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

Foot & ankle specialist Pub Date : 2024-02-01 Epub Date: 2021-06-18 DOI:10.1177/19386400211009732
Suhas P Dasari, Thomas M Langer, Derek Parshall, Brian Law
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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.

用骨移植和颗粒状幼年软骨异体移植开放式治疗距骨骨软骨损伤。
背景:距骨大囊性骨软骨损伤(OLT)的治疗具有挑战性,但颗粒状幼年软骨异体移植(PJCA)辅以骨移植是一种很有前景的治疗方案。本项目旨在进一步阐明颗粒状幼年软骨异体移植(PJCA)与同时进行的骨自体移植在治疗大面积软骨下骨受累(面积大于 150 平方毫米和/或深度大于 5 毫米)的大面积囊性 OLT 中的作用:我们确定了 6 名患者,他们的平均 OLT 面积为 307.2 ± 252.4 平方毫米,平均病变深度为 10.85 ± 6.10 毫米,在 2013 年至 2017 年期间接受了 DeNovo PJCA 和骨自体移植手术。术后结果通过X光片、足踝结果评分(FAOS)和视觉疼痛量表评分进行评估:在最终随访(27.0 ± 12.59 周)时,所有患者的症状均有所改善,并在X光片上显示出移植物的融合。术后平均(62±20.88)个月,没有患者需要进行翻修手术。所有在2018年和2020年通过电话联系的患者都表示,回想起来他们会再次进行手术,并表示他们的症状相对于术前状态有所改善,尤其是疼痛和FAOS日常生活活动分项(2018年为91.93±9.04,2020年为74.63±26.86):PJCA与同时进行的骨自体移植是大囊性OLT患者的可行治疗方案:IV级
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