Treatment of recurrent osteochondral lesions of the talus with periosteal graf

Abstract

Objective: To analyze the results of the treatment of recurrent talar osteochondral lesions with autologus bone graft and periosteal flap. Methods: A review of 12 cases of recurrent osteochondral lesions of talus, which were previously operated by arthroscopy and by open surgery. A medial malleolus osteotomy was performed in order to inject cancellous bone graft into the area of the defect, previously debridement and drilling-microfractures. The defect was covered with periosteal flap taken from the proximal medial tibia. Finally, the medial malleolus was fixed with 2 cancellous-bone screws. They were immobilizated during 3 weeks and non-weight-bearing until 6 weeks postoperatively. We assessed pain and function with VAS and AOFAS scores, both preoperative and postoperative. Mean follow up was 18 month with clinical and radiolographic controls. (RX, CT scan and MRI). Results: Subjectively, all patients improved after surgery. At 18nd postoperative month, the VAS score was a quarter of the preoperative. Functionally, the AOFAS score improved from 33 points preoperatively to 88 points at 18th month postoperative. Postoperatively, we did not observe any complications. Conclusion: The high rate of failures in the treatment of osteochondral lesions of the talus remains a challenge for the foot and ankle surgeons. With the results obtained in our study, we can conclude that this technique is an option for the treatment of these recurrences.