Osteochondral Lesions of the Ankle: Autologous Osteochondral Transplantation from the Knee. Clinical and Functional Outcomes of the Donor and Recipient Sites
Authors: Brue Julieta , Gala Santini-Araujo Maria , Cafruni Virginia M. , Conti Leonardo , Carrasco Marina , Villena Daniel , Sotelano Pablo , Manuel Parma Julian , Cecilia Parise Ana 
Published: December 2024

Category:

Ankle Arthritis; Sports

Introduction/Purpose:

The Autologous Osteochondral Transplantation (OAT) technique is presented as an effective strategy for treating osteochondral lesions in the talus, notable for its reliability and for promoting both functionality and return to sports activity. However, concerns exist regarding the morbidity that may accompany graft harvesting. The main purposes of this research include the evaluation of clinical and functional outcomes, as well as complications in patients who have undergone OAT, both in the knee and ankle. Additionally, it aims to analyze the return to work and sports activities and determine the level of patient satisfaction following the procedure.

Methods:

Observational, retrospective, descriptive study. Level of Evidence IV. It includes patients diagnosed with osteochondral lesions of the talus, treated with Autologous Osteochondral Transplantation (OAT) between 2011 and 2022. The inclusion criteria are individuals over 18 years of age, of any sex, with a minimum of one year of follow-up. The exclusion criteria include a history of pain or previous surgery in the ipsilateral knee, infections, advanced osteoarthritis in the ankle or knee, or rheumatologic diseases. Age, sex, affected limb, mechanism of injury, practiced sports, time from symptom onset to procedure, size and location of the lesion, associated surgical procedures, osteotomy consolidation time, follow-up time, and return to work and sports activities were recorded. AOFAS, Lysholm, Tegner activity scale, and VAS in the knee and ankle were registered. Satisfaction level, return to sports level, complications at the donor and recipient sites were assessed. A p-value < 0.05 was considered statistically significant.

Results:

37 patients. Median age was 36 years, 78.37% being male. Median follow-up was 24 months. Lesions, predominantly sports-related, were medially located with a median area of 150mm². The median time from injury to surgery was 12 months. Postoperative outcomes showed significant improvements; the AOFAS ankle score increased from an average of 54.45 to 95.81, and the ankle VAS score decreased from 7 to 1.59. The knee's postoperative VAS and Lysholm scores averaged 1.81 and 98.78, respectively. The average time to return to work was 2.29 months, and to sports was 6.53 months, with 37.5% changing their sports activity. Tegner score slightly improved from 5.4 to 5.45. Complications were minimal, with one case of knee hemarthrosis and one patient undergoing anterior ankle arthroscopy later.

Conclusion:

The treatment of talus chondral lesions through autologous osteochondral transfer from the knee is a safe and effective strategy with positive clinical and functional outcomes, a low complication rate, high satisfaction, a high level of return to sports, without increasing morbidity in the knee.