| BackgrandOsteochondral Lesion of Talus(OLT)is more common in the injury of the ankle joint.The incidence of OLT in malleolus injury is 6.5%.Long term ankle swelling,chronic pain and dysfunction of ankle joint after osteochondral injury of the talus serious impact on daily life.Traditional methods of treatment such as scratch,micro fracture,retrograde drilling and bone grafting.It repaired by fibrous cartilage.The wear resistance and biomechanical properties of fibrous cartilage are worse than hyaline cartilage.In recent years,osteochondral transplantation and chondrocyte transplantation have been used in clinical practice.It has been reported that autologous osteochondral transplantation(AOT)have obtained good curative effect in repairing articular cartilage defect of knee joint,and its application field has gradually expanded to talus cartilage defect.ObjectiveTo investigate the clinical effect of using autologous osteochondral transplantation which derived from ipsilateral femoral condyle of the patellofemoral joint surface for repairing osteochondral lesions of the talus(OLT).In order to provide the basis for clinical diagnosis and treatment of OLT.MethodsAccording to the inclusion and exclusion criteria,56 cases of OLT patients wereretrospectively reviewed during May 2014 to March 2017 hospitalization in our hospital.Among them,26 cases with AOT were the experimental group(group A),and 30 patients with simple ankle arthroscopy were treated as control group(group B).First,all patients underwent preoperative assessment of the extent of talus lesions by X-ray,CT or MRI.Then the position and area of osteochondral lesions were determined by arthroscopy in all patients.Clearing the edge of the defect area and ankle joint incision.In the group A,Osteochondral autograft transfer system was used to repair osteochondral lesions of the talus with non-weight bearing area osteochondral columns in the ipsilateral patellofemoral joint.Visual analogue scale(VAS)was used to assess ankle pain preoperative and the last follow-up after surgery.American Orthopaedic Foot and Ankle Society(AOFAS)ankle-hindfoot score was used to evaluation ankle function preoperative and the last follow-up after surgery.X-ray of ankle joint and MRI to understand the recovery of osteochondral defect area after operation.If necessary,observation of the survival of cartilage in the transplanted region by arthroscopy.The Lysholm score was used to evaluate the donor knee joint preoperative and the last follow-up after surgery in the group A.To investigation the degree of satisfaction of the patients with the results of the operation.Results1.A total of 25 patients received follow-up in group A.One patient lost follow up due to changing the way of contact.All 30 patients in group B were followed up.The average follow-up was 14.52±2.74 months.2.There was no statistically significant difference between the two groups in preoperative ankle joint VAS score(t=0.93,P>0.05).The pain of ankle joint were reduced in both groups in the last postoperative follow-up.In group A,the VAS reduced from(6.04±1.06)points to(1.48±0.96)points(t=16.44,P<0.01).The difference was statistically significant.In group B,the VAS reduced from(5.76±1.10)points to(2.06±1.41)points(t=17.69,P<0.01).The difference was statistically significant.The difference of VAS score between the two groups was statistically significant in the last postoperative follow-up(t=2.05,P<0.05).3.There was no statistically significant difference between the two groups in preoperative ankle joint AOFAS score.(t=0.28,P>0.05)The ankle joint function were better than that of preoperative in both groups in the last postoperative follow-up.In group A,the AOFAS improved from(53.24±13.80)points to(85.60±8.79)points(t=-14.91,P<0.01).The difference was statistically significant.In group B,the AOFAS improved from(54.43±11.28)points to(80.66±12.11)points(t=9.16,P<0.01).The difference was statistically significant.The difference of AOFAS score between the two groups was not statistically significant in the last postoperative follow-up(t=1.68,P>0.05).The ankle joint function excellent and good rate was 92%in group A and 70%in group B,with statistically significant difference(?~2=4.12,P<0.05).4.In group A,X-ray examination of ankle joint after operation show that the fracture line blurred in the medial malleolus.The low-density shadow from the site of the cartilage defect of the talus decreased or disappeared.The MRI of the ankle joint indicated that the graft and normal bone tissue healed well,the cartilage column did not collapse or loosen.And the cystic change disappeared under the cartilage.The postoperativet X-ray of ankle joint shows good joint clearance in group B.And the low-density shadow from the site of the cartilage defect of the talus decreased.Most of the postoperativet MRI of the ankle joint indicated that edema signal decreased.5.There was no statistically significant difference between the two groups in preoperative knee joint Lysholm score(t=0.72,P>0.05).In group A,the Preoperative knee joint Lysholm score is(98.84±1.46)point and the last follow up is(98.28±2.18)point.The difference was not statistically significant(t=2.28,P>0.025).In group B,the Preoperative knee joint Lysholm score is(98.70±1.48)point and the last follow up is(98.33±2.03)point.The difference was not statistically significant(t=1.54,P>0.025).The difference of Lysholm score between the two groups was not statistically significant in the last postoperative follow-up(t=0.92,P>0.05).ConclusionAutologous osteochondral transplantation is an effective treatment for the OLT.It can reduce the long term pain of the ankle.And it is mroe better than only arthroscopy on improving the function of the ankle joint. |
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