Outcomes from Osteochondral Autograft Transplant or Mosaicplasty in 26 Patients with Type V Osteochondral Lesions of the Talus

BACKGROUND: Mosaicplasty osteochondral transplantation (MOT) has been proved a feasible choice for the treatment of talus osteochondral injury. It can reduce ankle pain and allow performance of daily living activities and elementary sports. However, there are very little data on the restoration of normal life with large lesions. Our investigation focused on assessing outcomes in patients with large lesions. MATERIAL/METHODS: The MOT operation was used, and the donor site was located at the lateral condyle of the femur. Clinical evaluation included the Berndt and Harty outcome question, Visual Analog Scale (VAS) pain score (during rest, walking and running), American Orthopedic Foot and ankle Association (AOFAS) score, International Knee Documentation Committee (IKDC) subjective knee evaluation form, and the Short Form 36 (SF-36). Twenty-four months after surgery, the graft binding was assessed by MRI using the magnetic resonance observation of cartilage repair tissue (MOCART) score. RESULTS: We assessed 26 patients, including 14 males and 12 females. The average follow-up time was 33.9±5.2 months. The average lesion size was 173.1±23.5 mm(2). The average VAS score during rest improved from 4.62±0.85 preoperatively to 1.08±0.27 postoperatively (P<0.05), the score during walking improved from 5.19±0.63 preoperatively to 1.15±0.37 postoperatively (P<0.05), and the score during running improved from 6.08±0.74 preoperatively to 1.39±0.57 postoperatively (P<0.05). The average postoperative AOFAS ankle score improved to 91.5±2.6 (range, 88 to 96), compared with preoperative 75.0±2.8 (range, 70 to 79) (P<0.05). Two patients developed pain in the donor site of the knee joint, and both of them had 2 or more osteochondral plugs harvested. The postoperative SF-36 score increased to 92.2±2.4 (P<0.05). In the last follow-up, 18 patients answered the Berndt and Harty outcome question, all with “good” as the result. CONCLUSIONS: MOT is a feasible choice for patients with larger lesions. It can improve the VAS/AOFAS/IKDC/SF-36 scores, and has high patient satisfaction. Graft incorporation helps improve patient quality of life. Our results indicate that a larger osteochondral plug area increases the risk of developing knee donor site pain.