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Abstract

Background:

The results of the Talar OsteoPeriostic grafting from the Iliac Crest (TOPIC) procedure for lateral osteochondral lesions of the talus (OLTs) are unknown. Therefore, the present prospective study aims to assess the numeric rating scale (NRS) of pain during walking at 2-year follow-up. Secondarily, the aim is to assess other clinical, radiologic, and safety outcomes.

Methods:

This is a single-center, nonrandomized prospective cohort study in which all press-fit lateral TOPIC patients for an OLT are included. Patients with a follow-up of at least 2 years without a concomitant osteochondral lesion of the tibial plafond were included. The primary outcome is the NRS of pain during walking. Secondary clinical outcomes included the NRS during rest and during stair climbing. Additionally, the Foot and Ankle Outcome Score (FAOS), the AOFAS ankle-hindfoot score, and the mental and physical component summary of the 36-Item Short Form Health Survey were recorded. Radiologic follow-up was performed using computed tomography (CT) scans.

Results:

After application of the inclusion and exclusion criteria, 7 patients were included in the present study. The median age at time of surgery was 31.1 years. The NRS of pain during walking improved from a median of 5 (4-7) preoperatively to 1 (0-1) at 2 years of follow-up (P = .02). All FAOS subscales improved significantly, except the FAOS symptoms subscale. Graft consolidation was observed in 100% of the patients and cysts were present in 5 of 6 patients. No complications occurred and no patients complained of donor site morbidity. No reoperations were performed.

Conclusion:

Keywords

osteochondral lesion talus ankle foot TOPIC osteochondral autograft periosteal graft

Level of Evidence: Level IV, therapeutic.

Introduction

Osteochondral lesions of the talus (OLTs) are lesions of both the cartilage and underlying subchondral bone plate. These lesions have a profound impact on the quality of life of patients.⁸ Patients often complain of deep ankle pain during activity. To treat these patients, several options are available, both operatively and nonoperatively. No consensus exists on the best treatment, and thus is the treatment decision made based on both patient and lesion characteristics).^9,18,25 Lesions are primarily treated nonoperatively. If this fails, operative treatment is usually indicated. Small primary lesions can be treated using (arthroscopic) bone marrow stimulation techniques.⁶ In case of a fragmentary lesion, fixation is advised to be used (eg, using the Lift, Drill, Fill, and Fix technique).^17,24 However, for larger symptomatic (non-)primary lesions, more invasive techniques are often needed such as osteochondral auto- or allograft transplantation.^16,34

An example of osteoperiosteal transplantation is using a press-fit autograft from the ipsilateral technique, named Talar OsteoPeriostic grafting from the Iliac Crest (TOPIC). For medial osteochondral lesions of the talus, good to excellent clinical, radiologic, and safety outcomes have been observed.¹⁰ However, although the majority of the lesions are located on the medial side of the talar dome, 24% of OLTs are located on the lateral dome.³² Lesions located on the lateral talar dome are often treated substantially different to medially located lesions. Medial lesions are frequently treated using a medial malleolar osteotomy but may also be accessed through anteromedial or posteromedial approaches. Lateral lesions, however, often need an ATFL release at the fibular footprint, but an osteotomy or posterolateral approach is possible in some cases.¹¹ Moreover, it has been reported that medial lesions have better outcomes compared with lateral OLTs.² Therefore, the TOPIC procedure for lateral lesions may have different outcomes and other safety concerns compared with the medial TOPIC technique. To date, however, no reports have been published.

It is therefore the primary aim of the present prospective study to investigate the clinical outcome, measured by the numeric rating scale (NRS) for pain during walking, at 2-year follow-up after the TOPIC procedure for lateral OLTs. The secondary aim is to assess other clinical, radiologic, and safety outcomes at both 1- and 2-year follow-up.

Materials and Methods

The present study is a single-center, nonrandomized cohort study. It was approved by the Medical Ethical Committee of the Amsterdam UMC, location AMC, University of Amsterdam with reference number MEC 08/326. Moreover, the study has been conducted in accordance with the Declaration of Helsinki and the Dutch Medical Research Involving Human Subjects Act (WMO).

Patient Selection

All patients who underwent a press-fit TOPIC procedure for an OLT of the lateral talar dome in the Amsterdam UMC were eligible for inclusion in the present study. The inclusion and exclusion criteria are outlined in Table 1. The indication of the lateral TOPIC technique is a symptomatic (ie, deep ankle pain during activity), large (>10 mm) OLT that does not respond to nonoperative treatment of at least 3-6 months.^11,25 Both primary and nonprimary lesions were included.

Table 1.

Inclusion and Exclusion Criteria.

Inclusion	Exclusion
OLT of the lateral talar dome treated with a press-fit TOPIC graft	<2 y of follow-up
	Concomitant osteochondral lesion of the tibial plafond (OLTP)
	Comorbidities (eg, malignancy, active infectious ankle pathology, hemophilic or diffuse arthropathy)
	Advanced ankle osteoarthritis (tibiotalar osteoarthritis of grade III or IV, as described by Kellgren and Lawrence)

Abbreviations: OLT, osteochondral lesions of the talus; TOPIC, Talar OsteoPeriostic grafting from the Iliac Crest.

Treatment

All patients were treated by an experienced fellowship-trained foot and ankle academic orthopaedic surgeon (G.K. or S.A.S.). The surgical technique including aftertreatment has been previously described.¹¹

In summary, an anterolateral approach is used in which the ATFL is released from the footprint at the fibula, thereby allowing exposure of the OLT on the lateral talar dome. The lesion is excised in a rectangular shape, after which the base of the defect is debrided, drilled, and measured. An osteoperiosteal autograft is harvested from the iliac crest, which is 1 mm larger in all dimensions than the excised lesion (anteroposterior, mediolateral, and depth). This graft is then positioned 1 to 2 mm subchondral in the talar dome using a press-fit technique. Thereafter the ATFL is reinserted, and in case of gross chronic instability and nonviable ligamentous structures augmented using an InternalBrace. Lastly, the incision layers are closed. Patients are then placed in a nonweightbearing cast for 6 weeks, followed with a walking boot for another 6 weeks. This is done to ensure the incorporation of the iliac crest graft.

Outcome Assessment

All outcomes were prospectively assessed, both preoperatively and postoperatively.

Clinical outcomes

Clinical outcomes were assessed using electronic questionnaires using CASTOR, both preoperatively and postoperatively at the 6-month, 1-year, and 2-year follow-up. These questionnaires consisted of the numeric rating scale (NRS) of pain during walking, during rest, and during stairclimbing. Additionally, all subscales of the Foot and Ankle Outcome Score (FAOS) and the mental and physical component summary scores of the 36-Item Short Form Health Survey (SF-36) and the American Orthopaedic Foot & Ankle Society (AOFAS) were assessed.^1,3,29

Radiologic evaluation

Radiographic assessment was conducted preoperatively and 12 weeks, 1 year, and 2 year postoperatively using computed tomography (CT). All radiologic variables were measured by two researchers independently and for the categorical variables in case of inconsistencies a discussion was held. The senior author’s (S.A.S.) assessment was decisive if consensus could not be reached.

Preoperatively, the lesion surface area (maximal mediolateral diameter × maximal anteroposterior diameter × 0.79) and lesion volume (maximal mediolateral diameter × maximal anteroposterior diameter × depth) were determined.⁶ No intraclass correlations were calculated, as a previous study showed good to excellent inter- and intraobserver agreement.¹⁰ Additionally, lesion morphology (fragmentary, cystic, or craterlike), location (9-grid scheme), and ankle OA score were assessed.^7,23,26 At 12 weeks, incorporation of the TOPIC graft was assessed using CT. This was also performed at 1 and 2 years of follow-up as well as the development of cysts in or around the TOPIC graft.

Safety outcomes

All complications were assessed, which were defined as “any undesirable, unintended and direct result of an operation affecting the patient.”^13,30 Moreover, all reoperations (either graft- or non-graft-related) were recorded.

Statistical Analysis

All numerical variables were assessed for normality using visual inspection of box plots and the Shapiro-Wilk test. In case of normality, means with SDs were presented. If data were non-normally distributed, medians with interquartile ranges (IQRs) were presented. Categorical variables are presented as absolute numbers with percentages. The preoperative and 2-year postoperative clinical outcomes were compared using the paired t test (normally distributed) or Wilcoxon signed-rank test (non-normally distributed). A significance level (α) of .05 was used.

All statistical analyses were performed in Python (version 3.11.4) using package SciPy (version 1.11.2)^33,35

Source of Funding

No external funding was received for this study.

Results

Patient Selection and Characteristics

In total, 10 patients underwent the lateral TOPIC procedure more than 2 years ago within the Amsterdam UMC. After applying the inclusion and exclusion criteria, 8 patients were eligible for inclusion in the present study. One patient was lost to follow-up after 1-year. Therefore, 7 patients were included in the analysis (Figure 1), of which 4 patients received an InternalBrace. The demographic and lesion characteristics can be appreciated in Tables 2 and 3, respectively.

Figure 1.

Patient selection flow chart.

Table 2.

Patient Characteristics at Baseline.

Characteristic	Value
Age at surgery, y, median (IQR)	31.1 (24.5-33.6)
Sex, male/female, n (%)	3 (43) / 4 (57)
BMI, median (IQR)	23.1 (22.4-23.8)
Laterality, right/left, n (%)	4 (57) / 3 (43)
Smoking, yes/no, n (%)	2 (29) / 5 (71)
InternalBrace use, yes/no, n (%)	4 (57) / 3 (43)

Abbreviations: BMI, body mass index; IQR, interquartile range.

Table 3.

Lesion Characteristics at Baseline.

Characteristic	Value
Nature, primary/nonprimary, n (%)	6 (86%) / 1 (14%)
Lesion size, median (IQR)
AP, mm	16 (14-18)
ML, mm	10 (9-13)
Depth, mm	8 (6-11)
Surface area, mm²	126 (110-147)
Volume, cm³	1.2 (0.9-1.7)
Lesion location, n (%)
Zone 3	2 (29)
Zone 6	4 (57)
Zone 9	1 (14)
Lesion morphology, n (%)
Cystic	7 (100)
Preoperative ankle OA stage, n (%)
Stage 1	4 (57)
Stage 2	3 (43)

Abbreviations: AP, anteroposterior; IQR, interquartile range; ML, mediolateral; OA, osteoarthritis

Clinical outcomes

Primary outcome

The NRS of pain during walking improved from 5 (4-7) preoperatively to 1 (0-2) at 2-year follow-up (P = .02; Figure 2).

Figure 2.

NRS of pain during walking.

Secondary clinical outcomes

The baseline and 2-year outcomes can be appreciated in Table 4. The AOFAS improved from median 54 to 100 (P = .02). All FAOS subscales, except the FAOS symptoms (57 to 54, n.s.) improved significantly. Visual representation using boxplots are available in Appendix 1 until 10.

Table 4.

Secondary Clinical Outcomes.

Outcome	Preoperative, Median (IQR)	2-y Follow-Up, Median (IQR)	P Value
NRS during rest	1 (0-3)	0 (0-1)	n.s.
NRS during stairclimbing	7 (6-9)	1 (0-2)	0.03
AOFAS	54 (49-59)	100 (95-100)	0.02
FAOS symptoms	57 (46-61)	54 (52-86)	n.s.
FAOS pain	58 (52-70)	92 (88-99)	0.03
FAOS ADL	69 (55-82)	97 (91-100)	0.03
FAOS sports	30 (25-38)	90 (80-98)	0.02
FAOS QoL	25 (16-31)	62 (56-85)	0.03
SF-36 PCS	36 (32-38)	36 (28-36)	n.s.
SF-36 MCS	43 (32-46)	46 (43-51)	n.s.

Abbreviations: ADL, activities of daily living; AOFAS, American Orthopaedic Foot & Ankle Society; FAOS, Foot and Ankle Outcome Score; MCS, mental component summary; NRS, numeric rating scale; PCS, physical component summary; QoL, quality of life; SF-36, 36-Item Short Form Health Survey.

Radiologic outcomes

All patients (100%) were available for radiologic follow-up at 3 months postoperatively. At 1 year, 1 patient was not available because of pregnancy. At 2-year follow-up, 1 was not available for radiologic follow-up.

All patients (100%) showed graft incorporation at the 3-month follow-up CT scan. At the 2-year follow-up, 5 of 6 patients showed cyst presence in or around the TOPIC graft (Table 5).

Table 5.

Radiologic Outcomes.

Outcome	3 mo, n (%)(n = 7)	1 y, n (%)(n = 6)	2 y, n (%)(n = 6)
Graft consolidation	7 (100)	6 (100)	6 (100)
Cyst presence, yes/no	N/A	4 (67) / 2 (32)	5 (83) / 1 (17)

Safety outcomes

No complications occurred and none of the patients complained of donor site morbidity. None of the patients underwent any additional surgery.

Discussion

The present study shows that the TOPIC procedure for large lateral OLTs is a promising treatment option in the first 7 patients with an improvement from preoperatively a median of 6 to a median of 1 at 2-year follow-up on the NRS of pain during walking. Moreover, no safety concerns have been observed.

The change of 4 on the NRS of pain during walking is similar to what Dahmen et al¹⁰ found for the medial TOPIC procedure at 2-year follow-up. No patients underwent subsequent surgery in the present study, compared with a rate of 37% of the patients undergoing the TOPIC for a medial OLT need to undergo surgery again before 2 years of follow-up. This difference in the reoperation rate is, however, mainly attributable to the removal of the hardware that is used to fixate the medial malleolar osteotomy in case of a medial TOPIC, which is not the case in the lateral procedure.

Radiologically, 100% of the grafts incorporated within 3 months and did not disintegrate in the follow-up period. In 5 of 6 patients, cysts were present in or around the TOPIC graft at 2-year follow-up. This rate of cyst formation is in line with the existing literature on osteochondral and osteoperiosteal autografting.^{14,19,20,31,36,37} Of these, 2 studies^31,37 assessed a correlation with visual analog scale pain score and 3 studies^31,36,37 with the AOFAS outcome score. None of these studies have found any correlation. Moreover, in the 2-year outcomes of the medial TOPIC procedure, no relation has been observed between cyst presence and the NRS of pain during walking.¹⁰

In the literature, most studies have focused on medial OLTs. Al-Shaikh et al² reported that medial lesions have better outcomes when compared to lateral lesions after osteochondral autografting. However, for bone marrow stimulation, the opposite has been described.⁵

The TOPIC procedure provides several benefits when compared to other available techniques for large (cystic) lateral OLTs. One of the advantages is the limited costs of the TOPIC procedure when compared to techniques such as osteochondral allograft transplantation or (2-stage) cartilage implantation techniques. Moreover, the osteoperiosteal graft from the iliac crest mirrors the curvature of the talar dome, and because of the periosteal layer, it also may have chondrogenic potential.^15,21,22 Moreover, donor site morbidity is less frequently observed when compared to osteochondral autograft transplantation techniques in which the ipsilateral knee is used.^27,28 When performing the TOPIC procedure for a lateral OLT, the graft should be placed 1 to 2 mm subchondrally. Proudness of the graft might induce chondral damage to the opposing tibial plafond. However, the final thickness of the periosteal layer could not be measured in the present study.

The main strengths of the present study are that it is a prospective study with 83% radiologic follow-up. Additionally, all radiologic outcomes were extracted and cross-verified by 2 researchers independently from each other. The main limitation of the present study is however the limited sample size and thus low statistical power, which made it impossible to do any subgroup analyses. Moreover, the surgeries were performed by a highly experienced team that may not be generalizable to other settings. The results provided in this article for the clinical success need to be confirmed in different settings, with larger cohorts and optimally with comparative studies.

The clinical relevance of the present study is that it is the first to report on the outcomes after osteoperiosteal autografting from the iliac crest for specifically lateral OLTs. Cao et al⁴ and Guo et al¹² have respectively included 9 and 3 lateral patients but did not analyze these separately from medial lesions. Overall, these studies showed effective outcomes. Based on the results in the present study, further research is justified on this novel technique for lateral OLTs. The effect sizes and variances reported here can be used to power future studies.

Conclusion

In the first 7 prospectively followed patients who underwent the TOPIC procedure for large osteochondral lesions of the lateral talar dome, an improvement of the NRS of pain during walking from preoperatively (median 5) to 2-year follow-up (median 1) was observed. Additionally, all grafts showed incorporation, and no reoperations and complications were recorded. Cysts developed in up to 5 of 6 patients. The results of this study warrant further statistically powered research, including a higher number of patients and long-term outcomes.

Supplemental Material

sj-docx-2-fai-10.1177_10711007251329033 – Supplemental material for Talar OsteoPeriostic Grafting From the Iliac Crest (TOPIC): Prospective 2-Year Outcomes for Large Lateral Osteochondral Lesions of the Talus

Supplemental material, sj-docx-2-fai-10.1177_10711007251329033 for Talar OsteoPeriostic Grafting From the Iliac Crest (TOPIC): Prospective 2-Year Outcomes for Large Lateral Osteochondral Lesions of the Talus by Julian J. Hollander, Kaj S. Emanuel, Jari Dahmen, Gino M. M. J. Kerkhoffs and Sjoerd A. S. Stufkens in Foot & Ankle International

Supplemental Material

sj-pdf-1-fai-10.1177_10711007251329033 – Supplemental material for Talar OsteoPeriostic Grafting From the Iliac Crest (TOPIC): Prospective 2-Year Outcomes for Large Lateral Osteochondral Lesions of the Talus

Supplemental material, sj-pdf-1-fai-10.1177_10711007251329033 for Talar OsteoPeriostic Grafting From the Iliac Crest (TOPIC): Prospective 2-Year Outcomes for Large Lateral Osteochondral Lesions of the Talus by Julian J. Hollander, Kaj S. Emanuel, Jari Dahmen, Gino M. M. J. Kerkhoffs and Sjoerd A. S. Stufkens in Foot & Ankle International

Footnotes

Ethical Approval

Ethical approval for this study was obtained from the Medical Ethical Committee of the Amsterdam UMC, location AMC, University of Amsterdam (reference number MEC 08/326).

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Disclosure forms for all authors are available online.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iDs

Julian J. Hollander, LLB, BSc,

Jari Dahmen, MD, BSc,

Sjoerd A. S. Stufkens, MD, PhD,

Supplemental Material

Supplementary material is available online with this article.

References

Aaronson

Muller

Cohen

, et al. Translation, validation, and norming of the Dutch language version of the SF-36 Health Survey in community and chronic disease populations. J Clin Epidemiol. 1998;51(11):1055-1068. doi:10.1016/s0895-4356(98)00097-3

Al-Shaikh

Chou

Mann

Dreeben

Prieskorn

Autologous osteochondral grafting for talar cartilage defects. Foot Ankle Int. 2002;23(5):381-389. doi:10.1177/107110070202300502

Azam

Butler

, et al. Validation of the Foot and Ankle Outcome Score (FAOS) for osteochondral lesions of the ankle. Foot Ankle Int. 2023;44(8):745-753. doi:10.1177/10711007231174198

Cao

Ding

Zan

, et al. Autologous osteoperiosteal transplantation is effective in the treatment of single cystic osteochondral lesions of the talus and the prognostic impact of age should be emphasized. Knee Surg Sports Traumatol Arthrosc. 2024;32(11):2874-2884. doi:10.1002/ksa.12301

Cheng

Pei

, et al. Medial cystic osteochondral lesions of the talus exhibited lower sports levels, higher cyst presence rate, and inferior radiological outcomes compared with lateral lesions following arthroscopic bone marrow stimulation. Arthroscopy. 2025;41(1):110-118.e3. doi:10.1016/j.arthro.2024.05.011

Choi

Park

Kim

Lee

JW.

Osteochondral lesion of the talus: is there a critical defect size for poor outcome?

Am J Sports Med. 2009;37(10):1974-1980. doi:10.1177/0363546509335765

Cohen

Vela

Levine

Barnoy

EA.

Validating a new computed tomography atlas for grading ankle osteoarthritis. J Foot Ankle Surg. 2015;54(2):207-213. doi:10.1053/j.jfas.2014.06.017

D’Ambrosi

Maccario

Serra

Ursino

Usuelli

FG.

Relationship between symptomatic osteochondral lesions of the talus and quality of life, body mass index, age, size and anatomic location. Foot Ankle Surg. 2018;24(4):365-372. doi:10.1016/j.fas.2017.04.011

Dahmen

Lambers

KTA

Reilingh

van Bergen

CJA

Stufkens

SAS

Kerkhoffs

No superior treatment for primary osteochondral defects of the talus. Knee Surg Sports Traumatol Arthrosc. 2018;26(7):2142-2157. doi:10.1007/s00167-017-4616-5

10.

Dahmen

Rikken

Stufkens

SAS

Kerkhoffs

Talar OsteoPeriostic Grafting from the Iliac Crest (TOPIC): two-year prospective results of a novel press-fit surgical technique for large, complex osteochondral lesions of the medial talus. J Bone Joint Surg Am. 2023;105(17):1318-1328. doi:10.2106/jbjs.22.01322

11.

Dahmen

Rikken

QGH

Kerkhoffs

GMMJ

Stufkens

SAS

. Talar OsteoPeriostic grafting from the Iliac Crest (TOPIC) for lateral osteochondral lesions of the talus: operative technique. Oper Orthop Traumatol. 2023;35(2):82-91. doi:10.1007/s00064-022-00789-0

12.

Guo

Chen

Wei

, et al. Autologous osteoperiosteal transplantation for the treatment of large cystic talar osteochondral lesions. Orthop Surg. 2023;15(1):103-110. doi:10.1111/os.13586

13.

Hollander

Dahmen

Emanuel

Stufkens

SAS

Kennedy

Kerkhoffs

The frequency and severity of complications in surgical treatment of osteochondral lesions of the talus: a systematic review and meta-analysis of 6,962 lesions. Cartilage. 2023;14(2):180-197. doi:10.1177/19476035231154746

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. doi:10.1016/j.arthro.2013.05.014

15.

Ito

Fitzsimmons

Sanyal

Mello

Mukherjee

O’Driscoll

SW.

Localization of chondrocyte precursors in periosteum. Osteoarthritis Cartilage. 2001;9(3):215-223. doi:10.1053/joca.2000.0378

16.

Kennedy

Murawski

CD.

The treatment of osteochondral lesions of the talus with autologous osteochondral transplantation and bone marrow aspirate concentrate: surgical technique. Cartilage. 2011;2(4):327-336. doi:10.1177/1947603511400726

17.

Kerkhoffs

Reilingh

Gerards

de Leeuw

PA.

Lift, drill, fill and fix (LDFF): a new arthroscopic treatment for talar osteochondral defects. Knee Surg Sports Traumatol Arthrosc. 2016;24(4):1265-1271. doi:10.1007/s00167-014-3057-7

18.

Lambers

KTA

Dahmen

Reilingh

van Bergen

CJA

Stufkens

SAS

Kerkhoffs

. No superior surgical treatment for secondary osteochondral defects of the talus. Knee Surg Sports Traumatol Arthrosc. 2018;26(7):2158-2170. doi:10.1007/s00167-017-4629-0

19.

Leumann

Valderrabano

Wiewiorski

Barg

Hintermann

Pagenstert

Bony periosteum-covered iliac crest plug transplantation for severe osteochondral lesions of the talus: a modified mosaicplasty procedure. Knee Surg Sports Traumatol Arthrosc. 2014;22(6):1304-1310. doi:10.1007/s00167-013-2604-y

20.

Tang

Wang

, et al. Improved results from medium and long-term outcomes of autogenous osteoperiosteal grafting for large cystic lesions of the talus. Arthroscopy. 2024;40(5):1613-1622. doi:10.1016/j.arthro.2023.09.022

21.

Nägerl

Hansen

Kubein-Meesenburg

, et al. The upper ankle joint: curvature morphology of the articulating surfaces and physiological function. Acta Bioeng Biomech. 2016;18(3):83-90. doi:10.5277/ABB-00462-2015-03

22.

O’Driscoll

SW.

Articular cartilage regeneration using periosteum. Clin Orthop Relat Res. 1999;(367 suppl):S186-S203. doi:10.1097/00003086-199910001-00020

23.

Raikin

Elias

Zoga

Morrison

Besser

Schweitzer

ME.

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. doi:10.3113/fai.2007.0154

24.

Rikken

QGH

Favier

BJC

Dahmen

Stufkens

SAS

Kerkhoffs

. Open lift-drill-fill-fix for medial osteochondral lesions of the talus: surgical technique. Oper Orthop Traumatol. 2024;36(2):132-144. doi:10.1007/s00064-023-00833-7

25.

Rikken

QGH

Kerkhoffs

Osteochondral lesions of the talus: an individualized treatment paradigm from the Amsterdam perspective. Foot Ankle Clin. 2021;26(1):121-136. doi:10.1016/j.fcl.2020.10.002

26.

Rikken

QGH

Wolsink

LME

Dahmen

Stufkens

SAS

Kerkhoffs

. 15% of talar osteochondral lesions are present bilaterally while only 1 in 3 bilateral lesions are bilaterally symptomatic. J Bone Joint Surg Am. 2022;104(18):1605-1613. doi:10.2106/jbjs.22.00122

27.

Shi

Yang

Xiong

, et al. Comparison of autologous osteoperiosteal and osteochondral transplantation for the treatment of large, medial cystic osteochondral lesions of the talus. Am J Sports Med. 2022;50(3):769-777. doi:10.1177/03635465211068529

28.

Shimozono

Seow

Yasui

Fields

Kennedy

JG.

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. doi:10.1097/corr.0000000000000719

29.

Sierevelt

Beimers

van Bergen

CJA

Haverkamp

Terwee

Kerkhoffs

Validation of the Dutch language version of the Foot and Ankle Outcome Score. Knee Surg Sports Traumatol Arthrosc. 2015;23(8):2413-2419. doi:10.1007/s00167-014-3017-2

30.

Sokol

Wilson

What is a surgical complication?

World J Surg. 2008;32(6):942-944. doi:10.1007/s00268-008-9471-6

31.

Valderrabano

Leumann

Rasch

Egelhof

Hintermann

Pagenstert

Knee-to-ankle mosaicplasty for the treatment of osteochondral lesions of the ankle joint. Am J Sports Med. 2009;37(Suppl 1):105s-111s. doi:10.1177/0363546509351481

32.

van Diepen

Dahmen

Altink

Stufkens

SAS

Kerkhoffs

Location distribution of 2,087 osteochondral lesions of the talus. Cartilage. 2021;13(1_Suppl):1344s-1353s. doi:10.1177/1947603520954510

33.

Van Rossum

Drake

. Python reference manual. Centrum voor Wiskunde en Informatica Amsterdam; 1995.

34.

VanTienderen

Dunn

Kusnezov

Orr

JD.

Osteochondral allograft transfer for treatment of osteochondral lesions of the talus: a systematic review. Arthroscopy. 2017;33(1):217-222. doi:10.1016/j.arthro.2016.06.011

35.

Virtanen

Gommers

Oliphant

, et al. SciPy 1 0: fundamental algorithms for scientific computing in Python. Nat Methods. 2020;17(3):261-272. doi:10.1038/s41592-019-0686-2

36.

Wan

Huang

Dong

QY.

Results of the osteochondral autologous transplantation for treatment of osteochondral lesions of the talus with harvesting from the ipsilateral talar articular facets. Int Orthop. 2022;46(7):1547-1555. doi:10.1007/s00264-022-05380-7

37.

Woelfle

Reichel

Javaheripour-Otto

Nelitz

Clinical outcome and magnetic resonance imaging after osteochondral autologous transplantation in osteochondritis dissecans of the talus. Foot Ankle Int. 2013;34(2):173-179. doi:10.1177/1071100712467433

Supplementary Material

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