St. Michael's Hospital, Suite 800, 55 Queen Street East, Toronto, ON M5C 1R6 Canada.
J Bone Joint Surg Am. 2012 Jun 20;94(12):1105-10. doi: 10.2106/JBJS.J.02010.
Large osteochondral defects of the talus present a treatment challenge. Fresh osteochondral allograft transplantation can be used for large lesions without the donor-site morbidity associated with other procedures such as autologous chondrocyte implantation or osteochondral autograft transfer. The goal of this study was to prospectively evaluate the intermediate outcomes of fresh osteochondral allografting for osteochondral lesions of the talus with use of validated outcome measures.
Sixteen patients (seventeen ankles) received a fresh osteochondral allograft, and all sixteen were available for follow-up. Data were prospectively collected with use of the Ankle Osteoarthritis Scale (AOS), Short Form-36 (SF-36), and American Academy of Orthopaedic Surgeons (AAOS) Foot and Ankle Module outcome measures. Postoperative American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot scale scores were also collected. All sixteen patients underwent radiographic and computed tomographic (CT) analyses preoperatively, and fifteen patients had these studies postoperatively.
The average duration of follow-up was 4.1 years. The latest follow-up CT evaluation identified failure of graft incorporation in two of sixteen ankles. Osteolysis, subchondral cysts, and degenerative changes were found in five, eight, and seven ankles, respectively. Five ankles were considered failures, and two required a reoperation because of ongoing symptoms. The AOS Disability and the AAOS Foot and Ankle Core Scale scores significantly improved, but there was no significant change in the AOS Pain, AAOS Foot and Ankle Shoe Comfort Scale, or SF-36 scores. Overall, ten patients had a good or excellent result; however, persistent symptoms remained in six of these patients. Only four were symptom-free.
The use of a fresh osteochondral allograft is a reasonable option for the treatment of large talar osteochondral lesions. The high reoperation rate (two of seventeen) and failure rate (five of seventeen) must be taken into consideration when one is choosing this procedure for the management of these lesions.
距骨大的软骨骨缺损是一种治疗挑战。新鲜同种异体软骨移植可用于无供区并发症的大病变，而其他手术如自体软骨细胞移植或软骨骨块移植则存在供区并发症。本研究的目的是前瞻性评估使用经过验证的结果测量方法治疗距骨软骨骨缺损的新鲜同种异体软骨移植的中期结果。
16 例（17 个踝关节）患者接受了新鲜同种异体软骨移植，所有 16 例患者均接受了随访。使用踝关节骨关节炎量表（AOS）、36 项简短健康调查量表（SF-36）和美国矫形外科医师学会（AAOS）足部和踝关节模块结果测量方法前瞻性收集数据。术后还收集了美国矫形足踝协会（AOFAS）后足量表评分。所有 16 例患者均接受了术前的 X 线和计算机断层扫描（CT）分析，15 例患者接受了术后分析。
平均随访时间为 4.1 年。最新的随访 CT 评估发现 16 个踝关节中有 2 个存在移植物融合失败。在 5、8 和 7 个踝关节中分别发现了骨溶解、软骨下囊肿和退行性改变。5 个踝关节被认为是失败的，其中 2 个因持续存在症状需要再次手术。AOS 残疾和 AAOS 足部和踝关节核心量表评分显著改善，但 AOS 疼痛、AAOS 足部和踝关节鞋舒适量表和 SF-36 评分没有显著变化。总体而言，10 例患者的结果为良好或优秀；然而，其中 6 例患者仍存在持续症状。只有 4 例患者无症状。
对于距骨大的软骨骨缺损，使用新鲜同种异体软骨移植是一种合理的选择。在选择这种手术方法治疗这些病变时，必须考虑到高的再次手术率（17 例中有 2 例）和失败率（17 例中有 5 例）。
