Retrograde Cancellous Bone Plug Transplantation for the Treatment of Advanced Osteochondral Lesions With Large Subchondral Lesions of the Ankle

The American Journal of Sports Medicine, 08/02/2010

The authors recommend arthroscopic retrograde autologous cancellous bone plug transplantation from the iliac crest as a surgical procedure for the treatment of advanced osteochondral lesions with large subchondral lesions of the ankle.

Author Commentary

The OCL with large subchondral lesions has poor healing response of the lesions because of the non-viable subchondral bone and paucity of mesenchymal stem cells for restoring the lesions. Actually, the surgical results have been reported as poor with arthroscopic drilling in the advanced OCL cases with large subchondral lesions including large subchondral cyst. The osteochondral autograft transplantation from knee is one of the choices for treating such lesions, but there remain several apprehensions including the risk of malleolar osteotomy, risk of donor site complications, and incompatibility of an osteochondral fragment because of the different characteristics of the articular cartilage between the knee and ankle joints. To overcome these problems, we performed the reconstruction of the morbid subchondral lesions and supplying of sufficient mesenchymal stem cells from the patient’s pelvis, without osteotomy and without an injuring the knee joint. All 11 cases showed good to excellent clinical results regarding the AOFAS score. The mean diameter of the lesion was significantly decreased in MRI, with disappearance in 7 cases (73.8%). The defect of articular cartilage was well healed to nearly normal in arthroscopic findings with the mean ICRS score 10.5±0.8 (range, 8 to 11). Consequently, we recommend arthroscopic retrograde autologous cancellous bone plug transplantation as a surgical procedure for the treatment of advanced osteochondral lesions with large subchondral lesion of the ankle.

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