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Fresh Osteochondral Allografts for Large-Volume Cystic Osteochondral Defects of the Talus
Steven M. Raikin, MD1
1 925 Chestnut Street, Philadelphia, PA 19107. E-mail address: steven.raikin@rothmaninstitute.com
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Disclosure: The author did not receive any outside funding or grants in support of his research for or preparation of this work. Neither he nor a member of his immediate family received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.
Investigation performed at the Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2009 Dec 01;91(12):2818-2826. doi: 10.2106/JBJS.I.00398
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Background: Large-volume osteochondral lesions of the talus present a difficult dilemma for the treating physician. The purpose of this study was to evaluate the clinical outcomes of talar lesions with a volume of >3000 mm3 treated with fresh bulk osteochondral allograft transplantation.

Methods: Fifteen patients (mean age, 41.9 years) who had symptomatic osteochondral lesions of the talus with a mean volume of 6059 mm3 underwent fresh matched osteochondral allograft transplantation. All patients were followed prospectively for a minimum of two years and were evaluated with use of the pain score on a visual analog scale, which ranged from 0 to 10, and the American Orthopaedic Foot and Ankle Society ankle-hindfoot score, which had a maximum of 100 points. Patient satisfaction and radiographic stability of the graft were also assessed.

Results: All patients were available for follow-up at an average fifty-four months after surgery. Two ankles subsequently underwent conversion to an ankle arthrodesis at thirty-two and seventy-six months, respectively. With the scores for these patients included (at the time of arthrodesis), the mean pain score had improved from 8.5 to 3.3 and the mean American Orthopaedic Foot and Ankle Society ankle-hindfoot score had improved 45 points, from 38 to 83 points. Overall, five patients rated the result as excellent, six as good, two as fair, and two as poor.

Conclusions: Bulk fresh osteochondral allograft transplantation to the talus is a viable reconstructive option for patients with large-volume cystic lesions of the talar dome. Graft stability and viability are maintained both structurally and functionally over a mean follow-up period of 4.5 years (minimum, two years).

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

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    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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