title: Knee-to-Ankle Mosaicplasty for the Treatment of Osteochondral Lesions of the Ankle Joint.
abstract: BACKGROUND
  Osteochondral lesions are frequently seen in athletes after ankle injuries. At this time, osteochondral autologous transplantation (OATS, mosaicplasty) is the only surgical treatment that replaces the entire osteochondral unit in symptomatic lesions.
  
  
  OBJECTIVE
  To evaluate the clinical and radiological midterm to long-term outcome of ankles treated with knee-to-ankle mosaicplasty.
  
  
  METHODS
  Case series; Level of evidence, 4.
  
  
  METHODS
  Clinical evaluation consisted of patient satisfaction, pain evaluation (visual analog scale [VAS]), American Orthopaedic Foot and Ankle Society (AOFAS) ankle score, sports activity score, range of motion, the radiological evaluation of magnetic resonance imaging (MRI), and single photon emission computed tomography-computed tomography (SPECT-CT) analysis of both the ankle and the knee joint.
  
  
  RESULTS
  Twelve of 21 patients (mean age, 43 years; male, 8; female, 4) were available for latest follow-up (mean, 72 months). At follow-up, patients reported a satisfaction rate of good to excellent in 92% (n 5 11) and poor in 8% (n 5 1). The average VAS pain score was 3.9 (preoperative, 5.9; P 5 .02), AOFAS ankle score significantly increased from 45.9 to 80.2 points (P< .0001), sports activity score remained significantly decreased with 1.25 (preinjury level, 2.3; P 5 .035), and ankle dorsiflexion was significantly reduced (P 5 .003). Knee pain was reported in 6 patients (50%). Radiologically, recurrent lesions were found in 10 of 10 cases (100%) and some degree of cartilage degeneration and discontinuity of the subchondral bone plate in 100%.
  
  
  CONCLUSIONS
  Indications for mosaicplasty with a plug transfer from the knee to the talus must be considered carefully, as at midterm, moderate outcome and considerable donor-site morbidity may be found.
authors.affiliation: Orthopaedic Department, University Hospital of Basel, Basel, Switzerland.
authors.forename: Victor
authors.initials: V
authors.lastname: Valderrabano
authors.affiliation: Orthopaedic Department, University Hospital of Basel, Basel, Switzerland the Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.
authors.forename: André
authors.initials: A
authors.lastname: Leumann
authors.affiliation: Radiologic Department, University Hospital of Basel, Basel, Switzerland.
authors.forename: Helmut
authors.initials: H
authors.lastname: Rasch
authors.affiliation: Radiologic Department, University Hospital of Basel, Basel, Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Egelhof
authors.affiliation: Orthopaedic Department, University Hospital of Basel, Basel, Switzerland Orthopaedic Department, University Hospital of Bonn, Bonn, Germany.
authors.forename: Beat
authors.initials: B
authors.lastname: Hintermann
authors.affiliation: Orthopaedic Department, University Hospital of Basel, Basel, Switzerland, Orthopaedic Department, University Hospital of Bonn, Bonn, Germany.
authors.forename: Geert
authors.initials: G
authors.lastname: Pagenstert
keywords: SPECT-CT; ankle; morbidity; mosaicplasty; osteochondral lesion