Summary

Talar OsteoPeriostic grafting from the Iliac Crest (TOPIC) provides clinically effective outcomes for medial Osteochondral Lesions of the Talus (OLTs) at long-term follow-up.

Abstract

Background

Large Osteochondral Lesions of the Talus (OLTs) may be treated using osteochondral or osteoperiosteal autografting. However, osteochondral transplantation from the knee may result in donor-site moribidity in up to 35% of the patients. Therefore, the novel joint-sparing technique Talar OsteoPeriostic grafting from the Iliac Crest (TOPIC) has been developed to overcome this disadvantage by using an iliac crest autograft with concomitant overlying periosteal layer.
The TOPIC procedure has been shown to be effective at 2 years follow-up for osteochondral lesions of the medial talar dome. The aim of the present study is to prospectively evaluate the clinical, radiological and safety outcomes after 5 years of follow-up for patients who underwent the new TOPIC procedure for a medial OLT.

Methods

A prospective cohort study of patients who underwent the TOPIC procedure with a minimum follow-up of 5 years was conducted. The primary outcome was the Numeric Rating Scale (NRS) of pain during walking. Other clinical outcomes included the NRS during rest and stair climbing, all subscales of the Foot and Ankle Outcome Score (FAOS) and the Mental Component Summary (MCS) and Physical Component Summary (PCS) of the Short Form-36 (SF-36). In addition, the AOFAS ankle-hindfoot score was measured. All clinical outcomes were measured preoperatively and after 6 months, 1 year, 2 years and 5 years of follow-up. Computed tomography (CT) scans were performed preoperatively and postoperatively at 12 weeks, 1 year, 2 years and 5 years to assess osteotomy union, graft consolidation and graft cyst development. In addition, complications and hardware removal were evaluated.

Results

32 patients were assessed with 100% follow-up. The NRS of pain during walking improved from 7 [5-8] preoperatively to 2 [1-3] at 5-year follow-up (p < 0.001). The NRS during rest and stair climbing improved with 2 (p < 0.05) and 4 points (p < 0.001), respectively. All FAOS subscales improved significantly except for the FAOS symptoms subscale (48 to 61; n.s.). The SF-36 PCS improved (32 to 35; n.s.) and the MCS improved (39 to 47; p < 0.05). There was 100% union at the osteotomy site after 12 weeks and 100% of the graft showed consolidation at 1, 2 and 5 years postoperatively. No major complications occurred.

Conclusion

Osteoperiosteal autografting using the TOPIC procedure is an effective treatment option for large, complex osteochondral lesions of the medial talar dome, with durable results after more than 5 years of follow-up, as shown by this prospective series. The pain scores during walking improved from 7 points pre-operatively to 2 points at the 5-year post-operative follow-up thereby surpassing beyond clinically relevant changes.