title: Vascularized bone graft from the medial calcaneus for treatment of large osteochondral lesions of the medial talus.
abstract: BACKGROUND
  Operative treatment of large osteochondral lesions of the talus is difficult because the blood supply is poor in the talar dome. The purpose of this study was to evaluate the results of a vascularized bone graft transfer from the medial calcaneus to the large osteochondral lesion.
  
  
  METHODS
  Four ankles in four patients with medial osteochondral lesions were treated through a medial transmalleolar approach. Vascularized bone graft was harvested from the medial calcaneus using the calcaneal branch of the posterior tibial artery and was placed through a fenestration of the medial aspect of the talar dome. The mean duration of postoperative followup was 34 (range 24 to 48) months. Clinical and radiographic evaluations were made before surgery and at final followup.
  
  
  RESULTS
  According to the AOFAS ankle-hindfoot scale, mean pain and function scores improved from 20 to 33 points and 30 to 43 points, respectively. The mean total score improved from 60 to 83 points. Plain radiography at followup showed slight osteosclerosis in all patients, but joint space narrowing was not seen in any patient. Cysts seen preoperatively on MRI or CT resolved after 12 months postoperatively, and MRI or CT did not reveal any findings indicative of osteonecrosis.
  
  
  CONCLUSIONS
  Clinical and radiographic results were satisfactory. Vascularized bone grafts harvested from the calcaneus were successful for the treatment of large osteochondral lesions of the medial talus.
authors.affiliation: Nara Medical University, Department of Orthopaedic Surgery, Kashihara, Nara 634-8522, Japan. yatanaka@naramed-u.ac.jp
authors.forename: Yasuhito
authors.initials: Y
authors.lastname: Tanaka
authors.forename: Shohei
authors.initials: S
authors.lastname: Omokawa
authors.forename: Tadashi
authors.initials: T
authors.lastname: Fujii
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Kumai
authors.forename: Kazuya
authors.initials: K
authors.lastname: Sugimoto
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Takakura
mesh_terms: D000328:Adult; D000368:Aged; D016025:Bone Transplantation / Q000379:methods*; D002111:Calcaneus / Q000098:blood supply / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010008:Osteochondritis Dissecans / Q000601:surgery*; D013628:Talus / Q000601:surgery*; D016896:Treatment Outcome