Outcomes of arthroscopic bone graft transplantation for Hepple stage V osteochondral lesions of the talus

Abstract

Background: Based on MRI imaging findings, osteochondral lesions of the talus (OLT) can be classified into five stages, in which stage V represents OLT with subchondral cyst formation. The aim of this study was to evaluate the outcomes of patients undergoing arthroscopic transplantation of calcaneus bone graft for Hepple stage V OLT.

Methods: This retrospective study included 24 patients with Hepple stage V OLT (15 men and 9 women), with an average age of 39.8±12.9 years old. The mean follow-up period was 18.9±11.8 months. At this follow-up, all patients were clinically evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) score, the Karlsson Ankle Function Score (KAFS), the Tegner score, and the visual analogue scale (VAS). Furthermore, 14 patients underwent MRI imaging examinations, and the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) 2.0 score was assessed.

Results: The AOFAS score, KAFS, Tegner activity score, and VAS pain score (preoperative: 62.2, 60.4, 2.1, and 6.2, respectively; postoperative: 92.8, 88.5, 4.2, and 1.6, respectively) improved significantly (P=0.0001). The MRI-based MOCART score of the articular cartilage repair tissue after surgery was 68±14.8.

Conclusions: Arthroscopic transplantation of calcaneus bone graft for Hepple stage V OLT could obtain satisfying clinical and radiological outcomes in the short-term.

Keywords: Arthroscopic bone graft transplantation; calcaneus bone graft; osteochondral lesions; talus.

Figure 1

Intraoperative images. (A) OLT was confirmed and exposed. (B) Detection of the OLT with the probe. The endoscopic view shows an OLT with a subchondral cyst (black arrow). (C) Endoscopic view after debridement and scraping of the OLT shows the healthy bone bed (*). (D) Lesion site after bone graft transplantation and fixation with fibrin glue. T, tibia; OLT, osteochondral lesion of the talus.

Figure 2

Comparison of different clinical scores before and after the operation. (A) AOFAS score; (B) KAFS; (C) Tegner activity score; (D) VAS pain score. *, significant difference between scores pre- and postoperatively. AOFAS, American Orthopedic Foot and Ankle Society; KAFS, Karlsson Ankle Function Score; VAS, visual analogue scale.

Figure 3

The postoperative MRI image of the left foot of a 53-year-old female patient shows good cartilage healing at the bone graft site, with a MOCART score of 77.5. (A) Sagittal image of the bone graft site (long white arrow) at 17 months after surgery. (B) Coronal image of the bone graft site (short white arrow). MOCART, Magnetic Resonance Observation of Cartilage Repair Tissue.