New Trial Finds Two Surgical Approaches Equally Effective for Talus Lesions
BOSTON, MA – A new randomized controlled trial published today reveals that autologous osteoperiosteal transplantation (AOPT) is a non-inferior option to the more established autologous osteochondral transplantation (AOCT) for treating large cystic osteochondral lesions (OLTs) of the medial talus. The findings, stemming from a prospective study registered with ClinicalTrials.gov (NCT03347877),offer patients and surgeons another viable option for addressing these debilitating ankle injuries.
Osteochondral lesions of the talus – damage to the cartilage and underlying bone – commonly occur in active individuals and can lead to chronic pain and impaired function. While AOCT has long been a standard treatment, it carries the risk of donor site morbidity. This new research suggests AOPT, which utilizes bone and periosteum from a patient’s own body, can achieve comparable clinical outcomes and cartilage repair quality, with possibly reduced complications. The study followed 67 patients - 33 receiving AOPT and 34 receiving AOCT – for two years post-surgery.
Researchers assessed patient outcomes using several measures, including the visual analog scale for pain (VAS), the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, and the ankle activity score (AAS) at 3, 6, 12, and 24 months. Cartilage repair was evaluated using the magnetic resonance observation of cartilage repair tissue (MOCART) score and arthroscopic examination via the International Cartilage Repair Society (ICRS) score. Donor site morbidity was also tracked throughout the 24-month follow-up.
the trial demonstrated no important differences between the two groups in terms of pain, function, or overall clinical enhancement as measured by the VAS, AOFAS, and AAS scores. While the AOCT group initially showed better cartilage repair scores (MOCART and ICRS) within the first year, the AOPT group’s scores improved to a comparable level by the 24-month mark. Importantly, the AOPT group experienced a lower incidence of donor site morbidity and reported lower pain scores throughout the study period.
The study concludes that AOPT demonstrates non-inferiority to AOCT for treating large cystic OLTs, offering a potentially beneficial alternative with reduced donor site complications. Researchers emphasize the need for long-term follow-up to confirm these findings and fully understand the durability of the results.
Keywords: autologous osteochondral transplantation; autologous osteoperiosteal transplantation; donor site morbidity; osteochondral lesions of the talus; randomized controlled trial.
