title: Osteochondral transplantation of autologous graft for the treatment of osteochondral lesions of talus: 5- to 7-year follow-up.
abstract: OBJECTIVE
  Bone marrow stimulation procedures (microfractures/drilling) are considered the gold standard for the primary treatment of osteochondral talar lesions. In the literature, there is lack of evidence about the appropriate treatment in cases of failure of these procedures. A technique of osteochondral autologous transplantation of talar graft was used. It was hypothesized that this is a successful method with good results and low complication rates. Additionally, a technique of anterior ankle approach with temporary removal of a bone block from the distal tibia that gives adequate access to posterior talar dome lesions is demonstrated.
  
  
  METHODS
  Between 2004 and 2007, 46 patients (37 males, 9 females), with OLT for which arthroscopic treatment with curettage and drilling or microfracture had failed, underwent osteochondral transplantation with an osteochondral graft harvested from the ipsilateral talar articular facet. A medial malleolar osteotomy or a distal tibial wedge osteotomy was used to access the talar dome defect.
  
  
  RESULTS
  The median follow-up time was 5.5 years (range 52-75 m). Thirty-four lesions (70.8 %) were located in the central talar dome in the coronal plane, while 26 (54.1 %) and 19 (39.5 %) lesions were located in the lateral and medial aspect of talar dome in saggital plane, respectively. The overall improvement between the preoperative and post-operative AOFAS and VAS FA score was 35 points (p < 0.001) and 39 points (p < 0.001), respectively. Clinical results were considered as good in 43 patients (93.4 %) and fair in three patients (6.5 %). All the transplanted grafts were observed to incorporate fully into the recipient bed. No complications occurred at the site of the malleolus osteotomy or tibial osteotomy and the donor site at the talus.
  
  
  CONCLUSIONS
  The midterm results suggest that the technique of osteochondral transplantation of autologous talar graft for osteochondral lesions of talus after failure of primary treatment with bone marrow stimulation can be safely and successfully used. It demonstrates excellent post-operative scores including improvement of pain and function. This procedure is combined with removal of a tibial bone block and its subsequent replacement and does not yield complications experienced with other procedures.
  
  
  METHODS
  Retrospective case series, Level IV.
authors.affiliation: 1st Orthopaedic Department, 424 Military General Hospital, Thessaloníki, Greece. EVI_DIM45@hotmail.com.|Royal Bournemouth Hospital, Castle Lane East, Bournemouth, BH7 7DW, UK. EVI_DIM45@hotmail.com.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Georgiannos
authors.affiliation: 2nd Orthopaedic Department, 424 Military General Hospital, Thessaloníki, Greece.
authors.forename: Ilias
authors.initials: I
authors.lastname: Bisbinas
authors.affiliation: Department of Foot and Ankle Surgery, Metropolitan Hospital, Athens, Greece.
authors.forename: Athanasios
authors.initials: A
authors.lastname: Badekas
mesh_terms: D000328:Adult; D016512:Ankle Injuries / Q000601:surgery*; D000843:Ankle Joint / Q000601:surgery*; D001182:Arthroscopy; D064592:Autografts; D016025:Bone Transplantation / Q000379:methods; D002358:Cartilage, Articular / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods; D012189:Retrospective Studies; D013628:Talus / Q000293:injuries / Q000601:surgery*; D013977:Tibia / Q000601:surgery; D014182:Transplantation, Autologous; D055815:Young Adult
keywords: Autologous cartilaginous graft; Osteochondral lesion of talus (OLT); Osteochondral talar defect (OCD); Osteochondral transplantation; Surgical treatment