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Lee, Ahn, Nam, Lee, Lee, Kim, and Lee: Results of Autologous Osteochondral Transplantation of the Ostochondral Lesion on the Talus: A Comparison Study between Medial Malleolar Osteotomy Approach and Anterior Arthrotomy Approach
Original Article

J Korean Foot Ankle Soc 2017;21(4):139-143.

Published online: 19 January 2017

DOI: https://doi.org/10.14193/jkfas.2017.21.4.139

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

Yong-Sik Lee, Gil-Yeong Ahn, Il-Hyun Nam, Yeong-Hyun Lee, Tae-Hun Lee, Dae-Geun Kim, Dong-Hyun Lee

Department of Orthopedic Surgery, Pohang St. Mary’s Hospital, Pohang, Korea

Corresponding Author: Tae-Hun Lee Department of Orthopedic Surgery, Pohang St. Mary’s Hospital, 17 Daejamdong-gil, Nam-gu, Pohang 37661, Korea Tel: 82-54-289-4569, Fax: 82-54-277-2072, E-mail: osbonelee@gmail.com

Received 23 October 201711 November 2017       Accepted 13 November 2017

Copyright © 2017 Korean Foot and Ankle Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

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).

Keywords: Talus, Osteochondral lesion, Autologous osteochondral graft, Medial malleolar osteotomy

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Figure 1.
A case with medial malleolar osteotomy approach in group 1. (A, B) T2-weighted coronal and sagittal magnetic resonance images show medial osteochondral lesion with subchondral cyst. (C) Osteochondral lesion of talus after medial malleolar osteotomy. (D) Osteochondral autograft was transplanted into the lesion. (E) Final radiograph shows loss of subchondral cyst and union of graft and osteotomy site.
jkfas-21-139f1.tif
Figure 2.
A case with anterior arthrotomy approach in group 2. (A) T2-weighted coronal magnetic resonance image shows medial osteochondral lesion with subchondral cyst. (B) Sagittal image shows cystic lesion within 15。 posterior of talar dome apex. (C) Osteochondral lesion of talus after anterior arthrotomy approach. (D) Osteochondral autograft was transplanting into the lesion with 90。 to the articular surface. (E) Final radiograph shows loss of subchondral cyst and good union of osteochondral graft.
jkfas-21-139f2.tif
Table 1.
Patient Characteristics, Radiographic Findings and Clinical Outcomes
Case no. Sex/age (yr) Trauma history Diagnosis B&H stage Hepple stage Lesion site Lesion size (mm) With osteotmy With MBO AOFAS-preop AOFAS-last ROM-DF (。)
1 F/50 N OLT, CLAI 3 4 M 6×5 N Y 58 88 10
2 F/57 Y OLT, CLAI 4 5 M 6×6 Y Y 65 81 12
3 F/51 Y OLT, CLAI 4 5 M 8×6 Y Y 63 85 12
4 M/59 Y OLT 4 4 M 8×6 N Y 52 83 10
5 M/53 Y OLT 4 4 M, L M: 8×5, L: 6×4 N N 60 88 10
6 F/53 Y OLT, CLAI 4 5 L 8×5 N Y 72 96 10
7 F/59 N OLT 3 3 M 10×6 Y N 67 80 8
8 M/25 Y OLT 3 3 M 10×8 Y N 61 79 8
9 F/54 Y OLT 3 5 M 8×6 Y N 55 65 5
10 M/57 Y OLT 4 4 L 10×7 N N 68 92 10
11 M/58 Y OLT 3 4 M 8×7 Y N 62 79 8
12 M/26 N OLT 3 3 L 9×6 N N 64 89 12
13 M/35 Y OLT, CLAI 4 5 L 9×5 N Y 68 91 15
14 M/41 Y OLT 4 4 M 10×6 N N 62 83 10
15 M/37 Y OLT 3 3 L 12×8 N N 57 89 15
16 M/36 Y OLT, CLAI 4 5 M 8×6 Y Y 59 82 10
17 M/37 Y OLT 3 4 M 10×6 N N 60 88 10
18 M/50 Y OLT, CLAI 4 5 M 8×8 Y Y 57 78 8
19 M/42 Y OLT 3 3 M 10×7 N N 62 90 15
20 F/38 Y OLT 3 3 L 8×8 N N 52 87 10
21 F/45 N OLT, CLAI 4 5 M 8×6 Y Y 54 73 7
22 F/42 Y OLT 3 4 L 10×8 N N 70 88 12
23 F/47 Y OLT, CLAI 4 5 L 10×6 N Y 60 90 15
24 F/42 N OLT 4 5 M 11×7 N N 68 94 14

F: female, M: male (sex), N: no, Y: yes, OLT: osteochondral lesion of talus, CLAI: chronic lateral ankle instrability, B&H: Berndt and Harty, M: medial (lesion site), L: lateral, MBO: modified Broström operation, AOFAS: American Orthopaedic Foot and Ankle Society, preop: preoperative, ROM-DF: range of motion dorsiflexion.

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