Trasplante con aloinjerto estructural de astrágalo en lesión osteocondral masiva

Article information

Resumen

Las lesiones osteocondrales de astrágalo son causa habitual de dolor y pérdida de funcionalidad. El manejo terapéutico de los defectos osteocondrales masivos continua siendo un desafío para el cirujano ortopédico.

Presentamos el caso clínico de una mujer de 53 años con una lesión quística masiva de la mitad medial de la cúpula astragalina, tratada mediante trasplante con aloinjerto osteocondral.

Tras un año de seguimiento, no se observan signos de reabsorción o fallo del injerto. Los estudios por imagen muestran signos de unión e integración del injerto por TC a los 6 meses, sin evidenciarse signos de colapso o fragmentación en el control por TC al año.

La paciente se encuentra actualmente sin dolor, y deambulando en carga sin ayudas. El trasplante con aloinjerto estructural de astrágalo es una técnica reconstructiva viable y una buena opción quirúrgica para aquellos pacientes con lesiones osteocondrales masivas. La estabilidad e integración del injerto deben valorarse a medio y largo plazo.

Palabras clave:

Astrágalo

Lesión osteocondral

Aloinjerto

Abstract

Large osteochondral defects of the talus present a difficult clinical problem to orthopaedic surgeons. Massive-volume deep cystic lesions are rare. The use of an allograft transplantation offers an alternative in the treatment of these extensive lesions involving the talar dome.

We report on the outcome after an osteochondral fresh frozen allograft transplantation in a case of a 53-year old-woman with a massive cystic lesion of the talus.

No evidence of resorption or failure of the graft has been observed after 1 year of follow up. Radiological examination shows signs of union and incoroporation of the graft without subchondral collapse or fragmentation. After 1 year se has no pain and she is able to walk independently without assistance.

The present case offers a surgical alternative for massive lesions of the talus, that use rigidly fixed ostechondal allograft transplantation. Mid and long term survival of these kind of allografts remains unknown. Despite the good results after one year, worse outcomes or failures can be expected in the future.

Keywords:

Talus

Osteochondral defect

Allograft

Full text is only aviable in PDF

Bibliografía

[1.]

C. Becher, H. Thermann.

Results of microfracture in the treatment of articular cartilage defects of the talus.

Foot Ankle Int., 26 (2005), pp. 583-589

Medline

[2.]

A. Gobbi, R.A. Francisco, J.H. Lubowitz, F. Allegra, G. Canata.

Osteochondral lesions of the talus: randomized controlled trial comparing chondroplasty, microfracture, and osteochondral autograft transplantation.

Arthroscopy., 22 (2006), pp. 1085-1092

http://dx.doi.org/10.1016/j.arthro.2006.05.016 | Medline

[3.]

S.A. Hunt, O. Sherman.

Arthroscopic treatment of osteochondral lesions of the talus with correlation of outcome scoring systems.

Arthroscopy., 19 (2003), pp. 360-367

http://dx.doi.org/10.1053/jars.2003.50047 | Medline

[4.]

A.W. Baltzer, J.P. Arnold.

Bone-cartilage transplantation from the ipsilateral knee for chondral lesions of the talus.

Arthroscopy., 21 (2005), pp. 159-166

http://dx.doi.org/10.1016/j.arthro.2004.10.021 | Medline

[5.]

L. Hangody, G. Kish, L. Módis, I. Szerb, L. Gáspár, Z. Diószegi, et al.

Mosaicplasty for the treatment of osteochondritis dissecans of the talus: two to seven year results in 36 patients.

Foot Ankle Int., 22 (2001), pp. 552-558

Medline

[6.]

C.H. Lee, K.H. Chao, G.S. Huang, S.S. Wu.

Osteochondral autografts for osteochondritis dissecans of the talus.

Foot Ankle Int., 24 (2003), pp. 815-822

Medline

[7.]

S. Giannini, R. Buda, F. Vannini, F. Di Caprio, B. Grigolo.

Arthroscopic autologous chondrocyte implantation in osteochondral lesions of the talus: surgical technique and results.

Am J Sports Med., 36 (2008), pp. 873-880

http://dx.doi.org/10.1177/0363546507312644 | Medline

[8.]

J.P. Whittaker, G. Smith, N. Makwana, S. Roberts, P.E. Harrison, P. Laing, et al.

Early results of autologous chondrocyte implantation in the talus.

J Bone Joint Surg Br., 87 (2005), pp. 179-183

Medline

[9.]

R. Ferkel, N. Sgaglione, W. DelPizzo, et al.

Arthroscopic treatment of steochondral lesions of the talus: long-term results.

Orthop Trans., 14 (1990), pp. 172-173

[10.]

I.F. Anderson, K.J. Crichton, T. Grattan-Smith, R.A. Cooper, D. Brazier.

Osteochondral fractures of the dome of the talus.

J Bone Joint Surg Am., 71 (1989), pp. 1143-1152

Medline

[11.]

M. Pritsch, H. Horoshovski, I. Farine.

Arthroscopic treatment of osteochondral lesions of the talus.

J Bone Joint Surg Am., 68 (1986), pp. 862-865

Medline

[12.]

D.N. Mintz, G.S. Tashjian, D.A. Connell, J.T. Deland, M. O’Malley, H.G. Potter.

Osteochondral lesions of the talus: a new magnetic resonance grading system with arthroscopic correlation.

Arthroscopy., 19 (2003), pp. 353-359

http://dx.doi.org/10.1053/jars.2003.50041 | Medline

[13.]

T.W. Bauer, H.D. Dorfman.

Intraosseous ganglion: a clinicopathologic study of 11 cases.

Am J Surg Pathol., 6 (1982), pp. 207-213

Medline

[14.]

T.A. Glass, R. Dyer, L. Fisher, R.E. Fechner.

Expansile subchondral bone cyst.

AJR Am J Roentgenol., 139 (1982), pp. 1210-1211

http://dx.doi.org/10.2214/ajr.139.6.1210 | Medline

[15.]

A.K. Schachter, A.L. Chen, P.D. Reddy, N.C. Tejwani.

Osteochondral lesions of the talus.

J Am Acad Orthop Surg., 13 (2005), pp. 152-158

Medline

[16.]

R.S. Mulholland, A.E. Gross.

Osteocartilagenous lesions of the talus treated with fresh osteochondral allograft transplantation.

Transplantation/Implantation Today., (1990), pp. 15-23

[17.]

C.D. Murawski, J.G. Kennedy.

Operative treatment of osteochondral lesions of the talus.

J Bone Joint Surg Am., 95 (2013), pp. 1045-1054

http://dx.doi.org/10.2106/JBJS.L.00773 | Medline

[18.]

M.E. Brage, K.A. Reese.

Techniques for large osteochondral defects of the talus.

Tech Foot Ankle Surg., 8 (2009), pp. 43-49

[19.]

S.M. Raikin.

Fresh osteochondral allografts for large-volume cystic osteochondral defects of the talus.

J Bone Joint Surg Am., 91 (2009), pp. 2818-2826

http://dx.doi.org/10.2106/JBJS.I.00398 | Medline

[20.]

P.J. Mc Gahan, S.J. Pinney.

Current concept review: Osteochondral lesions of the talus.

Foot & Ankle Int., 31 (2010), pp. 90-101

http://dx.doi.org/10.3791/52921 | Medline

[21.]

H. El-Rashidy, D. Villacis, I. Omar, A.S. Kelikian.

Fresh osteochondral allograft for the treatment of cartilage defects of the talus: a retrospective review.

J Bone Joint Surg Am., 93 (2011), pp. 1634-1640

http://dx.doi.org/10.2106/JBJS.J.00900 | Medline

Follow us:

Subscribe to our newsletter