title: Anterolateral tibial osteotomy for accessing osteochondral lesions of the talus in autologous osteochondral transplantation: functional and t2 MRI analysis.
abstract: BACKGROUND
  Autologous osteochondral transplantation (AOT) is a primary treatment strategy for large or cystic osteochondral lesions of the talus (OLT) or a secondary replacement strategy after failed bone marrow stimulation. The technique requires perpendicular access to the talar dome, which is often difficult to obtain for posterior or lateral lesions. Traditional methods to access these areas have required disruption of the syndesmotic complex with concern over osteotomy reduction, malalignment, and ligament disruption. An alternate to these traditional methods of access is an anterolateral tibial osteotomy. The purpose of this study was to report functional and magnetic resonance imaging (MRI) outcomes in a series of patients that underwent AOT for treatment of an OLT via an anterolateral tibial osteotomy.
  
  
  METHODS
  Records of patients that underwent an anterolateral tibial osteotomy for AOT were retrospectively reviewed. Pre- and postoperative Foot and Ankle Outcome Scores (FAOS) and demographic data were recorded. Magnetic resonance observation of cartilage repair tissue (MOCART) was used to assess morphologic state of tibial cartilage at the repair site of the osteotomy. Quantitative T2 mapping MRI was analyzed in the superficial and deep cartilage layers of the repair site of the osteotomy and in adjacent normal cartilage to serve as control tissue. Seventeen patients with a mean age of 36.9 (range, 17-76) years underwent anterolateral tibial osteotomy with a mean follow-up of 64 (range, 29 to 108) months. MOCART data were available in 9 of 17 patients, and quantitative T2 mapping was available in 6 patients.
  
  
  RESULTS
  FAOS significantly improved from an average 39.2 (range, 14 to 66) out of 100 points preoperatively to 81.2 (range, 19 to 98) postoperatively (P < .01). The average MOCART score was 73.9 out of 100 points (range, 40 to 100). Quantitative T2 analysis demonstrated relaxation times that were not significantly different from the normal native cartilage in both the deep half and superficial half of interface repair tissue (P > .05).
  
  
  CONCLUSIONS
  This study demonstrated that the anterolateral tibial osteotomy was a reasonable alternative for accessing centrolateral or posterolateral OLT for AOT with limited morbidity associated with the osteotomy. The evidence demonstrated adequate osteotomy and cartilaginous healing with improvement in functional outcome scores at medium-term follow-up.
  
  
  METHODS
  Level IV, retrospective case series.
authors.affiliation: Hospital for Special Surgery, New York, NY, USA.
authors.forename: Arianna L
authors.initials: AL
authors.lastname: Gianakos
authors.affiliation: Hospital for Special Surgery, New York, NY, USA.
authors.forename: Charles P
authors.initials: CP
authors.lastname: Hannon
authors.affiliation: Hospital for Special Surgery, New York, NY, USA.
authors.forename: Keir A
authors.initials: KA
authors.lastname: Ross
authors.affiliation: Hospital for Special Surgery, New York, NY, USA.
authors.forename: Hunter
authors.initials: H
authors.lastname: Newman
authors.affiliation: Hospital for Special Surgery, New York, NY, USA.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Egan
authors.affiliation: East River Imaging, New York, NY, USA.
authors.forename: Timothy W
authors.initials: TW
authors.lastname: Deyer
authors.affiliation: 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; D000368:Aged; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010007:Osteochondritis / Q000601:surgery*; D019340:Osteotomy, Le Fort / Q000379:methods; D012189:Retrospective Studies; D013977:Tibia / Q000601:surgery*; D014182:Transplantation, Autologous; D055815:Young Adult
keywords: anterolateral tibial osteotomy; autologous osteochondral transplantation; osteochondral lesion; talus