title: Role of Demineralized Allograft Subchondral Bone in the Treatment of Shoulder Lesions of the Talus: Clinical Results With Two-Year Follow-Up.
abstract: Cystic osteochondral lesions of the talus present a considerable challenge for foot and ankle surgeons. The purpose of the present study was to evaluate the effect of a medial malleolar osteotomy and implantation of demineralized allograft subchondral bone on pain and function 2 years after surgery. For inclusion, patients demonstrated radiographic evidence of a medial cystic full-thickness osteochondral defect of the talus and previously failed microfracture (N = 12). We hypothesized that improvements in pain and disability would be maintained across time. Compared with the preoperative values, 2 years after surgery, pain and disability had significantly reduced (p < .001). Significant reductions had occurred in postoperative pain from 6 months to 1 year (p = .001) and from 6 months to 2 years (p = .005). Similarly, significant reductions had occurred in postoperative disability from 6 months to 1 year (p = .008) and from 6 months to 2 years (p = .03). The reductions in postoperative pain and disability were maintained from 1 year to 2 years (p ≥ .79). Multiple regression analyses identified depression as a predictor of 2-year postoperative pain (R(2) = 0.36, p = .04). No variables were identified as significant predictors of postoperative disability at 2 years. Other than 1 previously reported peroneal deep venous thrombosis, no additional complications occurred. With successful graft incorporation, no inflammatory response, and no additional complications, the allograft subchondral plug appears to successfully treat osteochondral lesions of the talus and maintain improvements in pain and disability at intermediate follow-up.
authors.affiliation: Fellow, Foot and Ankle Reconstruction Fellowship, Coordinated Health, Bethlehem, PA.
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Galli
authors.affiliation: Research Associate, Department of Clinical Education and Research, Coordinated Health, Bethlehem, PA.
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Protzman
authors.affiliation: Fellow, Foot and Ankle Reconstruction Fellowship, Coordinated Health, Bethlehem, PA.
authors.forename: Scott T
authors.initials: ST
authors.lastname: Bleazey
authors.affiliation: Director, Foot and Ankle Reconstruction Fellowship, Department of Foot and Ankle, Coordinated Health, Bethlehem, PA. Electronic address: drsbrigido@mac.com.
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Brigido
mesh_terms: D000328:Adult; D064591:Allografts; D016025:Bone Transplantation; D002358:Cartilage, Articular / Q000293:injuries / Q000601:surgery*; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D013628:Talus / Q000293:injuries / Q000601:surgery*; D064232:Visual Analog Scale
keywords: ankle injuries/surgery; articular surface injuries; bone substitutes; cartilage; osteochondral lesions of talus