Long Term Outcome Measures Following Arthroscopically Assisted Particulated Juvenile Allograft Cartilage Implantation for Treatment of Difficult to Treat Osteochondral Lesions of the Talus

Abstract

Category: Ankle; Arthroscopy; Sports Introduction/Purpose: Conventional methods are not suitable for difficult to treat osteochondral lesions of the talus (OCLT) such as those defects that are large, shoulder lesions, failed previous surgery, or certain patient factors. Osteochondral autograft transfer system (OATS) has been accepted as the primary method of treatment for these more difficult defects, however, complications such as residual knee pain from the graft site, a multiday procedure, and the necessity for a malleolar osteotomy have made this technique not devoid of complications. Particulated juvenile articular cartilage transplantation for these lesions has theoretical advantage of performing the procedure arthroscopically, without need for an osteotomy or autograft. The purpose of this study is to determine long term patient reported outcomes for this procedure. Methods: Thirteen patients with difficult to treat OCLT underwent arthroscopic assisted implantation of DeNovo NT graft into defects from 2010-2012 by the same surgeon. 'Difficult to treat’ was defined as having at least three of the following features or two if both variables described lesion characteristics: 1) lesions size of 107mm 2 or greater, 2) shoulder lesions, 3) patients who failed microfracture, 4) patient age over 40, or 5) patient BMI>25kg/m 2 . Patients were evaluated using physical examination, patient interviews, and pre and postoperative outcome score measures utilizing Visual Analogue Scale, Short Form 36 and Foot and Ankle Ability Measurement questionnaires, and the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale. Patients had follow-up at 2 years, 4 years, and between 6-9 years at their most recent follow-up. Differences in functional outcome scores were compared before and after surgery. Results: Patients (Age: 46.5+-11.8years, Body Mass Index: 28.5 +-6.1kg/m 2 ) had on average, most recent follow-up of 8.0 years (range 72-113 months). Average VAS pain score decreased for patients by 3.9 points, 95% CI [2.18, 5.60], when compared to preoperative assessment. FAAM ADL and Sports scores also showed improvement from 46.5 to 80.9, 95% CI [21.35, 47.43] and from 18.8 to 57.9, 95% CI [21.05, 57.10], respectively. SF-36 physical component scores showed significant improvement by an average of 45.5 points, 95% CI [32.42, 58.50]. AOFAS scores improved from 55.2 to 80.3, 95% CI [12.459, 37.741]. Patient demographics and results are seen in Tables 1 and 2 respectively. Conclusion: These results demonstrate clinically positive long-term outcomes for a cohort of patients with difficult OCLT, followed over the course of 6-8 years after treatment with arthroscopic assisted DeNovo NT implantation. Understanding the longevity of this intervention can better aid clinicians in deciding if this treatment option is appropriate for patients and should ultimately be included as part of the orthopedics’ armamentarium.