Fresh bipolar osteochondral allograft of the ankle. Review of the literature and case report of a young patient with bilateral post-traumatic osteoarthritis

Abstract

Objectives: The treatment of severe post-traumatic ankle arthritis remains a challenge nowadays. Since patients suffering from this pathology are mainly young and active people, a correct reconstruction, if possible, of the articular cartilage defects of the tibiotalar joint is very important to achieve a good result. Fresh bipolar osteochondral allograft (FBOA) is a promising operative technique, as an alternative to arthrodesis and total ankle replacement, in pain relief, restoration of function and indefinite delay of arthritic disease progression. Methods: The authors made a review of the literature and present a case report of a young 30-year-old man, with bilateral post-traumatic osteoarthritis of the ankle, treated with (FBOA). The patient was evaluated clinically and radiographically monthly. Results: Pain relief and postoperative function was significantly improved reaching 94 points in the left ankle (preoperative of 40 points), and 92 points in the right ankle (preoperative 42 points) AOFAS score. Conclusions: Fresh tibiotalar allografting seems to be a good alternative to arthrodesis and prosthetic replacement, in the treatment of ankle arthropathy and big articular cartilage defects mainly in young and active patients. This procedure achieves a good pain relief, maintaining functional joint motion and decreasing the risk of adjacent joint arthritis. © 2011 SECOT. Published by Elsevier España, S.L. All rights reserved. Aloinjerto osteocondral bipolar fresco del tobillo. Revisión de la literatura y presentación del caso de un paciente joven con artrosis bilateral postraumática ResumenObjetivo: El tratamiento de la artrosis postraumática grave del tobillo sigue siendo un reto en nuestros días. Dado que los pacientes afectos de esta afección son frecuentemente jóvenes y activos, la reconstrucción apropiada de los defectos articulares de la articulación tibioastragalina, si es posible, es muy importante para obtener un buen resultado. Los aloinjertos osteocondrales bipolares frescos (ABOF) constituyen una técnica quirúrgica prometedora, como una alternativa a la artrodesis o a la artroplastia de tobillo en cuanto al alivio de dolor, recuperación funcional y retraso de la progresión a la artrosis. Método: Se realiza una revisión de la literatura y se presenta el caso de un paciente varón de 30 años con artrosis bilateral postraumática del tobillo tratado con ABOF; el paciente fue revisado clínica y radiográficamente cada mes durante 15 meses.Resultados: Tanto el dolor como la función post-operatoria mejoraron de forma significativa, alcanzando 94 puntos en el tobillo izquierdo (puntuación preoperatoria de 40 puntos) y 92 puntos en el tobillo derecho (puntuación preoperatoria de 42 puntos).Conclusiones: El aloinjerto tibio-astragalino fresco parece ser una buena alternativa a la artrodesis o a la artroplastia en el tratamiento de la artropatía degenerativa del tobillo y de los defectos condrales articulares, principalmente en pacientes jóvenes y activos. Esta técnica consigue un buen alivio del dol...

Clinical applications of allografts in foot and ankle surgery

“…Studies were grouped according to surgical indications into ten categories: musculoskeletal tumours ( n = 16) [10–25], chronic ankle instability ( n = 15) [26–40], ankle arthritis ( n = 14) [41–54], osteochondral lesions of the talus ( n = 12) [55–66], Achilles tendon defects ( n = 11) [67–77], other tendon defects ( n = 9) [78–86], fusions ( n = 9) [87–95], fractures ( n = 8) [96–103], hallux rigidus ( n = 3) [104–106] and other indications ( n = 10) [107–116].…”

Functional evaluation of patients treated with osteochondral allograft transplantation for post-traumatic ankle arthritis: One year follow-up

“…It has been established that an appropriate layer of cartilage from a donor can survive transplantation when supported by intact subchondral bony structure, and is progressively replaced by the host bone after surgery [18]. Although preliminary studies have reported contrasting outcomes, with about 50% of cases requiring revision following failure [20,21], more recent clinical reports have indicated that BFOA is a promising option in the treatment of posttraumatic arthritic ankles and represents a practicable alternative for younger and more active patients, where arthrodesis is not accepted and prosthetic replacement is not desired [2,22]. BFOA of the ankle is also conservative and not irreversible, thus multiple options are still available to the surgeon in case of failure [21].…”