Steve K Kwak1, Brian S Kern2, Richard D Ferkel3, Keith W Chan4, Sina Kasraeian5, Gregory R Applegate6. 1. North Jersey Orthopaedic Specialists, Teaneck, New Jersey, USA. 2. The Orthopaedic Institute of Western Kentucky, Paducah, Kentucky, USA. 3. Southern California Orthopedic Institute, Van Nuys, California, USA Department of Orthopaedic Surgery, University of California, Los Angeles, California, USA rferkel@scoi.com. 4. California Pacific Orthopaedics and Sports Medicine, San Francisco, California, USA. 5. Orthopaedic Associates of St Augustine, St Augustine, Florida, USA. 6. Pacific Advanced Radiology, Van Nuys, California, USA.
Abstract
BACKGROUND: The treatment of osteochondral lesions of the talus after failed surgery is challenging, with no clear solution. Short-term results using autologous chondrocyte implantation have been promising. PURPOSE: To report the long-term outcomes of patients who underwent autologous chondrocyte implantation (ACI) of the talus after failed marrow stimulation techniques for osteochondral lesions of the talus (OLTs). STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Thirty-two consecutive patients underwent ACI of the talus, and 29 patients (15 male, 14 female; mean age, 34 years [range, 16-54 years]) were available for follow-up. There were 23 medial and 6 lateral lesions, with a mean size of 18 × 11 mm (198 mm(2); range, 80-500 mm(2)). Twenty patients underwent ACI of the talus alone; 9 underwent ACI with bone grafting of underlying cysts. Follow-up was performed at a mean of 70 months (range, 24-129 months). Patient outcomes were evaluated using the simplified symptomatology score, Tegner activity score, Finsen score, and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score. Twenty-five patients (86%) underwent second-look arthroscopic surgery at the time of hardware removal and were assessed with the International Cartilage Repair Society (ICRS) score. Postoperative magnetic resonance imaging (MRI) was performed on 24 patients (83%) and compared with preoperative MRI scans. RESULTS: Preoperatively, 26 patients rated their ankles as poor and 3 as fair using the simplified symptomatology score. At last follow-up, 9 were classified as excellent, 14 as good, 5 as fair, and 1 as poor using the same score. The mean AOFAS score improved from 50.1 to 85.9 (range, 65-100). The mean Tegner activity score improved from 1.6 to 4.3 (P < .0001). The mean Finsen score (modified Weber score) showed significant improvement from 13.7 to 5.1 (P < .0001). CONCLUSION: Autologous chondrocyte implantation of the talus yields improvement in all parameters tested with enduring long-term results in patients who have failed previous surgery for OLTs.
BACKGROUND: The treatment of osteochondral lesions of the talus after failed surgery is challenging, with no clear solution. Short-term results using autologous chondrocyte implantation have been promising. PURPOSE: To report the long-term outcomes of patients who underwent autologous chondrocyte implantation (ACI) of the talus after failed marrow stimulation techniques for osteochondral lesions of the talus (OLTs). STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Thirty-two consecutive patients underwent ACI of the talus, and 29 patients (15 male, 14 female; mean age, 34 years [range, 16-54 years]) were available for follow-up. There were 23 medial and 6 lateral lesions, with a mean size of 18 × 11 mm (198 mm(2); range, 80-500 mm(2)). Twenty patients underwent ACI of the talus alone; 9 underwent ACI with bone grafting of underlying cysts. Follow-up was performed at a mean of 70 months (range, 24-129 months). Patient outcomes were evaluated using the simplified symptomatology score, Tegner activity score, Finsen score, and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score. Twenty-five patients (86%) underwent second-look arthroscopic surgery at the time of hardware removal and were assessed with the International Cartilage Repair Society (ICRS) score. Postoperative magnetic resonance imaging (MRI) was performed on 24 patients (83%) and compared with preoperative MRI scans. RESULTS: Preoperatively, 26 patients rated their ankles as poor and 3 as fair using the simplified symptomatology score. At last follow-up, 9 were classified as excellent, 14 as good, 5 as fair, and 1 as poor using the same score. The mean AOFAS score improved from 50.1 to 85.9 (range, 65-100). The mean Tegner activity score improved from 1.6 to 4.3 (P < .0001). The mean Finsen score (modified Weber score) showed significant improvement from 13.7 to 5.1 (P < .0001). CONCLUSION: Autologous chondrocyte implantation of the talus yields improvement in all parameters tested with enduring long-term results in patients who have failed previous surgery for OLTs.
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