Medial vs. Anterior Malleolar Osteotomy in Osteochondral Autologous Transplantation for Hepple V Talar Lesions: A Retrospective Study - 22/07/25
Abstract |
Aims |
To compare clinical outcomes in patients with talar Osteochondral lesions (OLTs) treated with medial malleolar osteotomy (MMO) or anterior malleolar osteotomy (AMO) combined with Osteochondral autologous transplantation (OAT).
Methods |
From May 2014 to May 2020, 39 patients with Hepple V OLTs underwent MMO (n = 22) or AMO (n = 19). Functional outcomes were assessed using the American Orthopaedic Foot and Ankle Society ankle-hindfoot scale (AOFAS) and Visual Analog Scale (VAS) pain scores. Magnetic Response Observation of Cartilage Repair Tissues (MOCART) score was used for radiological evaluation. Second-look arthroscopy and hardware removal were performed 2 years postoperatively. International Cartilage Repair Society (ICRS) scores were used to assess cartilage quality at the graft and osteotomy sites.
Results |
There was no significant difference in the occurrence of surgical complications (P = 0.581) between groups. AOFAS, VAS and ICRS scores were significantly improved during follow-up in patients who underwent MMO or AMO (P < 0.01). At the 1-year follow-up, the AOFAS score (92.5±3.3 vs. 89.2±4.9, t = 2.53 P = 0.02) and MOCART score (67.0±3.7 vs. 63.0±8.5, t = 2.14, P = 0.048) were significantly higher in patients who underwent MMO vs. AMO (t = 2.53 P = 0.02). There was no significant difference in AOFAS scores at the 2-year follow-up (MMO, 94.0±4.0 vs. AMO, 91.5±5.5, t = 1.63 P = 0.11); however, the VAS pain score (0.3±0.5 vs. 0.8±0.9, t = 2.53 P = 0.02) was significantly lower and MOCART score (69.3±5.0 vs. 64.1±7.5, t = 2.59 P = 0.013) was significantly higher in patients who underwent MMO vs. AMO. Second-look arthroscopy revealed superior cartilage quality at the osteotomy site in patients who underwent MMO vs. AMO (χ2 = 22.826 P < 0.05), but no significant difference at the graft site (χ2 = 6.049 P = 0.327).
Conclusion |
Both MMO and AMO combined with OAT can achieve good clinical outcomes for Hepple V OLTs; however, better pain relief and cartilage repair at the osteotomy site at 2-years of follow-up indicate that MMO may be the best choice.
Level of evidence |
III; Retrospective Comparative Study.
Il testo completo di questo articolo è disponibile in PDF.Keywords : Osteochondral Lesion (OLTs), Talus, Osteochondral Autologous Transplantation (OAT), Malleolar Osteotomy
Mappa
Benvenuto su EM|consulte, il riferimento dei professionisti della salute.
L'accesso al testo integrale di questo articolo richiede un abbonamento.
Già abbonato a @@106933@@ rivista ?