■骨软骨自体移植(OAT)已广泛用于治疗距骨软骨损伤(OLT)。先前的研究报告了从膝关节髁间凹口或股骨髁非负重区域使用骨软骨自体移植物的成功结果。然而,在一些病例中观察到膝关节的供体部位发病率。这项研究旨在研究从同侧距骨外侧关节小关节移植OAT作为内侧OLT的替代供体部位的结果和安全性。
■在接受OAT的40名患者中,29例患者被排除在外。回顾性分析2011年至2022年的11例患者接受了从同侧距骨外侧关节突获取骨软骨移植物的OAT。在踝关节磁共振成像上测量OLT的大小,包括日冕长度,矢状长度,深度,和面积。使用美国骨科足踝协会(AOFAS)踝足后足量表和视觉模拟量表(VAS)评估临床结果。术后和手术后1年获得负重踝关节X光片。
■术后平均随访时间为64.7个月(范围,14-137个月)。病灶直径平均8.8mm(范围,8-9.9毫米)。病灶的平均大小为51.2mm2(范围,33.6-71.3mm2),所有病变包括软骨下囊肿。病灶平均深度为7.3mm(范围,6.2-9.1mm)。移植物的直径范围从8到10毫米(8毫米,n=1;10mm,n=10)术后所有测量的临床结果均得到改善,包括AOFAS评分(术前,55.4±9.0;1年随访,92.1±7.6;p=0.001)和VAS评分(术前,5.5±0.7;1年随访,1.9±0.8;p=0.001)。移植和供体部位的所有负重踝关节X线照片均未显示踝关节的关节炎改变,外侧距骨穹顶塌陷,术后1年移植部位延迟愈合或不愈合。
■对于单个中间OLT,在OAT中,从同侧距骨外侧关节面收获自体移植物,而没有膝关节供体部位的发病率,可以作为OLT的一种很好的选择。
UNASSIGNED: Osteochondral autologous transplantation (OAT) has been widely used in the treatment of osteochondral lesion of the
talus (OLT). Previous studies have reported successful outcomes following the use of osteochondral autogenous grafts from the intercondylar notch of the knee or a non-weight-bearing region of the femoral condyle. However, donor-site morbidity of the knee joint has been observed in several cases. This study aimed to investigate the outcomes and safety of OAT with autografts from the ipsilateral lateral talar articular facet as an alternative donor site for medial OLT.
UNASSIGNED: Among 40 patients who underwent OAT, 29 patients were excluded. Eleven patients who underwent OAT with an osteochondral graft harvested from the ipsilateral lateral talar articular facet from 2011 to 2022 were retrospectively analyzed. The size of OLT was measured on ankle magnetic resonance imaging, including coronal length, sagittal length, depth, and area. Clinical outcomes were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale and a visual analog scale (VAS). Weight-bearing ankle radiographs were obtained postoperatively and at 1 year after surgery.
UNASSIGNED: The average follow-up time after surgery was 64.7 months (range, 14-137 months). The average diameter of lesions was 8.8 mm (range, 8-9.9 mm). The average size of lesions was 51.2 mm2 (range, 33.6-71.3 mm2) , and all lesions included subchondral cysts. The average depth of lesions was 7.3 mm (range, 6.2-9.1 mm). Graft sizes ranged from 8 to 10 mm in diameter (8 mm, n = 1; 10 mm, n = 10) All measured clinical outcomes improved postoperatively, including the AOFAS scores (preoperative, 55.4 ± 9.0; 1-year follow-up, 92.1 ± 7.6; p = 0.001) and VAS scores (preoperative, 5.5 ± 0.7; 1-year follow-up, 1.9 ± 0.8; p = 0.001). All weight-bearing ankle radiographs of the graft and donor sites did not reveal arthritic change in the ankle joint, lateral talar dome collapse, and graft-site delayed union or nonunion at 1 year after surgery.
UNASSIGNED: For a single medial OLT, harvesting autografts from the ipsilateral lateral talar articular facet without knee donor-site morbidities can be a good alternative in OAT for OLT.