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Clinical Outcome and Magnetic Resonance Imaging after Osteochondral Autologous Transplantation in Osteochondritis Dissecans of the Talus

Background: Osteochondral autologous transplantation (OAT) has been performed for years for osteochondritis dissecans of the knee with good clinical results. In osteochondritis dissecans of the talus, however, OAT represents a challenge to the orthopaedic surgeon as frequently malleolar osteotomy has to be performed for exposure of the talus and the harvesting of the osteochondral graft usually requires an arthrotomy of the knee. Methods: In this study, we evaluated the clinical outcome of OAT in 32 patients (mean follow-up 29 months) by means of the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale, ankle pain on the visual analogue scale (VAS), HSS Patella Score, and magnetic resonance imaging (MRI) of the osteochondral graft. Results: Median AOFAS score was 86, median ankle pain on VAS was 2.0, and median HSS Patella score was 95. Complications included 1 case of delayed wound healing and 1 case of nonunion of the malleolar osteotomy requiring revision surgery. MRI findings were abnormal in 14 out of 28 cases; however, with the numbers available in our study no correlation to clinical outcome could be detected. Conclusion: OAT in osteochondritis dissecans of the talus was a safe procedure with good clinical results. As abnormal MRI finding was not necessarily diagnostically conclusive, MRI might be of limited value in postoperative follow-up. Level of Evidence: Level IV, retrospective case series.