Structural Allograft Transplantation for Osteochondral Lesions of the Talus.

Abstract

We describe the technique for structural allograft transplantation to treat large talar shoulder lesions. 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. Inspect the graft for the correct approximate size, operative side, and quality of the cartilage surface prior to proceeding with surgery. 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. Measure the dimensions of the talar defect and its location from anterior to posterior along the talar shoulder at least twice. Err on the side of creating too large a graft that later can be trimmed instead of a graft that is initially too small. Secure the graft with one or two 1.5 or 2.0-mm-diameter solid screws. Ensure that there is no intra-articular step-off. After transitioning to a boot-brace, the patient should remove it to perform ankle range-of-motion exercises four to five times per day. In our series, there were eight patients with a mean age of thirty-one years (range, seventeen to forty-four years). IndicationsContraindicationsPitfalls & Challenges.