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. 2018 Jan;39(1):28-34.
doi: 10.1177/1071100717732342. Epub 2017 Oct 3.

Prospective Evaluation of Structural Allograft Transplantation for Osteochondral Lesions of the Talar Shoulder

Samuel B Adams  1 , Travis J Dekker  1 , Adam P Schiff  1 , Christopher P Gross  1 , James A Nunley  1 , Mark E Easley  1
Affiliations

Prospective Evaluation of Structural Allograft Transplantation for Osteochondral Lesions of the Talar Shoulder

Samuel B Adams et al. Foot Ankle Int. 2018 Jan.

Abstract

Background: Structural or bulk osteochondral allograft transplantation for shoulder talar osteochondral lesions as a salvage procedure has demonstrated efficacy in several retrospective reviews. The purpose of this study was to evaluate prospectively patients who received fresh structural allograft transplantation to the talus.

Methods: Prospective evaluation of a consecutive series of patients who underwent fresh structural allograft transplantation for an osteochondral lesion of the talus (OLT) was performed. Preoperative magnetic resonance imaging (MRI) and/or computed tomography (CT) and plain radiographs were obtained on all patients. The following patient-reported outcomes questionnaires were administered preoperatively and yearly after surgery: 100-mm visual analog scale (VAS) pain scale, American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Scale, Short Form 36 (SF-36), and the Short Musculoskeletal Functional Assessment (SMFA). Preoperative and postoperative radiographs were assessed for allograft incorporation and subsequent arthritis. Fourteen patients with an average age of 40 years (range, 18-69) and a mean follow-up of 55 months (range, 24-97) underwent structural fresh osteochondral allograft transplantation to the talar shoulder.

Results: The average size of the OLT was 2269 mm3 (range, 813-8366) based on CT imaging and 5797 mm3 (range, 1136-12 489) based on MRI imaging. There was significant ( P < .05) improvement in the VAS pain, AOFAS scale, SF-36, and SMFA scores. Five (36%) of the patients required additional surgery for pain and stiffness. Two patients had cartilage delamination and were considered treatment failures. Therefore, the success rate was 86% (12/14).

Conclusion: Significant improvement in pain and function was achieved with structural allograft transplantation for large OLTs at midterm follow-up. This was a safe and effective treatment option in this small series for large OLTs.

Level of evidence: Level IV, prospective case series.

Keywords: allograft; osteochondral; osteochondral lesions of the talus; osteochondritis dessicans; talus.

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