Osteochondral Allograft Transplantation Surgery for Osteochondral Lesions of the Talus in Athletes

Jackson, Andrew T.; Drayer, Nicholas J.; Samona, Jason; Dukes, Chase; Chen, Christopher; Arrington, Edward A.; Ryan, Paul M.

doi:10.1053/j.jfas.2018.11.020

Cited by 18 publications

(27 citation statements)

References 38 publications

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“…Further surgery was required in 5 of the 20 ankles. Jackson et al 22 assessed 30 athletes (31 ankles) who were refractory to marrow stimulation or predicted to be refractory based on size and location of the lesion. The mean follow-up period was 21 months, and the mean lesion size was 1.37 cm 2 .…”

Section: Discussionmentioning

confidence: 99%

Midterm Results of Fresh-Frozen Osteochondral Allografting for Osteochondral Lesions of the Talus

et al. 2020

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Background: Osteochondral lesions of the talus (OLT) are relatively common. Following the failure of conservative treatment, many operative options have yielded varied results. In this study, midterm outcomes after fresh-frozen osteochondral allograft transplantation for the treatment of OLT were evaluated. Methods: Twenty-five patients (12 women and 13 men) with a mean age 40.4 (range 18-70) years between 2009 and 2014 were enrolled. Of 25 ankles, 3, 13, 4, and 4 were involved with the talus at Raikin zone 3, 4, 6, and 7 as well as one coexisted with zone 4 and 6 lesion. The mean OLT area was 1.82 cm2 (range, 1.1-3.0). The mean follow-up period was 5.5 years (range, 4-9.3). Outcomes evaluation included the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, visual analog scale score, and 12-item Short Form Health Survey (SF-12). Result: AOFAS ankle-hindfoot score increased from 74 preoperatively to 94 at 2 years postoperatively ( P < .001) and the SF-12 physical health component scores increased from 32 to 46 points ( P < .001). Incorporation was inspected in all patients in the latest follow-up, and graft subsidence and radiolucency were observed in 2 and 7 cases, respectively, whereas graft collapse and revision OLT graft were not observed. Bone sclerosis was found in 6 of 25 patients. Conclusion: With respect to midterm results, fresh, frozen-stored allograft transplantation might be an option in the management of symptomatic OLT. Level of Evidence: Level IV, retrospective case series.

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Section: Discussionmentioning

confidence: 99%

Midterm Results of Fresh-Frozen Osteochondral Allografting for Osteochondral Lesions of the Talus

et al. 2020

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“…Medial or lateral malleolar osteotomy is always performed to achieve adequate intra-articular exposure for autologous bone cartilage transplantation or other transplantation procedures. 2,10,12,15 In 2007, Elias et al 7 showed that OLTs are more frequently located in the medial talar dome. Access to the medial half of the talus can be challenging, even with osteotomy.…”

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confidence: 99%

“…Displacement after osteotomy can lead to advanced ankle osteoarthritis. 10 In addition, there is always a risk of injuries to the posterior tibial tendon behind the medial malleolus, so care needs to be taken to protect anatomic structures during osteotomy. 9,15,18 The aim of the current study was to evaluate a partial step-cut technique consisting of osteotomy to only the anterior one-third to two-thirds of the medial malleolus (depending on the OLT location).…”

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A Novel Medial Malleolar Osteotomy Technique for the Treatment of Osteochondral Lesions of the Talus

Cheng

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: The current techniques for medial malleolar osteotomy may lead to posterior tibial tendon injury and have a high rate of malunion. Purpose: To describe a novel partial step-cut medial malleolar osteotomy technique and evaluate its technical feasibility and its advantages compared with traditional methods. Study Design: Case series; Level of evidence, 4. Methods: The novel technique consisted of osteotomy of the anterior one-third to two-thirds of the medial malleolus. A total of 19 ankles (18 patients) with osteochondral lesions of the talus underwent the novel osteotomy technique before osteochondral reconstruction. All patients were evaluated for more than 2 years. Radiographs were analyzed for postoperative displacement and malunion, and postoperative ankle function was evaluated according to the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale and the visual analog scale (VAS) for pain. Results: The partial step-cut osteotomy technique was able to provide adequate intra-articular exposure without disturbing the posterior tibial tendon. The 19 ankles healed at a mean of 7.3 ± 1.5 weeks (range, 6-12 weeks). There was slight incongruence in 4 ankles, with a displacement of 1.0 ± 0.1 mm proximally and 0.3 ± 0.1 mm medially. The mean postoperative AOFAS and VAS scores improved compared with preoperatively, from 54.2 ± 12.1 to 84.6 ± 6.6 and from 6.4 ± 1.0 to 1.8 ± 1.3, respectively ( P < .001 for both). No intraoperative tendon injuries were observed. Conclusion: Results indicated that partial step-cut osteotomy is a reliable and effective method for providing enough exposure, avoiding displacement after reduction, and not disturbing the anatomic structures behind the medial malleolus.

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Large variation in postoperative rehabilitation protocols following operative treatment of osteochondral lesions of the talus: A systematic review and meta‐analysis on >200 studies

Buck,

Dahmen,

Tak

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeA treatment‐specific rehabilitation protocol and well‐defined return‐to‐play criteria guide clinical decision‐making on return to normal function, activity, sports and performance after surgical treatment for osteochondral lesion of the talus (OLT). The optimal rehabilitation protocols in the current literature remain unclear. The purpose of this study was to explore the existing literature on rehabilitation protocols from the early postoperative phase to return to sport onwards after different types of surgical treatment of OLTs.MethodsPubMed, Embase, CDSR, DARE and Central were searched systematically from inception to February 2023 according to the PRISMA 2020 guidelines. All clinical studies with a description of postoperative rehabilitation criteria after surgical treatment of OLTs were included. The primary outcome of this study is the extent of reportage for each rehabilitation parameter expressed in percentage. The secondary outcome is the reported median time for each parameter in rehabilitation protocols for all different treatment modalities (type of surgery). The median time, expressed as number of weeks, for each parameter was compared between different types of surgery.ResultsA total of 227 articles were included reporting on 255 different rehabilitation protocols from seven different types of surgery. Weight‐bearing instructions were reported in 84%–100% and the use of a cast or walker was prescribed in 27%–100%. Range of motion exercises were described in 54%–100% whereas physical therapy was advised in 21%–67% of the protocols. Any advice on return to sport was described in 0%–67% protocols. A nonparametric analysis of variance showed significant differences between the different surgical treatment modalities for the following parameters between the treatment groups: time to full weight‐bearing (p < 0.0003) and return to high impact level of sports (p < 0.0003). Subjective or objective criteria for progression during rehabilitation were reported in only 24% of the studies.ConclusionAn in‐depth exploration of the current literature showed substantial variation in postoperative rehabilitation guidelines with an associated underreporting of the most important rehabilitation parameters in postoperative protocols after surgical treatment of OLTs. Furthermore, nearly all rehabilitation protocols were constructed according to a time‐based approach. Only one out of four reported either objective or subjective criteria.Level of EvidenceLevel IV, systematic review.

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Osteochondral Allograft Transplantation Surgery for Osteochondral Lesions of the Talus in Athletes

Cited by 18 publications

References 38 publications

Midterm Results of Fresh-Frozen Osteochondral Allografting for Osteochondral Lesions of the Talus

Midterm Results of Fresh-Frozen Osteochondral Allografting for Osteochondral Lesions of the Talus

A Novel Medial Malleolar Osteotomy Technique for the Treatment of Osteochondral Lesions of the Talus

Large variation in postoperative rehabilitation protocols following operative treatment of osteochondral lesions of the talus: A systematic review and meta‐analysis on >200 studies

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