PURPOSE: To investigate the clinical, radiologic, and second-look arthroscopic outcomes of autologous iliac crest osteoperiosteal cylinder graft transplantation for medial osteochondral lesions of the talus (OLTs) with large subchondral cysts. METHODS: Between January 2008 and December 2010, 17 consecutive cases of medial OLT with a subchondral cyst larger than 10 mm in diameter received transplantation of autologous osteoperiosteal cylinder graft, which was harvested from the ipsilateral iliac crest. The visual analog scale score for pain during daily activities, American Orthopaedic Foot & Ankle Society hindfoot and ankle scores, and subjective satisfaction survey rating were obtained. Plain radiographs and magnetic resonance imaging of the ankle were obtained before and after surgery. In 13 cases second-look arthroscopy was performed 12 months postoperatively and the cartilage repair was assessed with the criteria of the International Cartilage Repair Society. RESULTS: Sixteen patients were available for follow-up at a mean of 32.6 months (range, 24 to 48 months). The mean visual analog scale score decreased from 5.51 ± 0.83 preoperatively to 0.98 ± 0.98 at the latest follow-up, and the median American Orthopaedic Foot & Ankle Society score improved from 75 preoperatively to 90 at the latest follow-up. Seven patients resumed sporting activities. Overall, 7 patients rated the result as excellent, 8 as good, and 1 as fair. The radiolucent area of the cysts disappeared on the plain radiographs in all cases. The mean Magnetic Resonance Observation of Cartilage Repair Tissue score was 60 ± 9.4 points, whereas subchondral bone edema persisted on the postoperative magnetic resonance images in 16 cases. The mean International Cartilage Repair Society arthroscopic score for cartilage repair at second-look arthroscopy was 9 ± 1.4 points. CONCLUSIONS: Autologous iliac crest osteoperiosteal cylinder graft transplantation with supplemental bone grafting is a simple, safe, and effective procedure for treatment of large cystic medial OLT. It can successfully fill the subchondral cyst and repair the cartilage defect. LEVEL OF EVIDENCE: Level IV, therapeutic case series.
PURPOSE: To investigate the clinical, radiologic, and second-look arthroscopic outcomes of autologous iliac crest osteoperiosteal cylinder graft transplantation for medial osteochondral lesions of the talus (OLTs) with large subchondral cysts. METHODS: Between January 2008 and December 2010, 17 consecutive cases of medial OLT with a subchondral cyst larger than 10 mm in diameter received transplantation of autologous osteoperiosteal cylinder graft, which was harvested from the ipsilateral iliac crest. The visual analog scale score for pain during daily activities, American Orthopaedic Foot & Ankle Society hindfoot and ankle scores, and subjective satisfaction survey rating were obtained. Plain radiographs and magnetic resonance imaging of the ankle were obtained before and after surgery. In 13 cases second-look arthroscopy was performed 12 months postoperatively and the cartilage repair was assessed with the criteria of the International Cartilage Repair Society. RESULTS: Sixteen patients were available for follow-up at a mean of 32.6 months (range, 24 to 48 months). The mean visual analog scale score decreased from 5.51 ± 0.83 preoperatively to 0.98 ± 0.98 at the latest follow-up, and the median American Orthopaedic Foot & Ankle Society score improved from 75 preoperatively to 90 at the latest follow-up. Seven patients resumed sporting activities. Overall, 7 patients rated the result as excellent, 8 as good, and 1 as fair. The radiolucent area of the cysts disappeared on the plain radiographs in all cases. The mean Magnetic Resonance Observation of Cartilage Repair Tissue score was 60 ± 9.4 points, whereas subchondral bone edema persisted on the postoperative magnetic resonance images in 16 cases. The mean International Cartilage Repair Society arthroscopic score for cartilage repair at second-look arthroscopy was 9 ± 1.4 points. CONCLUSIONS: Autologous iliac crest osteoperiosteal cylinder graft transplantation with supplemental bone grafting is a simple, safe, and effective procedure for treatment of large cystic medial OLT. It can successfully fill the subchondral cyst and repair the cartilage defect. LEVEL OF EVIDENCE: Level IV, therapeutic case series.
Authors: Christian David Weber; Gino Kerkhoffs; Jari Dahmen; Dari Ush Arbab; Philipp Kobbe; Frank Hildebrand; Philipp Lichte Journal: Unfallchirurg Date: 2021-03-05 Impact factor: 1.000
Authors: Jari Dahmen; Kaj T A Lambers; Mikel L Reilingh; Christiaan J A van Bergen; Sjoerd A S Stufkens; Gino M M J Kerkhoffs Journal: Knee Surg Sports Traumatol Arthrosc Date: 2017-06-27 Impact factor: 4.342
Authors: Pascal R van Diepen; Jari Dahmen; J Nienke Altink; Sjoerd A S Stufkens; Gino M M J Kerkhoffs Journal: Cartilage Date: 2020-09-10 Impact factor: 4.634