Treatment of extended osteochondral lesions of the talus with a free vascularised bone graft from the medial condyle of the femur.
Large osteochondral lesions (OCLs) of the shoulder of the talus cannot always be treated by traditional osteochondral autograft techniques because of their size, articular geometry and loss of an articular buttress. We hypothesised that they could be treated by transplantation of a vascularised corticoperiosteal graft from the ipsilateral medial femoral condyle. Between 2004 and 2011, we carried out a prospective study of a consecutive series of 14 patients (five women, nine men; mean age 34.8 years, 20 to 54) who were treated for an OCL with a vascularised bone graft. Clinical outcome was assessed using a visual analogue scale (VAS) for pain and the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score. Radiological follow-up used plain radiographs and CT scans to assess graft incorporation and joint deterioration. At a mean follow-up of 4.1 years (2 to 7), the mean VAS for pain had decreased from 5.8 (5 to 8) to 1.8 (0 to 4) (p = 0.001) and the mean AOFAS hindfoot score had increased from 65 (41 to 70) to 81 (54 to 92) (p = 0.003). Radiologically, the talar contour had been successfully reconstructed with stable incorporation of the vascularised corticoperiosteal graft in all patients. Joint degeneration was only seen in one ankle. Treatment of a large OCL of the shoulder of the talus with a vascularised corticoperiosteal graft taken from the medial condyle of the femur was found to be a safe, reliable method of restoring the contour of the talus in the early to mid-term.
Kantonsspital Baselland, Rheinstrasse 26, CH-4410 Liestal, Switzerland.
B
B
Hintermann
Kantonsspital Baselland, Rheinstrasse 26, CH-4410 Liestal, Switzerland.
J
J
Wagener
Kantonsspital Baselland, Rheinstrasse 26, CH-4410 Liestal, Switzerland.
M
M
Knupp
Kantonsspital Baselland, Rheinstrasse 26, CH-4410 Liestal, Switzerland.
C
C
Schweizer
University Hospital, Spital Strasse 21, CH-4056, Basel, Switzerland.
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D
J Schaefer
D000328:Adult; D016025:Bone Transplantation / Q000379:methods*; D002358:Cartilage, Articular / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D005260:Female; D005269:Femur / Q000098:blood supply / Q000637:transplantation*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D016348:Osseointegration; D011446:Prospective Studies; D012086:Reoperation / Q000379:methods; D013628:Talus / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D055815:Young Adult
Osteochondral lesion; Talus; Vascularised bone graft