Osteochondral allograft transplantation in the ankle: a review of current practice

Figures & data

Figure 1 T1 magnetic resonance imaging appearance of a posteromedial osteochondral shoulder lesion.

Figure 2 Open exposure of a large medial talus osteochondral lesion (A), followed by curettage to expose subchondral bone (B), drilling to perforate the subchondral bone (C), final appearance prior to closure (D).

Figure 3 Anterior approach to ankle for hemitalus osteochondral allograft.

Note: Temporary external fixator is used for distraction.

Figure 4 Preparation of a fresh osteochondral lateral hemitalus allograft.

Figure 5 Implantation of fresh osteochondral lateral hemitalus allograft with headless screw fixation through an anterior approach.

Table 1 Overview of the reported case series to date for fresh osteochondral allograft

Study	N	Follow-up	Lesion characteristics and technical details	Key findings
Gross et al^Citation1	9	12 years	Stage IV Berndt and Harty classification > 1 cm diameter, 5 mm depth All had failed prior operation Block-shaped allografts	Six grafts viable at 11 years, three patients required ankle fusion Average survival 9 years Surviving grafts had satisfactory clinical and radiographic result
Raikin^Citation42	15	54 months	>3 cm^Citation3 Nine patients with prior operation Four MMO, one LMO, ten ant approach (hemitalus transplant) Block-shaped allografts	45 point average improved AOFAS score Two patients required arthrodesis Eleven good or excellent results Radiographic resorption and/or collapse but did not correlate with clinical outcomes
Görtz et al^Citation76	12	38 months	Minimum size 1.7 cm^Citation2 All had prior operation No osteotomies Block-shaped allografts	Graft survival 10/12 Three reoperations One ankle arthrodesis 43% good or excellent results 90% satisfaction
Hahn et al^Citation77	13	48 months	Minimum size 1 cm diameter Ten patients with prior operation Eight patients required malleolar osteotomy Block-shaped allografts	Five reoperations (four hardware removal, one debridement) All allografts healed 36 point average improved AOFAS score 100% patient satisfaction
Adams et al^Citation43	8	48 months	All shoulder lesions Minimum size 1 cm^Citation3 Seven MMO, one LMO Block-shaped allografts	Five point average improved VAS score Four reoperations (no arthrodesis or arthroplasty)
Berlet et al^Citation78	12	3.3 years	Mean size 1.5 cm^Citation2 Ten MMO, two LMO Six block-shaped allografts Six plug allografts	18 point average improved AOFAS score One graft failure requiring revision 3/12 radio-lucencies, 4/12 edema, 11/12 graft incorporation, 0/12 subsidence
El-Rashidy et al^Citation39	38	38 months	24 patients with prior operation Plug-shaped allografts 13 plafondplasty, 20 MMO, five LMO	27 point average improved AOFAS score 73% good or excellent results Graft failure in four patients three additional patients required arthroscopic debridement 10/15 stable on postop MRi
Haene et al^Citation44	17	4.1 years	Shoulder lesions 16 patients without prior operation All but one >15 mm diameter 14 MMO, two LMO	Ten good/excellent results Five failures (two failures to incorporate, one withdrew from study, two had ankle arthrodesis) Two additional patients required arthroscopic debridement

Abbreviations: AOFAS, American Orthopaedic Foot and Ankle Society; LMO, lateral malleolar osteotomy; MMO, medial malleolar osteotomy; MRI, magnetic resonance imaging; VAS, Visual Analog Scale.

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