Kwak Steve K, Kern Brian S, Ferkel Richard D, Chan Keith W, Kasraeian Sina, Applegate Gregory R
North Jersey Orthopaedic Specialists, Teaneck, New Jersey, USA.
The Orthopaedic Institute of Western Kentucky, Paducah, Kentucky, USA.
Am J Sports Med. 2014 Sep;42(9):2156-64. doi: 10.1177/0363546514540587. Epub 2014 Jul 23.
The treatment of osteochondral lesions of the talus after failed surgery is challenging, with no clear solution. Short-term results using autologous chondrocyte implantation have been promising.
To report the long-term outcomes of patients who underwent autologous chondrocyte implantation (ACI) of the talus after failed marrow stimulation techniques for osteochondral lesions of the talus (OLTs).
Case series; Level of evidence, 4.
Thirty-two consecutive patients underwent ACI of the talus, and 29 patients (15 male, 14 female; mean age, 34 years [range, 16-54 years]) were available for follow-up. There were 23 medial and 6 lateral lesions, with a mean size of 18 × 11 mm (198 mm(2); range, 80-500 mm(2)). Twenty patients underwent ACI of the talus alone; 9 underwent ACI with bone grafting of underlying cysts. Follow-up was performed at a mean of 70 months (range, 24-129 months). Patient outcomes were evaluated using the simplified symptomatology score, Tegner activity score, Finsen score, and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score. Twenty-five patients (86%) underwent second-look arthroscopic surgery at the time of hardware removal and were assessed with the International Cartilage Repair Society (ICRS) score. Postoperative magnetic resonance imaging (MRI) was performed on 24 patients (83%) and compared with preoperative MRI scans.
Preoperatively, 26 patients rated their ankles as poor and 3 as fair using the simplified symptomatology score. At last follow-up, 9 were classified as excellent, 14 as good, 5 as fair, and 1 as poor using the same score. The mean AOFAS score improved from 50.1 to 85.9 (range, 65-100). The mean Tegner activity score improved from 1.6 to 4.3 (P < .0001). The mean Finsen score (modified Weber score) showed significant improvement from 13.7 to 5.1 (P < .0001).
Autologous chondrocyte implantation of the talus yields improvement in all parameters tested with enduring long-term results in patients who have failed previous surgery for OLTs.
距骨骨软骨损伤手术失败后的治疗具有挑战性，尚无明确的解决方案。自体软骨细胞移植的短期效果令人期待。
报告距骨骨软骨损伤（OLT）骨髓刺激技术失败后接受距骨自体软骨细胞移植（ACI）患者的长期疗效。
病例系列；证据等级，4级。
32例连续患者接受了距骨ACI，29例患者（15例男性，14例女性；平均年龄34岁[范围16 - 54岁]）可供随访。有23例内侧损伤和6例外侧损伤，平均大小为18×11 mm（198 mm²；范围80 - 500 mm²）。20例患者仅接受距骨ACI；9例接受ACI并对下方囊肿进行植骨。平均随访70个月（范围24 - 129个月）。使用简化症状评分、Tegner活动评分、Finsen评分和美国矫形足踝协会（AOFAS）踝 - 后足评分评估患者预后。25例患者（86%）在取出内固定装置时接受了二次关节镜手术，并采用国际软骨修复协会（ICRS）评分进行评估。24例患者（83%）进行了术后磁共振成像（MRI）检查，并与术前MRI扫描进行比较。
术前，使用简化症状评分，26例患者将其踝关节评为差，3例评为一般。在最后一次随访时，使用相同评分，9例评为优秀，14例评为良好，5例评为一般，1例评为差。AOFAS平均评分从50.1提高到85.9（范围为65 - 100）。Tegner平均活动评分从1.6提高到4.3（P <.0001）。Finsen平均评分（改良Weber评分）从13.7显著提高到5.1（P <.0001）。
距骨自体软骨细胞移植使所有测试参数均得到改善，对于既往OLT手术失败的患者产生了持久的长期疗效。
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