title: Factors associated with the clinical outcomes of the osteochondral autograft transfer system in osteochondral lesions of the talus: second-look arthroscopic evaluation.
abstract: BACKGROUND
  Identifying factors associated with the clinical outcomes of the osteochondral autograft transfer system would be helpful for treating patients with an osteochondral lesion of the talus.
  
  
  OBJECTIVE
  To investigate the clinical and second-look arthroscopic results of the osteochondral autograft transfer system and to identify the prognostic factors associated with this procedure.
  
  
  METHODS
  Case series; Level of evidence, 4.
  
  
  METHODS
  The authors retrospectively evaluated 52 ankles that underwent osteochondral autograft transfer for a medial osteochondral lesion of the talus. Second-look arthroscopies were performed at a mean of 13.1 months postoperatively. Clinical outcomes were evaluated according to a visual analog scale (VAS) for pain, American Orthopaedic Foot and Ankle Society (AOFAS) score, and the Tegner activity scale. Statistical analyses were performed to identify various prognostic factors associated with the clinical outcomes.
  
  
  RESULTS
  The mean VAS, AOFAS, and Tegner activity scale scores were all significantly improved from 6.9 ± 0.9 to 3.3 ± 1.4 (VAS), from 67.4 ± 4.9 to 82.6 ± 7.8 (AOFAS), and from 3.0 ± 0.8 to 3.9 ± 0.9 (Tegner; P < .05). Regarding overall patient satisfaction with the operation, 49 (95%) patients reported good to excellent results. Prognostic factors including the patient's age, sex, body mass index, duration of symptoms, defect size and depth, location of osteochondral lesion of the talus, and the existence of a subchondral cyst did not significantly influence clinical outcomes (P > .05), except for body mass index on the Tegner activity scale score (P = .021). Significant differences were observed among clinical outcomes for second-look arthroscopy according to the presence of soft tissue impingement and uncovered areas around the graft (P < .05). The VAS and AOFAS score at the last follow-up were significantly worse when the articular surface of the tibial plafond at the malleolar osteotomy site was uneven (P = .031 and .012, respectively).
  
  
  CONCLUSIONS
  This study showed that the articular surface of the tibial plafond at the malleolar osteotomy site, soft tissue impingement, and uncovered areas around the graft were important factors affecting the clinical outcomes, as observed through second-look arthroscopy. Therefore, surgeons should restore the articular surface accurately after the osteotomy, and more caution should be taken to avoid soft tissue impingement and uncovered areas around the graft when performing osteochondral autograft transfer.
authors.affiliation: Department of Orthopaedic Surgery, Yonsei Sarang Hospital, Seoul, Korea.
authors.forename: Yong Sang
authors.initials: YS
authors.lastname: Kim
authors.forename: Eui Hyun
authors.initials: EH
authors.lastname: Park
authors.forename: Yong Chan
authors.initials: YC
authors.lastname: Kim
authors.forename: Yong Gon
authors.initials: YG
authors.lastname: Koh
authors.forename: Jin Woo
authors.initials: JW
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D016512:Ankle Injuries / Q000175:diagnosis / Q000601:surgery*; D001182:Arthroscopy; D016025:Bone Transplantation; D002356:Cartilage / Q000637:transplantation*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D012189:Retrospective Studies; D024162:Second-Look Surgery; D013628:Talus / Q000293:injuries*; D014182:Transplantation, Autologous; D055815:Young Adult