Y. Shimozono (New York, US)
NYU Langone Health Orthopaedic SurgeryPresenter Of 1 Presentation
18.4.2 - Allograft Compared with Autograft in Osteochondral Transplantation for the Treatment of Osteochondral Lesions of the Talus
Abstract
Purpose
There is a lack of clinical studies comparing the effectiveness of cylindrical autograft and allograft plugs in osteochondral transplantation for the treatment of osteochondral lesions of the talus (OLT). The purpose of this study is to compare the clinical and radiological outcomes of autograft or allograft plug osteochondral transplantation for OLT.
Methods and Materials
A retrospective study comparing outcomes of cylindrical autograft or allograft plug for OLT was performed. After discussion of the risks and benefits of each procedure, the decision in graft choice was made based on patient preference. Clinical outcomes were evaluated using the Foot and Ankle Outcome Score (FAOS) and the Short Form-12 (SF-12) score. MRI was evaluated using Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score. The rates of cyst occurrence, graft degradation, graft failure, and revision surgeries were also evaluated.
Results
Twenty-five patients with autograft and 16 with allograft were included, with mean follow-up of 26 months in autograft and 22 months in allograft. There were no significant differences in all demographic variables between the groups. The mean postoperative FAOS and SF-12 were both significantly higher in autograft group than in allograft group (81.9 vs 70.1, p=0.006, 74.7 vs 66.1, p=0.021, respectively). MOCART scores were significantly higher in autograft group (87.1 vs 75.5, p=0.005). The rate of chondral wear on MRI was higher in the allograft group (53% vs 4%, p<0.001). Cyst formation in the graft itself was more likely to occur in allograft (47% vs 8%, p=0.017). The rate of secondary procedures for the graft was higher in the allograft group (25% vs 0%, p=0.009), including 2 nonunions in allograft.
Conclusion
Osteochondral transplantation using cylindrical autograft plug provided better clinical and MRI outcomes than the allograft procedure. The rate of chondral wear on MRI was higher with allograft, and allograft-treated patients had a higher rate of clinical failure.