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

ABSTRACT

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.