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Favourable clinical, arthroscopic and radiographic outcomes after autologous osteoperiosteal transplantation for massive medial cystic osteochondral defects of the talus

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

Abstract

Purpose

The purpose of this study was to retrospectively evaluate the clinical, arthroscopic and radiological outcomes of autologous osteoperiosteal transplantation for massive cystic osteochondral defects of the talus.

Methods

Cases of autologous osteoperiosteal transplantation for medial massive cystic defects of the talus between 2014 and 2018 were reviewed. The visual analogue scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) score, Foot and Ankle Outcome Score (FAOS), and Ankle Activity Scale (AAS) were assessed preoperatively and postoperatively. The Magnetic Resonance Observation of Cartilage Tissue (MOCART) system and the International Cartilage Repair Society (ICRS) score were evaluated after surgery. The ability to return to daily activity and sport, as well as complications, were recorded.

Results

Twenty-one patients were available for follow-up, with a mean follow-up of 60.1 ± 11.7 months. All subscales of preoperative FAOS had significant (P < 0.001) improvement at the final follow-up. The mean AOFAS and VAS scores significantly (P < 0.001) improved from 52.4 ± 12.4 preoperatively to 90.9 ± 5.2 at the last follow-up and from 7.9 ± 0.8 to 1.5 ± 0.9, respectively. The mean AAS decreased from 6.0 ± 1.4 preinjury to 1.4 ± 0.9 postinjury and then increased to 4.6 ± 1.4 at the final follow-up (P < 0.001). All 21 patients resumed daily activities after a mean of 3.1 ± 1.0 months. Fifteen patients (71.4%) returned to sports after a mean of 12.9 ± 4.1 months. All patients underwent follow-up MRI with a mean MOCART score of 68.6 ± 5.9. Eleven patients underwent second-look arthroscopy, and the average ICRS was 9.4 ± 0.8. No donor site morbidity was found in any patient during the follow-up.

Conclusion

Autologous osteoperiosteal transplantation provided favourable clinical, arthroscopic and radiographic outcomes in patients with massive cystic osteochondral defects of the talus during a minimum 3-year follow-up.

Level of evidence

IV.

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Data availability

The data are available on request.

Abbreviations

VAS:

Visual analogue scale

AOFAS:

American orthopaedic foot and ankle society score

FAOS:

Foot and ankle outcome score

AAS:

Ankle activity scale

MOCART:

Magnetic resonance observation of the cartilage tissue system

ICRS:

International cartilage repair society score

OLTs:

Osteochondral lesions of the talus

AOT:

Autologous osteochondral transplantation

BMI:

Body mass index

PACS:

Picture archiving and communication system

ROM:

Range of motion

References

  1. Ahmad J, Jones K (2016) Comparison of osteochondral autografts and allografts for treatment of recurrent or large talar osteochondral lesions. Foot Ankle Int 37:40–50

    Article  PubMed  Google Scholar 

  2. Bai L, Guan S, Liu S, You T, Xie X, Chen P et al (2020) 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 8:2325967120937798

    Article  PubMed  PubMed Central  Google Scholar 

  3. Becher C, Malahias MA, Ali MM, Maffulli N, Thermann H (2019) Arthroscopic microfracture vs. arthroscopic autologous matrix-induced chondrogenesis for the treatment of articular cartilage defects of the talus. Knee Surg Sports Traumatol Arthrosc 27:2731–2736

    Article  PubMed  Google Scholar 

  4. Brittberg M, Winalski CS (2003) Evaluation of cartilage injuries and repair. J Bone Joint Surg Am 85-A(Suppl 2):58–69

    Article  Google Scholar 

  5. Bruns J, Habermann C, Werner M (2021) Osteochondral lesions of the talus: a review on talus osteochondral injuries Including Osteochondritis Dissecans. Cartilage 13:1947603520985182

    Article  Google Scholar 

  6. Carlsson AM (1983) Assessment of chronic pain. I. Aspects of the reliability and validity of the visual analogue scale. Pain 16:87–101

    Article  PubMed  Google Scholar 

  7. Chen W, Tang K, Yuan C, Zhou Y, Tao X (2015) Intermediate results of large cystic medial osteochondral lesions of the talus treated with osteoperiosteal cylinder autografts from the medial tibia. Arthroscopy 31:1557–1564

    Article  PubMed  Google Scholar 

  8. Chu C-H, Chen I-H, Yang K-C, Wang C-C (2021) Midterm Results of fresh-frozen osteochondral allografting for osteochondral lesions of the talus. Foot Ankle Int 42:8–16

    Article  PubMed  Google Scholar 

  9. Debnath S, Yallowitz AR, McCormick J, Lalani S, Zhang T, Xu R et al (2018) Discovery of a periosteal stem cell mediating intramembranous bone formation. Nature 562:133–139

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Deng E, Gao L, Shi W, Xie X, Jiang Y, Yuan H et al (2020) Both magnetic resonance imaging and computed tomography are reliable and valid in evaluating cystic osteochondral lesions of the talus. Orthop J Sports Med 8:2325967120946697

    Article  PubMed  PubMed Central  Google Scholar 

  11. El-Rashidy H, Villacis D, Omar I, Kelikian AS (2011) Fresh osteochondral allograft for the treatment of cartilage defects of the talus: a retrospective review. J Bone Joint Surg Am 93:1634–1640

    Article  PubMed  Google Scholar 

  12. Gross AE, Agnidis Z, Hutchison CR (2001) Osteochondral defects of the talus treated with fresh osteochondral allograft transplantation. Foot Ankle Int 22:385–391

    Article  CAS  PubMed  Google Scholar 

  13. Halasi T, Kynsburg A, Tállay A, Berkes I (2004) Development of a new activity score for the evaluation of ankle instability. Am J Sports Med 32:899–908

    Article  PubMed  Google Scholar 

  14. Hu Y, Guo Q, Jiao C, Mei Y, Jiang D, Wang J et al (2013) Treatment of large cystic medial osteochondral lesions of the talus with autologous osteoperiosteal cylinder grafts. Arthroscopy 29:1372–1379

    Article  PubMed  Google Scholar 

  15. Kadakia AR, Espinosa N (2013) Why allograft reconstruction for osteochondral lesion of the talus? The osteochondral autograft transfer system seemed to work quite well. Foot Ankle Clin 18:89–112

    Article  PubMed  Google Scholar 

  16. Kerkhoffs GMMJ, Altink JN, Stufkens SAS, Dahmen J (2021) Talar OsteoPeriostic grafting from the Iliac Crest (TOPIC) for large medial talar osteochondral defects: Operative technique (Talar OsteoPeriostic grafting from the Iliac Crest (TOPIC) for large medial talar osteochondral defects: operative technique). Oper Orthop Traumatol 33:160–169

    Article  CAS  PubMed  Google Scholar 

  17. Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M (1994) Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int 15:349–353

    Article  CAS  PubMed  Google Scholar 

  18. Looze CA, Capo J, Ryan MK, Begly JP, Chapman C, Swanson D et al (2017) Evaluation and management of osteochondral lesions of the talus. Cartilage 8:19–30

    Article  PubMed  Google Scholar 

  19. Marlovits S, Singer P, Zeller P, Mandl I, Haller J, Trattnig S (2006) Magnetic resonance observation of cartilage repair tissue (MOCART) for the evaluation of autologous chondrocyte transplantation: determination of interobserver variability and correlation to clinical outcome after 2 years. Eur J Radiol 57:16–23

    Article  PubMed  Google Scholar 

  20. McCollum GA, Myerson MS, Jonck J (2013) Managing the cystic osteochondral defect: allograft or autograft. Foot Ankle Clin 18:113–133

    Article  PubMed  Google Scholar 

  21. Mercer NP, Samsonov AP, Dankert JF, Kennedy JG (2022) Outcomes of autologous osteochondral transplantation with and without extracellular matrix cartilage allograft augmentation for osteochondral lesions of the talus. Am J Sports Med 50:162–169

    Article  PubMed  Google Scholar 

  22. Raikin SM (2004) Stage VI: massive osteochondral defects of the talus. Foot Ankle Clin 9:737–744

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  24. Rikken QGH, Dahmen J, Reilingh ML, van Bergen CJA, Stufkens SAS, Kerkhoffs GMMJ (2021) Outcomes of bone marrow stimulation for secondary osteochondral lesions of the talus equal outcomes for primary lesions. Cartilage 13:1429S-1437S

    Article  PubMed  PubMed Central  Google Scholar 

  25. Rikken QG, Kerkhoffs GM (2021) Osteochondral lesions of the talus. Foot Ankle Clin 26:121–136

    Article  PubMed  Google Scholar 

  26. Roos EM, Brandsson S, Karlsson J (2001) Validation of the foot and ankle outcome score for ankle ligament reconstruction. Foot Ankle Int 22:788–794

    Article  CAS  PubMed  Google Scholar 

  27. Shi W, Yang S, Xiong S, Xu M, Pi Y, Chen L et al (2022) Comparison of autologous osteoperiosteal and osteochondral transplantation for the treatment of large, medial cystic osteochondral lesions of the talus. Am J Sports Med 50:769–777

    Article  PubMed  Google Scholar 

  28. Shim DW, Park KH, Lee JW, Yang Y-J, Shin J, Han SH (2021) 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 37:989–997

    Article  PubMed  Google Scholar 

  29. Shimozono Y, Hurley ET, Nguyen JT, Deyer TW, Kennedy JG (2018) Allograft compared with autograft in osteochondral transplantation for the treatment of osteochondral lesions of the talus. J Bone Joint Surg Am 100:1838–1844

    Article  PubMed  Google Scholar 

  30. Shimozono Y, Hurley ET, Myerson CL, Kennedy JG (2018) Good clinical and functional outcomes at mid-term following autologous osteochondral transplantation for osteochondral lesions of the talus. Knee Surg Sports Traumatol Arthrosc 26:3055–3062

    Article  PubMed  Google Scholar 

  31. Slabaugh MA (2019) CORR insights®: knee-to-talus donor-site morbidity following autologous osteochondral transplantation: a meta-analysis with best-case and worst-case analysis. Clin Orthop Relat Res 477:1932–1933

    Article  PubMed  PubMed Central  Google Scholar 

  32. Smith GD, Taylor J, Almqvist KF, Erggelet C, Knutsen G, Garcia Portabella M et al (2005) Arthroscopic assessment of cartilage repair: a validation study of 2 scoring systems. Arthroscopy 21:1462–1467

    Article  PubMed  Google Scholar 

  33. Sung MS, Jeong CH, Lim YS, Yoo WJ, Chung SK, Jung NY (2011) Periosteal autograft for articular cartilage defects in dogs: MR imaging and ultrasonography of the repair process. Acta Radiol 52:181–190

    Article  PubMed  Google Scholar 

  34. Weigelt L, Hartmann R, Pfirrmann C, Espinosa N, Wirth SH (2019) 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 47:1679–1686

    Article  PubMed  Google Scholar 

  35. Winkler PW, Geyer S, Walzl D, Woertler K, Paul J, Siebenlist S et al (2022) Favorable long-term clinical and radiologic outcomes with high survivorship after autologous osteochondral transplantation of the talus. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-022-07237-3

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

The authors would like to thank Wenqiang Yan and Fengyi Hu for writing assistance and language help with the manuscript.

Funding

This work was supported by grants from Beijing Municipal Science & Technology Commission (No. Z161100000116072), Beijing Nova Program (No. Z201100006820011) from the Beijing Municipal Science & Technology Commission and the National Natural Science Foundation of China (No. 81902208).

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Author notes

  1. Shuai Yang and Lizhong Jing have contributed equally to this work and thus share first authorship.

Authors and Affiliations

  1. Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, 49 North Garden Road, Haidian District, 100191, Beijing, People’s Republic of China

    Shuai Yang, Linxin Chen, Feng Zhao, Yanbin Pi, Dong Jiang, Xing Xie, Chen Jiao, Yuelin Hu, Weili Shi & Qinwei Guo

  2. Department of Orthopedics, Affiliated Hospital to Shandong University of Traditional Chinese Medicine, 250011, Jinan, People’s Republic of China

    Lizhong Jing

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  1. Shuai Yang
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Contributions

SY and LJ both contributed to the literature search, data collection and analysis, statistics analysis and manuscript preparation. LC, YP, DJ, CJ and YH contributed to the surgical data provision and manuscript editing. FZ and XX contributed to the conceptualization and manuscript review. WS contributed to the data collection and analysis, literature search and manuscript review. QG contributed to the substantial conceptualization, surgical data provision, supervision and final approval of the draft version. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Weili Shi or Qinwei Guo.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the Board of Research Ethics of Peking University Third Hospital Medical Science Research Ethics Committee (IRB00006761-M2021296).

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Informed consent was obtained from all individual participants included in the study.

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Yang, S., Jing, L., Chen, L. et al. Favourable clinical, arthroscopic and radiographic outcomes after autologous osteoperiosteal transplantation for massive medial cystic osteochondral defects of the talus. Knee Surg Sports Traumatol Arthrosc 31, 3509–3516 (2023). https://doi.org/10.1007/s00167-023-07397-w

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