title: Osteochondral autograft transplantation for acute osteochondral fractures associated with an ankle fracture.
abstract: BACKGROUND
  Osteochondral fractures of the talar dome (OCFT) are frequently associated with ankle fractures. Controversy exists regarding the treatment of acute Grade III and IV OCFT. Osteochondral autograft transplantation (OAT) is a possible operative solution.
  
  
  METHODS
  We performed OAT in 16 patients with acute Grade III or IV OCFT. There were ten males and six females with the average age of 33.9 (range, 18 to 49) years. The average period of followup was 36.3 (range, 21 to 48) months. OCFT was identified, and clinically determined to be Grade III or IV using radiographs and intraoperative assessment. Seven patients were Grade III, nine patients were Grade IV OCFT. The OAT consisted of two sequential procedures: 1) harvesting of osteochondral autograft cylinder from the nonweightbearing surface of the ipsilateral knee, and 2) implanting the donor graft into the talar defect with press-fit technique. Single cylinder transplantation or a mosaicplasty was used. The outcome was determined by the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale, the simplified symptomatology evaluation, plain radiography and MRI.
  
  
  RESULTS
  The mean size of the osteochonral fracture defects was 84.1 (range, 50 to 125) mm(2), and the mean depth was 2.5 (range, 1 to 5) mm. The mean AOFAS score was 95.4 (range, 86 to 100) points postoperatively. At the latest followup, there was no radiographic evidence of post-traumatic arthritis. Based on the MRI of all patients, 93.7% of the osteochondral grafts showed bony integration and articular congruity of the talar dome.
  
  
  CONCLUSIONS
  OAT was shown to be an effective treatment with excellent clinical outcome and imaging evidence of graft integration.
authors: Yantaishan Hospital, Yantai China-France Friendship Hospital, Orthopaedics, 91 Jiefang Road, Yantai City, 264001, Shandong Province, China. ytwanjun@gmail.com
authors: Wanjun
authors: W
authors: Liu
authors: Fang
authors: F
authors: Liu
authors: Wen
authors: W
authors: Zhao
authors: Jaehon M
authors: JM
authors: Kim
authors: Zhenghai
authors: Z
authors: Wang
authors: Mark S
authors: MS
authors: Vrahas
mesh_terms: D000293:Adolescent; D000328:Adult; D016512:Ankle Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D016025:Bone Transplantation; D002358:Cartilage, Articular / Q000000981:diagnostic imaging*; D005260:Female; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D013628:Talus / Q000000981:diagnostic imaging / Q000601:surgery*; D014182:Transplantation, Autologous / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult