TREATMENT OF OSTEOCHONDRAL LESIONS OF THE TALUS BY MEANS OF AUTOLOGOUS OSTEOCHONDRAL GRAFTS (MOSAICPLASTY)

Abstract

Introduction and Objectives: Osteochondral lesions of the talus are difficult to treat due to difficult access, vascularisation, and because the head of the talus is a region with significant mechanical load. Among the therapeutic options for osteochondral lesions of the head of the talus, we present a treatment alternative using mosaicplasty with an autologous osteochondral graft taken from the knee.

Materials and Methods: We have treated 8 patients affected with osteochondral lesions of the head of the talus (7 medial and 1 lateral) of greater than 7mm diameter, younger than 45 years of age, and with no instability of the ligament. The talus was approached in all cases by means of osteotomy of the malleolus. Osteocartilaginous cores were collected from the ipsilateral lateral condyle of the ipsilateral knee with minimal arthrotomy. Rehabilitation began between days 3 and 5 with no weight bearing before the 6th week. Results were measured by means of CTscan, MRI, and pathology, and clinically using the Maryland scale.

Results: All patients presented with evidence of osteointegration of the osteochondral graft. All were classified as excellent or good on the Maryland scale. Functional results were good with flexion and extension movements of the ankle practically symmetrical with the healthy limb. There were no complications in the donor site or infections. None of the patients has required repeat treatment except in the cases in which material for osteosynthesis was removed from the malleolus.

Discussion and Conclusions: We believe that in view of the results of mosaicplasty with an autologous osteochondral graft taken from the knee, this provides a new therapeutic approach to treatment of grade III and IV osteochondral lesions of the talus. The most significant advantages of this technique include the repair of articular cartilage with type II collagen and an earlier discharge time due to osseous integration. The most important disadvantages were potential morbidity associated with the donor site and the technical difficulty in achieving convexity.