Autologous osteochondral transplantation for osteochondral lesions of the talus and aeromedical assessment of pilots

LI Songlin; ZHANG Jinkang; DU Junjie; WANG Han; WU Di; WANG Bin; CHEN Yufei

doi:10.3969/j.issn.2097-1753.2025.04.007

Abstract：Objective To investigate the clinical efficacy of autologous osteochondral transplantation for treating large osteochondral lesions of the talus(OLT)in pilots and the principles of aeromedical assessment.Methods The clinical data of 6 pilots with Hepple type Ⅴ OLT treated at the Air Force Medical Center between May 2016 and May 2022 was retrospectively analyzed.All these pilots underwent exposure of the talar osteochondral injury lesion through an internal malleolar osteotomy approach,and multi-column mosaic-style transplantation repair was performed using autologous osteochondral transplantation devices to harvest non-weight-bearing articular surface osteochondral columns from the lateral condyle of the ipsilateral femur.Anteroposterior X-ray of the ankle joint,CT,and MRI were used to assess the severity of talar osteochondral injury and the healing of the cartilage transplantation area.The Lysholm knee joint score,American Orthopedic Foot and Ankle Society(AOFAS)ankle-hindfoot score,and Visual Analog Scale(VAS)were used to evaluate the knee joint function,ankle joint activity,and pain conditions of the pilots before surgery and during follow-up(3 months and 6 months postoperatively).Results Radiographs(anteroposterior/lateral),CT,and MRI at 3 and 6 months postoperatively confirmed healing of the medial malleolar osteotomy site and excellent integration of the osteochondral grafts with a smooth articular surface.No complications,such as wound infection or nonunion of the osteotomy,occurred during follow-up.Knee joint function at 3 and 6 months postoperatively was not significantly different from the preoperative levels(F=0.294,P=0.611).VAS scores significantly improved at both 3 and 6 months postoperatively(both P＜0.001).AOFAS ankle-hindfoot scores also significantly improved during the two follow-ups(both P＜0.001).The AOFAS score at 6 months postoperatively was significantly higher than at 3 months postoperatively(P=0.004).All the pilots were assessed as eligible for flight at 6 months postoperatively.Conclusion Autologous osteochondral transplantation for treating Hepple V-type talar osteochondral injuries in pilots can significantly relieve pain and improve ankle joint function without affecting the function of the knee joint in the area where the osteochondral graft is taken.It is more appropriate for pilots with talar osteochondral injuries to be permitted to return to duty at 6 months postoperatively.