Comparison of Autologous Osteoperiosteal and Osteochondral Transplantation for the Treatment of Large,Medial Cystic Osteochondral Lesions of the Talus

Abstract

Background:

Autologous osteoperiosteal transplantation (AOPT) using graft harvested from the iliac crest is used to treat large cystic osteochondral lesions of the talus (OLTs). However, no studies have compared clinical and radiologic outcomes between AOPT and autologous osteochondral transplantation (AOCT) using graft harvested from the nonweightbearing zone of the femoral condyle of the ipsilateral knee in patients with large cystic OLTs.

Purpose:

To compare clinical and radiologic outcomes between patients undergoing AOPT and those undergoing AOCT for large cystic OLTs.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

Between March 2015 and March 2018, patients who underwent AOCT and AOPT to treat medial large cystic OLTs (>10 mm) were retrospectively evaluated. For comparability, the 2 groups were matched 1:1 based on their characteristics, including sex, age, body mass index, side of injury, follow-up period, and the preoperative cyst volume. After propensity score matching, 23 patients were enrolled in each group for the analysis. Clinical outcomes were assessed using the visual analog scale (VAS), the American Orthopaedic Foot & Ankle Society (AOFAS) score, and the Tegner score. Donor-site morbidity was recorded according to the symptoms, including pain, stiffness, swelling, and discomfort. In addition, the Lysholm score was used to assess the most common knee donor-site morbidity. Radiologic outcomes were evaluated using the magnetic resonance observation of cartilage repair tissue (MOCART) score, and the International Cartilage Regeneration & Joint Preservation Society (ICRS) score was obtained during second-look surgery.

Results:

The mean follow-up period was about 48 months. There were no significant differences in patient characteristics and lesion volumes between groups. Postoperative ankle pain VAS score, AOFAS score, and Tegner score were not significantly different between groups at final follow-up. Total donor-site morbidity (P = .004) and discomfort morbidity (P = .009) were significantly lower in the AOPT group than in the AOCT group. However, the Lysholm score showed no significant difference between the donor knee and the opposite knee (P = .503) in the AOCT group. The MOCART and ICRS scores were not significantly different between groups.

Conclusion:

Clinical and radiologic outcomes of patients who underwent AOPT from the iliac crest were found to be comparable with those of patients who underwent AOCT from the ipsilateral knee for the treatment of medial large cystic OLTs. These results may be helpful for orthopaedic surgeons to decide appropriate treatments for patients with large cystic OLTs.

Keywords

osteochondral lesions of the talus (OLT)autologous osteoperiosteal transplantation (AOPT)autologous osteochondral transplantation (AOCT)large cystic OLTs

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References

Al-Shaikh

Chou

Mann

Dreeben

Prieskorn

. Autologous osteochondral grafting for talar cartilage defects. Foot Ankle Int. 2002;23(5):381-389.

Bai

Guan

Liu

, et al. Clinical outcomes of osteochondral lesions of the talus with large subchondral cysts treated with osteotomy and autologous chondral grafts: minimum 2-year follow-up and second-look evaluation. Orthop J Sports Med. 2020;8(7):2325967120937798.

Brittberg

Winalski

. Evaluation of cartilage injuries and repair. J Bone Joint Surg Am. 2003;85(suppl 2):58-69.

Chen

Tang

Yuan

Zhou

Tao

. Intermediate results of large cystic medial osteochondral lesions of the talus treated with osteoperiosteal cylinder autografts from the medial tibia. Arthroscopy. 2015;31(8):1557-1564.

Choi

Park

Kim

Lee

. Osteochondral lesion of the talus: is there a critical defect size for poor outcome? Am J Sports Med. 2009;37(10):1974-1980.

Choi

Potter

Chun

. MR imaging of cartilage repair in the knee and ankle. Radiographics. 2008;28(4):1043-1059.

Chuckpaiwong

Berkson

Theodore

. Microfracture for osteochondral lesions of the ankle: outcome analysis and outcome predictors of 105 cases. Arthroscopy. 2008;24(1):106-112.

Dekker

Tainter

Easley

Adams

. Treatment of osteochondral lesions of the talus: a critical analysis review. JBJS Rev. 2017;5(3):e4.

Elias

Zoga

Morrison

, et al. Osteochondral lesions of the talus: localization and morphologic data from 424 patients using a novel anatomical grid scheme. Foot Ankle Int. 2007;28(2):154-161.

10.

Flynn

Ross

Hannon

, et al. Autologous osteochondral transplantation for osteochondral lesions of the talus. Foot Ankle Int. 2016;37(4):363-372.

11.

Gobbi

Francisco

Lubowitz

Allegra

Canata

. Osteochondral lesions of the talus: randomized controlled trial comparing chondroplasty, microfracture, and osteochondral autograft transplantation. Arthroscopy. 2006;22(10):1085-1092.

12.

Grässel

Rickert

Opolka

, et al. Coculture between periosteal explants and articular chondrocytes induces expression of TGF-beta1 and collagen I. Rheumatology (Oxford, England). 2010;49(2):218-230.

13.

Hannon

Bayer

Murawski

, et al. Debridement, curettage, and bone marrow stimulation: Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle. Foot Ankle Int. 2018;39:16S-22S.

14.

Guo

Jiao

, et al. Treatment of large cystic medial osteochondral lesions of the talus with autologous osteoperiosteal cylinder grafts. Arthroscopy. 2013;29(8):1372-1379.

15.

Kerkhoffs

Altink

Stufkens

SAS

Dahmen

. Talar OsteoPeriostic grafting from the Iliac Crest (TOPIC) for large medial talar osteochondral defects: operative technique. Oper Orthop Traumatol. 2021;33(2):160-169.

16.

Lee

Kim

. Simultaneous osteoperiosteal autologous iliac crest graft and lateral meniscus allograft transplantation for osteochondral lesion with bony defect and lateral discoid meniscus tear. Knee Surg Relat Res. 2016;28(2):165-171.

17.

McCollum

Myerson

Jonck

. Managing the cystic osteochondral defect: allograft or autograft. Foot Ankle Clin. 2013;18(1):113-133.

18.

Nguyen

Ramasamy

Walsh

McMenemy

Calder

JDF

. Autologous osteochondral transplantation for large osteochondral lesions of the talus is a viable option in an athletic population. Am J Sports Med. 2019;47(14):3429-3435.

19.

Park

Hwang

Han

, et al. Primary versus secondary osteochondral autograft transplantation for the treatment of large osteochondral lesions of the talus. Am J Sports Med. 2018;46(6):1389-1396.

20.

Paul

Sagstetter

Lämmle

, et al. Sports activity after osteochondral transplantation of the talus. Am J Sports Med. 2012;40(4):870-874.

21.

Raikin

. Fresh osteochondral allografts for large-volume cystic osteochondral defects of the talus. J Bone Joint Surg Am. 2009; 91(12):2818-2826.

22.

Ramponi

Yasui

Murawski

, et al. Lesion size is a predictor of clinical outcomes after bone marrow stimulation for osteochondral lesions of the talus: a systematic review. Am J Sports Med. 2017; 45(7):1698-1705.

23.

Reddy

Pedowitz

Parekh

Sennett

Okereke

. The morbidity associated with osteochondral harvest from asymptomatic knees for the treatment of osteochondral lesions of the talus. Am J Sports Med. 2007;35(1):80-85.

24.

Rikken

QGH

Kerkhoffs

. Osteochondral lesions of the talus: an individualized treatment paradigm from the Amsterdam perspective. Foot Ankle Clin. 2021;26(1):121-136.

25.

Samuelson

Brown

. Cost-effectiveness analysis of autologous chondrocyte implantation: a comparison of periosteal patch versus type I/III collagen membrane. Am J Sports Med. 2012; 40(6):1252-1258.

26.

Savage-Elliott

Smyth

Deyer

, et al. Magnetic resonance imaging evidence of postoperative cyst formation does not appear to affect clinical outcomes after autologous osteochondral transplantation of the talus. Arthroscopy 2016;32(9):1846-1854.

27.

Saxena

Eakin

. Articular talar injuries in athletes: results of microfracture and autogenous bone graft. Am J Sports Med. 2007; 35(10):1680-1687.

28.

Seow

Shimozono

Gianakos

, et al. Autologous osteochondral transplantation for osteochondral lesions of the talus: high rate of return to play in the athletic population. Knee Surg Sports Traumatol Arthrosc. 2021;29(5):1554-1561.

29.

Shim

Park

Lee

, et al. Primary autologous osteochondral transfer shows superior long-term outcome and survival rate compared with bone marrow stimulation for large cystic osteochondral lesion of talus. Arthroscopy 2021;37(3):989-997.

30.

Shimozono

Hurley

Nguyen

Deyer

Kennedy

. Allograft compared with autograft in osteochondral transplantation for the treatment of osteochondral lesions of the talus. J Bone Joint Surg Am. 2018;100(21):1838-1844.

31.

Shimozono

Seow

Yasui

Fields

Kennedy

. Knee-to-talus donor-site morbidity following autologous osteochondral transplantation: a meta-analysis with best-case and worst-case analysis. Clin Orthop Relat Res. 2019;477(8):1915-1931.

32.

Sung

Jeong

Lim

, et al. Periosteal autograft for articular cartilage defects in dogs: MR imaging and ultrasonography of the repair process. Acta Radiol. 2011;52(2):181-190.

33.

Thompson

Roukis

. Osteochondral lesions of the talar dome. Clin Podiatr Med Surg. 2020;37(3):533-551.

34.

Weigelt

Hartmann

Pfirrmann

Espinosa

Wirth

. Autologous matrix-induced chondrogenesis for osteochondral lesions of the talus: a clinical and radiological 2- to 8-year follow-up study. Am J Sports Med. 2019;47(7):1679-1686.

35.

Yoon

Park

Lee

Choi

Lee

. Osteochondral autologous transplantation is superior to repeat arthroscopy for the treatment of osteochondral lesions of the talus after failed primary arthroscopic treatment. Am J Sports Med. 2014;42(8):1896-1903.