Summary

While patients with and without calcaneal bone graft showed improvement, patients without calcaneal bone graft incorporation had significantly greater improvement in functional outcome scores. Whether these differences are due to graft incorporation or larger lesion size is unclear

Abstract

Introduction

Osteochondral lesions of the talus (OCLT) are common traumatic injuries that can be difficult to treat.
To date, long-term patient reported outcome measures (PROMs) of patients with particulated juvenile allograft cartilage
implantation with or without calcaneal autograft have not been compared.

Methods

From 2010-2012, thirteen patients with difficult to treat OCLTs underwent arthroscopic-assisted implantation of
particulated juvenile allograft cartilage (DeNovo NT®) with or without autogenous calcaneal bone grafting by a single
surgeon. Inclusion criteria included at least two of the following: 1) shoulder lesions, 2) lesion size >107mm2, 3) failed
previous microfracture treatment, or 4) age >40 with a Body Mass Index (BMI) >25kg/m2. Calcaneal bone graft use was
determined by lesion size >150mm2 and/or deeper than 5mm. Patients were fully evaluated using physical examination,
patient interviews, and PROMs. Pre-operative and post-operative PROMs were compared with a Mann Whitney test.

Results

When comparing patients in regards to calcaneal bone graft implantation, no difference in age (43.8±14.0 vs.
48.9±10.0yrs. respectively; p-value=0.667), BMI (28.4±6.7 vs. 29.5±4.5kg/m2 respectively; p-value=0.834), pre-operative
PROMs (pmin=0.110) or follow-up (100.8±14.6 vs. 107.7±11.3months respectively; p-value=0.153) was noted, however,
calcaneal bone graft patients did have a significantly larger lesion size (188.5±50.9 vs. 118.7±29.4mm2 respectively; pvalue=
0.027). VAS score final follow-up improvement did not significantly differ between cohorts (p-value=0.889), nor did
the FAAM ADL score (p-value=0.522). The FAAM Sports score improved significantly more for the DeNovo alone group
compared to the bone graft cohort (p-value=0.032). The AOFAS score improvement did not differ between cohorts (pvalue=
0.944), however, the SF-36 PCS improved significantly more for the DeNovo alone group compared to the bone
graft cohort (p-value=0.038). No intraoperative/perioperative complications were observed with calcaneal bone grafting.

Discussion And Conclusion

This is the first reported study to compare patient reported outcomes of particulated
juvenile allograft cartilage alone compared to particulated juvenile allograft cartilage with calcaneal bone autograft,
demonstrating positive post-operative, self-reported functional outcomes. While patients with and without calcaneal bone
graft showed improvement, patients without calcaneal bone graft incorporation had significantly greater improvement in
functional outcome scores. Whether these differences are due to graft incorporation or larger lesion size is unclear.