Comparison of autologous osteochondral transplantation and osteochondral drilling in treatment of a-cute osteochondral fractures of the talus

Objective To compare autologous esteochondral transplantation and osteochondral drilling in treatment of osteochondral fracture lesions(types Ⅲ＆IV)on the talus dome associated with ankle fracture. Methods There were 38 patients with osteochondral fracture defects(types Ⅲ ＆IV)of the talar dome associated with ankle fracture.The position and size of the fracture deflects were defined during operation.The procedures involved removal of the fracture segments and drilling for 18 cases(Drilling Group) and transplantation with grafts harvested from the ipsilateral knee for 20 cases(Transplantation Group). Transplantation Was conducted by harvesting osteochondral cylinders from non-weight bearing surface of the ipsilateral knee and implanting the donor grafts into the recipient holes of talus to repair cartilaginous defects with press-fit technique.Single donor transplantation or mosaicplasty was adopted.The outcomes were as- sessed on the basis of ankle functional rating Scores.radiographic findings and MRI findings.Results The patients were followed up for 1.5 to 4.0(mean,2.92±0.65)years in Transplantation Group,and 2.5 to 5[mean,3.02±0.83)years in Drilling Group.Ankle funetions were rated by the Baird and Jackson e- valuation system.The average score was 89.85±4.83 for Transplantation Group and 84.28.4±5.65 for Drilling Group(P=0.002).Three patients in Transplantation Group(15.0%)and 8 patients in DriHi Group(44.4%)had posttraumatic arthritis(x2=31.7,P<0.05).Six patients had osteochondritis dis-z secans in Drilling Group(33.3%).In Transplantation Group,the grafts showed excellent bony integration with surrounding tissues and congruity of the articular surface except in 3 patients who had osteochondritis dissecans(15.0%)(x2=39.6,P<0.05). Conclusion Autogenous osteochondral transplantation using ipsilateral knee osteochondral grafte is a better snrgical procedure for treating acute local osteoehondral fracture lesions of the talus associated with ankle fracture than osteochondral drilling.because it improves the functional recovery of the ankle and reduces postoperative complications. Key words: Transplantation.autologons; Osteochondral; Acute disease; Talus; Fracture