New Trialโฃ Finds Two Surgical Approaches Equally Effective for Talus Lesions
BOSTON, MA – A โฃnew randomized controlled trial โpublished โขtoday revealsโข that autologous osteoperiostealโ transplantation (AOPT) is a non-inferiorโข option โคto the more established autologous osteochondral transplantation (AOCT) for treating large cystic osteochondral โฃlesions (OLTs) of the medial talus. The findings, stemming from a prospective study registered โwith ClinicalTrials.gov (NCT03347877),offer patients and surgeons โanother viable option for addressing these debilitating ankle injuries.
Osteochondral lesions of the talus – damage to theโข cartilage and underlying bone – commonlyโ occur in active individuals and can lead to chronic pain and impairedโฃ function. While AOCT hasโข 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 โclinical outcomes and cartilage repairโ quality, โwith possibly reduced complications. Theโ study followed 67 patients โฃ- 33โ receiving AOPT and 34 โreceiving AOCT – for two yearsโข post-surgery.
Researchers assessed patient outcomes using several measures, includingโ the visual analog scale for pain (VAS), the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, and the ankle activity score (AAS) at โ3, 6, 12, and 24 months. Cartilage repair was โevaluated using the magnetic resonance observation of cartilage repair tissue (MOCART) score and arthroscopic examination via the International Cartilage Repair Societyโข (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 โAAS scores. โฃWhile the AOCT group initially showed better cartilage repair scores โค(MOCART โฃandโฃ ICRS) within the โคfirst year, the AOPT group’s scores improved toโข a comparable level by the 24-month mark. Importantly, the AOPT group experienced a lower incidence of โคdonor site morbidity and reported lower pain scores throughout the study period.
The study โconcludes that AOPT demonstrates โnon-inferiority to AOCT for treating large cystic OLTs, offering aโ potentially beneficial alternative with reduced donor site complications. Researchersโฃ emphasize the need for long-term follow-up to confirm these findings and fully understand โthe durability of โthe results.
Keywords: autologous osteochondral transplantation; autologous โosteoperiosteal transplantation; donorโ site morbidity; osteochondral lesions of the talus; randomized controlledโฃ trial.