Skip to main content
Log in

Autologous osteochondral transplantation for osteochondral lesions of the talus in an athletic population

  • Ankle
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To assess clinical outcomes and return to sport in an athletic population treated with autologous osteochondral transplantation (AOT) for osteochondral lesions of the talus.

Methods

A total of 36 patients were included in this retrospective study including 21 professional athletes and 15 amateur athletes who participated in regular moderate- or high-impact athletic activity. All patients underwent autologous osteochondral transplantation of the talus under the care of a single surgeon. At a mean follow-up of 5.9 years, patients were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) scoring system. All patients also received pre-operative MRI with the follow-up MRI performed at 1 year and underwent assessment of return to athletic activity.

Results

The overall AOFAS score improved from 65.5 (SD ± 11.1) to 89.4 (SD ± 14.4) (p = 0.01). At a final follow-up, 90 % of professional athletes (19 of 21) were still competing in athletic activity or still able to participate in unrestricted activity. Of the recreational athletes, 87 % (13 of 15) had full return to pre-injury activity levels, while two (13 %) returned to activity with restrictions or reduced intensity. MRI showed cystic change in 33 % of patients post-operatively; however, this did not appear to affect outcomes (n.s.). Donor site symptoms were seen in 11 % of the cohort at final follow-up, despite high function at donor knee.

Conclusion

The results of our study indicate that AOT procedure is able to achieve good outcomes in an athletic population at a midterm follow-up.

Level of evidence

Retrospective case series, Level IV.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Al-Shaikh RA, Chou LB, Mann JA, Dreeben SM, Prieskorn D (2002) Autologous osteochondral grafting for talar cartilage defects. Foot Ankle Int 23(5):381–389

    PubMed  Google Scholar 

  2. Buckwalter JA, Mankin HJ (1998) Articular cartilage: degeneration and osteoarthritis, repair, regeneration, and transplantation. Instr Course Lect 47:487–504

    CAS  PubMed  Google Scholar 

  3. Cha SD, Kim HS, Chung ST, Yoo JH, Park JH, Kim JH, Hyung JW (2012) Intra-articular lesions in chronic lateral ankle instability: comparison of arthroscopy with magnetic resonance imaging findings. Clin Orthop Surg 20124(4):293–299

    Article  Google Scholar 

  4. Choi WJ, Park KK, Kim BS, Lee JW (2009) Osteochondral lesion of the talus: is there a critical defect size for poor outcome? Am J Sports Med 37(10):1974–1980

    Article  PubMed  Google Scholar 

  5. Choi WJ, Kim BS, Lee JW (2012) Osteochondral lesion of the talus: could age be an indication for arthroscopic treatment? Am J Sports Med 40:419–424

    Article  PubMed  Google Scholar 

  6. Chuckpaiwong B, Berkson EM, Theodore GH (2008) Microfracture for osteochondral lesions of the ankle: outcome analysis and outcome predictors of 105 cases. Arthroscopy 24:106–112

    Article  PubMed  Google Scholar 

  7. Czajka CM, Tran E, Cai AN, DiPreta JA (2014) Ankle sprains and instability. Med Clin North Am 98(2):313–329

    Article  PubMed  Google Scholar 

  8. Dvorak J, Junge A, Derman W, Schwellnus M (2011) Injuries and illnesses of football players during the 2010 FIFA World Cup. Br J Sports Med 45(8):626–630

    Article  PubMed  PubMed Central  Google Scholar 

  9. Elias I, Zoga AC, Morrison WB, Besser MP, Schweitzer ME, Raikin SM (2007) Osteochondral lesions of the talus: localization and morphologic data from 424 patients using a novel anatomical grid scheme. Foot Ankle Int 28(2):154–161

    Article  PubMed  Google Scholar 

  10. Fansa AM, Murawski CD, Imhauser CW, Nguyen JT, Kennedy JG (2011) Autologous osteochondral transplantation of the talus partially restores contact mechanics of the ankle joint. Am J Sports Med 39(11):2457–2465

    Article  PubMed  Google Scholar 

  11. Garras DN, Santangelo JA, Wang DW, Easley ME (2008) A quantitative comparison of surgical approaches for posterolateral osteochondral lesions of the talus. Foot Ankle Int 29(4):415–420

    Article  PubMed  Google Scholar 

  12. Gautier E, Kolker D, Jakob RP (2002) Treatment of cartilage defects of the talus by autologous osteochondral grafts. J Bone Joint Surg Br 84(2):237–244

    Article  CAS  PubMed  Google Scholar 

  13. Gobbi A, Francisco RA, Lubowitz JH, Allegra F, Canata G (2006) Osteochondral lesions of the talus: randomized controlled trial comparing chondroplasty, microfracture, and osteochondral autograft transplantation. Arthroscopy 22:1085–1092

    Article  PubMed  Google Scholar 

  14. Gomoll AH, Madry H, Knutsen G, van Dijk N, Seil R, Brittberg M, Kon E (2010) The subchondral bone in articular cartilage repair: current problems in the surgical management. Knee Surg Sports Traumatol Arthrosc 18(4):434–447

    Article  PubMed  PubMed Central  Google Scholar 

  15. Grunfeld R, Ayodogan U, Juliano P (2014) Ankle arthritis review of diagnosis and operative management. Med Clin North Am 98(2):267–289. doi:10.1016/j.mcna.2013.10.005

    Article  PubMed  Google Scholar 

  16. Hangody L, Dobos J, Baló E, Pánics G, Hangody LR, Berkes I (2010) Clinical experiences with autologous osteochondral mosaicplasty in an athletic population: a 17-year prospective multicenter study. Am J Sports Med 38(6):1125–1133

    Article  PubMed  Google Scholar 

  17. Hangody L, Fules P (2003) Autologous osteochondral mosaicplasty for the treatment of full-thickness defects of weight-bearing joints: ten years of experimental and clinical experience. J Bone Joint Surg Am 85-A(Suppl 2):25–32

    PubMed  Google Scholar 

  18. Hangody L, Rathonyi GK (2004) Mosaicplasty in active sportsmen. Sportorthopadie Sporttraumatologie 20:159–164

    Google Scholar 

  19. Hangody L, Rathonyi GK, Duska Z (2004) Autologous osteochondral mosaicplasty. Surgical technique. J Bone Joint Surg 86-A:65–72

    PubMed  Google Scholar 

  20. Hangody L, Vasarhelyi G, Hangody LR, Sukosd Z, Tibay G, Bartha L (2008) Autologous osteochondral grafting: technique and long-term results. Injury 39(Suppl 1):S32–S39

    Article  PubMed  Google Scholar 

  21. Hannon CP, Smyth NA, Savage-Elliot I, Deyer TW, Calder JDF, Kennedy JG (2014) Osteochondral lesions of the talus: aspects of current management. Bone Joint J 96-B:164–171

    Article  CAS  PubMed  Google Scholar 

  22. Harris JD, Brophy RH, Siston RA, Flanigan DC (2010) Treatment of chondral defects in the athlete’s knee. Arthroscopy 26:841–852

    Article  PubMed  Google Scholar 

  23. Hintermann B, Regazzoni P, Lampert C, Stutz G, Gächter A (2000) Arthroscopic findings in acute fractures of the ankle. J Bone Joint Surg [Br] 82-B:345–351

    Article  Google Scholar 

  24. Junge A, Engebretsen L, Mountjoy ML, Alonso JM, Renström PA, Aubry MJ, Dvorak J (2009) Sports injuries during the Summer Olympic Games 2008. Am J Sports Med 37(11):2165–2172

    Article  PubMed  Google Scholar 

  25. Karlsson J, Sancone M (2006) Management of acute ligament injuries of the ankle. Foot Ankle Clin 11(3):521–530

    Article  PubMed  Google Scholar 

  26. Kennedy JG, Murawski CD (2011) The treatment of osteochondral lesions of the talus with autologous osteochondral transplantation and bone marrow aspirate concentrate: surgical technique. Cartilage 2(4):327–336

    Article  PubMed  PubMed Central  Google Scholar 

  27. Kim YS, Park EH, Kim YC, Koh YG, Lee JW (2012) Factors associated with the clinical outcomes of the osteochondral autograft transfer system in osteochondral lesions of the talus: second-look arthroscopic evaluation. Am J Sports Med 40(12):2709–2719

    Article  PubMed  Google Scholar 

  28. Kitaoka HB, Alexander IJ, Adelaar RS et al (1994) Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int 15(7):349–353

    Article  CAS  PubMed  Google Scholar 

  29. Kreuz PC, Steinwachs M, Erggelet C, Lahm A, Henle P, Niemeyer P (2006) Mosaicplasty with autogenous talar autograft for osteochondral lesions of the talus after failed primary arthroscopic management. Am J Sports Med 34(1):55–663

    Article  PubMed  Google Scholar 

  30. Lamb J, Murawski CD, Deyer TW, Kennedy JG (2013) Chevron-type medial malleolar osteotomy: a functional, radiographic and quantitative T2-mapping MRI analysis. Knee Surg Sports Traumatol Arthrosc 21:1283–1288

    Article  PubMed  Google Scholar 

  31. Leontaritis N, Hinojosa L, Panchbhavi VK (2009) Arthroscopically detected intra-articular lesions associated with acute ankle fractures. J Bone Joint Surg Am 91(2):333–339

    Article  PubMed  Google Scholar 

  32. Lynch SA, Renström PA (1999) Treatment of acute lateral ankle ligament rupture in the athlete conservative versus surgical treatment. Sports Med 27(1):61–71

    Article  CAS  PubMed  Google Scholar 

  33. Marymont JV, Shute G, Zhu H, Varner KE, Paravic V, Haddad JL, Noble PC (2005) Computerized matching of autologous femoral grafts for the treatment of medial talar osteochondral defects. Foot Ankle Int 26:708–712

    PubMed  Google Scholar 

  34. Messner K (1993) Hydroxylapatite supported Dacron plugs for repair of isolated full-thickness osteochondral defects of the rabbit femoral condyle: mechanical and histological evaluations from 6 to 48 weeks. J Biomed Mater Res 27:1527–1532

    Article  CAS  PubMed  Google Scholar 

  35. Mithoefer K, Hambly K, Della Villa S, Silvers H, Mandelbaum BR (2009) Return to sports participation after articular cartilage repair in the knee: scientific evidence. Am J Sports Med 37(1):167S–176S

    Article  PubMed  Google Scholar 

  36. Nakagawa Y, Suzuki T, Matsusue Y, Kuroki H, Mizuno Y, Nakamura T (2005) Bony lesion recurrence after mosaicplasty for osteochondritis dissecans of the talus. Arthroscopy 21(5):630

    Article  PubMed  Google Scholar 

  37. Nosewicz TL, Reilingh ML, Wolny M, van Dijk CN, Duda GN, Schell H (2013) Influence of basal support and early loading on bone cartilage healing in press-fitted osteochondral autografts. Knee Surg Sports Traumatol Arthrosc 22(6):1445–1451

    PubMed  Google Scholar 

  38. Paul J, Sagstetter A, Kriner M, Imhoff AB, Spang J, Hinterwimmer S (2009) Donor-site morbidity after osteochondral autologous transplantation for lesions of the talus. J Bone Joint Surg Am 91(7):1683–1688

    Article  CAS  PubMed  Google Scholar 

  39. Paul J, Sagstetter M, Lämmle L, Spang J, El-Azab H, Imhoff AB, Hinterwimmer S (2012) Sports activity after osteochondral transplantation of the talus. Am J Sports Med 40(4):870–874

    Article  PubMed  Google Scholar 

  40. Qiu YS, Shahgaldi BF, Revell WJ, Heatley FW (2003) Observations of subchondral plate advancement during osteochondral repair: a histomorphometric and mechanical study in the rabbit femoral condyle. Osteoarthritis Cartilage 11:810–820

    Article  PubMed  Google Scholar 

  41. Radin EL, Rose RM (1986) Role of subchondral bone in the initiation and progression of cartilage damage. Clin Orthop Relat Res 213:34–40

    PubMed  Google Scholar 

  42. Sammarco GJ, Makwana NK (2002) Treatment of talar osteochondral lesions using local osteochondral graft. Foot Ankle Int 23:693–698

    Article  PubMed  Google Scholar 

  43. Scranton PE Jr, Frey CC, Feder KS (2006) Outcome of osteochondral autograft transplantation for type-V cystic osteochondral lesions of the talus. J Bone Joint Surg Br 88(5):614–619

    Article  PubMed  Google Scholar 

  44. Thomas RH, Daniels TR (2003) Ankle arthritis. J Bone Joint Surg Am 85-A(5):923–936

    PubMed  Google Scholar 

  45. Valderrabano V, Leumann A, Rasch H, Egelhof T, Hintermann B, Pagenstert G (2009) Knee-to-ankle mosaicplasty for the treatment of osteochondral lesions of the ankle joint. Am J Sports Med 37(Suppl):105S–111S

    Article  PubMed  Google Scholar 

  46. van Dijk NC, Zengerink RM, van Bergen CJ (2010) Osteochondral defects in the ankle: why painful? Knee Surg Sports Traumatol Arthrosc 18:570–580

    Article  PubMed  PubMed Central  Google Scholar 

  47. Woelfle JV, Reichel H, Nelitz M (2013) Indications and limitations of osteochondral autologous transplantation in osteochondritis dissecans of the talus. Knee Surg Sports Traumatol Arthrosc 21(8):1925–1930

    Article  PubMed  Google Scholar 

  48. Zengerink M, Struijs PA, Tol JL, van Dijk CN (2010) Treatment of osteochondral lesions of the talus: a systematic review. Knee Surg Sports Traumatol Arthrosc 18(2):238–246

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to John G. Kennedy.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fraser, E.J., Harris, M.C., Prado, M.P. et al. Autologous osteochondral transplantation for osteochondral lesions of the talus in an athletic population. Knee Surg Sports Traumatol Arthrosc 24, 1272–1279 (2016). https://doi.org/10.1007/s00167-015-3606-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-015-3606-8

Keywords

Navigation