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Scientific Articles   |    
Bipolar Fresh Osteochondral Allografting of the Tibiotalar Joint
William D. Bugbee, MD1; Gaurav Khanna, MD2; Marco Cavallo, MD3; Julie C. McCauley, MPHc4; Simon Görtz, MD5; Michael E. Brage, MD6
1 Division of Orthopaedic Surgery, Scripps Clinic, 10666 North Torrey Pines Road, MS116, La Jolla, CA 92037. E-mail address for W.D. Bugbee: Bugbee.william@scrippshealth.org
2 Department of Orthopaedic Surgery, Kaiser Permanente, 1011 Baldwin Park Boulevard, Baldwin Park, CA 91706
3 II Clinic of Orthopaedics and Traumatology, Rizzoli Orthopaedic Institute, Via G.C. Pupilli 1, Bologna 40136, Italy
4 Shiley Center for Orthopaedic Research & Education at Scripps Clinic, 11025 North Torrey Pines Road, Suite 200, MS 126, La Jolla, CA 92037
5 Department of Orthopaedic Surgery, University of California San Diego, 350 Dickinson Street, San Diego, CA 92103
6 Department of Orthopaedic Surgery and Sports Medicine, University of Washington, Harborview Medical Center, 3325 Ninth Avenue, Box 359799, Seattle, WA 98104
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Investigation performed at the Scripps Clinic, La Jolla, California



Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of an aspect of this work. In addition, one or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2013 Mar 06;95(5):426-432. doi: 10.2106/JBJS.L.00165
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Abstract

Background: 

Tibiotalar arthritis in the young, active patient is a debilitating condition with limited treatment options. Bipolar tibiotalar fresh osteochondral allograft transplantation was conceived as a possible alternative to arthrodesis and arthroplasty. We reported our experience with bipolar ankle osteochondral allografts for the treatment of tibiotalar joint arthritis.

Methods: 

Between 1999 and 2008, we performed bipolar ankle allografts in eighty-eight ankles (eighty-four patients). Eighty-six ankles (eighty-two patients) had a minimum follow-up duration of two years. The mean patient age was forty-four years and 52% of the patients were male. Evaluation included frequency and type of reoperations, the Olerud-Molander Ankle Score, pain, function, and patient satisfaction. Radiographs were evaluated for graft healing, joint space narrowing, and graft collapse.

Results: 

The mean duration of follow-up was 5.3 years (range, two to eleven years). Thirty-six (42%) of the eighty-six ankles that had undergone allograft had further surgery since implantation. Of the eighty-six ankles, twenty-five ankles (29%) had undergone graft-related reoperations and were considered clinical failures (ten underwent revision allografts, seven underwent arthrodeses, six underwent conversions to total ankle arthroplasty, and two underwent below-the-knee amputations) and eleven ankles (13%) had had reoperations that were not necessarily related to the graft (e.g., implant removal, debridement, synovectomy, or distraction). Survivorship of the osteochondral allograft was 76% at five years and 44% at ten years. The mean Olerud-Molander Ankle Score was 61 points at the time of the latest follow-up. The majority of patients reported satisfaction (92%) with osteochondral allograft transplantation and less pain (85%) and improved function (83%) after the procedure.

Conclusions: 

Transplantation of a fresh bipolar ankle osteochondral allograft for the treatment of tibiotalar arthritis resulted in acceptable outcomes in this difficult population, with most patients having improved objective and subjective outcome measures. Subjective satisfaction was high in spite of the 29% clinical failure rate. Osteochondral allograft failure did not limit further surgical options. We concluded that transplantation of a bipolar ankle allograft is a useful alternative in carefully selected patients with advanced tibiotalar arthritis.

Level of Evidence: 

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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