title: Double-Plug Autologous Osteochondral Transplantation Shows Equal Functional Outcomes Compared With Single-Plug Procedures in Lesions of the Talar Dome: A Minimum 5-Year Clinical Follow-up.
abstract: BACKGROUND
  Autologous osteochondral transplantation (AOT) is used for large (>100-150 mm(2)) or cystic osteochondral lesions (OCLs) of the talus. Larger lesions may require using more than 1 graft to fill the defect. While patients with larger OCLs treated with microfracture exhibit inferior clinical outcomes, there is little evidence regarding the effect of lesion size and number of grafts required on clinical and radiological outcomes after AOT.
  
  
  OBJECTIVE
  Larger OCLs of the talar dome treated by double-plug AOT (dp-AOT) have inferior clinical and radiological MRI outcomes compared with smaller OCLs requiring single-plug AOT (sp-AOT).
  
  
  METHODS
  Cohort study; Level of evidence, 3.
  
  
  METHODS
  Fourteen consecutive patients with a large OCL (mean, 208 ± 54 mm(2)) treated using dp-AOT with a minimum 5-year follow-up were matched by age and sex to a control cohort of 28 patients who underwent sp-AOT for a smaller OCL (mean, 74 ± 26 mm(2)) over the same period. Functional outcomes were assessed both pre- and postoperatively using the Foot and Ankle Outcome Score (FAOS) and Short Form-12 (SF-12) general health questionnaire. Mean follow-up was 85 months (range, 65-118 months). Latest postoperative MRI was evaluated with modified magnetic resonance observation of cartilage repair tissue (MOCART) score.
  
  
  RESULTS
  There was no significant difference between groups demographically (P > .05). All patients with dp-AOT and sp-AOT showed a significant pre- to postoperative increase in FAOS and SF-12 scores (P < .001). When comparing preoperative scores for both groups, there was no statistical significance between sp-AOT and dp-AOT scores (FAOS, P = .719; SF-12, P = .947). There was no significant difference in functional scores between the 2 groups postoperatively for both FAOS (P = .883) and SF-12 (P = .246). Mean MOCART scores did not exhibit any statistically significant difference between groups (P = .475). Two patients complained of knee donor site stiffness (4.8%), which later resolved.
  
  
  CONCLUSIONS
  Patients with large OCLs treated using a dp-AOT procedure did not show inferior clinical or radiological outcomes compared with those treated with sp-AOT at a minimum 5-year follow-up. The dp-AOT procedure is as effective as sp-AOT in treating larger OCLs of the talar dome in the intermediate term, with similar high postoperative clinical and radiological outcomes.
authors.affiliation: Department of Orthopedic Surgery, Foot and Ankle Service, Hospital for Special Surgery, New York, NY, USA.
authors.forename: Amgad M
authors.initials: AM
authors.lastname: Haleem
authors.affiliation: Department of Orthopedic Surgery, Foot and Ankle Service, Hospital for Special Surgery, New York, NY, USA.
authors.forename: Keir A
authors.initials: KA
authors.lastname: Ross
authors.affiliation: Department of Orthopedic Surgery, Foot and Ankle Service, Hospital for Special Surgery, New York, NY, USA.
authors.forename: Niall A
authors.initials: NA
authors.lastname: Smyth
authors.affiliation: Department of Radiology, East River Medical Imaging, New York, NY, USA.
authors.forename: Gavin L
authors.initials: GL
authors.lastname: Duke
authors.affiliation: Department of Radiology, East River Medical Imaging, New York, NY, USA.
authors.forename: Timothy W
authors.initials: TW
authors.lastname: Deyer
authors.affiliation: Epidemiology and Biostatistics Core, Hospital for Special Surgery, New York, NY, USA.
authors.forename: Huong T
authors.initials: HT
authors.lastname: Do
authors.affiliation: Department of Orthopedic Surgery, Foot and Ankle Service, Hospital for Special Surgery, New York, NY, USA kennedyj@hss.edu.
authors.forename: John G
authors.initials: JG
authors.lastname: Kennedy
mesh_terms: D000328:Adult; D016512:Ankle Injuries / Q000473:pathology / Q000601:surgery*; D016025:Bone Transplantation / Q000009:adverse effects / Q000379:methods*; D002356:Cartilage / Q000637:transplantation*; D002358:Cartilage, Articular / Q000293:injuries* / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013628:Talus / Q000293:injuries* / Q000473:pathology / Q000601:surgery*; D014182:Transplantation, Autologous
keywords: MRI; autologous osteochondral transplantation; double plug; functional scores; outcomes