High complication rate after biplanar open wedge high tibial osteotomy stabilized with a new spacer plate (Position HTO plate) without bone substitute.

PURPOSE: We performed a prospective clinical and radiographic evaluation after open wedge high tibial osteotomy (HTO) using the new Position HTO plate (Aesculap, Tuttlingen, Germany) without bone transplantation. METHODS: Thirty-five open wedge HTOs with the Position HTO plate were performed without bone wedges. The mean patient age was 44.6 ± 9.2 years at the time of osteotomy, which was planned with mediCAD II software (Hectec, Niederviehbach, Germany). The Hospital for Special Surgery score, Lysholm-Gillquist score, Tegner activity level, and International Knee Documentation Committee subjective score were used for clinical assessment. We evaluated radiographs obtained preoperatively and at 2, 6, and 12 months postoperatively using full-weight-bearing anteroposterior whole-leg views and anteroposterior and lateral views of the knee. For statistical analyses, JMP 8.0.1 (SAS, Cary, NC) was used. RESULTS: We observed an overall complication rate of 34% and a plate-related complication rate of 23%. Plate-related complications included loss of correction, fracture of the tibial plateau, screw failure, malunion, and fracture of the lateral cortical bone. A significant difference in the mechanical tibiofemoral angle of -1.3° ± 1.4° (P < .001) was found between the follow-up at 2 and 6 months. The mean Hospital for Special Surgery score was 74.8 ± 11.7 preoperatively, and it increased to 87.8 ± 11.0 (P < .001). The mean score on the Lysholm-Gillquist knee functional scoring scale was 55.5 ± 21.7 preoperatively, and it improved to 73.0 ± 23.9 (P < .001). The Tegner activity level was 2.6 ± 0.9 preoperatively, and it improved significantly at final follow-up to 3.7 ± 1.8 (P < .02). The International Knee Documentation Committee subjective score was 43.0 ± 14.9 preoperatively, and it increased to 66.1 ± 21 (P < .001). CONCLUSIONS: We have shown a high plate-related complication rate and a significant loss of correction between 2 and 6 months of follow-up after open wedge HTO using the new Position HTO plate without bone wedges. The preoperatively planned mechanical tibiofemoral angle was not achieved. Despite these complications, the clinical outcome improved significantly. The Position HTO plate cannot be recommended with the presented technique. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Matrix-associated autologous chondrocyte implantation with autologous bone grafting of osteochondral lesions of the talus in adolescents: patient-reported outcomes with a median follow-up of 6 years.

BACKGROUND: This study presents patient-reported outcome measures after combined matrix-associated autologous chondrocyte implantation and autologous bone grafting in high-stage osteochondral lesions of the talus in adolescents. METHODS: A total of 12 adolescent patients (13 ankles) received matrix-associated autologous chondrocyte implantation and autologous bone grafting for a solitary osteochondral lesion of the talus at a single centre. The Foot and Ankle Outcome Score and Foot and Ankle Ability Measure were defined as outcome measures (median follow-up 80 months [range 22-107 months]). Pre- and postoperative ankle radiographs were evaluated according to the van Dijk ankle osteoarthritis scale. RESULTS: The study population consisted of four male and nine female cases (mean age at the time of surgery, 17.7 ± 2.1 years). Eight lesions were classified as traumatic and five as idiopathic. Twelve lesions were located medial vs one lateral in the coronal plane and all central in the sagittal plane. The median lesion size and depth were 1.3 cm2 (range 0.9-3.2 cm2) and 5 mm (range 5-9 mm), respectively. There were no perioperative complications in any of the cases. In 9 cases patient-reported outcome measures were available. The results of the Foot and Ankle Outcome Score subscales were symptoms, 70 ± 14; pain, 83 ± 10; activities of daily living, 89 ± 12; sports/recreational activities, 66 ± 26; and quality of life, 51 ± 17. The mean overall Foot and Ankle Outcome Score was 78 ± 13. The results of the Foot and Ankle Ability Measure subscales were activities of daily living, 81 ± 20; function/activities of daily living, 84 ± 13; sports, 65 ± 29; and function/sports, 73 ± 27. According to the function overall subscale of the Foot and Ankle Ability Measure, in two cases, the patients assessed the ankle function as normal, in three as nearly normal, and in three as abnormal (missing data, n = 1). Preoperative van Dijk scale: stage 0 in five cases and stage I in eight cases; postoperative van Dijk scale: stage 0 in four cases, stage I in 9 cases CONCLUSIONS: Patient-reported outcome measures following matrix-associated autologous chondrocyte implantation and autologous bone grafting for high-stage osteochondral lesions of the talus in adolescents show heterogeneous results. Long-term limitations mainly affect sports and recreational activities. Osteochondral lesions of the talus are associated with osteoarthritis, even preoperatively. However, we did not find significant osteoarthritis progression after matrix-associated autologous chondrocyte implantation and autologous bone grafting in the long term.

Re-operation rate after surgical treatment of osteochondral lesions of the talus in paediatric and adolescent patients.

BACKGROUND: The aim of this study is to analyse the re-operation rate after surgical treatment of osteochondral lesions of the talus (OCLTs) in children and adolescents. METHODS: Between 2009 and 2019, 27 consecutive patients with a solitary OCLT (10 male, 17 female; mean age 16.9 ± 2.2 years; 8 idiopathic vs. 19 traumatic) received primary operative treatment (arthroscopy + bone marrow stimulation [BMS], n = 8; arthroscopy + retrograde drilling, n = 8; autologous chondrocyte implantation [ACI]/autologous bone grafting, n = 9; arthroscopy + BMS + retrograde drilling; n = 1; flake fixation, n = 1). Seventeen OCLTs were located at the medial and ten at the lateral talus. 'Re-operation' as the outcome measure was evaluated after a median follow-up of 42 months (range 6-117 months). Patients were further subdivided into groups A (re-operation, n = 7) and B (no re-operation, n = 20). Groups A and B were compared with respect to epidemiological, lesion- and therapy-related variables. RESULTS: Seven of 27 patients needed a re-operation (re-operation rate 25.9% after a median interval of 31 months [range 13-61 months]). The following operative techniques were initially used in these seven patients: arthroscopy + BMS n = 2, arthroscopy + retrograde drilling n = 4, ACI + autologous bone grafting n = 1. A comparison of group A with group B revealed different OCLT characteristics between both groups. The intraoperative findings according to the International Cartilage Repair Society (ICRS) classification revealed significantly more advanced cartilage damage in group B than in group A (p = 0.001). CONCLUSIONS: We detected a re-operation rate of 25.9% after primary surgical OCLT treatment. Patients with re-operation had significantly lower ICRS classification stages compared to patients without re-operation.