Surgical technique of an innovative patient-specific metal implant for talar osteochondral lesions.

Abstract

Treatment strategies for osteochondral defects (OCDs) of the ankle have substantially increased over the last decade. The development of a small metallic implant to fill the defect has led to the second-generation patient-specific metal implant (Episealer Talus® Implant) designed based on computed tomography and magnetic resonance imaging images. There is a pool of patients falling into the so-called 'treatment gap', a grey zone composed of active patients with symptomatic OCDs in the context of an otherwise healthy joint, or patients with a failed primary treatment. To minimize the risk of perioperative complications, there are a series of tips and tricks that can be considered. Correct execution of the operative approach, proper positioning of the guides, posterior capsule and deep deltoid ligament release and the use of Hintermann spreader allow a perfect visualization of the OCDs minimizing the risk of iatrogenic lesions. Correct execution of the medial malleolus osteotomy, release of soft tissue, proper triplanar alignment of the custom-made guide, its strong stabilization during the reaming and the use of vigorous washes minimizes the potential damage on healthy cartilage. Correct sinking of the implant is crucial; the goal is to place the Episealer Talus at least 0.5 mm below the cartilage surface. Filling a large subchondral cyst with the cancellous bone can be useful to provide better stability of the implant. Episealer Talus for talar OCDs possibly represents an additional tool for surgeons and patients. It is important to avoid mistakes during implant placement. Level V, expert opinion.