Osteochondral lesions of the talus treated with fresh talar allografts

Osteochondral lesions of the talar dome (OLT) can be devastating injuries. Many of these problems occur in younger adult patients and can cause permanent joint pain and stiffness. Several treatment methods have been used to treat the symptomatic lesion, including arthroscopic debridement and microfracture, transfer of autologous osteoarticular tissue from the knee or talus (OATS), autologous chondrocyte implantation (ACI), frozen and fresh allograft transplantation.

Eighteen patients underwent fresh talar allograft transplantation with internal fixation for an OLT. Fresh talar allograft transplantation involved arthrotomy of the ankle, often with malleolar osteotomy, and replacement of the talar dome defect with fresh talar allograft tissue and internal fixation. Thirteen of the 18 patients returned for clinical and radiographic examination in addition to completing two validated questionnaires. The other five patients did not return for followup evaluation. The 13 patients who were seen in followup had an average age of 30 (range, 15 to 44) years with a mean followup of 48 months.

There was a significant difference (p < 0.01) between the patients' preoperative and postoperative pain and activity abilities as measured with the Foot Function Index and AOFAS Ankle-Hindfoot questionnaires. Clinical examination and X-rays confirmed healing of the graft.

Based on these results, we conclude that this is a reasonable procedure for younger adult patients with focal osteochondral talar defects that cannot be corrected with curettage and microfracture.