Bipolar Osteochondral Allograft Transplantation of the Tibiotalar Joint for Ankle Arthritis

Bipolar osteochondral allografting is a technically complex procedure envisioned as an alternative to arthrodesis or arthroplasty¹ in carefully selected young patients with advanced tibiotalar arthritis, usually as a result of trauma.

Confirm that the grafts are not damaged and that the side (left or right) and size (not too small) are properly matched to the donor.

Place an external fixator across the ankle joint using fluoroscopy and distract the ankle prior to incision.

Perform a standard anterior approach to the ankle joint.

Mount the jig on the ankle and confirm the cutting block position both visually and fluoroscopically.

Using a reciprocating saw and careful technique to protect the tendons and neurovascular structures, perform osseous resection of the distal part of the tibia and the talar dome.

Prepare the tibial and talar allografts from the donor tissue to match the resection gap created in Step 5.

Insert and fix the allograft construct and remove the external fixator.

Postoperative care is straightforward, including initial immobilization and a three-month period of non-weight-bearing.

In our recent clinical study², we used our clinical outcomes database to identify eighty-four consecutive patients (eighty-eight ankles) who underwent bipolar osteochondral allograft transplantation of the tibiotalar joint, had surgery in 1999 or later, and had not had a previous arthroplasty or osteochondral allograft transplantation involving the tibial plafond and/or talus.IndicationsContraindicationsPitfalls & Challenges.