Autologous osteochondral transplantation for large osteochondral lesions of the talus produces excellent outcomes in an athletic population
ESSKA Academy. Ramasamy A. 11/09/19; 286371
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Autologous osteochondral transplantation for large osteochondral lesions of the talus produces excellent outcomes in an athletic population

AFAS Free Papers

Topic: Cartilage

Calder J.1, Nguyen A.2, Ramasamy A.3, Mcmenemy L.3, Walsh M.1
1Fortius Clinic, London, United Kingdom, 2Royal Adelaide Hospital, Adelaide, Australia, 3Imperial College, London, United Kingdom

Introduction: Autologous osteochondral transplantation (AOT) has been shown to be a viable treatment option for large osteochondral lesions of the talus. However, there is limited data regarding the management of large lesions in an athletic population, notably with regards to return to sport.
Objectives: Our investigation focussed on assessing both qualitative and quantitative outcomes in the high demand athlete with large (>150mm2) lesions.
Aims: To prove the following hypothesis: Autologous Osteochondral Transplantation produces excellent outcomes in athletes with large osteochondral lesions and can allow them to return to sport at their pre-injury level.
Methods: The study population was limited to professional or amateur athletes (Tegner score >6) with a talar osteochondral lesion of size 150mm2 or greater. The uniform surgical intervention was AOT with a donor site from the lateral femoral condyle. Clinical outcomes at a minimum of 24 months included Return to Sport, VAS and FAOS Scores. In addition graft incorporation was evaluated by MRI using MOCART scores at 12 months post-surgery.
Results: 38 athletes including 11 professional athletes were assessed. Mean follow-up was 46 months. Mean lesion size was 249mm2. 33 patients returned to sport at their previous level, 4 at a lower level compared with pre-injury, and 1 did not return to sport (mean return to play 8.2 months). Visual analogue scores improved from 4.53 pre-operatively to 0.63 post-operatively (p=0.002). FAOS Scores improved significantly in all domains (p< 0.001). 2 patients developed knee donor site pain; in both cases 3 osteochondral plugs were harvested. Univariant analysis demonstrated no association between pre-operative patient or lesion characteristics and ability to return to sport. However, there was a strong correlation between MOCART scores and ability to return to sport (AUC=0.89).
Conclusions: Our study suggests that AOT is a viable option in the management of large osteochondral talar defects in an athletic population, with favourable return to sport levels, patient satisfaction, and FAOS/VAS scores. The ability to return to sport is predicated upon good graft incorporation and further research is required to optimise this technique. Our data also suggests that patients should be aware of the increased risk of developing knee donor site pain when 3 osteochondral plugs are harvested.
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