title: Treatment of large cystic medial osteochondral lesions of the talus with autologous osteoperiosteal cylinder grafts.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Level IV, therapeutic case series.
authors.affiliation: Institute of Sports Medicine, Beijing, China.
authors.forename: YueLin
authors.initials: Y
authors.lastname: Hu
authors.forename: QinWei
authors.initials: Q
authors.lastname: Guo
authors.forename: Chen
authors.initials: C
authors.lastname: Jiao
authors.forename: Yu
authors.initials: Y
authors.lastname: Mei
authors.forename: Dong
authors.initials: D
authors.lastname: Jiang
authors.forename: JiaNing
authors.initials: J
authors.lastname: Wang
authors.forename: Zhuozhao
authors.initials: Z
authors.lastname: Zheng
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000843:Ankle Joint / Q000503:physiopathology; D001182:Arthroscopy / Q000379:methods* / Q000534:rehabilitation; D001845:Bone Cysts / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000534:rehabilitation / Q000601:surgery*; D016025:Bone Transplantation / Q000379:methods* / Q000534:rehabilitation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010521:Periosteum / Q000637:transplantation*; D011859:Radiography; D016059:Range of Motion, Articular; D020127:Recovery of Function; D024162:Second-Look Surgery; D013628:Talus / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D055815:Young Adult