2017 ISAKOS Biennial Congress ePoster #124

 

Large Talar Bone Cysts with Chondral Collapse Managed with Autologous Bone Grafting ± DBM and Periosteum Transfer

Dimitrios Nikolopoulos, PhD, Athens GREECE
Neoptolemos Sergides, MD, Athens, Attiki GREECE
Konstantinos Moustakas, MD, megara attikis, MORAVA 16 STREET GREECE
George Safos, MD, Athens GREECE
Petros Safos, MD, Ikaria GREECE

Central Clinic of Athens, Athens, GREECE

FDA Status Not Applicable

Summary

Autologous cancellous graft transplantation ± DBM with periosteum from the ipsilateral proximal tibia to the talus is a very promising surgical procedure to treat large talus bone cysts with chondral defect.

Abstract

Objective

Large bone cysts of the talus can be challenging to treat, due to fact that the damaged articular cartilage has a poor intrinsic reparative capability; and because they can cause chronic pain and serious disability. Our objective is to evaluate efficiency and effectiveness of autologous cancellous graft transplantation from the proximal tibial metaphysis ± DBM (Demineralized Bone Matrix) in the treatment of talus large defects in adults (>400mm2).

Methods

From Jan 2007 to Jan 2015, 17 patients (9 males and 8 females), of mean age 29.7 years old (range; 17 to 51) were operated for large talar bone cysts with chondral collapse. The surgical steps followed consisted of: (1) chevron medial malleolar osteotomy, (2) excision of the necrotic sequestrum and curetting the crater to bleeding bone, (3) autologous cancellous graft transferring from the proximal tibial metaphysis and (4) periosteum transfix of the distal tibia over the talus osteochondral lesion (Nylon 8-0). In 7 cases DBM was also used. The post-operative regime included a 3-month period of non-weight-bearing. Preoperative planning was performed (X-rays, CT scan and MRI). Preoperative and postoperative clinical evaluation was performed at 6 and 12 months based on VAS and American Orthopaedic Foot and Ankle Society (AOFAS) scores. The patients were followed-up for an average of 2 years (range; 12-36 months).

Results

The VAS and AOFAS scores were statistically significant improved from an M=8.5 (7-10) and M=24.8 (14-54) pre- to M=1.7 (0-3) and M=88.7 (74-97) post-operative respectively (p<0,001). At last follow-up there were 14 patients (88.4%) with excellent and very good results and 3 (11.6%) with good based on AOFAS score. Fourteen patients were active at the same level as prior to talar defect, whereas 3 patients dropped to a lower activity level (abstain from high level sport activities). Based on last post-operative X-rays and MRIs follow-up in 5 patients observed residual chondral lesion (less than 20% of the initial defect); but with limited clinical symptoms (occasional pain, swelling, limitation in everyday activities). In the 7 cases where DBM was used the osteointegration was statistically significant improved (M=9 weeks vs 12 weeks).

Conclusions

Autologous cancellous graft transplantation with periosteum from the ipsilateral proximal tibia to the talus is a very promising surgical procedure to treat large talus bone cysts with chondral defect. The technique of autologous bone grafting, DBM and periosteum transfer should be considered as the primary treatment in all the adult patients with a symptomatic advanced large osteochondral defect of the talus.