Treatment of talar osteochondral lesions using local osteochondral talar autograft mid term results
Background Osteochondral lesion of the talus (OLT) is a broad term used to describe an injury or abnormality of the talar articular cartilage and adjacent bone. A variety of treatment methods exist for OLT. The use of local Osteochondral talar autograft is an established treatment method for such articular cartilage defects. We present a series of patients treated this way for osteochondral defects of the ankle, and assess the functional and clinical long-term results.
Materials and methods From March 2005 to December 2008, 11 patients underwent implantation of local osteochondral talar autograft for OLT, 6 male and 5 female. The graft was harvested from the medial or lateral talar articular facet on the same side of the lesion. Graft sizes ranged from 4 to 8 mm in diameter. Age ranged from 19 to 53 (mean 38) years. Sports related injury concerned eight patients and the duration of symptoms was mean 65 months (range 6–98). Mean follow-up was 41 months (range 16–61). Preoperative and postoperative results evaluated used the American Orthopaedic Foot & Ankle Society (AOFAS) score. Special diagnostics studies performed preoperative, MRI (11 patients), computed axial tomography (11 patients), bone scan 2 patients and weight-bearing radiographs to all of them to evaluate the injury.
Results All osteotomies healed. The AOFAS average score improved from mean 65 pre- to 89 postop. The AOFAS score was slightly higher in patients under 40 years of age and in those without pre-existing joint arthritis. Concerned satisfaction all the patients would have the procedure again. The most common post op complaint was a mold ache at anteromedial joint line of the ankle. There were no complications in the study group. Most returned to pre injury level of activity. Two patients had a second look arthroscopy one 6 and one 12 months post because of impingement of lateral malleolus the first and debridement of anterior tibial margin the second. Both of them had incorporation of the graft into the surrounding talar dome cartilage.
Conclusion We believe treatment of talar osteochondral lesions using local osteochondral talar autograft is a reliable treatment method. The long-term results confirm that it is a well-accepted procedure from the patients with no high risk of complications compared to other procedures.