title: Treatment of osteochondral lesions of the talus with cryopreserved talar allograft and ankle distraction with external fixation.
abstract: This article presents the results of a retrospective review of six osteochondral lesions on six patients (five men and one woman) treated with transplantation of cryopreserved talar allograft and ankle joint distraction. All patients complained of ankle pain existing for a long time secondary to a traumatic episode confirmed through MRI. Lesions ranged in measurement from 0.8 cm x 0.8 cm to 3.2 cm x 1.8 cm with an average size of 2.1 cm x 1.5 cm. Each patient underwent talar dome transplantation using fresh frozen talar allograft followed by ankle distraction. Distraction was obtained using a three-ring multiplanar external fixation device. All surgeries were performed between 2002 and 2004. All external fixators were removed at 8 weeks and patients remained partial-weight bearing in a removable cast boot for an additional 8 weeks. Serial postoperative radiographs showed complete consolidation of the allograft within 16 weeks. The average follow up time was 24 months, and all patients related a subjective decrease in symptoms and increase in activity levels. Patients were also evaluated utilizing the Maryland Foot Score both pre- and postoperatively. Preoperatively, four patients were graded as fair and two were graded as poor. Postoperatively, two patients related excellent results, three patients related good results, and one patient related fair results. Several patients experienced minor complications such as pin site irritation (five patients), painful talar wire (one patient), and periostitis (one patient). No patients experienced any major complications and none have required additional surgery. We feel that these initial results warrant further investigation of this treatment.
authors.affiliation: Chicago Foot and Ankle Deformity Correction Center, Chicago, IL, USA.
authors.forename: Edgardo G
authors.initials: EG
authors.lastname: Rodriguez
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Hall
authors.forename: Raymond L
authors.initials: RL
authors.lastname: Smith
authors.forename: John P
authors.initials: JP
authors.lastname: Rachoy
authors.forename: Tomasz
authors.initials: T
authors.lastname: Szmyd
mesh_terms: D000328:Adult; D000843:Ankle Joint / Q000601:surgery*; D015925:Cryopreservation / Q000379:methods*; D016267:External Fixators; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010007:Osteochondritis / Q000601:surgery*; D019857:Osteogenesis, Distraction / Q000295:instrumentation* / Q000379:methods*; D013628:Talus / Q000637:transplantation*; D016896:Treatment Outcome