Autogenous periosteal iliac bone graft with external fixation for treatment of severe osteochondral lesion of talus_West China Medical Journal

Authors：

YANG Heng ¹ , SHI Bo ² , TANG Shitian ² , WANG Tao ² , ZANG Yonghui ² ,  HUANG Junqi ²

1. Department of Orthopaedics, Jiange People’s Hospital, Jiange, Sichuan 628300, P. R. China;
2. Department of Orthopaedics, Mianyang Central Hospital, Mianyang, Sichuan 621000, P. R. China;

Corresponding author：

HUANG Junqi, Email: 402278385@qq.com

Keywords：

Talus; cartilage; bone graft; external fixation

DOI：

10.7507/1002-0179.202212076

Video：

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Objective To explore the clinical efficacy of external fixation combined with autogenous periosteal iliac bone for repairing cartilage injury of the talus. Methods The data of 18 patients with talus cartilage injury treated in Mianyang Central Hospital between January 2018 and January 2022 were retrospectively analyzed. All patients received autogenous periosteal iliac bone transplantation and external fixation brackets. The Visual Analogue Scale (VAS), joint range of motion, and the American Orthopedic Foot and Ankle Society (AOFAS) ankle posterior foot score were assessed before surgery and 6 months after surgery. The changes of cartilage damage of the talus on MRI before and after surgery were compared. The complications related to the operation were recorded. Results The patients included 5 males and 13 females, with an average age of (50.7±5.4) years. There were 6 cases injured on the left side and 12 cases injured on the right side. The Hepple’s classification was type Ⅲ in 8 cases and type Ⅳ in 10 cases. The average follow-up time was (17.6±8.2) months. The preoperative VAS score, ankle range of motion, and AOFAS score were 5.5±1.5, (48.0±10.5)°, and 54.9±11.1, respectively. Six months after surgery, the VAS score, ankle range of motion, and AOFAS score were 2.1±0.9, (64.8±7.8)°, and 82.6±8.7, respectively, and the differences from preoperative scores were all statistically significant (P<0.05). The preoperative MRI showed that the area of talus cartilage injury was (2.6±0.6) cm², and the depth was (10.0±0.4) mm; the 1-year follow-up MRI showed that the area of talus cartilage injury was (0.6±0.2) cm², and the depth was (5.5±0.3) mm, which statistically differed from those before surgery (P<0.05). By the last follow-up, no postoperative complications such as incision infection, bone graft fracture, and nonunion of the inner ankle were found. Conclusions Autogenous periosteal iliac bone graft can repair cartilage injury of the talus. External fixation stent provides early joint stability, avoiding uneven joint compression or joint impact.

Citation： YANG Heng, SHI Bo, TANG Shitian, WANG Tao, ZANG Yonghui, HUANG Junqi. Autogenous periosteal iliac bone graft with external fixation for treatment of severe osteochondral lesion of talus. West China Medical Journal, 2023, 38(4): 525-529. doi: 10.7507/1002-0179.202212076 Copy

1.	Natsuhara KM, Sarcon A, Kreulen C, et al. Treatment of osteochondral lesions of talus with extracellular matrix cartilage allografts. Tech Foot Ankle Surg, 2019, 18(2): 61-67.
2.	Bajuri MY, Sabri S, Mazli N, et al. Osteochondral injury of the talus treated with cell-free hyaluronic acid-based scaffold (Hyalofast®) - a reliable solution. Cureus, 2021, 13(9): e17928.
3.	马玉海, 刘彧, 陈长松, 等. 自体带骨膜髂骨移植治疗重度距骨软骨损伤. 中华创伤杂志, 2021, 37(7): 635-640.
4.	Sadlik B, Kolodziej L, Puszkarz M, et al. Surgical repair of osteochondral lesions of the talus using biologic inlay osteochondral reconstruction: clinical outcomes after treatment using a medial malleolar osteotomy approach compared to an arthroscopically-assisted approach. Foot Ankle Surg, 2019, 25(4): 449-45.
5.	Hepple S, Winson IG, Glew D. Osteochondral lesions of the talus: a revised classification. Foot Ankle Int, 1999, 20(12): 789-793.
6.	Cunningham DJ, Adams SB. Arthroscopic treatment of osteochondral lesions of the talus with microfracture and platelet-rich plasma-infused micronized cartilage allograft. Arthrosc Tech, 2020, 9(5): e627-e637.
7.	Luick L, Steinmetz G, Haleem A. All-arthroscopic osteochondral autograft transfer technique for osteochondritis dissecans of the talus. Arthrosc Tech, 2020, 9(4): e499-e503.
8.	Latt LD, Glisson RR, Montijo HE, et al. Effect of graft height mismatch on contact pressures with osteochondral grafting of the talus. Am J Sports Med, 2011, 39(12): 2662-2669.
9.	史雪峰, 唐翔宇, 项毅, 等. 髂骨带骨膜移植治疗距骨骨软骨损伤的临床疗效. 实用骨科杂志, 2022, 60(6): 615-618.
10.	Badekas T, Takvorian M, Souras N. Treatment principles for osteochondral lesions in foot and ankle. Int Orthop, 2013, 37(9): 1697-1706.
11.	Bruns J, Habermann C, Werner M. Osteochondral lesions of the talus: a review on talus osteochondral injuries, including osteochondritis dissecans. Cartilage, 2021, 13(1_Suppl): 1380S-1401S.
12.	Bruns J, Rosenbach B, Kahrs J. Etiopathogenetic aspects of medial osteochondrosis dissecans tali. Sportverletz Sportschaden, 1992, 6(2): 43-49.
13.	Yasui Y, Hannon CP, Seow D, et al. Ankle arthrodesis: a systematic approach and review of the literature. World J Orthop, 2016, 7(11): 700-708.
14.	Hurley ET, Stewart SK, Kennedy JG, et al. Current management strategies for osteochondral lesions of the talus. Bone Joint J, 2021, 103-B(2): 207-212.
15.	Zwingmann J, Südkamp NP, Schmal H, et al. Surgical treatment of osteochondritis dissecans of the talus: a systematic review. Arch Orthop Trauma Surg, 2012, 132(9): 1241-1250.
16.	Hannon CP, Bayer S, Murawski CD, et al. Debridement, curettage, and bone marrow stimulation: proceedings of the international consensus meeting on cartilage repair of the ankle. Foot Ankle Int, 2018, 39(1_Suppl): 16S-22S.
17.	Shimozono Y, Seow D, Yasui Y, et al. Knee-to-talus donor-site morbidity following autologous osteochondral transplantation: a meta-analysis with best-case and worst-case analysis. Clin Orthop Relat Res, 2019, 477(8): 1915-1931.
18.	Kreuz PC, Steinwachs M, Erggelet C, et al. Mosaicplasty with autogenous talar autograft for osteochondral lesions of the talus after failed primary arthroscopic management: a prospective study with a 4-year follow-up. Am J Sports Med, 2006, 34(1): 55-63.
19.	Nguyen A, Ramasamy A, Walsh M, et al. Autologous osteochondral transplantation for large osteochondral lesions of the talus is a viable option in an athletic population. Am J Sports Med, 2019, 47(14): 3429-3435.
20.	Sato GEN, Pagnano RG, Duarte MPM, et al. Which clinical outcome scores are more frequently used in the literature on osteochondral lesions of the talus? A systematic review. Acta Ortop Bras, 2021, 29(3): 167-170.
21.	Scranton PE, Frey CC, Feder KS. Outcome of osteochondral autograft transplantation for type-V cystic osteochondral lesions of the talus. J Bone Joint Surg Br, 2006, 88(5): 614-619.
22.	Vogel J, Soti V. Effectiveness of autograft and allograft transplants in treating athletic patients with osteochondral lesions of the talus. Cureus, 2022, 14(10): e29913.

1. Natsuhara KM, Sarcon A, Kreulen C, et al. Treatment of osteochondral lesions of talus with extracellular matrix cartilage allografts. Tech Foot Ankle Surg, 2019, 18(2): 61-67.
2. Bajuri MY, Sabri S, Mazli N, et al. Osteochondral injury of the talus treated with cell-free hyaluronic acid-based scaffold (Hyalofast®) - a reliable solution. Cureus, 2021, 13(9): e17928.
3. 马玉海, 刘彧, 陈长松, 等. 自体带骨膜髂骨移植治疗重度距骨软骨损伤. 中华创伤杂志, 2021, 37(7): 635-640.
4. Sadlik B, Kolodziej L, Puszkarz M, et al. Surgical repair of osteochondral lesions of the talus using biologic inlay osteochondral reconstruction: clinical outcomes after treatment using a medial malleolar osteotomy approach compared to an arthroscopically-assisted approach. Foot Ankle Surg, 2019, 25(4): 449-45.
5. Hepple S, Winson IG, Glew D. Osteochondral lesions of the talus: a revised classification. Foot Ankle Int, 1999, 20(12): 789-793.
6. Cunningham DJ, Adams SB. Arthroscopic treatment of osteochondral lesions of the talus with microfracture and platelet-rich plasma-infused micronized cartilage allograft. Arthrosc Tech, 2020, 9(5): e627-e637.
7. Luick L, Steinmetz G, Haleem A. All-arthroscopic osteochondral autograft transfer technique for osteochondritis dissecans of the talus. Arthrosc Tech, 2020, 9(4): e499-e503.
8. Latt LD, Glisson RR, Montijo HE, et al. Effect of graft height mismatch on contact pressures with osteochondral grafting of the talus. Am J Sports Med, 2011, 39(12): 2662-2669.
9. 史雪峰, 唐翔宇, 项毅, 等. 髂骨带骨膜移植治疗距骨骨软骨损伤的临床疗效. 实用骨科杂志, 2022, 60(6): 615-618.
10. Badekas T, Takvorian M, Souras N. Treatment principles for osteochondral lesions in foot and ankle. Int Orthop, 2013, 37(9): 1697-1706.
11. Bruns J, Habermann C, Werner M. Osteochondral lesions of the talus: a review on talus osteochondral injuries, including osteochondritis dissecans. Cartilage, 2021, 13(1_Suppl): 1380S-1401S.
12. Bruns J, Rosenbach B, Kahrs J. Etiopathogenetic aspects of medial osteochondrosis dissecans tali. Sportverletz Sportschaden, 1992, 6(2): 43-49.
13. Yasui Y, Hannon CP, Seow D, et al. Ankle arthrodesis: a systematic approach and review of the literature. World J Orthop, 2016, 7(11): 700-708.
14. Hurley ET, Stewart SK, Kennedy JG, et al. Current management strategies for osteochondral lesions of the talus. Bone Joint J, 2021, 103-B(2): 207-212.
15. Zwingmann J, Südkamp NP, Schmal H, et al. Surgical treatment of osteochondritis dissecans of the talus: a systematic review. Arch Orthop Trauma Surg, 2012, 132(9): 1241-1250.
16. Hannon CP, Bayer S, Murawski CD, et al. Debridement, curettage, and bone marrow stimulation: proceedings of the international consensus meeting on cartilage repair of the ankle. Foot Ankle Int, 2018, 39(1_Suppl): 16S-22S.
17. Shimozono Y, Seow D, Yasui Y, et al. Knee-to-talus donor-site morbidity following autologous osteochondral transplantation: a meta-analysis with best-case and worst-case analysis. Clin Orthop Relat Res, 2019, 477(8): 1915-1931.
18. Kreuz PC, Steinwachs M, Erggelet C, et al. Mosaicplasty with autogenous talar autograft for osteochondral lesions of the talus after failed primary arthroscopic management: a prospective study with a 4-year follow-up. Am J Sports Med, 2006, 34(1): 55-63.
19. Nguyen A, Ramasamy A, Walsh M, et al. Autologous osteochondral transplantation for large osteochondral lesions of the talus is a viable option in an athletic population. Am J Sports Med, 2019, 47(14): 3429-3435.
20. Sato GEN, Pagnano RG, Duarte MPM, et al. Which clinical outcome scores are more frequently used in the literature on osteochondral lesions of the talus? A systematic review. Acta Ortop Bras, 2021, 29(3): 167-170.
21. Scranton PE, Frey CC, Feder KS. Outcome of osteochondral autograft transplantation for type-V cystic osteochondral lesions of the talus. J Bone Joint Surg Br, 2006, 88(5): 614-619.
22. Vogel J, Soti V. Effectiveness of autograft and allograft transplants in treating athletic patients with osteochondral lesions of the talus. Cureus, 2022, 14(10): e29913.

West China Medical Journal

Autogenous periosteal iliac bone graft with external fixation for treatment of severe osteochondral lesion of talus

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