the prognosis of non-operative treatment for OLT patients. MATERIALS AND METHODS: This retrospective study included 104 patients (57 male, 47 female) with OLTs having a follow-up period of more than two years, between 2003 and 2013. The location, size, and stage of the OLT were confirmed by magnetic resonance imaging or computed tomography. At the final follow-up, simple radiographs confirmed the progression of osteoarthritis. We surveyed the limitations of sports activity, visual analogue scale (VAS), American Orthopedic Foot and Ankle Society (AOFAS) scale, and SF-36. RESULTS: There were no patients with progression of osteoarthritis at the final follow-up. Only two patients (2.4%) complained the limitation of desired sports activity. The mean VAS significantly decreased from 4.3 (range, 0–8) to 1.1 (range, 0–4) (p<0.001). The mean AOFAS scale significantly improved from 83.3 (range, 41–100) to 92.5 (range, 65–100). Moreover, the mean SF-36 also improved from 52.6 (range, 30.0–91.0) to 72.9 (range, 40.6–97.0) (p<0.001). CONCLUSION: Sufficient non-operative treatment is initially recommended to OLT patients because pain, in general, improves in most cases despite the presence of symptoms. Moreover, it's worth noting that the progression to osteoarthritis is rare.

Results of Autologous Osteochondral Transplantation of the Ostochondral Lesion on the Talus: A Comparison Study between Medial Malleolar Osteotomy Approach and Anterior Arthrotomy Approach / 대한족부족관절학회지

PURPOSE: Osteochondral lesion of the talus (OLT) has traditionally been treated using an autologous osteochondral graft via the medial malleolar approach. Here, we compare the traditional method with the anterior arthrotomy approach. MATERIALS AND METHODS: Between January 2005 and June 2015, 24 cases of patients who received autologus osteochondral graft for OLT and with at least 2 years of follow-up were evaluated. They were divided into two groups; one group receiving autologous osteochondral graft via the medial malleolar osteotomy approach (group 1, n=9) and another group via the anterior arthrotomy approach (group 2, n=15). The clinical outcomes were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) score. RESULTS: In all cases, the size of the subchondral cyst of the talus decreased, if not disappeared on the final follow-up radiograph. All osteochondral grafts were united. The mean AOFAS score increased from 61.5 preoperatively to 84.9 at the final follow-up. The mean AOFAS score of group 1 increased from 60.3 preoperatively to 78.0 (p=0.007) at the final follow-up, and the mean AOFAS score of group 2 also increased from 62.2 to 89.1 (p=0.006). The AOFAS score was statistically better in group 2 than in group 1 (p=0.034) at the final follow-up. CONCLUSION: Autologous osteochondral graft of the OLT yields satisfactory radiologic and clinical outcomes. Especially, better clinical outcome was observed in the group using the anterior arthrotomy approach (group 2) than in the group using the medial malleolar osteotomy approach (group 1).

Redomicrofracture as a Treatment for Osteochondral Lesion of Talus after the Failure of Arthroscopic Microfracture / 대한족부족관절학회지

Arthroscopic treatment has been reported to provide effective improvement of ankle function when used in treatment of small osteochondral lesion of talus; however, favorable long-term results have been less predictable for large osteochondral lesion of talus. In cases in which primary arthroscopic treatment fails, the decision regarding which subsequent technique to choose has become increasingly difficult, as good clinical outcomes may be unlikely for such patients irrespective of the surgical technique used. Redomicrofracture should be used judiciously for treatment of osteochondral lesion of talus in which arthroscopic treatment has failed.

Autologous Osteochondral Transplantation as a Secondary Procedure after Failed Microfracture for Osteochondral Lesion of Talus / 대한족부족관절학회지

Microfracture procedure has been widely recognized as the primary surgical treatment for an osteochondral lesion of the talus. However, if symptoms persist after initial surgery, selection of a secondary procedure can be difficult. The author desciribes the advantage and value of autologous osteochondral transplantation as a secondary procedure after failed microfracture for osteochondral lesion with a review of sevral previous published articles.

Autologous Chondrocyte Implantation as a Secondary Procedure after Failed Microfracture for Osteochondral Lesion of Talus / 대한족부족관절학회지

Microfracture as a reparative strategy is the treatment of choice for an osteochondral lesion of talus. Although the results of microfracture are generally excellent, at least 30% of patients who received microfracture have acute or chronic ankle pain with several or unknown causes. The most important factor for unsatisfactory outcome after microfracture is the size of the lesion. For failed osteochondral lesion of talus, the second options are autologous osteochondral graft, autologous chondrocyte implantation, or re-microfracture. In this article, we present the autologous chondrocyte implantation as a second procedure for failed microfracture and compare its clinical outcome with other methods based on a literature review.

Osteochondral Lesion of the Bilateral Femoral Heads in a Young Athletic Patient

Osteochondral lesions of the femoral head are uncommon and few studies have reported their imaging findings. Since joints are at risk of early degeneration after osteochondral damage, timely recognition is important. Osteochondral lesions of femoral head may often be necessary to differentiate from avascular necrosis. Here, we report a case of osteochondral lesions on bilateral femoral heads. This lesion manifested as subchondral cysts in initial radiographs, which led to further evaluation by computed tomography arthrography and magnetic resonance imaging, which revealed overlying cartilage defects.

Subdeltoid Bursa Chondromatosis Associated with Osteochondral Lesion of the Proximal Humerus and a Rotator Cuff Tear / 대한정형외과학회잡지

Synovial chondromatosis involving the bursa is uncommon, and those cases synovial chondromatosis within the bursa around the shoulder are especially rare. We report here a case of a 57-year-old male who had subdeltoid bursal subdeltoid bursal chondromatosis associated with osteochondral lesion of the proximal humerus and a rotator cuff tear. We also review the relevant literatures.

A Comparison of Clinical Outcomes after Osteochondral Autologous Transplantation & Arthroscopic Microfracture Surgery for Treating of Osteochondral Lesions of the Knee / 대한정형외과학회잡지

PURPOSE: We wanted to compare the clinical outcomes after osteochondral autologous transplantation (OAT) and arthroscopic microfracture for treating of osteochondral lesions of the knee. MATERIALS AND METHODS: We reviewed 12 cases (12 patients) of arthroscopic microfracture and 10 cases (9 patients) of OAT. The mean patient ages were 33.5 years in the microfracture group and 31.3 years in the OAT group. The mean follow-up period was 31.1 months. The mean lesion sizes were 12.9x17.4 mm in the microfracture group and 16.1x21.4 mm in the OAT group. We compared clinical results using the Tegner activity score, the Lysholm knee scoring scale, the IKDC and the VAS. MRI was used to determine the recovery of the osteochondral lesions at last follow-up. RESULTS: There was no statistically significant difference between the groups for the Tegner Activity Score. Regarding the Lysholm Knee Scoring Scale, the OAT group had a better overall score than did the microfracture group (p<0.05). Both groups had similar results for the IKDC and VAS. The MRI at the last follow-up showed cartilage recovery in 53% of the microfracture cases (compared to the surrounding cartilage) and in 96.1% of the OAT cases. CONCLUSION: Microfracture and OAT both offered good clinical results when used to treat active persons in the 3rd or 4th decades of life and who have osteochondral lesions of the knee. However, OAT led to better cartilage recovery on MRI, as well as to better functional results. Therefore, OAT is the recommended method of treatment.

Results in Conservative Treatment of Osteochondral Lesion of Talus / 대한족부족관절학회지

PURPOSE: The purpose of this study is to determine the results of conservative treatment of osteochondral lesion of talus (OLT). This study would be helpful to determine the treatment methods for OLT patients. MATERIALS AND METHODS: We have established 69 cases of osteochondral lesion of talus, from December 2004 to June 2006 in a period of 18 months. Symptoms were confirmed through survey and a medical examination by interviewing patients. Diagnosis was made through physical examination, simple radiography and MRI. AOFAS score of all the patients were measured. When the patients did not get improved with conservative treatment, surgical operation was done. RESULTS: 27 out of the 69 patients were treated using conservative treatment. Initial AOFAS scored was 66.37+/-8.89 points. After treatment, AOFAS scores had increased to 83.78+/-8.48 points. In cases of surgery, AOFAS scores had increased from 64.17+/-13.43 points preoperatively to 80.45+/-8.67 points. CONCLUSION: 60% of conservative treatment was useless in treating OLT patients. Surgical operation is still needed to be performed. Therefore, treatment should be done with sufficient understanding of the results.

Clinical Results of the Multiple Drilling for Osteochondral Lesion of the Medial Talar Dome / 대한정형외과학회잡지

PURPOSE: To evaluate the treatment outcomes of transmalleolar multiple drilling with a K-wire for an osteochondral lesion of the medial talar dome after an mean follow-up period of 77 months. MATERIALS AND METHODS: Among patients treated surgically for a symptomatic osteochondral lesion of the talus between March 1997 and December 2002, sixteen ankles (fifteen patients) with a medial talar dome lesion were treated by transmalleolar multiple drilling and followed-up for at least 3 years. The average age at the time of surgery was 34.4 years (range, 19-58 years). The mean follow-up period was 77 months (range, 41-107 months). RESULTS: At the latest follow-up, the average VAS at motion decreased from 6.8 to 2.1 (p=0.004). The AOFAS score improved from 64 points to 86.2 points (p=0.001). The 8 ankles in those less than thirty years of age at that time of surgery showed a VAS at motion of 1.8 and an AOFAS score of 91.1 points. In contrast, 8 ankles in those who older than thirty one years of age had a VAS at motion of 2.4 and an AOFAS score of 81.2 points. The younger group showed a significantly better AOFAS score than the older group (p=0.001). However, there was no significant difference in the VAS score (p=0.22). CONCLUSION: Multiple drilling has a good effect in pain control and ankle function for patients with an osteochondral lesion of the medial talar dome 10 mm. The procedure is particularly effective and useful in younger patients.

The Clinical Results of Autologous Osteochondral Grafts in Osteochondral Lesion of the Talus / 대한족부족관절학회지

PURPOSE: To evaluate clinical results of autologous osteochondral graft in osteochondral lesions of the talus. MATERIALS AND METHODS: Twenty feet in twenty patients underwent osteochondral autologous transfer in the osteochondral lesions of the talus. Sixteen were men and four were women. The mean age was 40.8 years old. The mean follow up was 2 years 9 months. Eighteen cases were medial, one case was lateral and one case was both, respectively. The average duration of symptom was 4 years 3 months. AOFAS ankle/hindfoot score (AOFAS score), visual analogue scale (VAS), Lysholm knee score were evaluated preoperatively and at the final follow up. RESULTS: Postoperative AOFAS score was 87.3 (range, 69-100), which was significantly improved from preoperative AOFAS score of 62.0 (p=0.000). Postoperative VAS was 2.9 (range, 0-7), which was significantly improved from preoperative VAS of 7.5 (p=0.000). Postoperative Lysholm knee score was 92.4 (range, 80-100). All osteotomy of medial malleolus was united by the 4th month after surgery. Postoperative VAS was conversely correlated with the follow up period (p=0.024). There was no complications associated with surgery. CONCLUSION: Autologous osteochondral grafts in osteochondral lesion of the talus demonstrated excellent results with a short-term follow up.