2023 ISAKOS Biennial Congress ePoster
Autologous Bone Grafting With Periosteum Transfer For Treatment Of Large Talar Osteochondral Defects
Dimitrios Nikolopoulos, PhD, Athens GREECE
George Safos, MD, Athens GREECE
Petros Safos, MD, Ikaria GREECE
Konstantinos Moustakas, MD, megara attikis, MORAVA 16 STREET GREECE
Neoptolemos Sergides, MD, Athens, Attiki GREECE
ΜΠΟΝΑΤΣΟΣ ΣΠΥΡΙΔΩΝ, GALATSI, ATTIKI GREECE
Central Clinic of Athens, Athens, GREECE
FDA Status Cleared
Summary
Large talus osteochondral lesions can be challenging to treat, as the damaged articular cartilage has a poor intrinsic reparative capability; and secondly because cause chronic pain and serious disability. Our objective is to evaluate efficiency and effectiveness of autologous cancellous graft transplantation from proximal tibial metaphysis in the treatment of large talar osteochondral defects.
ePosters will be available shortly before Congress
Abstract
Purpose
Large talus osteochondral lesions can be challenging to treat, as the damaged articular cartilage has a poor intrinsic reparative capability; and secondly because cause chronic pain and serious disability. Our objective is to evaluate efficiency and effectiveness of autologous cancellous graft transplantation from proximal tibial metaphysis in the treatment of large talar osteochondral defects (>400mm2) in adults.
Materials And Methods
From January 2010 to January 2021, 55 patients (24 males, 31females), of mean age 33.6 years old (range; 18 to 72) were operated for large talar osteochondral lesions (7 lateral and 48 posteromedial). The surgical steps followed were: (1) chevron medial or lateral malleolar osteotomy, (2) excision of the necrotic sequestrum and curetting the crater to bleeding bone, (3) autologous cancellous graft transferring from the proximal tibial metaphysis and (4) tibia periosteum transfix over the talus lesion (5) reduction and internal fixation of the osteotomy. The post-operative regime included a 1-month period of non-weight-bearing, following by partial weight bearing for the next 2 months. Preoperative ankle X-rays, CT and MRI scan were performed. Preoperative and postoperative clinical evaluation was performed at 1 and 2 years based on the VAS, the ankle ROM, the American Orthopaedic Foot and Ankle Society (AOFAS) scores and the Foot & Ankle Disability Index (FADI). The patients were followed-up for an average of 3 years (range; 1-5 years).
Results
The VAS score were statistically significant improved from an M=7.7 (5-9) pre- to M=1.1 (0-2) in 6 months post- and to M=0.4 (0-2) in 1 year post-operatively (p<0,001). The AOFAS and FADI scores were statistically significant improved from an M=40.3 (18-55) and M=53.3 (44-63) pre- to M=95 (85-100) and M=93.2 (89-99) post-operative in 1 year, and to M=95 (85-100) and M=93.2 (89-99) post-operative in 2 years, respectively (p<0,001). There were improvement on patients’ AOFAS and FADI scores from 1 to 2 years; but without to be a statistical significant difference.
At last follow-up there were 46 patients (88,5%) with excellent and very good results and 6 (11,5%) with good based on AOFAS score. 48 patients were active at the same level as prior to talar defect, whereas 4 dropped to a lower activity level. Based on last post-operative X-rays and MRIs follow-up in 6/52 of patients observed residual chondral lesion (less than 20% of the initial defect); but with limited clinical symptoms.
Conclusion
Autologous cancellous graft transplantation with periosteum is a very promising surgical procedure to treat large osteochondral lesions of the ankle joint.