Arthroscopically assisted autologous osteochondral transplantation for Osteochondral Lesions of the Talar Dome: An MRI and clinical follow-up study

Osteochondral Lesions of the Talar Dome (OLT) are common problems encounter ed in orthopedics. Although the etiology remains uncertain, a myriad of tre atment options exists. The authors describe arthroscopically assisted autol ogous osteochondral graft (OCG) transplantation procedures in the treatment of unstable OLTs in nine patients. The patients underwent standard preoper ative MRI examination to assess fragment stability (using De Smet criteria for stability). Intraoperative arthroscopy was used to correlate the preope rative MRI assessment (using Cheng/Ferkel grading). After transplantation p rocedures, MRI (using De Smet criteria for stability) assessed graft incorp oration for stability at an average of 9.3 months after the procedure. Preo perative MRI correlated highly with arthroscopic findings of OLT instabilit y (sensitivity = 1.0). This has been demonstrated in the current orthopedic literature. The post transplantation MRI demonstrated stable graft osteoin tegration by De Smet criteria in all patients. Postoperative visual analogu e pain scales showed significant improvement from preoperative assessment. Postoperative AOFAS Ankle-Hindfoot scores averaged 80.2 (S.D. +/- 18.9). Ou r favorable early results and those of other authors using similar techniqu es may validate OCG transplantation as a viable alternative for treating un stable osteochondral defects In the talus that are refractive to more commo nly used surgical techniques.