Background:

Autologous osteochondral transplantation (AOT) has been shown to be a viable treatment option for large osteochondral lesions of the talus. However, there are limited data regarding the management of large lesions in an athletic population, notably with regard to return to sport. Our investigation focused on assessing both qualitative and quantitative outcomes in the high-demand athlete with large (>150 mm²) lesions.

Hypothesis:

AOT is a viable option in athletes with large osteochondral lesions and can allow them to return to sport at their preinjury level.

Study Design:

Case series; Level of evidence, 4.

Methods:

The study population was limited to professional and amateur athletes (Tegner score, >6) with a talar osteochondral lesion size of 150 mm² or greater. The surgical intervention was AOT with a donor site from the lateral femoral condyle. Clinical outcomes at a minimum of 24 months included return to sport, visual analog scale (VAS) for pain score, and Foot and Ankle Outcome Score (FAOS). In addition, graft incorporation was evaluated by magnetic resonance imaging (MRI) using MOCART (magnetic resonance observation of cartilage repair tissue) scores at 12 months after surgery.

Results:

A total of 38 athletes, including 11 professional athletes, were assessed. The mean follow-up was 45 months. The mean lesion size was 249 mm². Thirty-three patients returned to sport at their previous level, 4 returned at a lower level compared with preinjury, and 1 did not return to sport (mean return to play, 8.2 months). The VAS improved from 4.53 preoperatively to 0.63 postoperatively (P = .002). FAOSs improved significantly in all domains (P < .001). Two patients developed knee donor site pain, and both had 3 osteochondral plugs harvested. Univariant analysis demonstrated no association between preoperative patient or lesion characteristics and ability to return to sport. However, there was a strong correlation between MOCART scores and ability to return to sport. The area under receiver operating characteristic of the MOCART score and return to play was 0.891 (P = .005), with a MOCART score of 52.50 representing a sensitivity of 0.85 and specificity of 0.80 in determining ability to return to one’s previous level of activity.

Conclusion:

Our study suggests that AOT is a viable option in the management of large osteochondral talar defects in an athletic population, with favorable return to sport level, patient satisfaction, and FAOS/VAS scores. The ability to return to sport is predicated upon good graft incorporation, and further research is required to optimize this technique. Our data also suggest that patients should be aware of the increased risk of developing knee donor site pain when 3 osteochondral plugs are harvested.

中文翻译：

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对于距骨的大骨软骨病变，自体骨软骨移植在运动人群中是可行的选择。

背景：

自体骨软骨移植（AOT）已被证明是治疗距骨大骨软骨病变的可行选择。但是，关于运动人群中大面积病变的管理的数据有限，特别是在恢复运动方面。我们的研究着重于评估具有大（> 150 mm ²）病变的高需求运动员的定性和定量结果。

假设：

对于骨软骨损伤较大的运动员，AOT是一种可行的选择，并且可以使他们恢复到受伤前的水平。

学习规划：

案例系列；证据水平4。

方法：

研究人群仅限于距骨骨软骨病变大小为150 mm ²或更大的专业和业余运动员（Tegner得分，> 6）。手术干预为AOT，股骨the外侧有供体部位。至少24个月的临床结局包括运动恢复，疼痛评分的视觉模拟量表（VAS）以及足踝结局评分（FAOS）。此外，在手术后12个月使用MOCART（软骨修复组织的磁共振观察）评分通过磁共振成像（MRI）评估移植物掺入情况。

结果：

总共评估了38名运动员，其中包括11名职业运动员。平均随访45个月。平均病变大小为249 mm ²。33名患者恢复了以前的水平运动，有4名患者恢复了比受伤前更低的水平，还有1名未恢复运动（平均恢复运动8.2个月）。VAS从术前的4.53改善到术后的0.63（P = .002）。FAOS在所有领域都有显着改善（P<.001）。两名患者出现膝盖供体部位疼痛，并且均收获了3个骨软骨栓。单因素分析表明，术前患者或病变特征与恢复运动能力之间没有关联。但是，MOCART得分与重返运动的能力之间存在很强的相关性。接收者操作特征下的MOCART得分和恢复比赛区域为0.891（P = .005），而MOCART得分为52.50，表示在确定恢复至先前活动水平的能力时的敏感性为0.85，特异性为0.80。

结论：

我们的研究表明，AOT是管理运动人群中大型骨软骨距骨缺损的可行选择，其运动水平，患者满意度和FAOS / VAS评分均具有良好的回报。恢复运动的能力取决于良好的移植物结合，需要进一步研究以优化该技术。我们的数据还表明，当收获3个骨软骨栓塞时，患者应意识到发生膝盖供体部位疼痛的风险增加。