Haleem Amgad M, Ross Keir A, Smyth Niall A, Duke Gavin L, Deyer Timothy W, Do Huong T, Kennedy John G
Department of Orthopedic Surgery, Foot and Ankle Service, Hospital for Special Surgery, New York, NY, USA.
Department of Radiology, East River Medical Imaging, New York, NY, USA.
Am J Sports Med. 2014 Aug;42(8):1888-95. doi: 10.1177/0363546514535068. Epub 2014 Jun 19.
Autologous osteochondral transplantation (AOT) is used for large (>100-150 mm(2)) or cystic osteochondral lesions (OCLs) of the talus. Larger lesions may require using more than 1 graft to fill the defect. While patients with larger OCLs treated with microfracture exhibit inferior clinical outcomes, there is little evidence regarding the effect of lesion size and number of grafts required on clinical and radiological outcomes after AOT.
Larger OCLs of the talar dome treated by double-plug AOT (dp-AOT) have inferior clinical and radiological MRI outcomes compared with smaller OCLs requiring single-plug AOT (sp-AOT).
Cohort study; Level of evidence, 3.
Fourteen consecutive patients with a large OCL (mean, 208 ± 54 mm(2)) treated using dp-AOT with a minimum 5-year follow-up were matched by age and sex to a control cohort of 28 patients who underwent sp-AOT for a smaller OCL (mean, 74 ± 26 mm(2)) over the same period. Functional outcomes were assessed both pre- and postoperatively using the Foot and Ankle Outcome Score (FAOS) and Short Form-12 (SF-12) general health questionnaire. Mean follow-up was 85 months (range, 65-118 months). Latest postoperative MRI was evaluated with modified magnetic resonance observation of cartilage repair tissue (MOCART) score.
There was no significant difference between groups demographically (P > .05). All patients with dp-AOT and sp-AOT showed a significant pre- to postoperative increase in FAOS and SF-12 scores (P < .001). When comparing preoperative scores for both groups, there was no statistical significance between sp-AOT and dp-AOT scores (FAOS, P = .719; SF-12, P = .947). There was no significant difference in functional scores between the 2 groups postoperatively for both FAOS (P = .883) and SF-12 (P = .246). Mean MOCART scores did not exhibit any statistically significant difference between groups (P = .475). Two patients complained of knee donor site stiffness (4.8%), which later resolved.
Patients with large OCLs treated using a dp-AOT procedure did not show inferior clinical or radiological outcomes compared with those treated with sp-AOT at a minimum 5-year follow-up. The dp-AOT procedure is as effective as sp-AOT in treating larger OCLs of the talar dome in the intermediate term, with similar high postoperative clinical and radiological outcomes.
自体骨软骨移植（AOT）用于距骨的大型（>100 - 150 mm²）或囊性骨软骨损伤（OCL）。较大的损伤可能需要使用不止1块移植物来填充缺损。虽然接受微骨折治疗的较大OCL患者临床结局较差，但关于AOT后损伤大小和所需移植物数量对临床和影像学结局的影响，几乎没有证据。
与需要单栓AOT（sp - AOT）的较小OCL相比，双栓AOT（dp - AOT）治疗的距骨穹顶较大OCL的临床和MRI影像学结局较差。
队列研究；证据等级，3级。
连续纳入14例接受dp - AOT治疗的大型OCL患者（平均面积208±54 mm²），随访至少5年，按照年龄和性别匹配28例同期接受sp - AOT治疗较小OCL（平均面积74±26 mm²）的对照队列。术前和术后使用足踝结局评分（FAOS）和简短健康调查问卷12项（SF - 12）评估功能结局。平均随访85个月（范围65 - 118个月）。采用改良的软骨修复组织磁共振观察（MOCART）评分评估最新术后MRI。
两组在人口统计学上无显著差异（P >.05）。所有接受dp - AOT和sp - AOT的患者术后FAOS和SF - 12评分均较术前显著提高（P <.001）。比较两组术前评分，sp - AOT和dp - AOT评分之间无统计学意义（FAOS，P =.719；SF - 12，P =.947）。术后两组在FAOS（P =.883）和SF - 12（P =.246）功能评分上均无显著差异。平均MOCART评分在两组之间无统计学显著差异（P =.475）。2例患者抱怨膝关节供区僵硬（4.8%），但后来症状缓解。
在至少5年的随访中，接受dp - AOT治疗的大型OCL患者与接受sp - AOT治疗的患者相比，临床或影像学结局并不差。中期来看，dp - AOT治疗距骨穹顶较大OCL的效果与sp - AOT相当，术后临床和影像学结局相似且良好。
