The use of a cell-free chondroinductive implant in a child with massive cartilage loss of the talus after an open fracture dislocation of the ankle: a case report.

Abstract

We present a case report of a 3-year-old girl who sustained a severe open fracture dislocation of her talus with complete loss of full-thickness articular cartilage and subchondral bone over 80% of the talar dome. At presentation there was an extensive soft tissue defect including absent anterior joint capsule. She required a free anterolateral thigh flap to reconstruct this defect. The talar dome defect was treated with a cell-free chondroinductive implant made of resorbable polyglycolic acid felt and hyaluronic acid. This was the first use of such an implant in the United Kingdom and the first use in a child anywhere in the world. The case has been followed prospectively for 3 years. At 3 years postoperative, the patient underwent thinning of the anterolateral thigh flap and trimming of an anterior tibial overgrowth, which was causing impingement. At surgery the talar dome cartilage looked pristine, with a line representing the tidemark between the original cartilage and the new formed. Biopsies were taken and histopathology performed. This was a rare and difficult case that has achieved an excellent outcome at this follow-up stage. Level V.