Autologous Osteochondral Transplantation for Large Osteochondral Lesions of the Talus Is a Viable Option in an Athletic Population

Abstract

Background: Autologous osteochondral transplantation (AOT) has been shown to be a viable treatment option for large osteochondral lesions of the talus. However, there are limited data regarding the management of large lesions in an athletic population, notably with regard to return to sport. Our investigation focused on assessing both qualitative and quantitative outcomes in the high-demand athlete with large (>150 mm2) lesions. Hypothesis: AOT is a viable option in athletes with large osteochondral lesions and can allow them to return to sport at their preinjury level. Study Design: Case series; Level of evidence, 4. Methods: The study population was limited to professional and amateur athletes (Tegner score, >6) with a talar osteochondral lesion size of 150 mm2 or greater. The surgical intervention was AOT with a donor site from the lateral femoral condyle. Clinical outcomes at a minimum of 24 months included return to sport, visual analog scale (VAS) for pain score, and Foot and Ankle Outcome Score (FAOS). In addition, graft incorporation was evaluated by magnetic resonance imaging (MRI) using MOCART (magnetic resonance observation of cartilage repair tissue) scores at 12 months after surgery. Results: A total of 38 athletes, including 11 professional athletes, were assessed. The mean follow-up was 45 months. The mean lesion size was 249 mm2. Thirty-three patients returned to sport at their previous level, 4 returned at a lower level compared with preinjury, and 1 did not return to sport (mean return to play, 8.2 months). The VAS improved from 4.53 preoperatively to 0.63 postoperatively ( P = .002). FAOSs improved significantly in all domains ( P < .001). Two patients developed knee donor site pain, and both had 3 osteochondral plugs harvested. Univariant analysis demonstrated no association between preoperative patient or lesion characteristics and ability to return to sport. However, there was a strong correlation between MOCART scores and ability to return to sport. The area under receiver operating characteristic of the MOCART score and return to play was 0.891 ( P = .005), with a MOCART score of 52.50 representing a sensitivity of 0.85 and specificity of 0.80 in determining ability to return to one’s previous level of activity. Conclusion: Our study suggests that AOT is a viable option in the management of large osteochondral talar defects in an athletic population, with favorable return to sport level, patient satisfaction, and FAOS/VAS scores. The ability to return to sport is predicated upon good graft incorporation, and further research is required to optimize this technique. Our data also suggest that patients should be aware of the increased risk of developing knee donor site pain when 3 osteochondral plugs are harvested.

Outcomes of arthroscopic bone graft transplantation for Hepple stage V osteochondral lesions of the talus

“…As patients with OLT with subchondral cysts greater than 6 mm in depth do not do well with conventional marrow stimulation techniques, autologous/allogeneic osteochondral or autologous chondrocyte transplantation is recommended (7,20). Although osteochondral autograft or allograft transplantation may be a reasonable option for Hepple stage V OLT (21), it still has problems such as undesirable donor site morbidity, which was reported in 16.9% of cases in the knee-to-ankle procedure (22), malunion, or non-union. Therefore, the objective of this study was to retrospectively evaluate the postoperative clinical scores and MRI findings of a novel method with calcaneus bone graft transplantation for patients with Hepple stage V OLT under arthroscopy.…”

Characteristics of Osteochondral Lesions of the Talus in Different Age Groups

“…OAT was used to treat the patients with large subchondral cysts. A number of studies have reported good to excellent outcomes of MF and OAT at a mid-term follow-up [27][28][29][30][31][32]. Besides the management of intraarticular lesions, lateral ligaments reconstruction was performed for the patients combined with CAI.…”

Osteochondral tissue engineering: Perspectives for clinical application and preclinical development

“…Osteochondral autograft transplantation (OAT) fills the defect site with osteochondral autograft collected from less weight-bearing portions of the joint, which may lead to donor site lesion [ 13 ]. In the case of large osteochondral lesion, in which multiple osteochondral autografts are necessary to fill the defect, the risk of donor site morbidity might increase with the number of used autologous osteochondral plugs [ 14 ].…”