외측 거골 골연골 병변에 대한 자가 골연골 이식술 후의 중기 추시 임상결과
Intermediate-Term Clinical Outcomes after Autologous Osteochondral Transplantation for Lateral Osteochondral Lesions of the Talus
0
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Purpose: Autologous osteochondral transplantation (AOT) is indicated for patients with a large osteochondral lesion of the talus (OLT), accompanying subchondral cyst, and the failure of bone marrow stimulation (BMS) procedures. Despite the many reports on the clinical results of surgical treatment for medial osteochondral lesions, those of lateral lesions are rare. This paper reports the intermediate-term clinical outcomes after AOT for lateral OLTs. Materials and Methods: Twenty-one patients with lateral OLTs were followed up for at least three years after AOT. The clinical evalua- tions comprised the Foot and Ankle Outcome Score (FAOS) and Foot and Ankle Ability Measure (FAAM). The radiographic assessment included the irregularity of the articular surface (subchondral plate), the progression of degenerative arthritis, and the changes in talar tilt angle and anterior talar translation. Results: The mean FAOS and FAAM scores improved significantly from 42.1 to 89.5 and 39.5 to 90.6 points, respectively, at the final follow-up (p<0.001). The radiological evaluation revealed two cases (9.5%) of articular step-off ≥2 mm and 1 case (4.8%) of progressive arthritis. The mean talar tilt angle and anterior talar translation improved significantly. As postoperative complications, there was one case of a local wound problem, one case of superficial peroneal nerve injury, and one case of donor site morbidity. At a mean follow-up of 62.3 months, no patient showed a recurrence of instability or required reoperation for OLT. Conclusion: AOT for the lateral OLTs demonstrated satisfactory intermediate-term clinical outcomes, including daily and sports activity abilities. Most OLT could be accessed through lateral ligament division and capsulotomy, and the incidence of iatrogenic complications, such as recurrent sprains or chronic instability, was minimal. AOT appears to be an effective and relatively safe treatment for patients with large lateral osteochondral lesions unresponsive to conservative therapy, with subchondral cysts, or with failed primary BMS.
Abstract
Purpose: Autologous osteochondral transplantation (AOT) is indicated for patients with a large osteochondral lesion of the talus (OLT), accompanying subchondral cyst, and the failure of bone marrow stimulation (BMS) procedures. Despite the many reports on the clinical results of surgical treatment for medial osteochondral lesions, those of lateral lesions are rare. This paper reports the intermediate-term clinical outcomes after AOT for lateral OLTs. Materials and Methods: Twenty-one patients with lateral OLTs were followed up for at least three years after AOT. The clinical evalua- tions comprised the Foot and Ankle Outcome Score (FAOS) and Foot and Ankle Ability Measure (FAAM). The radiographic assessment included the irregularity of the articular surface (subchondral plate), the progression of degenerative arthritis, and the changes in talar tilt angle and anterior talar translation. Results: The mean FAOS and FAAM scores improved significantly from 42.1 to 89.5 and 39.5 to 90.6 points, respectively, at the final follow-up (p<0.001). The radiological evaluation revealed two cases (9.5%) of articular step-off ≥2 mm and 1 case (4.8%) of progressive arthritis. The mean talar tilt angle and anterior talar translation improved significantly. As postoperative complications, there was one case of a local wound problem, one case of superficial peroneal nerve injury, and one case of donor site morbidity. At a mean follow-up of 62.3 months, no patient showed a recurrence of instability or required reoperation for OLT. Conclusion: AOT for the lateral OLTs demonstrated satisfactory intermediate-term clinical outcomes, including daily and sports activity abilities. Most OLT could be accessed through lateral ligament division and capsulotomy, and the incidence of iatrogenic complications, such as recurrent sprains or chronic instability, was minimal. AOT appears to be an effective and relatively safe treatment for patients with large lateral osteochondral lesions unresponsive to conservative therapy, with subchondral cysts, or with failed primary BMS.
참고문헌 (28)
- Yoshiharu Shimozono, "Allograft Compared with Autograft in Osteochondral Transplantation for the Treatment of Osteochondral Lesions of the Talus", Journal of Bone and Joint Surgery, 100(21), pp.1838~1844 (2018), Ovid Technologies (Wolters Kluwer Health)[DOI]
- Marcelo Pires Prado, "Diagnosis and treatment of osteochondral lesions of the ankle: current concepts", Revista Brasileira de Ortopedia (English Edition), 51(5), pp.489~500 (2016), Georg Thieme Verlag KG[DOI]
- Christopher D. Murawski, "Operative Treatment of Osteochondral Lesions of the Talus", Journal of Bone and Joint Surgery, 95(11), pp.1045~1054 (2013), Ovid Technologies (Wolters Kluwer Health)[DOI]
- Hang Seob Yoon, "Osteochondral Autologous Transplantation Is Superior to Repeat Arthroscopy for the Treatment of Osteochondral Lesions of the Talus After Failed Primary Arthroscopic Treatment", The American Journal of Sports Medicine, 42(8), pp.1896~1903 (2014), SAGE Publications[DOI]
- Ian Savage-Elliott, "Osteochondral lesions of the talus: a current concepts review and evidence-based treatment paradigm", Foot Ankle Spec, 7(5), pp.414~422 (2014), SAGE Publications[DOI]
- Dong Woo Shim, "Primary Autologous Osteochondral Transfer Shows Superior Long-Term Outcome and Survival Rate Compared With Bone Marrow Stimulation for Large Cystic Osteochondral Lesion of Talus", Arthroscopy, 37(3), pp.989~997 (2021), Elsevier BV[DOI]
- Peter N. Mittwede, "Revision and Salvage Management: Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle", Foot Ankle Int, 39(1_suppl), pp.54S~60S (2018), SAGE Publications[DOI]
- LÁSZLÓ HANGODY, "AUTOLOGOUS OSTEOCHONDRAL MOSAICPLASTY FOR THE TREATMENT OF FULL-THICKNESS DEFECTS OF WEIGHT-BEARING JOINTS", The Journal of Bone and Joint Surgery-American Volume, 85(A Suppl 2), pp.25~32 (2003), Ovid Technologies (Wolters Kluwer Health)[DOI]
- Raad A. Al-Shaikh, "Autologous Osteochondral Grafting for Talar Cartilage Defects", Foot Ankle Int, 23(5), pp.381~389 (2002), SAGE Publications[DOI]
- László Hangody, "Clinical Experiences With Autologous Osteochondral Mosaicplasty in an Athletic Population", The American Journal of Sports Medicine, 38(6), pp.1125~1133 (2010), SAGE Publications[DOI]
- László Hangody, "Mosaicplasty for the Treatment of Osteochondritis Dissecans of the Talus: Two to Seven Year Results in 36 Patients", Foot Ankle Int, 22(7), pp.552~558 (2001), SAGE Publications[DOI]
- P. E. Scranton, "Outcome of osteochondral autograft transplantation for type-V cystic osteochondral lesions of the talus", The Journal of Bone and Joint Surgery. British volume, 88-B(5), pp.614~619 (2006), British Editorial Society of Bone & Joint Surgery[DOI]
- Eoghan T. Hurley, "Osteochondral Autograft: Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle", Foot Ankle Int, 39(1_suppl), pp.28S~34S (2018), SAGE Publications[DOI]
- Cuttica DJ, "Osteochondral lesions of the talus : predictors of clinical outcome", Foot Ankle Int, 32, pp.1045~1051 (2011)[DOI]
- Premjit Pete S. Deol, "Osteochondral lesions of the talus: size, age, and predictors of outcomes", Foot and Ankle Clinics, 18(1), pp.13~34 (2013), Elsevier BV[DOI]
- RobRoy L. Martin, "Evidence of Validity for the Foot and Ankle Ability Measure (FAAM)", Foot Ankle Int, 26(11), pp.968~983 (2005), SAGE Publications[DOI]
- Ewa M. Roos, "Validation of the Foot and Ankle Outcome Score for Ankle Ligament Reconstruction", Foot Ankle Int, 22(10), pp.788~794 (2001), SAGE Publications[DOI]
- Kyoung Min Lee, "Transcultural adaptation and testing psychometric properties of the Korean version of the Foot and Ankle Outcome Score (FAOS)", Clinical Rheumatology, 32(10), pp.1443~1450 (2013), Springer Science and Business Media LLC[DOI]
- Ronald A.W Verhagen, "Systematic review of treatment strategies for osteochondral defects of the talar dome", Foot and Ankle Clinics, 8(2), pp.233~242 (2003), Elsevier BV[DOI]
- Dahmen J, "No superior treatment for primary osteochondral defects of the talus", Knee Surg Sports Traumatol Arthrosc, 26, pp.2142~2157 (2018)[DOI]
- O'Loughlin PF, "Current concepts in the diagnosis and treatment of osteochondral lesions of the ankle", Am J Sports Med, 38, pp.392~404 (2010)[DOI]
- Travis J. Dekker, "Treatment of osteochondral lesions of the talus: a critical analysis review", JBJS Reviews, 5(3), pp.e4~ (2017), Ovid Technologies (Wolters Kluwer Health)[DOI]
- Maartje Zengerink, "Treatment of osteochondral lesions of the talus: a systematic review", Knee Surgery, Sports Traumatology, Arthroscopy, 18(2), pp.238~246 (2009), Wiley[DOI]
- Jochen Paul, "Sports Activity After Osteochondral Transplantation of the Talus", The American Journal of Sports Medicine, 40(4), pp.870~874 (2012), SAGE Publications[DOI]
- Ethan J. Fraser, "Autologous osteochondral transplantation for osteochondral lesions of the talus in an athletic population", Knee Surgery, Sports Traumatology, Arthroscopy, 24(4), pp.1272~1279 (2015), Wiley[DOI]
- Dawson Muir, "Talar Dome Access for Osteochondral Lesions", The American Journal of Sports Medicine, 34(9), pp.1457~1463 (2006), SAGE Publications[DOI]
- Mariana Korbage de Araujo, "ARTHROSCOPIC TREATMENT OF OSTEOCHONDRAL LESIONS OF THE TALUS", Acta Ortopédica Brasileira, 24(1), pp.32~34 (2016), FapUNIFESP (SciELO)[DOI]
- Julia V. Woelfle, "Indications and limitations of osteochondral autologous transplantation in osteochondritis dissecans of the talus", Knee Surgery, Sports Traumatology, Arthroscopy, 21(8), pp.1925~1930 (2013), Wiley[DOI]