title: Survivorship of bipolar fresh total osteochondral ankle allograft.
abstract: BACKGROUND
  Severe posttraumatic ankle arthritis poses a reconstructive challenge in the young and active patient. Bipolar fresh total osteochondral allograft (BFTOA) may represent an intriguing alternative to arthrodesis and prosthetic replacement. The purpose of this article was to evaluate the outcomes of BFTOA performed through an anterior approach to the ankle and to investigate the parameters influencing the results.
  
  
  METHODS
  A total of 26 patients (18 males and 8 females with a mean age of 34.9 ± 7.7 years) underwent BFTOA. The allograft was prepared with the help of specifically designed jigs and the surgery was performed using a direct anterior approach. Patients were evaluated clinically and radiographically at 2, 4, 6, and 12 months after the operation, and at a mean 40.9 ± 14.1 months of follow-up. Radiographic evaluation included the measurement of allograft size matching and alignment.
  
  
  RESULTS
  The AOFAS score improved from 26.6 ± 6 preoperatively to 77.8 ± 8.7 after a mean follow-up of 40.9 ± 14.1 months (P < .0005). Six failures occurred. Joint degeneration was classified as 2 in 12 and as 3 in 14 patients. A statistically significant correlation between low degrees of distal tibial slope and better clinical outcomes was observed (P = .049).
  
  
  CONCLUSIONS
  BFTOA appears to be a viable option to arthrodesis or arthroplasty. Precise allograft sizing, stable fitting, and fixation and delayed weight-bearing were key factors for a successful outcome. In this series the correct alignment of the tibial graft, in terms of slope, was found to play a crucial role in the allograft survivorship.
  
  
  METHODS
  Level IV, case series.
authors.affiliation: Istituti Ortopedici Rizzoli, Bologna University, Bologna, Italy.
authors.forename: Sandro
authors.initials: S
authors.lastname: Giannini
authors.forename: Roberto
authors.initials: R
authors.lastname: Buda
authors.forename: Gherardo
authors.initials: G
authors.lastname: Pagliazzi
authors.forename: Alberto
authors.initials: A
authors.lastname: Ruffilli
authors.forename: Marco
authors.initials: M
authors.lastname: Cavallo
authors.forename: Matteo
authors.initials: M
authors.lastname: Baldassarri
authors.forename: Francesca
authors.initials: F
authors.lastname: Vannini
mesh_terms: D000328:Adult; D064591:Allografts; D000843:Ankle Joint / Q000503:physiopathology / Q000601:surgery*; D001168:Arthritis / Q000601:surgery*; D001174:Arthrodesis; D002356:Cartilage / Q000637:transplantation*; D005260:Female; D005684:Gait; D006801:Humans; D008297:Male; D019637:Orthopedic Procedures / Q000379:methods*; D055815:Young Adult
keywords: arthritis; biomechanics; gait studies; outcome studies; trauma