Department of Orthopedic Sports Medicine, Technical University, Munich, Germany.
Am J Sports Med. 2011 Jul;39(7):1487-93. doi: 10.1177/0363546510397726. Epub 2011 Mar 3.
Osteochondral lesions of the ankle are a common injury after ankle sprains, especially in young and active patients. The Osteochondral Autograft Transfer System (OATS) is the only 1-step surgical technique designed to replace the entire osteochondral unit.
This study was conducted to evaluate the long-term clinical and radiographic outcomes of the OATS procedure for the talus and compare the results of patients who have had prior surgical interventions with patients for whom OATS represents the primary surgical treatment.
Case series; Level of evidence, 4.
The authors retrospectively analyzed 26 talus OATS procedures (25 patients) with an average follow-up of 84 months (range, 53-124 months); 9 patients had OATS as a second surgical intervention. The patients completed the American Orthopaedic Foot & Ankle Society (AOFAS) and Tegner scores plus the visual analog scale (VAS) preoperatively and at follow-up. Magnetic resonance imaging examinations were conducted on a 1.5-T whole-body magnet that assessed transplant congruency, adjacent surface of the talus, the corresponding distal tibia, and joint effusion.
The authors found significant increases for the AOFAS score (50 to 78 points, P < .01) and the Tegner score (3.1 to 3.7, P < .05) and a significant decrease for the VAS (7.8 to 1.5, P < .01) from preoperative to postoperative. Patients with normal integration or minor incongruity of the transplant on magnetic resonance imaging (81%) had significantly better AOFAS scores (P = .03). Other magnetic resonance imaging criteria did not predict clinical results. Patients for whom OATS represented a second procedure had significantly worse clinical AOFAS and Tegner scores plus a higher VAS.
Long-term clinical and magnetic resonance imaging results after osteochondral transplantation are good and patients significantly benefit from this surgery. Magnetic resonance imaging should not be a routine control but appears to be indicated when clinical symptoms persist after osteochondral transplantation.
踝关节骨软骨损伤是踝关节扭伤后的常见损伤，尤其是在年轻和活跃的患者中。骨软骨自体移植系统（OATS）是唯一一种设计用于替代整个骨软骨单位的 1 步手术技术。
本研究旨在评估 OATS 治疗距骨的长期临床和影像学结果，并比较既往接受过手术干预的患者与初次接受 OATS 手术的患者的结果。
病例系列；证据等级，4 级。
作者回顾性分析了 26 例（25 例患者）距骨 OATS 手术，平均随访 84 个月（范围，53-124 个月）；9 例患者将 OATS 作为第二次手术干预。患者在术前和随访时完成美国矫形足踝协会（AOFAS）和 Tegner 评分以及视觉模拟评分（VAS）。磁共振成像检查在 1.5-T 全身磁体上进行，评估移植物的一致性、距骨的相邻表面、相应的胫骨远端和关节积液。
作者发现 AOFAS 评分（从 50 分增加到 78 分，P <.01）和 Tegner 评分（从 3.1 分增加到 3.7 分，P <.05）显著增加，VAS 评分（从 7.8 分降低到 1.5 分，P <.01）显著降低。磁共振成像显示移植体存在正常整合或轻微错位的患者的 AOFAS 评分显著更好（P =.03）。其他磁共振成像标准不能预测临床结果。对于将 OATS 作为第二次手术的患者，AOFAS 和 Tegner 评分明显较差，VAS 更高。
骨软骨移植后的长期临床和磁共振成像结果良好，患者从该手术中显著获益。磁共振成像不应作为常规检查，但在骨软骨移植后临床症状持续存在时似乎是必要的。
