Does Fresh Osteochondral Allograft Transplantation of Talar Osteochondral Defects Improve Function?

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• 作者：Gregory C. Berlet MD (1)
  Christopher F. Hyer DPM (1)
  Terrence M. Philbin DO (1)
  Jodi F. Hartman MS (2)
  Michelle L. Wright MPH (2)
  
• 刊名：Clinical Orthopaedics and Related Research?
• 出版年：2011
• 出版时间：August 2011
• 年：2011
• 卷：469
• 期：8
• 页码：2356-2366
• 全文大小：516KB
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• 作者单位：Gregory C. Berlet MD (1)
  Christopher F. Hyer DPM (1)
  Terrence M. Philbin DO (1)
  Jodi F. Hartman MS (2)
  Michelle L. Wright MPH (2)
  
  1. Orthopedic Foot and Ankle Center, 300 Polaris Parkway, Suite 2000, Westerville, OH, 43082, USA
  2. Orthopaedic Research & Reporting, Ltd, Gahanna, OH, USA
  

文摘

Background Fresh osteochondral allograft transplantation can be used to replace talar osteochondral defects (OCDs) with single bulk osteochondral graft. While limited studies report improvement of function, improvement in quality of life and radiographic durability is unknown. Questions/purpose We therefore determined if this technique improved function, increased quality of life, and provided durable graft stability radiographically and by MRI. Patients and Methods We prospectively followed 19 patients (19 OCDs). We excluded seven patients (four with insufficient followup, two who were lost to followup, and one with graft failure), leaving 12 patients with a minimum followup of 2?years (average, 3.3?years; range, 2.0-.6?years). Functional and quality of life outcomes were quantified using the American Orthopaedic Foot and Ankle Society (AOFAS) score and the SF-12 Health Survey. Graft incorporation and stability were assessed through radiographs and MRI. Results Mean total AOFAS scores (61?±?9 to 79?±?6), pain subscores (17?±?8 versus 26?±?5), and function subscores (34?±?3 versus 42?±?4) improved from preoperatively to last followup. We observed no improvements of the physical and mental health components of the SF-12 Health Survey from preoperatively to last followup. At last followup, three of the 12 grafts had radiolucencies, four had edema, one failed to incorporate, and none had subsidence. One of the 19 patients in the overall series underwent graft revision. Conclusions Patients with talar OCDs can expect functional improvement after this technique. The majority will have stable grafts at least short term. Larger studies with longer followup are needed to determine if this procedure substantially improves quality of life, if graft radiolucencies and edema have any long-term implications, and whether the grafts are durable. Level of Evidence Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.