Long-term Follow-up of Revision Osteochondral Allograft Transplantation of the Ankle

Gaul, Florian; Tírico, Luis Eduardo Passarelli; McCauley, Julie C.; Bugbee, William D.

doi:10.1177/1071100717750578

Cited by 19 publications

(8 citation statements)

References 25 publications

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“…However, the long-term survival rate and functional outcome were not predictable. 8,10 In our cohort, comminution in the anterolateral region or at the front edge frequently consisted of smaller fragments that were hard to effectively reduce and fix. Therefore, most of the defects were found to be located in the anterolateral region and at the front edge, after removal of the tiny irreducible fragments.…”

Section: Discussionmentioning

confidence: 83%

“…However, the long-term outcome was rather unpredictable, even though good results were achieved in some patients. 8,10…”

Section: Introductionmentioning

confidence: 99%

“…However, the long-term outcome was rather unpredictable, even though good results were achieved in some patients. 8,10 The present study aimed to improve the long-term therapeutic outcome by preserving the ankle joint with osteochondral autograft transplantation for young patients with relatively early posttraumatic arthritis after AO/OTA type C3 pilon fractures.…”

Section: Introductionmentioning

confidence: 99%

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Autologous Osteochondral Graft for Early Posttraumatic Arthritis of Tibiotalar Joints After Comminuted Pilon Fractures in Young Patients

Liu

Zhang

et al. 2019

Foot Ankle Int.

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Background: Posttraumatic arthritis of tibiotalar joints after AO/OTA type C3 pilon fractures, especially in young patients with a significant osteochondral defect in the tibial plafond joint surface, is a challenging situation. We report a joint-preserving technique using autologous osteochondral graft in combination with ankle distraction and supramalleolar osteotomy (SMOT), if necessary, to improve its outcome. Methods: Seventeen patients with an average age of 32.1 years with Takakura grade 1 to 3A posttraumatic arthritis of the tibiotalar joint after AO/OTA type C3 pilon fractures received osteochondral autograft transplantation, ankle distraction, and SMOT, when supramalleolar malalignment was present, between February 2010 and November 2015. The visual analog scale (VAS), Short-Form 36 (SF-36) score, American Orthopaedic Foot & Ankle Society (AOFAS) score, and ankle range of motion were used for outcome analysis. Radiographic assessment of any SMOT and the apparent joint space was performed. Fourteen patients were followed for an average of 18 months. Results: The VAS, SF-36, and AOFAS scores as well as the ankle range of motion all improved significantly at the last follow-up after the surgery ( P < .01). No deep surgical site infection, donor site complication, nonunion, osteochondral block loosening, or resorption was noted. No secondary arthrodesis was needed at the end of follow-up. Conclusion: Autologous osteochondral graft transplantation in combination with ankle distraction and SMOT was a promising joint-preserving technique for early posttraumatic arthritis of tibiotalar joint after severe pilon fractures in young patients. Level of Evidence: Level IV, case series.

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Section: Discussionmentioning

confidence: 83%

“…However, the long-term outcome was rather unpredictable, even though good results were achieved in some patients. 8,10…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Autologous Osteochondral Graft for Early Posttraumatic Arthritis of Tibiotalar Joints After Comminuted Pilon Fractures in Young Patients

Liu

Zhang

et al. 2019

Foot Ankle Int.

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“…Additionally, revision OCA has an encouraging survival rate of 65% at 10 years. 10 In the present study, we report outcomes of AA and TAA as salvage procedures after primary failed ankle OCA. The comparison of our data with the existing literature is difficult because no outcome data are available for these procedures.…”

Section: Discussionmentioning

confidence: 94%

“…Revision OCA of the ankle appears to have similar clinical outcomes as primary OCA transplantations, with high failure rates (~30%) and promising survivorship of 65% at 10 years. 10 No clinical outcome data is available for ankle arthrodesis (AA) or total ankle arthroplasty (TAA) as a salvage procedure after primary failed ankle OCA. Performed as primary procedures, these operations have lower failure and revision rates in comparison to OCA transplantations.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of Salvage Arthrodesis and Arthroplasty for Failed Osteochondral Allograft Transplantation of the Ankle

et al. 2019

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Background: Osteochondral allograft (OCA) transplantation is a useful treatment for posttraumatic ankle arthritis in young patients, but failure rates are high and reoperations are not uncommon. The aim of this study was to evaluate the outcomes of failed ankle OCA transplantation converted to ankle arthrodesis (AA) or total ankle arthroplasty (TAA). Methods: We evaluated 24 patients who underwent salvage procedures (13 AA and 11 TAA) after primary failed ankle OCA transplantation. Reoperations were assessed. Failure of the salvage procedure was defined as an additional surgery that required a revision AA/TAA or amputation. Evaluation among nonfailing ankles included the American Academy of Orthopaedic Surgeons Foot and Ankle Module (AAOS-FAM), pain, and satisfaction. Results: In the salvage AA cohort, 3 patients were classified as failures (2 revision AA and 1 amputation). The 10 nonfailing patients had a mean follow-up of 7.4 years. Eighty-eight percent were satisfied with the procedure, but 63% reported continued problems with their ankle (eg, pain, swelling, stiffness). Mean pain level was 1.9 and AAOS-FAM core score was 83±13. In the salvage TAA cohort, 2 patients were classified as failures (both revision TAA). The 9 nonfailing patients had a mean follow-up of 3.8 years. Fifty percent were satisfied with the procedure, but 40% reported continued problems with their ankle. The mean pain level was 1.3, and the median AAOS-FAM core score was 82±26. Conclusion: Revision and reoperation rates for salvage procedures following failed OCA transplantation of the ankle are higher compared to published data for primary AA and TAA procedures. However, we believe OCA transplantation can serve as an interim procedure for younger patients with advanced ankle joint disease who may not be ideal candidates for primary AA or TAA at the time of initial presentation. Level of Evidence: Level IV, case series.

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Cartilage Pathology and Repair: Fresh Allografts

Gaul

Tírico

Bugbee

2020

Lower Extremity Joint Preservation

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Long-term Follow-up of Revision Osteochondral Allograft Transplantation of the Ankle

Abstract: Level IV, case series.

Cited by 19 publications

References 25 publications

Autologous Osteochondral Graft for Early Posttraumatic Arthritis of Tibiotalar Joints After Comminuted Pilon Fractures in Young Patients

Autologous Osteochondral Graft for Early Posttraumatic Arthritis of Tibiotalar Joints After Comminuted Pilon Fractures in Young Patients

Outcomes of Salvage Arthrodesis and Arthroplasty for Failed Osteochondral Allograft Transplantation of the Ankle

Cartilage Pathology and Repair: Fresh Allografts

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