Medium-term outcomes using fresh osteochondral allograft transplantation for treatment of large osteochondral lesion of the talus.

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1 Medium-term outcomes using fresh osteochondral allograft transplantation for treatment of large osteochondral lesion of the talus.,2 Chamnanni Rungprai, M.D. Co-author Taylor Den Hartog, MD Jason A. Patterson, MD Phinit Phisitkul, MD John E. Femino, MD Annunziato Amendola, MD University of Iowa Hospital and Clinic, Iowa, USA 2 Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand AOFAS 206

2 Disclosure The authors have no conflicts to disclose. Medium-term outcomes using fresh osteochondral allograft transplantation for treatment of large osteochondral lesion of the talus. Taylor Den Hartog, MD Jason A. Patterson, MD Phinit Phisitkul, MD John E. Femino, MD Annunziato Amendola, MD My disclosure is in the Final AOFAS app. We have no potential conflicts with this presentation.

3 Introduction Large lesion of osteochondral lesion of the talus is the challenging problem for orthopaedic surgeon. Osteochondral allograft has been proven to be successful surgical option for treatment of large osteochondral defect of the talus. -3 However, there are currently limited literatures reported outcomes of this technique.

4 Materials and methods Retrospective Chart review with prospectively collected data of 26 patients with 26 ankles who had been diagnosed with large osteochondral lesion of the talus and underwent fresh osteochondral allograft transplantation 2004 and 20 in single institution. All patients had failure of conservative treatment and minimum follow-up to be included in this study was year (mean 40.9 months, range, 2 to 23 months).

5 Materials and methods The functional outcome included Visual Analogue Scale (VAS), Foot Function Index (FFI, pain, disability, activity limitations, and total scores), Short Form-36 (SF-36, PCS and MCS) 5- and 0-year survival rate Complications. Statistic Analysis Pre- and post-operative pain (Visual Analog Scale (VAS)), SF-36 (PCS and MCS), and Foot Functional Index (FFI) were obtained and compared using Wilcoxon Singed-Ranks test.

6 Table : Demographic data of the patients who underwent osteochondral allograft. Number of patients / ankles 26 / 26 Age of time at surgery (year) (range) 3.7 ± 4.2 (4-59) Male : Female ratio (no. of patients) 3 : 3 BMI(Kg/m 2 ) (range) 29.0 ± 6.5 ( ) Duration of follow up (month) (range) 40.9 ± 40.6 (6-23) 5-year survival 8/8 (00.0%) 0-year survival / (00.0%)

7 Table 2: Overall results of osteochondral allograft. Parameters Pre-operative Post-operative Patients satisfaction (percent) (range) 62% (0-00%) Patient who will definitely do the surgery again 8 / Recommend surgery to family or friends 8 / *Visual Analog Scale (VAS) (number of available patients) (n=26) 6.9 ± 2.4 (2-0) (n=9) SF-36 Score: at final follow up (n=26)) *PCS: (number of available patients) 4.3 ± 6.3 (n=2) **MCS: (number of available patients) 54.7 ± 8.8 (n=2) Foot Functional Index (FFI) (n=26) at final follow up: **Pain: (number of available patients) 48.0 ± 23.5 (n=9) ** Disability: (number of available patients) 48.8 ± 24.0 (n=9) * Activity limitation: (number of available patients) 57.6 ± 25.9 (n=9) *Total score: (number of available patients) 45.8 ± 22.8 (n=9) 4.8 ± 2.3 (-8) (n=9) (p=0.007)* 47.2 ± 7.8 (n=2) (p=0.084) 56.0 ± 4.4 (n=2) (p=0.875) 53.4 ± 20.0 (n=9) (p=674) 57.6 ± 25.9 (n=9) (p=575) 68.5 ± 2.2 (n=9) (p=0) 54.6 ± 2.0 (n=9) (p=859) *Wilcoxon Rank Sum Test was used to compare pre and postoperative SF-36 (PCS), FFI (Activity limitation and total score), VAS, and ankle dorsiflexion (significant with p value less than 0.05).

8 Result There were 6.8% patient satisfaction with this surgery and 82.7% of the patients will do the surgery again and they will recommend this type of surgery to their friends and family. There were 00% survival rate at 5-year (8 of 8) and 0-year ( of ).

9 Discussion Limitations Strengths Retrospective design with no randomization was used in the methods. Some patients were lost to followup and some did not response to the questionnaires. Small number of the subject at longterm of follow-up. Consecutive case collection. Systematically collected outcome data using validated assessment methods. Intermediate to long-term of followup. All surgeries were performed by the same group of fellowship-trained orthopaedic foot and ankle surgeons.

10 Conclusion Osteochondral allograft demonstrated significant relief of pain in medium-term of follow-up as measured with VAS. This procedure was successful for treatment of large osteochondral lesion of the talus.

11 Reference:. Bisicchia S, Rosso F, Amendola A. Osteochondral allograft of the talus. Iowa Orthop J. 204;34:30-7. Review. 2. Dragoni M, Bonasia DE, Amendola A. Osteochondral talar allograft for large osteochondral defects: technique tip. Foot Ankle Int. 20 Sep;32(9):90-6. No abstract available. 3. El-Rashidy H, Villacis D, Omar I, Kelikian AS. Fresh osteochondral allograft for the treatment of cartilage defects of the talus: a retrospective review. J Bone Joint Surg Am. 20 Sep 7;93(7): doi: 0.206/JBJS.J Thank You for your attention!