Liu Lequan, Jin Jiangtao, Pan Jinping, Guo Huikang, Li Sen, Li Jisheng, Zhang Zheng
Arthroplasty Dept, Jincheng General Hospital, 1st Kangping Road, Beishidian Area, Jincheng, 048006, Shanxi, People's Republic of China.
J Orthop Traumatol. 2025 Feb 7;26(1):8. doi: 10.1186/s10195-025-00818-1.
Osteochondral lesions of the talus (OLTs) with a large subchondral cyst have been shown to have inferior clinical outcomes after reparative techniques. Replacement techniques such as autologous osteoperiosteal transplantation (AOPT) and autologous osteochondral transplantation (AOCT) are indicated for large lesions. The aim of the study was to compare the short-term clinical and radiographic outcomes between patients undergoing AOPT and those undergoing AOCT for large cystic OLTs.
Patients who underwent AOPT or AOCT for medial large cystic OLTs between May 2019 and June 2023 were retrospectively evaluated. According to their characteristics, 1:1 propensity-score matching was performed, and 65 pairs of patients with ages ranging from 18 to 60 years old were recruited. Clinical outcomes were compared between both groups with the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and Visual Analogue Scale (VAS). The Ankle Activity Score (AAS), time to return to sports activity (RTA), rate of return to sports level, complications, and results of a subjective evaluation were also collected. The integrity of subchondral bone and the quality of repaired cartilage were evaluated using the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score 12 months postoperatively. Second-look arthroscopy was performed 12 months postoperatively, and the cartilage repair was assessed with the criteria of the International Cartilage Repair Society (ICRS).
The within-group comparison showed significant improvements in pain severity and function in both groups post-treatment compared with pre-treatment. Between-group analysis, however, showed no significant statistical difference between groups in any of the variables for clinical and radiographic outcomes, except for donor-site morbidity of the AOPT group, which showed a better outcome compared to the AOCT group.
In the treatment of large cystic OLTs, for patients with a chondral lesion of the patellofemoral joint that is unsuitable for AOCT, AOPT may be a safe and effective choice, with lower donor-site morbidity of the normal knee joint.
距骨骨软骨损伤（OLTs）伴有大的软骨下囊肿，经修复技术治疗后临床疗效较差。对于大的损伤，可采用自体骨膜移植（AOPT）和自体骨软骨移植（AOCT）等置换技术。本研究的目的是比较接受AOPT和AOCT治疗大囊性OLTs患者的短期临床和影像学结果。
回顾性评估2019年5月至2023年6月间因内侧大囊性OLTs接受AOPT或AOCT治疗的患者。根据其特征进行1:1倾向评分匹配，招募了65对年龄在18至60岁之间的患者。采用美国矫形足踝协会（AOFAS）踝-后足评分和视觉模拟量表（VAS）比较两组的临床结果。还收集了踝关节活动评分（AAS）、恢复运动活动时间（RTA）、恢复运动水平的比率、并发症以及主观评估结果。术后12个月使用磁共振软骨修复组织观察（MOCART）评分评估软骨下骨的完整性和修复软骨的质量。术后12个月进行二次关节镜检查，并根据国际软骨修复协会（ICRS）的标准评估软骨修复情况。
组内比较显示，与治疗前相比，两组治疗后疼痛严重程度和功能均有显著改善。然而，组间分析显示，除AOPT组的供区并发症优于AOCT组外，两组在临床和影像学结果的任何变量上均无显著统计学差异。
在治疗大囊性OLTs时，对于不适合AOCT的髌股关节软骨损伤患者，AOPT可能是一种安全有效的选择，且正常膝关节的供区并发症较低。
