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Synthetic bone grafting with preserved cartilage flap via a medial malleolus osteotomy approach to treat osteochondral lesion of the talus: technical note and preliminary clinical results

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Abstract

Purpose

Although various surgical procedures are available for osteochondral lesion of the talus (OLT), there is still no consensus on its best treatment. The purposes of this study were to describe a new surgical technique to treat OLT and to analyze its preliminary clinical results.

Methods

Eight patients were enrolled in this retrospective study between March 2019 and May 2022 in the Second Affiliated Hospital of Chongqing Medical University. All patients were treated by synthetic bone grafting with preserved cartilage flap via a medial malleolus osteotomy approach. The patients’ characteristics, operative time, and estimated blood loss were evaluated. Intraoperative photos, preoperative and postoperative X-ray and MRI imaging were recorded. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and visual analog scale (VAS) score were also recorded before surgery and at each follow-up.

Results

At six months after the operation, all patients showed bone ingrowth and remodeling according to X-ray and MRI. No obvious defects or ladder was found on the cartilage surface of all patients according to MRI. The AOFAS score improved from 61.63 ± 8.85 (range, 49–74) to 91.13 ± 4.49 (range, 83–97) (p < 0.001) and VAS score improved from 5.50 ± 1.60 (range, 4–8) before surgery to 1.88 ± 0.83 (range, 1–3) (p < 0.001) at latest follow-up. In all eight patients, no wound infection, skin necrosis, or delayed healing of osteotomy was found.

Conclusion

We proposed a simple and effective technique that restored the shape of the cartilage surface by preserving the cartilage flap and restoring the natural congruency of the subchondral bone by synthetic bone grafting. We found satisfying clinical outcomes in short-term follow-up. Our new technique might be a new surgical option for the treatment of OLT and its effectiveness should be further evaluated.

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Funding

This research was supported by Medical Technology Innovation Project of The Second Affiliated Hospital of Chongqing Medical University.

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Authors and Affiliations

  1. Center for Joint Surgery, Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China

    Xudong Yao, Xiaowei Xie, Shirong Chen & Xiangjun Cheng

  2. Emergency Department, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China

    Zhu Yun

  3. Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China

    Yu Du

Authors
  1. Xudong Yao
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  2. Zhu Yun
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  3. Yu Du
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  4. Xiaowei Xie
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  5. Shirong Chen
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  6. Xiangjun Cheng
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Contributions

All authors contributed to the study conception and design. Xiangjun Cheng designed and performed the surgery. Material preparation, data collection, and analysis were performed by Xudong Yao, Yun Zhu, and Yu Du. The first draft of the manuscript was written by Xudong Yao and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Xiangjun Cheng.

Ethics declarations

Ethics approval

This is an observational study. The Medical Ethics Committee at the Second Affiliated Hospital of Chongqing Medical University has confirmed that no ethical approval is required.

Consent to participate

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

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The authors affirm that human research participants provided informed consent for publication of the images in Figs. 1 and 5.

Competing interests

The authors declare no competing interests.

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Yao, X., Yun, Z., Du, Y. et al. Synthetic bone grafting with preserved cartilage flap via a medial malleolus osteotomy approach to treat osteochondral lesion of the talus: technical note and preliminary clinical results. International Orthopaedics (SICOT) 47, 2743–2749 (2023). https://doi.org/10.1007/s00264-023-05920-9

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  • DOI: https://doi.org/10.1007/s00264-023-05920-9

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