[Operative therapy of osteochondral lesions of the talus with autologous cartilage-bone transplantation].
Since 1996 we have gained experience in the development and clinical application of the OATS technique in 167 cases. Operative management, technical demands and early results of osteochondral cylindrical autograft plugs at the talus are presented. Between April 1996 and November 2000 we treated 39 patients (21 male, 18 female) with an average age of 28.4 years (range: 16-57 years) for osteochondral defects with an average size of 8 x 15 mm-20 x 15 mm at the medial (n = 31) and lateral (n = 6) talar dome as well as at the distal tibia (n = 2) with an OATS technique. Indications were osteochondral defects after trauma in 12 patients (med., n = 5; lat., n = 5; dist. tibia n = 2) and osteochondrosis dissecans (grades III and IV) in 27 patients (med., n = 26; lat., n = 1). The donor site was the proximal lateral femoral condyle in all patients. An additional osteotomy of the malleolus was necessary in 30 patients. All patients were scored pre- and postoperatively by a Lysholm Bruns score and monitored by postoperative MRI. The follow-up extended for an average of 19.6 months (6-42). The Lysholm score for all patients rose from 62 points (range: 20-77) up to 92 points (range: 63-100). There was no correlation between patients with and without an osteotomy of the malleolus. The postoperative MRI showed a complete incorporation and vitality of the transplanted cylinders as well as a congruence of the joint surface. Complications were pain in three cases in the region of the osteotomy, which decreased after removal of the screws, and synovialitis in one case. One patient reported femoropatellar pain for about 4 weeks. The OATS technique achieves encouraging results in limited osteochondral defects in the talar dome even in preoperated osteochondral defects. Because of the mostly posterior localization of the defect zone, osteotomy of the malleolus is necessary in most cases. Harvesting the donor cylinders from the ipsilateral knee joint by mini-arthrotomy shows a low mortality. The OATS technique is a suitable, causal and cost-effective therapy, which can possibly prevent and at least delay the development of an arthrosis.
Abteilung und Poliklinik für Sportorthopädie TU München, Connollystrasse 32 80809 München.
P B
PB
Schöttle
G M
GM
Oettl
J D
JD
Agneskirchner
A B
AB
Imhoff
D000293:Adolescent; D000328:Adult; D016512:Ankle Injuries / Q000175:diagnosis / Q000601:surgery*; D016025:Bone Transplantation; D002358:Cartilage, Articular / Q000637:transplantation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010008:Osteochondritis Dissecans / Q000175:diagnosis / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis; D013628:Talus / Q000293:injuries / Q000601:surgery*