SLR - June 2013 - Bryce Jolley
Reference: El-Rashidy H, Villacis D, Omar I, Kelikian A. Fresh Osteochondral Allograft for theTreatment of Cartilage Defects of the Talus: A Retrospective Review, J Bone Joint Surg Am. 2011;93:1634-40
Scientific Literature Review
Reviewed by: Bryce Jolley, DPM
Residency Program: North Colorado Medical Center Podiatric Medicine and Surgery Residency
Podiatric Relevance: Osteochondral lesions of the talus frequently cause pain, functional limitations, and disability. Management of symptomatic lesions remains a challenge to the podiatric physician. Patients typically complain of ankle pain, intermittent swelling, weakness, stiffness, and ankle instability. Traditionally, following failed conservative care, surgical treatment has consisted of debridement of loose cartilage fragments and drilling of the lesion bed. Satisfactory results from this technique have been reported to be as high as 80 percent to 86 percent. However, the repair tissue formed is fibrocartilage, and this modality may not prevent the progression of degenerative joint disease. Therefore, other cartilage repair and restoration techniques have been developed, including osteochondral allograft.
Methods: This is a retrospective study of 38 patients who underwent operative transfer of fresh osteochondral allograft of the talus. Specific indications for allograft treatment included lesions that had previously failed debridement and/or microfracture, lesions of >200 mm¬ and deemed unsuitable for other operative options, or lesions with a depth of >5 mm. All patients were also asked about their subjective satisfaction with the procedure. Magnetic resonance images were acquired for fifteen patients to assess graft incorporation, subsidence, articular cartilage congruity, osteoarthritis, and stability.
Results: The average duration of follow-up after osteochondral allograft transplantation was 37.7 months. Graft failure occurred in four patients. Patient satisfaction with the outcome was rated as excellent, very good, or good by 28 of the 38 patients and as fair or poor by 10 patients. Of the fifteen magnetic resonance imaging scans, 14 had no evidence of graft subsidence, while one demonstrated complete graft collapse. The preoperative AOFAS ankle-hindfoot scores averaged 52.3 points, and these scores improved postoperatively to an average of 78.8.
Conclusions: Transplantation of fresh osteochondral allograft is a viable and effective method for the treatment of osteochondral lesions that do not respond to conservative treatment, arthroscopic debridement and curettage. In this study of 38 patients, four allografts failed, creating an overall failure rate of 10.5 percent. However, a previously failed osteochondral allograft did not negatively affect the ability to perform a repeat allograft, ankle arthrodesis, or a total ankle replacement.