Operative management of osteochondral lesions of the talus with the OATS technique

Since 1996 we have gained experience in the development and clinical applic ation of the OATS technique in 167 cases. Operative management, technical d emands and early results of osteochondral cylindrical autograft plugs at th e talus are presented. Between April 1996 and November 2000 we treated 39 p atients (21 male, 18 female)with an average age of 28.4 years (range: 16-57 years) for osteochondral defects with an average size of 8x15 mm - 20x15 m m at the medial (n=31) and lateral (n=6) talar dome as well as at the dista l tibia (n=2) with an OATS technique. Indications were osteochondral defect s after trauma in 12 patients (med., n=5; tat., n=5; dist. tibia n=2) and o steachondrosis dissecans (grades III and IV) in 27 patients (med., n=26; la t., n=1). The donor site was the proximal lateral femoral condyle in all pa tients. An additional osteotomy of the malteolus was necessary in 30 patien ts. Ail patients were scored pre- and postoperatively by a Lysholm Bruns sc ore and monitored by postoperative MRI. The follow-up extended for an avera ge of 19,6 months (6-42). The Lysholm score for ail patients rose from 62 p oints (range: 20-77) up to 92 points (range: 63-100). There was no correlat ion between patients with and without an osteotomy of the malleolus. The po stoperative MRI showed a complete incorporation and vitality of the transpl anted cylinders as well as a congruence of the joint surface. Complications were pain in three cases in the region of the osteotomy, which decreased a fter removal of the screws,and synovialitis in one case. One patient report ed femoropatellar pain for about 4 weeks. The OATS technique achieves encou raging results in limited osteochondral defects in the talar dome even in p reoperated osteochondral defects. Because of the mostly posterior localizat ion of the defect zone, osteotomy of the malleolus is necessary in most cas es. Harvesting the donor cylinders from the ipsilateral knee joint by mini- arthrotomy shows a low mortality. The OATS technique is a suitable, causal and cost-effective therapy, which can possibly prevent and at least delay t he development of an arthrosis.