Retrograde cancellous bone plug transplantation for the treatment of advanced osteochondral lesions with large subchondral lesions of the ankle.

Background: The surgical results have been reported as poor for advanced osteochondral lesions of the ankle with large subchondral lesions including subchondral cyst.

Hypothesis: Transplanting an autologous cancellous bone plug from the pelvis to the lesions retrogradely may bring good clinical results for the treatment of advanced osteochondral lesions with large subchondral lesions including subchondral cyst of the ankle.

Study Design: Cohort study; Level of evidence, 3.

Methods: Twenty-five osteochondral lesion patients who had large subchondral lesions of the ankle (diameter > or =10 mm on magnetic resonance imaging) met the criteria of this study. Fourteen of those patients were treated with arthroscopic antegrade drilling (group AD), and the other 11 patients were treated with arthroscopic retrograde cancellous bone plug transplantation from the iliac crest (group RC). The clinical results in conjunction with the American Orthopaedic Foot and Ankle Society (AOFAS) scores, diameters of the subchondral lesions on magnetic resonance imaging, and the regenerative cartilage in second-look arthroscopy using International Cartilage Repair Society (ICRS) visual repair assessment score were evaluated.

Results: The mean AOFAS score at 2 years after surgery was 82.2 +/- 7.2 in group AD and 95.8 +/- 4.6 in group RC (P < .0001). Diameter of the subchondral lesion was almost unchanged in 11 cases (78.5%) in group AD, compared with disappearance in 7 cases (73.8%) and decreased lesion size in 4 cases (36.4%) in group RC. The mean ICRS score at second-look arthroscopy was 5.1 +/- 1.9 in group AD and 10.5 +/- 0.8 in group RC (P = .0001).

Conclusion: The authors recommend arthroscopic retrograde autologous cancellous bone plug transplantation from the iliac crest as a surgical procedure for the treatment of advanced osteochondral lesions with large subchondral lesions of the ankle.