Anterior ankle wedge osteotomy combined with periosteum-iliac bone autografting in the treatment of Hepple type Ⅴ osteochondral lesions of the medial talus
Objective:To evaluate the clinical outcomes of anterior ankle wedge osteotomy combined with periosteum-iliac bone autografting in the treatment of Hepple type Ⅴ osteochondral lesions of the medial talus. Methods:A retrospective analysis was conducted on the clinical data of 20 patients with Hepple type Ⅴ osteochondral lesions of the medial talus who underwent anterior ankle wedge osteotomy combined with periosteum-iliac bone autografting at the Sixth Affiliated Hospital of Xinjiang Medical University from January 2019 to January 2024. There were 15 males and 5 females with an average age of 35.5±7.9 years (range:20-60 years). Preoperative and final follow-up assessments included the visual analogue scale (VAS) score,American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score,and Karlsson Peterson ankle score were collected and compared preoperatively and at the final follow-up. Magnetic resonance observation of cartilage repair tissue (MOCART) and imaging results at the final follow-up were recorded,along with any complications. Results:Twenty patients were followed up for 12 to 24 months,with an average duration of 14.0±2.5 months. At the final follow-up,the VAS score decreased from 7.2±1.2 preoperatively to 1.9±0.6,the AOFAS ankle-hindfoot score increased from 74.1±4.8 preoperatively to 94.5±4.8,and the Karlsson-Peterson ankle score increased from 58.2±2.5 preoperatively to 86.3±3.6 (all P<0.05). MRI at the last follow-up revealed complete filling of the bone cyst area and a smooth cartilage surface. The MOCART score was 82.2±4.5. Bony union was achieved at the osteotomy site in all patients,with no occurrences of non-union or delayed union. No complications such as pain or infection occurred at the ipsilateral iliac bone harvesting site. Conclusions:The combination of anterior ankle wedge osteotomy with periosteum-iliac bone autografting is an effective treatment for Hepple type Ⅴ osteochondral lesions of the medial talus,relieving ankle joint pain and improving ankle joint function,resulting in good clinical outcomes.
OsteotomyTransplantationOsteochondral Lesions of Talus
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