gms | German Medical Science

German Congress of Orthopedic and Trauma Surgery (DKOU 2018)

23.10. - 26.10.2018, Berlin

Long-term follow-up after osteochondral allograft transplantation for recurrent osteochondral lesions of the talus

Meeting Abstract

  • presenting/speaker Florian Gaul - Shiley Center for Orthopaedic Research and Education, Scripps Health, La Jolla, United States
  • Luis Eduardo Tirico - University of São Paulo, Hospital das Clinicas, Medical School, São Paulo, Brazil
  • Julie McCauley - Shiley Center for Orthopaedic Research and Education, Scripps Health, La Jolla, United States
  • William Bugbee - Shiley Center for Orthopaedic Research and Education, Scripps Health, La Jolla, United States

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2018). Berlin, 23.-26.10.2018. Düsseldorf: German Medical Science GMS Publishing House; 2018. DocST42-19

doi: 10.3205/18dkou267, urn:nbn:de:0183-18dkou2676

Published: November 6, 2018

© 2018 Gaul et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objectives: Fresh osteochondral allograft (OCA) transplantation represents a biologic restauration technique and is an alternative treatment option for larger osteochondral lesions of the talus (OCLT). While the general clinical outcome data is limited to few case series with short to mid-term follow-up, the purpose of this study was to evaluate long-term outcomes after OCA transplantations for the treatment of OCLT.

Methods: Nineteen patients (20 ankles) received a partial unipolar osteochondral allograft transplant for a symptomatic OCLT between January 1998 and October 2014. Mean age was 34.7 years, 52.6% were male. The average graft size was 3.75 cm². All patients had a minimum follow-up of two years. Outcomes included the AAOS Foot and Ankle Module (AAOS-FAM), the Olerud-Molander Ankle Score (OMAS), radiographic evaluation and questionnaires evaluating pain and satisfaction. Failure of the OCA was defined as a conversion to arthrodesis or revision OCA transplantation.

Results: Five of 20 ankles required further surgery, of which 15% were considered OCA failures (2 arthrodesis, 1 OCA revision). The mean time to failure was 3.5 years (range, 0.9 to 6.7). Survivorship of the OCA was 88.7% at 5 years and 81.3% at 10 years. Patients with grafts remaining in situ had an average follow-up of 9.7 years; mean OMAS improved significantly from 40 points preoperatively to 71 points postoperatively (p < 0.05; range, 5 to 55); mean AAOS-FAM Core Score was 81.5 ± 15 (range, 40.5 to 96.6); 93.3% of patients reported less pain and better function; and 86.7% were satisfied with the procedure. After a mean of 4.1 years (range, 1 to 9.7) after the operation 55% (11 patients) were available for radiographic follow-up examination. There was an evidence of joint space narrowing (of around 25%) in 36.4% of the patients as well as subchondral cysts in 27.3%. However, we found no signs of graft collapse or radiographic evidence of graft failure. Furthermore, only one patient (9%) showed subchondral sclerosis, in 91% (10 patients) the graft interface was not visible anymore and in 72.7% (8 patients) the radiodensity of the graft was equal to the host tissue.

Conclusion: Our study shows promising long-term results after OCA transplantations for OCLT. However, the high failure and reoperation rate concludes that a proper patient selection and education is required prior to the procedure. Considering the treatment alternatives, we think that this procedure is a reasonable treatment option for large OCLT.