Fresh-frozen navicular allograft for a navicular osteochondral lesion: A case report

Osteochondral lesions of the navicular bone represent diagnostically challenging pathologies in foot and ankle surgery, with limited literature on effective treatments. The concave articular surfaces are challenging to reconstruct with conventional knee-derived autografts due to substantial contour mismatch, necessitating innovative surgical approaches.

A 32-year-old male gardener presented with progressive left dorsal hindfoot pain following a work-related twisting injury. Initial conservative management, specifically platelet-rich plasma injection, immobilization, and activity modification, failed to provide sustained relief.

Magnetic resonance imaging revealed a large osteochondral defect measuring 0.9 cm × 0.7 cm × 1.1 cm on the posterior facet of the navicular bone, with a concomitant anterior talofibular ligament tear.

The patient underwent an osteochondral allograft transplantation with an anatomically matched fresh-frozen navicular allograft from the ipsilateral navicular of a cadaveric donor. The size- and contour-matching osteochondral allograft was secured into the defect using a press-fit maneuver and biodegradable screws, along with ligamentous repair.

Postoperative imaging confirmed stable fixation and successful incorporation of the graft. At follow-up, the patient reported substantial pain relief, improved mobility, and enhanced quality of life.

This case represents one of the few documented instances of a navicular osteochondral lesion treated with anatomically matched fresh-frozen allograft transplantation. It highlights the feasibility, short-term radiologic incorporation, and clinically meaningful improvement in scores associated with this surgical approach for large navicular osteochondral lesions, emphasizing its potential value as a tailored option for younger patients with refractory lesions.