Talar Osteo-Periostic grafting from the Iliac Crest (TOPIC): 1-year Results of a New Press-fit Surgical Treatment for Large Talar Osteochondral Defects

Abstract

Category: Ankle Introduction/Purpose: The purpose of this study was to present the surgical technique and to evaluate the short-term clinical and radiological outcomes of a new press-fit OATS technique for large primary and secondary talar osteochondral defects of the talus, Talar OsteoPeriostic grafting from the Iliac Crest (TOPIC). Methods: Twenty-eight underwent a press-fit TOPIC procedure. Mean age was 38 years (SD 4.6). Pre- and postoperative clinical assessment at 12 months follow-up included the American Orthopaedic Foot & Ankle Society (AOFAS) score, the Short-Form 36 (SF-36) Mental Component Scale (MCS) and Physical Component Scale (PCS), the Numeric Rating Scales (NRS) of pain at rest, during walking and stairclimbing, and the Foot and Ankle Outcome Score (FAOS) including accompanying subscales. Remodeling of the contour of the talus, bone ingrowth and consolidation of the implanted graft were assessed on computed tomography (CT) one year post-operatively. Results: 28 out of 29 patients were available for follow up. The AOFAS significantly improved from 45 to 92 (p=0.001). The NRS on pain during rest improved from 3 to 0 (p=0.001), the NRS during walking improved from 5 to 1 and the NRS during stairclimbing also improved from 5 to 1 (p=0.001). Both components of the SF-36 improved. The PCS improved from 34 to 47 (p=0.001) and the MCS improved from 37 to 66 (p=0.001). Finally all FAOS subscales significantly improved. All patients were satisfied with the procedure and indicated that the level of functioning was good or very good. On the post-operative CT scans, all patients showed remodeling of the talus and all grafts showed consolidation as well as bone ingrowth. No complications occurred. Conclusion: The TOPIC procedure appears to be a very promising surgical treatment option for large primary and secondary talar OCDs. Despite these good short-term clinical and radiological outcomes, a prospective study with longer follow-up is necessary to assess the clinical outcome and the progression of osteoarthritis at the long term.

Osteochondral lesions of the talus

“…Even though the OATS procedure is regarded as an effective surgical management option with success rates up to 90% reported in the literature, donor‐site morbidity has been reported to occur relatively frequently with incidence rates ranging from 11 to 35% when the graft was harvested from the ipsilateral femoral condyle [3, 11]. As an alternative to an OATS procedure harvesting the graft from the knee, an autologous osteoperiosteal graft can be harvested from the iliac crest [2, 6, 8]. Matrix‐associated stem cell transplantation (MAST) is a good alternative treatment that does not have the limitation of donor‐site morbidity.…”