Histological and Gross Evaluation through Second-Look Arthroscopy of Osteochondral Lesions of the Talus after Failed Treatment with Particulated Juvenile Cartilage: A Case Series.

INTRODUCTION

The treatment of osteochondral lesions of the talus (OLTs) recalcitrant to non-surgical interventions is challenging. Particulated juvenile cartilage allograft transplantation (PJCAT) has become a viable treatment option, obviating the need for an osteotomy or second-stage surgery and eliminating risk of donor site morbidity. Short-term outcomes have been promising, but failures associated with PJCAT have not been well described.

CASE REPORT

Four patients with OLTs who had continued symptoms after PJCAT underwent a second-look arthroscopic evaluation. The quality of cartilage repair was evaluated using the international cartilage repair society (ICRS) score. Biopsy of the repair was taken for histological analysis. Two patients demonstrated a lack of integration of the allograft into the surrounding cartilage, and two had failures associated with impingement. Three patients' repairs were consistent with a Grade III ICRS score and one with a Grade II score. Histological examination demonstrated fibrotic repair tissue (Type 1 collagen) with depleted proteoglycans and Type II collagen.

CONCLUSION

There were no obvious patients or surgical factors associated with poor outcomes. Integration of PJCAT with surrounding cartilage appears to be affected by biological and mechanical factors. Further, understanding of factors influencing PJCAT integration will help develop more specific indications for use.