Abstract
Purpose: Autologous osteochondral grafts using the Mosaicplasty(r) technique have been employed for more then a decade for the treatment of osteocartilaginous tissue loss in weight-bearing zones. The advantage is to repair damage using a hyaline cartilage. Application of this technique to the talar dome is more recent and has been inspired by the good results obtained at the knee level. The purpose of this retrospective analysis was to determine outcome in 36 patients presenting tissue loss of the talar dome who underwent surgery between June 1997 and September 2001 using the method described by L. Hangody and to determine the contribution of the malleolar osteotomy.
Material and methods: Patients, aged 17 to 53 years, complaining of ankle problems were managed in three centres. Surgery was performed by three senior surgeons experienced with knee Mosaicplasty(r). The Acufex Mosaicplasty(r) instrumentation furnished by Smith-Nephew was used in all cases. The ankle was rarely opened by direct arthrotomy. Osteotomy of the medial or lateral malleolus was preferred. Bone grafts were harvested, with the patient’s consent, from a non-weight-bearing articular zone of the homolateral knee. The International Cartilage Repair Society (ICRS) chart, modified for the ankle, was used to assess outcome. Epi-Info 6.0 was used for statistical analysis.
Results: The deep lesions were all ICRS grade III or IV and involved dissecting osteochondritis (n=21), chondral or osteochondral avulsion (n=13) and dome necrosis (n=2). Osteotomy of the medial malleolus was required to access the lesions in 27 ankles; a lateral osteotomy was used in six ankles. After a mean follow-up of 18 months, outcome was considered excellent or good in 81% (ICRS grade I and II). Mild knee pain was reported by 14 patients. All malleolar osteotomies healed without complication. None of the cases worsened.
Discussion: This technique is to be reserved for young symptomatic patients. Despite the more traumatic technique compared with the traditional method, Mosaicplasty(r) enables repair with hyaline cartilage giving more satisfactory short- and mid-term results. Use of a medial or lateral osteotomy does not create any major problem. This is the only was to obtain good lesion exposure, particularly for more posterior lesions. Morbidity at the donor site, though not significantly proven in this series, should be examined in more detail.
Conclusion: Autologous osteochondral grafts using Mosaicplasty(r) is a validated technique for ankle repair. Malleolar osteotomy has been found to be important to achieve proper repair. A long-term study will be needed to evaluate the persistence of these results, and possible donor site morbidity, as well as the preventive effect against osteoarthritis.
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