Structural Allograft Transplantation for Osteochondral Lesions of the Talus.

INTRODUCTION

We describe the technique for structural allograft transplantation to treat large talar shoulder lesions.

STEP 1 PATIENT SELECTION AND EDUCATION: The patient and surgeon must be prepared for a waiting time of unknown length and have a flexible schedule for when the graft is ready for implantation.

STEP 2 PREOPERATIVE PLANNING AND APPROVAL: Inspect the graft for the correct approximate size, operative side, and quality of the cartilage surface prior to proceeding with surgery.

STEP 3 SURGICAL APPROACH AND OSTEOTOMY: Make sure that the proposed osteotomy site exits into the tibial plafond and not at the axilla as this allows for easier access to the lesion.

STEP 4 PREPARE RECIPIENT SITE: Measure the dimensions of the talar defect and its location from anterior to posterior along the talar shoulder at least twice.

STEP 5 HARVEST GRAFT FROM DONOR TALUS: Err on the side of creating too large a graft that later can be trimmed instead of a graft that is initially too small.

STEP 6 IMPLANT AND SECURE GRAFT INTO RECIPIENT SITE: Secure the graft with one or two 1.5 or 2.0-mm-diameter solid screws.

STEP 7 REDUCE OSTEOTOMY SITE AND CLOSE: Ensure that there is no intra-articular step-off.

STEP 8 POSTOPERATIVE CARE: After transitioning to a boot-brace, the patient should remove it to perform ankle range-of-motion exercises four to five times per day.

RESULTS

In our series, there were eight patients with a mean age of thirty-one years (range, seventeen to forty-four years).

WHAT TO WATCH FOR

IndicationsContraindicationsPitfalls & Challenges.