Knee-to-Ankle Mosaicplasty for the Treatment of Osteochondral Lesions of the Ankle Joint

Abstract

Indications for mosaicplasty with a plug transfer from the knee to the talus must be considered carefully, as at midterm, moderate outcome and considerable donor-site morbidity may be found.

Treatment of osteochondral defects of the talus

“…458 Both can lead to satisfactory clinical results, but disadvantages include donor site morbidity in up to 50%, talar surface mismatching, and limited availability. 122,343,407 Furthermore, recurrent lesions, cartilage degeneration, and discontinuity of the subchondral bone plate have been observed aft er osteochondral autograft transfer, 407 as well as inferior results in the treatment of secondary OCDs. 193 Autologous chondrocyte implantation is another alternative but involves two surgical procedures and is more suitable for superfi cial cartilage defects than for cystic lesions.…”

“…The main disadvantage of OATS is the donor-site morbidity, which has been reported to occur in up to 50% of cases. 312,327,407 Allograft transplantation has gained increased attention as an alternative for large OCDs in the United States. El-Rashidy et al and Haene et al reported satisfactory outcomes after a mean follow-up of 3 to 4 years.…”

“…458 However, these techniques are associated with donor site morbidity and limited availability or involve two-stage surgery. 39,312,407 In order to treat OCDs of the medial talar dome after failed primary treatment, a metal resurfacing inlay implant (HemiCAP ® , Arthrosurface Inc., Franklin, MA, USA) has been developed. 17,411 The implant comprises two components: a cobalt-chromium modular articular component, with a diameter of 15 mm, and a titanium cannulated screw, which are connected together via a taper interlock.…”

Osteochondral lesions of the talus in the athlete: up to date review

“…Gül et al [70] also reported that the clinical outcomes following AOT with subchondral cyst formation were as successful as those without a subchondral cyst. Donor site morbidity is also a concern in some series [71]. More recent studies, however, demonstrated that OLT treated with AOT have a low incidence of donor site morbidity with good functional outcomes.…”

Scaffold Based Reconstruction of Focal Full Thickness Talar Cartilage Defects

“…It has proven to be delicate because of the incongruency of the donor-and recipient site and is associated with high donor-site morbidity. In more than 50% of the cases, complaints in the knee joint from where the grafts were harvested have been reported [31]. Furthermore, an autograft cannot be implanted in the ankle without an osteotomy of the medial or lateral malleolus, which can lead to future complications and late adverse effects already described above.…”