Open Treatment of Osteochondral Lesions of the Talus With Bone Grafting and Particulated Juvenile Cartilage Allografting

Abstract

Background: Large cystic osteochondral lesions of the talus (OLT) are challenging pathological conditions to treat, but particulated juvenile cartilage allografts (PJCAs) supplemented with bone grafts are a promising therapeutic option. The purpose of this project was to further elucidate the role of PJCA with concomitant bone autografts for treating large cystic OLTs with extensive subchondral bone involvement (greater than 150 mm2 in area and/or deeper than 5 mm). Methods: We identified 6 patients with a mean OLT area of 307.2 ± 252.4 mm2 and a mean lesion depth of 10.85 ± 6.10 mm who underwent DeNovo PJCA with bone autografting between 2013 and 2017. Postoperative outcomes were assessed with radiographs, Foot and Ankle Outcome Scores (FAOS), and visual pain scale scores. Results: At final follow-up (27.0 ± 12.59 weeks), all patients had symptomatic improvement and incorporation of the graft on radiographs. At an average of 62 ± 20.88 months postoperatively, no patients required a revision surgery. All patients contacted by phone in 2018 and 2020 reported they would do the procedure again in retrospect and reported an improvement in their symptoms relative to their preoperative state, especially with pain and in the FAOS activities of daily living subsection (91.93 ± 9.04 in 2018, 74.63 ± 26.86 in 2020). Conclusion: PJCA with concomitant bone autograft is a viable treatment option for patients with large cystic OLTs. Levels of Evidence: Level IV

Particulated juvenile cartilage allograft for the treatment of osteochondral lesions of the talus is associated with a high complication rate and a high failure rate at short‐term follow‐up: A systematic review

“…Study characteristics and patient demographic data are listed in Table 2. Two studies were LOE II [22, 26] and 10 studies were LOE IV [6, 8–11, 16, 18, 21, 27, 34]. There were three studies with a serious risk of bias [9, 10, 18] and nine studies with a moderate risk of bias [6, 8, 11, 16, 21, 22, 26, 27, 34] (Figure 2).…”

“…Two studies were LOE II [22,26] and 10 studies were LOE IV [6, 8-11, 16, 18, 21, 27, 34]. There were three studies with a serious risk of bias [9,10,18] and nine studies with a moderate risk of bias [6,8,11,16,21,22,26,27,34] (Figure 2). In total, 241 patients (242 ankles) underwent PJCA for the treatment of OLT.…”

“…The weighted mean age was 36.4 ± 5.3 years (range, 31.5−46.9) and 115 patients (53.9%) were male. There were 23 right ankles (53.4%) recorded in four studies [8,9,27,34]. The weighted mean BMI was 29.0 ± 3.1 kg/m 2 (range 28.0−37.2).…”

Validation of the Foot and Ankle Outcome Score (FAOS) for Osteochondral Lesions of the Ankle

“…The FAOS was designed as a pure patient-reported assessment in order to avoid observer bias. A Likert scale is used to rate each question as none (0), mild (1), moderate (2), severe (3), or extreme (4). The resultant score for each subscale is determined through summation of each item and normalization to a subscale score reported from 0 (worst) to 100 (best) using a formula uniquely devised for this assessment; there is no overall FAOS score.…”

“…Patient-reported outcome (PRO) measures have become the standard by which patient health, quality of life, and functional status are assessed, tracked, and compared following treatment for a specific disease. However, despite the utilization of a litany of PRO instruments for ankle OLTs, 4,10,21,28 none have been validated for this pathology. In addition, no validated outcome radiographic parameter has been described to date.…”