Summary

We advise that the operative indication conclude age less then 50, defect size less then 4cm, the depth of defect could be full-thickness or osteochondral defect. If the ankle is unstable, ligament repair should be done to ensure the efficacy. Compare with autologous ilium transplantation, autologous osteochondral transplantation has reliable effect.

Abstract

There were 23 patients from May 2015 to June 2016 with cartilage defects of the talus including post- traumatic cartilage defects(n=5), osteochondritis dissecans(n=2), local osteoarthritis(n=3), and bone cyst(n=3). We first used arthroscopic debridement (Focal cleaning for bone cyst), and the position and size of the defect were defined under ankle arthroscopy. The procedures consisted of debriding its edges and base drilled under ankle arthroscopy or arthrotomy, then harvesting osteochondral cylinders from non- weight bearing surface of the ipsilateral knee under arthroscopy, and using the osteochondral auto graft transfer system (OATS) to implant the donor graft into the recipient holes of talus cartilaginous defects with press- fit technique. A single donor transplantation or the mosaicplasty was used.
All the patients were followed up for 15 to 24 months (mean, 19 months) . The pain intensity measured by standard visual analogue scale (VAS) reduced from 4.5±1.2 to 2.1 ±0.6 at final follow-up(P<0.05). The ankle joints flexion and extension degree of the angle were measured to indicate that the range of motion(ROM) improved significantly from 40.3°±3.6°to 59.5°±4.8°9 compared with preoperative status(P<0.05). Finally, the overall status of the ankle were validated by the AOFAS Ankle Hindfoot Scale. The scores improved from 51.3±2.3 to 78.6±5.4 after surgery. The grafts showed excellent bony integration with surrounding tissues and congruity of the articular surface through the ankle MRI.