SLR - August 2012 - Brian T. Dix
Reference: Haene R, Qamirani E, Story RA, Pinsker E, Daniels TR. J Bone Joint Surg Am. 2012 Jun 20;94(12):1105-10.
Scientific Literature Review
Reviewed by: Brian T. Dix, DPM
Residency Program: The Western Pennsylvania Hospital, Pittsburgh, PA
Podiatric Relevance:
An osteochondral lesion of the talus greater than 15mm (1.5cm) poses a surgical dilemma with respect to management. One option for these rather large talar defects is fresh osteochondral allograft transplantation. This option is desirable because there is no donor-site morbidity related with other surgical options such as osteochondral autograft transfer or autologous chondrocyte implantation.
Methods:
The study design was a prospective evaluation of the intermediate results of fresh osteochondral allografting for osteochondral lesions of the talus with use of validated outcome measures. More specially, seventeen ankles had fresh osteochondral allograft implanted. Outcome measures prospectively collected included the Short Form-36 (SF-36), American Academy of Orthopaedic Surgeons (AAOS) Foot and Ankle Module outcome measures, American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot scores and Ankle Osteoarthritis Scale (AOS). Radiographs and computed tomographies (CT) were performed preoperatively on seventeen ankles and postoperatively on sixteen ankles.
Results:
The mean follow-up period was a little greater than four years. Two out of sixteen ankles were diagnosed on follow up CT as failure of graft incorporation. Furthermore, subchondral cysts were present in eight ankles, degenerative changes were identified in seven ankles and osteolysis was found in five ankles on the last follow up CT. There was significant improvement in the AAOS Foot and Ankle Score Scale and the AOS Disability scores. However, in the SF-36, AOS Pain, AAOS Foot and Ankle Shoe Comfort Scale scores there was no significant difference. In the end, ten out of seventeen ankles were rated as excellent or good with only four being totally free of symptoms. Moreover, eight ankles had continued pain with two of those necessitating arthroscopic debridement, and five out of seventeen ankles were deemed clinical failures.
Conclusions:
Fresh osteochondral allograft for the management of large talar osteochondral defects can significantly enhance the functional condition of the ankle as concluded by the validated outcome measures for the first time. However, when deciding to perform this transplantation, the patient must be educated on the relatively elevated failure rate (29 percent) and reoperation rate (12 percent).