SLR - August 2019 - Ashley Jensen
Reference: French M, McCauley J, Pulido P, Brage M, Bugbee W. Bipolar Fresh Osteochondral Allograft Transplantation of the Tibiotalar Joint: A Concise Mid-Term Follow-up of a Previous Report The Journal of Bone and Joint Surgery. 2019 May 1; 101(A).Scientific Literature Review
Reviewed By: Ashley Jensen, DPM
Residency Program: Maricopa Medical Center/Creighton University – Phoenix, AZ
Podiatric Relevance: Ankle arthritis is a difficult problem to treat as podiatric physicians. There are not many treatment options for degenerative ankle disease. Treatment options range from ankle bracing, joint injections for temporary relief, ankle replacement and ankle fusion. There have been minimal treatment advancements in the area of ankle arthritis and many patients continue to suffer from chronic pain without treatment alternatives. This article provides a surgical alternative to degenerative joint disease of the ankle. The current authors reviewed an article published in 2013 and expanded their outcomes which included a 5.3 year follow up on patients who underwent an osteochondral allograft for end stage ankle arthritis.
Methods: The current study included 82 patients (86 ankles) who received an osteochondral allograft for end stage ankle arthrosis. Allograft was collected within 24 hours of death of donors. Each specimen was preserved at 4 degrees Celsius until implantation. All grafts were sized and evaluated pre operatively and successfully implanted within 7-28 days post-harvest via direct anterior approach after resecting the diseased tibial and talar components. Each graft was cut to fit by hand and ranged from 8-12 mm in thickness. Each graft was secured with 3.0mm compressive screws. Each patient was strictly non weight bearing for 12 weeks and gradually returned to full weight bearing at 12-16 weeks.
Results: Mean follow up averaged 9.2 years. Forty four of the 86 ankles ultimately required additional operations including revision osteochondral allograft, ankle fusion, ankle replacement and amputation of affected extremity. Thirty five of the 86 allografts were considered graft failures. Sixteen of the 35 failures were able to be saved with revision of osteochondral allograft. This study concluded that at five years after original allograft there was 74.8 percent success and at 10 years the success rate reduced to 56 percent.
Conclusions: Managing end stage degenerative joint disease affecting the ankle is extremely challenging. Ankle joint fusion is considered the gold standard as it has the most reliable results; however, fusions may leave the patient with other compensatory issues from limb length abnormality, gait difficulty, and knee and back pain. Ankle fusion may be the gold standard but it is not the most ideal surgical option for every patient. Ankle arthroplasty is an alternative to fusion in an older patient with low physical demand. Ankle fusion and replacement are not ideal for younger or active patients. Although the osteochondral allograft is a difficult procedure associated with high failure rates it may be considered in the correct patient population. The current authors concluded that osteochondral allograft is an alternative to fusion in the younger population and can be associated with reduction of pain and return to activity.