SLR - July 2018 - Brian Mattison

Primary Versus Secondary Osteochondral Autograft Transplantation for the Treatment of Large Osteochondral Lesions of the Talus

Reference: Park, Kwang Hwan, et al. “Primary Versus Secondary Osteochondral Autograft Transplantation for the Treatment of Large Osteochondral Lesions of the Talus.” The American Journal of Sports Medicine, Vol. 46, No. 6, 2018, pp. 1389–1396.

Scientific Literature Review

Reviewed By: Brian Mattison, DPM
Residency Program: Larkin Community Hospital, Miami, FL

Podiatric Relevance:
Osteochondral lesions of the talus (OLTs) involve injury to the articular cartilage of the talus and can lead to chronic pain and disability if not treated properly. Conservative care with immobilization is the first line of treatment, but it has been shown to have a less than 50 percent success rate. Surgical interventions include excision of the lesion with curettage, bone marrow stimulation (microfracture drilling), allograft implantation and osteochondral autograft transplantation (OAT). While microfracture drilling has generally been preferred as the initial operative treatment, previous studies have shown that patients with large OLTs, generally considered greater than 150 mm^2, do not respond well to microfracture drilling alone. This study aimed to compare clinical outcomes of patients with large OLTs (>150 mm^2) undergoing primary OAT versus secondary OAT following failed microfracture drilling.

Methods: The researchers performed a retrospective study involving 46 patients with large OLTs (>150 mm^2) who underwent OAT procedure for OLTs. Eighteen patients underwent OAT as the initial surgical management, and 28 patients underwent secondary OAT after failed microfracture drilling. Outcomes were measured by VAS score, FAOS, Roles and Maudsley score, and revisional surgery rates.

Results: A total of 46 patients were studied with a mean follow-up period of six years. The mean lesion size was 194.9 mm^2. There was no significant difference of VAS, Roles and Maudsley score, FAOS and revisional surgery rates at last follow-up between the two groups. They found no clinically significant signs of failure with patients who had prior microfracture surgery. They also found that patients with lesions greater than 225 mm^2 had a higher association of clinical failure.

Discussion: The aim of this study was to determine whether there was a clinical difference in postoperative outcome of large OLTs treated initially with OAT versus secondarily to microdrilling. This study could benefit surgeons in preventing multiple surgeries and skipping the microdrilling in patients with large OLTs and proceeding straight to OAT procedure. The limitations of this study include a small sample size (46) that was not randomized to the treatment groups.

Educational Opportunities