SLR - July 2010 - Vu Thai Nguyen
Reference:
Hahn, D.B., Aanstoos, M.E., Wilkins, R.M. (2010). Osteochondral lesions of the talus treated with fresh talar allografts. Foot and Ankle International, 31(4), 277-282.
Scientific Literature Reviews
Reviewed by: Vu Thai Nguyen, DPM
Residency program: Maricopa Medical Center, Phoenix, AZ
Podiatric Relevance:
The management of osteochondral defects of the talus remains a challenge, especially as many lesions do not respond to traditional treatments. The use of fresh talar allograft transplantation (FTAT) may be particularly beneficial for patients who are considered too young and active for total ankle arthroplasty or ankle arthrodesis.
Methods:
Eighteen patients with osteochondral lesions greater than 1 cm (as measured by MRI), and who demonstrated little or no degenerative changes on the tibial side, with functional ankle range of motion present, and skeletal maturity who were treated between April 2002 and January 2007 were included in the analysis. Only 13 of these patients, eight females and five males, were able to return for follow-up and complete a functional survey. The average age of patients was 30 (ranging from 15 to 44) years, and average follow up as 48 (ranging from 20 to 78) months. All patients had pain in the ankle preoperatively, and the locations of lesions were posterolateral, lateral, posteromedial, and medial. Allograft used in the study was collected within 24 hours of death from donors aged 15 to 44 years, properly treated, and stored (up to 28 days) in fresh culture medium until ordered for surgery. All patients had the same post-op management, and two functional scores, the Foot Functional Index (FFI) and the American Orthopedic Foot and Ankle Society Ankle-Hindfoot Score (AOFAS), were used for measurement of pain, function, and satisfaction..
Results:
All 13 allografts healed. There was a significant difference between the preoperative and postoperative pain and activity scores. The average AOFAS score improved from 45 (range, 24 to 64) preoperatively to 81 (range, 61 to 95) postoperatively, and the average FFI score also improved from 5.56 to 2.01. All patients reported a return to daily activities within a year of the surgery and all were satisfied with the results.
Conclusions:
The use of FTAT to restore the osteoarticular integrity of the ankle joint was highly successful in young, otherwise healthy, patients for whom total ankle arthroplasty or arthrodesis was not a good option. The authors of this paper conclude the FTAT is a viable option in the presence of osteochondral lesions of the talus.