Butler James J, Robert Guillaume, Dahmen Jari, Lin Charles C, Robin Joseph X, Samsonov Alan P, Kerkhoffs Gino M M J, Kennedy John G
Foot and Ankle Division, Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA.
Department of Orthopaedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands.
Cartilage. 2024 Oct 29:19476035241293268. doi: 10.1177/19476035241293268.
The purpose of this study was to evaluate outcomes following autologous osteochondral transplantation (AOT) for the treatment of osteochondral lesions of the talus (OLT) at a minimum of 10-year follow-up.
Retrospective chart review identified patients who underwent AOT for the treatment of OLT. Pre-operative magnetic resonance imaging (MRI) scans were obtained in all patients. Clinical outcomes assessed included: pre- and post-operative foot and ankle outcome score (FAOS), visual analog scale (VAS), patient satisfaction, complications, failures and secondary surgical procedures.
Thirty-nine patients with a mean lesion size was 122.3 ± 64.1 mm and mean follow-up time of 138.9 ± 16.9 months were included. The mean FAOS scores improved from a preoperative score of 51.9 ± 16.0 to 75.3 ± 21.9 ( < 0.001). Increasing lesion size was variable associated with inferior FAOS scores (R = 0.2228). There was statistically significant higher mean T2 relaxation values at the superficial layer at the site of the AOT graft (42.9 ± 5.2 ms) compared to the superficial layer of the adjacent native cartilage (35.8 ± 3.8 ms) ( < 0.001). Seventeen complications (43.6%) were observed, the most common of which was anterior ankle impingement (25.6%). There were 2 failures (5.1%), both of which had a history of prior bone marrow stimulation via microfracture and post-operative cysts identified on MRI.
This retrospective review found that AOT for the treatment of large OLTs produced a 94.9% survival rate at a minimum of 10-year follow-up. Increasing lesion size was associated with inferior clinical outcomes. The findings of this study indicates that AOT is a viable long-term surgical strategy for the treatment of large OLTs.
本研究旨在评估自体骨软骨移植（AOT）治疗距骨骨软骨损伤（OLT）至少10年随访后的结果。
通过回顾性图表审查确定接受AOT治疗OLT的患者。所有患者均进行了术前磁共振成像（MRI）扫描。评估的临床结果包括：术前和术后足踝结果评分（FAOS）、视觉模拟量表（VAS）、患者满意度、并发症、失败情况和二次手术。
纳入39例患者，平均病变大小为122.3±64.1mm，平均随访时间为138.9±16.9个月。FAOS平均评分从术前的51.9±16.0提高到75.3±21.9（P<0.001）。病变大小增加与较低的FAOS评分相关（R=0.2228）。与相邻天然软骨表层相比，AOT移植物部位表层的平均T2弛豫值在统计学上显著更高（42.9±5.2ms对35.8±3.8ms）（P<0.001）。观察到17例并发症（43.6%），最常见的是前踝撞击（25.6%）。有2例失败（5.1%），均有既往微骨折骨髓刺激史且MRI发现术后囊肿。
这项回顾性研究发现，AOT治疗大型OLT在至少10年随访时的生存率为94.9%。病变大小增加与较差的临床结果相关。本研究结果表明，AOT是治疗大型OLT的一种可行的长期手术策略。
