Ayhan KILIÇ, Yavuz KABUKÇUOĞLU, MURAT GÜL, Ufuk ÖZKAYA, SAMİ SÖKÜCÜ

Talus osteokondral lezyonlarında açık mozaikplasti uygulamalarımızın erken dönem sonuçları

Amaç: Bu çalışmada, kronik seyirli yakınmalara neden olan talus osteokondral lezyonlarının tedavisinde açık mozaikplastinin erken dönem sonuçları değerlendirildi. Çalışma planı: Çalışmaya talus çatısında osteokondral lezyon saptanan sekiz hasta (1 erkek, 7 kadın; ort. yaş 35; dağılım 18-74) alındı. Tanı öncesi geçen süre ortalama 11 aydı. Ortalama büyüklüğü 17x9 mm olan lezyonlar, beş hastada medial, üç hastada lateral yerleşimliydi. Bristol sınıﬂamasına göre, lezyon evreleri iki hastada evre IIa, bir hastada IIb, iki hastada III, bir hastada IV, iki hastada ise V idi. Hastaların tümünde mozaikplasti, osteotomili mini artrotomi yöntemi ile uygulandı. Hastalar, ameliyat öncesi ve sonrası dönemde Amerikan Ortopedik Ayak ve Ayak Bileği Derneği’nin (AOFAS) skorlama sistemiyle değerlendirildi. Ağrı değerlendirmesinde görsel analog skala kullanıldı. Lezyon bölgesindeki yeni kıkırdak gelişimi manyetik rezonans görüntüleme ile incelendi. Ortalama takip süresi 17 ay (dağılım 8-34 ay) idi. Sonuçlar: Osteotomi sahası tüm hastalarda ortalama altı haft ada kaynad ı . Amel iyat önc es i 58 (dağ ı l ım 4 0 - 68) ola n AOFAS puanı son kontrolde 89’a (dağılım 80-97) yükseldi (p

Anahtar Kelimeler:

Talus, Yara iyileşmesi, Manyetik rezonans görüntüleme, Osteotomi, Kemik nakli, Kıkırdak, Artroskopi

Early results of open mosaicplasty in osteochondral lesions of the talus

Objectives: The aim of this study was to evaluate early results of open mosaicplasty for the treatment of talus osteochondral lesions associated with chronic complaints. Methods: The study included eight patients (1 male, 7 fe-males; mean age 35 years; range 18 to 74 years) with osteochondral lesions of the talar dome. The mean duration of symptoms was 11 months and the mean lesion size was 17x9 mm. The lesions were of medial localization in ﬁve patients, and lateral localization in three patients. According to the Bristol classiﬁcation, the stages of the lesions were as follows: stage IIa (n=2), IIb (n=1), III (n=2), IV (n=1), and V (n=2). Mosaicplasty was performed via a mini arthrotomy with os- teotomy. Functional assessments were made using the AOFAS (American Orthopaedic Foot & Ankle Society) scoring system pre- and postoperatively. Pain was assessed using a visual analog scale. Regeneration of new cartilage tissue at the lesion site was monitored by magnetic resonance imaging. The mean follow-up was 17 months (range 8 to 34 months). Results: The osteotomy site healed in a mean of six weeks in all the patients. The mean pre- and postoperative AOFAS scores were 58 (range 40-68) and 89 (range 80-97), respectively (p<0.005). Pain scores decreased from a mean of 8 (range 5 to 10) to 2 (range 1 to 4; p<0.005). Surgery-related complication was seen in one patient. All the patients returned to preoperative levels of activity and occupation. Magnetic resonance imaging showed graft incorporation in all the patients. Conclusion: Open mosaicplasty is a simple, safe, and effective alternative in the treatment of cartilage losses of the talar dome, in particular those of cystic type and ex- ceeding 10 mm in size.

Keywords:

Talus, Wound Healing, Magnetic Resonance Imaging, Osteotomy, Bone Transplantation, Cartilage, Arthroscopy,

___

1. Berndt AL, Harty M. Transchondral fractures (osteochondritis dissecans) of the talus. J Bone Joint Surg [Am] 1959; 41:988-1020.
2. Canale ST, Belding RH. Osteochondral lesions of the talus. J Bone Joint Surg [Am] 1980;62:97-102.
3. Schachter AK, Chen AL, Reddy PD, Tejwani NC. Osteochondral lesions of the talus. J Am Acad Orthop Surg 2005;13:152-8.
4. Giannini S, Buda R, Faldini C, Vannini F, Bevoni R, Grandi G, et al. Surgical treatment of osteochondral lesions of the talus in young active patients. J Bone Joint Surg [Am] 2005;87 Suppl 2:28-41.
5. Hepple S, Winson IG, Glew D. Osteochondral lesions of the talus: a revised classification. Foot Ankle Int 1999; 20:789-93.
6. De Smet AA, Fisher DR, Burnstein MI, Graf BK, Lange RH. Value of MR imaging in staging osteochondral lesions of the talus (osteochondritis dissecans): results in 14 patients. AJR Am J Roentgenol 1990;154:555-8.
7. Flick AB, Gould N. Osteochondritis dissecans of the talus (transchondral fractures of the talus): review of the literature and new surgical approach for medial dome lesions. Foot Ankle 1985;5:165-85.
8. Özenci AM, Aydın AT. Osteochondral lesions of the talus in adolescents. [Article in Turkish] Acta Orthop Traumatol Turc 2004;38 Suppl 1:138-44.
9. Easley ME. Osteochondral lesions of the talus: diagnosis and treatment. Ankle and foot. Curr Opin Orthop 2003; 14:69-73.
10. Chodos MD, Schon LC. Osteochondral lesions of the talus: current treatment modalities and future possibilities. Ankle and foot. Curr Opin Orthop 2006;17:111-6.
11. Merian M, Easley M. Diagnosis and treatment of osteochondral lesions of the talus. [Article in German] Orthopade 2008;37:204.
12. Tol JL, Struijs PA, Bossuyt PM, Verhagen RA, van Dijk CN. Treatment strategies in osteochondral defects of the talar dome: a systematic review. Foot Ankle Int 2000; 21:119-26.
13. Gautier E, Kolker D, Jakob RP. Treatment of cartilage defects of the talus by autologous osteochondral grafts. J Bone Joint Surg [Br] 2002;84:237-44.
14. Assenmacher JA, Kelikian AS, Gottlob C, Kodros S. Arthroscopically assisted autologous osteochondral transplantation for osteochondral lesions of the talar dome: an MRI and clinical follow-up study. Foot Ankle Int 2001; 22:544-51.
15. Al-Shaikh RA, Chou LB, Mann JA, Dreeben SM, Prieskorn D. Autologous osteochondral grafting for talar cartilage defects. Foot Ankle Int 2002;23:381-9.
16. Hangody L, Füles P. Autologous osteochondral mosaicplasty for the treatment of full-thickness defects of weightbearing joints: ten years of experimental and clinical experience. J Bone Joint Surg [Am] 2003;85 Suppl 2:25-32.
17. Scranton PE Jr. Osteochondral lesions of the talus: autograft and allograft replacement. Tech Foot Ankle Surg 2004;3:25-39.
18. Hangody L, Ráthonyi GK, Duska Z, Vásárhelyi G, Füles P, Módis L. Autologous osteochondral mosaicplasty. Surgical technique. J Bone Joint Surg [Am] 2004;86 Suppl 1: 65-72.
19. Sasaki K, Ishibashi Y, Sato H, Toh S. Arthroscopically assisted osteochondral autogenous transplantation for osteochondral lesion of the talus using a transmalleolar approach. Arthroscopy 2003;19:922-7.
20. Pettine KA, Morrey BF. Osteochondral fractures of the talus. A long-term follow-up. J Bone Joint Surg [Br] 1987; 69:89-92.
21. Lee CH, Chao KH, Huang GS, Wu SS. Osteochondral autografts for osteochondritis dissecans of the talus. Foot Ankle Int 2003;24:815-22.
22. Sexton AT, Labib SA. Osteochondral lesions of the talus: current opinions on diagnosis and management. Sports medicine. Curr Opin Orthop 2007;18:166-71.
23. Kreuz PC, Steinwachs M, Edlich M, Kaiser T, Mika J, Lahm A, et al. The anterior approach for the treatment of posterior osteochondral lesions of the talus: comparison of different surgical techniques. Arch Orthop Trauma Surg 2006;126:241-6.
24. Scranton PE Jr, Frey CC, Feder KS. Outcome of osteochondral autograft transplantation for type-V cystic osteochondral lesions of the talus. J Bone Joint Surg [Br] 2006; 88:614-9.
25. Baums MH, Heidrich G, Schultz W, Steckel H, Kahl E, Klinger HM. Autologous chondrocyte transplantation for treating cartilage defects of the talus. J Bone Joint Surg [Am] 2006;88:303-8.
26. Dozin B, Malpeli M, Cancedda R, Bruzzi P, Calcagno S, Molfetta L, et al. Comparative evaluation of autologous chondrocyte implantation and mosaicplasty: a multicentered randomized clinical trial. Clin J Sport Med 2005;15:220-6.
27. Gobbi A, Francisco RA, Lubowitz JH, Allegra F, Canata G. Osteochondral lesions of the talus: randomized con- trolled trial comparing chondroplasty, microfracture, and osteochondral autograft transplantation. Arthroscopy 2006; 22:1085-9
28. Nakagawa Y, Suzuki T, Kuroki H, Kobayashi M, Okamoto Y, Nakamura T. The effect of surface incongruity of grafted plugs in osteochondral grafting: a report of fiv
29. Sugimoto K, Takakura Y, Tohno Y, Kumai T, Kawate K, Kadono K. Cartilage thickness of the talar dome. Arthroscopy 2005;21:401-4.