{"title":"Medial vs. Anterior Malleolar Osteotomy in Osteochondral Autologous Transplantation for Hepple V Talar Lesions: A Retrospective Study.","authors":"Lu Bai, Sanbiao Liu, Yuxin Yan, Jianjing Lin, Sumeng Chen, Xintao Zhang","doi":"10.1016/j.otsr.2025.104332","DOIUrl":null,"url":null,"abstract":"<p><strong>Aims: </strong>To compare clinical outcomes in patients with talar Osteochondral lesions (OLTs) treated with medial malleolar osteotomy (MMO) or anterior malleolar osteotomy (AMO) combined with Osteochondral autologous transplantation (OAT).</p><p><strong>Methods: </strong>From May 2014 to May 2020, 39 patients with Hepple V OLTs underwent MMO (n = 22) or AMO (n = 19). Functional outcomes were assessed using the American Orthopaedic Foot and Ankle Society ankle-hindfoot scale (AOFAS) and Visual Analog Scale (VAS) pain scores. Magnetic Response Observation of Cartilage Repair Tissues (MOCART) score was used for radiological evaluation. Second-look arthroscopy and hardware removal were performed 2 years postoperatively. International Cartilage Repair Society (ICRS) scores were used to assess cartilage quality at the graft and osteotomy sites.</p><p><strong>Results: </strong>There was no significant difference in the occurrence of surgical complications (P = 0.581) between groups. AOFAS, VAS and ICRS scores were significantly improved during follow-up in patients who underwent MMO or AMO (P < 0.01). At the 1-year follow-up, the AOFAS score (92.5±3.3 vs. 89.2±4.9, t = 2.53 P = 0.02) and MOCART score (67.0±3.7 vs. 63.0±8.5, t = 2.14, P = 0.048) were significantly higher in patients who underwent MMO vs. AMO (t = 2.53 P = 0.02). There was no significant difference in AOFAS scores at the 2-year follow-up (MMO, 94.0±4.0 vs. AMO, 91.5±5.5, t = 1.63 P = 0.11); however, the VAS pain score (0.3±0.5 vs. 0.8±0.9, t = 2.53 P = 0.02) was significantly lower and MOCART score (69.3±5.0 vs. 64.1±7.5, t = 2.59 P = 0.013) was significantly higher in patients who underwent MMO vs. AMO. Second-look arthroscopy revealed superior cartilage quality at the osteotomy site in patients who underwent MMO vs. AMO (χ<sup>2</sup> = 22.826 P < 0.05), but no significant difference at the graft site (χ<sup>2</sup> = 6.049 P = 0.327).</p><p><strong>Conclusion: </strong>Both MMO and AMO combined with OAT can achieve good clinical outcomes for Hepple V OLTs; however, better pain relief and cartilage repair at the osteotomy site at 2-years of follow-up indicate that MMO may be the best choice.</p><p><strong>Level of evidence: </strong>III; Retrospective Comparative Study.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104332"},"PeriodicalIF":2.2000,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Orthopaedics & Traumatology-Surgery & Research","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.otsr.2025.104332","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0
Abstract
Aims: To compare clinical outcomes in patients with talar Osteochondral lesions (OLTs) treated with medial malleolar osteotomy (MMO) or anterior malleolar osteotomy (AMO) combined with Osteochondral autologous transplantation (OAT).
Methods: From May 2014 to May 2020, 39 patients with Hepple V OLTs underwent MMO (n = 22) or AMO (n = 19). Functional outcomes were assessed using the American Orthopaedic Foot and Ankle Society ankle-hindfoot scale (AOFAS) and Visual Analog Scale (VAS) pain scores. Magnetic Response Observation of Cartilage Repair Tissues (MOCART) score was used for radiological evaluation. Second-look arthroscopy and hardware removal were performed 2 years postoperatively. International Cartilage Repair Society (ICRS) scores were used to assess cartilage quality at the graft and osteotomy sites.
Results: There was no significant difference in the occurrence of surgical complications (P = 0.581) between groups. AOFAS, VAS and ICRS scores were significantly improved during follow-up in patients who underwent MMO or AMO (P < 0.01). At the 1-year follow-up, the AOFAS score (92.5±3.3 vs. 89.2±4.9, t = 2.53 P = 0.02) and MOCART score (67.0±3.7 vs. 63.0±8.5, t = 2.14, P = 0.048) were significantly higher in patients who underwent MMO vs. AMO (t = 2.53 P = 0.02). There was no significant difference in AOFAS scores at the 2-year follow-up (MMO, 94.0±4.0 vs. AMO, 91.5±5.5, t = 1.63 P = 0.11); however, the VAS pain score (0.3±0.5 vs. 0.8±0.9, t = 2.53 P = 0.02) was significantly lower and MOCART score (69.3±5.0 vs. 64.1±7.5, t = 2.59 P = 0.013) was significantly higher in patients who underwent MMO vs. AMO. Second-look arthroscopy revealed superior cartilage quality at the osteotomy site in patients who underwent MMO vs. AMO (χ2 = 22.826 P < 0.05), but no significant difference at the graft site (χ2 = 6.049 P = 0.327).
Conclusion: Both MMO and AMO combined with OAT can achieve good clinical outcomes for Hepple V OLTs; however, better pain relief and cartilage repair at the osteotomy site at 2-years of follow-up indicate that MMO may be the best choice.
Level of evidence: III; Retrospective Comparative Study.
期刊介绍：
Orthopaedics & Traumatology: Surgery & Research (OTSR) publishes original scientific work in English related to all domains of orthopaedics. Original articles, Reviews, Technical notes and Concise follow-up of a former OTSR study are published in English in electronic form only and indexed in the main international databases.
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