2023 ISAKOS Biennial Congress ePoster
Favorable Long-Term Clinical And Radiologic Outcomes With High Survivorship After Autologous Osteochondral Transplantation of the Talus
Philipp Wilhelm Winkler, MD, Linz AUSTRIA
Stephanie Geyer, MD, Munich GERMANY
Daniela Walzl, MD, Munich GERMANY
Klaus Wörtler, MD, Prof., Munich, Bavaria GERMANY
Jochen Paul, Basel SWITZERLAND
Sebastian Siebenlist, MD, MHBA, Prof., Munich, Bavaria GERMANY
Andreas B. Imhoff, MD, Prof. Emeritus, Sauerlach / Munich, Bavaria GERMANY
Andrea E. Achtnich, Assoc. Prof., Munich GERMANY
Technical University of Munich, Munich, GERMANY
FDA Status Not Applicable
Summary
Autologous osteochondral transplantation is a safe and viable technique to treat osteochondral lesions of the talus, achieving high patient satisfaction, favorable patient-reported outcomes, and minimal limitations in athletic and working performance with a 20-year survival rate of almost 80%.
ePosters will be available shortly before Congress
Abstract
Background
Osteochondral lesions of the talus (OLT) represent debilitating injuries associated with early ankle deterioration and functional limitations.
Purpose
To evaluate long-term clinical and radiologic outcomes of patients undergoing autologous osteochondral transplantation (AOT) for OLT and to perform a correlation analysis between clinical and radiologic outcomes.
Methods
Patients undergoing AOT for OLT between 1997 and 2003 were screened for eligibility. Demographic, surgical, and injury-related data were collected. After a minimum 18-year follow-up, patient-reported outcome scores (PROs) were collected, including the American Orthopaedic Foot & Ankle Society (AOFAS) score, the Foot and Ankle Outcome Score (FAOS), Tegner Activity Scale, and Visual Analogue Scale (VAS) for pain of the ankle. The Lysholm Score and VAS for pain of the knee were collected to assess donor site morbidity. Magnetic resonance imaging scans were obtained to conduct an assessment of the replaced cartilage using the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) 2.0 scoring system. Any revision surgery (except symptomatic hardware removal and arthroscopic debridement) was defined as clinical failure. A Spearman’s rank-order correlation analysis was conducted to assess the relationship between radiologic and clinical outcomes. The Kaplan-Meier method was applied to evaluate the mean estimated time of survival. The level of significance was set at p < 0.05.
Results
Thirty-five patients with a mean age of 32.2 ± 8.9 years at the time of AOT were available for follow-up after an average of 19.1 ± 1.4 years. Favorable clinical and radiologic (MOCART score, 73.7 ± 16.7 points) outcomes without any donor site morbidities were observed. Twenty-three (65.7%) patients were satisfied or very satisfied with the surgical treatment. Fourteen (40.0%) and 25 (71.4%) patients had no or minor limitations in their athletic and working performance, respectively. A significant correlation between the MOCART and the FAOS Sport and Recreational activities subscale was found (rs, 0.491; p = 0.033). Six (17.1%) patients met the criteria for clinical failure an average of 12.2 ± 6.6 years after AOT. Survival analysis demonstrated a mean estimated time of survival of 21.3 years (95% CI [19.55, 22.96]) and a 20-year survival rate of 77.9%.
Conclusion
Autologous osteochondral transplantation is a safe and viable technique to treat OLT, achieving high patient satisfaction, favorable PROs, and an acceptable rate of limitations in athletic and working performance with a 20-year survival rate of almost 80%.