SLR - September 2011 - Kathryn Jetter
Reference: Takao, M., Innami, K., Komatsu, F., & Matsushita, T. The American Journal of Sports Medicine, 38 (8), 1653-1660.
Scientific Literature Review
Reviewed by: Kathryn Jetter, DPM
Residency Program: St. John Hospital and Medical Center
Podiatric Relevance:
Osteochondral lesions (OLCs) of the ankle, particularly those of a large subchondral size, can be difficult to treat. This article evaluates arthroscopic drilling with iliac crest autograft retrograde cancellous bone plug transplantation. As specialists in rearfoot surgery, it is important to be well versed on options for treating osteochondral lesions. The study’s results show evidence that a cancellous bone plug from the iliac crest could be a feasible option for treatment of some OLCs.
Methods:
MRI and CT results were used to diagnosis 211 patients with OLCs of the ankle. Of these 211 patients, 25 met the requirements of large subchondral lesions (≥ 10mm). The first 14 were treated between April 2005 and July 2006 with an arthroscopic drilling procedure (AD group). The remaining 11 were treated between August 2006 and July 2007 with arthroscopic retrograde cancellous bone plug transplantation from the iliac crest (RC group). All 25 patients were also evaluated for lateral ankle instability utilizing a stress test. Those who met the criteria had reconstruction of the lateral ligaments with autologous gracilis tendon using interference-fit anchoring system. All procedures were performed by one surgeon.
All patients underwent a similar post-operative course. The ankle was immobilized with a soft ankle orthosis for 2 weeks. Patients began AROM one day after surgery. PROM and partial weightbearing was allowed after 4 weeks and full weightbearing after 8 weeks. Clinical results were evaluated with the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale score (AOFAS) preoperatively and 2 years after surgery. MRI and a second-look ankle arthroscopy were performed 1 year following surgery. Regenerative cartilage was assessed using International Cartilage Repair Society (ICRS) visual repair assessment score.
Results:
The mean AOFAS score preoperatively was nearly the same for both groups. Two years following surgery, the AD group’s score was 82.2 ± 7.2 where as the RC group’s was 95.8 ± 4.6. The diameter of the subchondral lesion was virtually unchanged in 11 cases in the AD group, but had disappeared in 7 cases and decreased size in 4 for the RC group. The mean ICRS score was 5.1 ± 1.9 in AD group and 10.5 ± in RC group.
Conclusions:
The RC group demonstrated promising results and could be a viable option for OLC repair, however longer term follow-up is needed to reach definitive conclusions.