Abstract
Objective
Replacement of cartilaginous defects of the talus by autologous osteochondral cylinders allowing restoration of form and function of ankle. Elimination of pain and joint irritation, delay of osteoarthritis.
Indications
Localized osteochondral defects not exceeding a diameter of 2 cm.
Circumscribed cartilage damage of grade III and IV according to Bauer & Jackson.
Osteochondritis dissecans of grade III and IV.
Localized avascular necrosis not exceeding a diameter of 2 cm.
Contraindications
Osteoarthritis involving the entire ankle.
Defects exceeding 2 cm in diameter.
Surgical Technique
Transmalleolar approach, either medial or lateral. Determination of size of defect, removal of defect with a punch covering the entire lesion. Harvesting of osteochondral cylinder from the ipsilateral lateral femoral condyle, its diameter exceeding the diameter of the defect zone by 0.3 mm. The harvested cylinder is press-fit into the surgical defect.
Results
In a prospective study between 04/1997 and 12/2000, this technique was used in 39 patients (20 men, 19 women, average age 28.7 [16–57] years). Involvement of the medial aspect of the talar dome 31 times, of the lateral six times, and of the tibial articular surface twice. At average follow-up of 15.9 months, Lysholm score improved from an average of 62 points to an average of 92 points. Postoperative MRIs with gadolinium i.v. showed perfect incorporation of the cylinders in all patients. Complications: transient patellofemoral symptoms at the area of harvesting, slight pain over the osteotomy site of the medial malleolus which disappeared after implant removal. One instance of synovitis; a wound infection proved to be transient.
Similar content being viewed by others
References
Bauer M, Jackson RW. Chondral lesions of the femoral condyles: a system of arthroscopic classification. Arthroscopy 1988;4:97–102.
Bobic V. Arthroscopic osteochondral autograft transplantation in anterior cruciate ligament reconstruction: a preliminary clinical study. Knee Surg Sports Traumatol Arthrosc 1996;3:262–4.
Bobic V. Authologe osteochondrale Transplantation zur Behandlung von Gelenkknorpeldefekten. Orthopäde 1999;28:19–25.
Bruns J. Osteochondrosis dissecans tali. Results of surgical therapy. Unfallchirurg 1993;96:75–81.
Bruns J, Rosenbach B. Osteochondrosis dissecans des Talus. Z Orthop 1989;127:549–55.
Bruns J, Steinhagen J. Transplantation of chondrogenic tissue in the treatment of lesions of of the articular cartilage. Orthopäde 1998;28:52–60.
Burkart A, Imhoff AB. Bildgebung nach autologer Chondrozyten-transplantation: Korrelation kernspintomographischer, histologischer und arthroskopischer Befunde. Orthopäde 2000;29:135–44.
Draper SD, Fallat LM. Autogenous bone grafting for the treatment of talar dome lesions. J Foot Ankle Surg 2000;39:15–23.
Hangody L. Autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects of the femoral condyle. In: Imhoff AB, Burkart A, Hrsg. Knieinstabilität — Knorpelschaden. Darmstadt: Steinkopff, 1998:97–108.
Hangody L, Kish G, Karpati Z. Treatment of osteochondrosis dissecans of the talus: use of the mosaicplasty technique — a preliminary report. Foot Ankle Int 1996;18:628–34.
Hangody L, Kish G, Karpati Z. Mosaicplasty for the treatment of articular cartilage defects: application in clinical practice. J Orthop 1998;21:751–6.
Homminga GN, Bulstra SK, Bouwmeester PSM, Van der Linden AJ. Perichondrial grafting for cartilage lesions of the knee. J Bone Joint Surg Br 1990;72:1003–7.
Imhoff AB, Burkart A. Knorpelschaden — Knieinstabilität. Das instabile Knie und der Knorpelschaden des Sportlers. Darmstadt: Steinkopff, 1998:189.
Imhoff AB, Martinek V. Gene therapy in cartilage repair. European Instructional Course Lectures (EFORT) 2001;5:18–23.
Imhoff AB, Oettl GM. Arthroscopic and open techniques for transplantation of osteochondral autografts and allografts in various joints. Surg Technol Int 1999;VIII:249–52.
Imhoff AB, Öttl G, Burkart A, Traub S. Osteochondrale autologe Transplantation an verschiedenen Gelenken. Orthopäde 1999;28:33–45.
Imhoff AB, Oettl GM, Schöttle PB, Agneskirchner J, Burkart A. Arthroscopic and open techniques for transplantation of osteochondral autografts and allografts in different joints. In: Grifka J, Ogilvie-Harris J, eds. Osteoarthritis. Berlin: Springer, 2000:103–11.
Johnson LL. Arthroscopic abrasion arthroplasty. In: McGinty JB, ed. Operative arthroscopy. New York: Raven Press, 1991:341–60.
Josten C, Rose T. Acute and chronic osteochondral lesions of the talus. Orthopäde 1999;28:500–8.
Kish G, Hangody L. Osteochondral mosaicplasty for the treatment of focal chondral and osteochondral lesions of the knee and talus in the athlete. Rationale, indications, techniques, and results. Clin Sports Med 2000;18:45–66.
Lorentzon R. Treatment of deep cartilage defects of the patella with periosteal transplantation. Knee Surg Sports Traumatol Arthrosc 1998;6:202–8.
Lysholm J, Gillquist J. Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med 1982;10:150–4.
Martinek V, Oettl G, Imhoff AB. Chondrale und osteochondrale Läsionen am oberen Sprunggelenk. Klinik, Diagnostik und Therapie. Unfallchirurg 1998;101:468–75.
Müller W. Osteochondrosis dissecans. In: Hastings DE, ed. Progress in Orthopaedic Surgery 1978;3:135–42.
Oettl G, Martinek V, Imhoff AB. Möglichkeiten der Diagnostik und Therapie chondraler und osteochondraler Läsionen am Talus. In: Hempfling H, Beikert R, Hrsg. Arthroskopie am Sprunggelenk. Landsberg: Ecomed, 1997:250–8.
Outerbridge HK, Outerbridge AR, Outerbridge RE. The use of a lateral patellar autologous graft for the repair of a large osteochondral defect in the knee. J Bone Joint Surg Am 1995;77:65–72.
Rodrigo JJ, Steadman RJ, Silliman JF, Fulstone HA. Improvement of full-thickness chondral defect healing in the human knee after debridement and microfracture using continuous passive motion. Am J Knee Surg 1994;7:109–16.
Schoettle PB, Oettl GM, Agneskirchner JD, Imhoff AB. Therapie von osteochondralen Läsionen am Talus mit autologer Knorpel-Knochen-Transplantation. Orthopäde 2001;30:53–8.
Steadman JR, Rodkey WG, Briggs KK, Rodrigo JJ. Die Technik der Mikrofrakturierung zur Behandlung von kompletten Knorpeldefekten im Kniegelenk. Orthopäde 1999;28:26–32.
Tippet JW. Articular cartilage drilling and osteotomy in osteoarthritis of the knee. In: McGinty JB, Caspari RB, Jackson RW, Poehling GG, eds. Operative arthroscopy. New York: Raven Press, 1996:411–26.
Traub S, Imhoff AB, Oettl G. Die Technik der osteochondralen autologen Knorpeltransplantation (OATS) zum Ersatz chondraler oder osteochondraler Defekte. Osteologie 2000;9:46–55.
Wagner H. Operative Behandlung der Osteochondrosis dissecans des Kniegelenkes. Z Orthop 1964;99:62–4.
Wagner H. Möglichkeiten und Erfahrungen mit der Knorpeltransplantation. Z Orthop 1972;110:705–8.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Schoettle, P.B., Imhoff, A.B. Autologous osteochondral transplantation for talar lesions. Orthop Traumatol 10, 113–129 (2002). https://doi.org/10.1007/s00065-002-1041-0
Issue Date:
DOI: https://doi.org/10.1007/s00065-002-1041-0