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Scientific Articles   |    
Fresh Osteochondral Allograft for the Treatment of Cartilage Defects of the Talus: A Retrospective Review
Hany El-Rashidy, MD1; Diego Villacis, MD2; Imran Omar, MD3; Armen S. Kelikian, MD4
1 105 North Greenleaf Street, Gurnee, IL 60031. E-mail address: hanyel79@gmail.com
2 Department of Orthopaedic Surgery, University of Southern California Keck School of Medicine, 1200 North State Street, GNH 3900, Los Angeles, CA 90033. E-mail address: diego.villacis@gmail.com
3 Northwestern Radiology, 676 North St. Clair Street, Suite 800, Chicago, IL 60611. E-mail address: i-omar@northwestern.edu
4 680 North Lake Shore Drive, Suite 924, Chicago, IL 60611. E-mail address: armen@kelikian.com
View Disclosures and Other Information
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.

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Investigation performed at Northwestern Memorial Hospital, Chicago, Illinois

Copyright © 2011 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2011 Sep 07;93(17):1634-1640. doi: 10.2106/JBJS.J.00900
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Abstract

Background: 

Osteochondral lesions of the talar dome can cause substantial functional impairment and present a difficult treatment dilemma. Interest has recently focused on fresh osteochondral allografts as a promising treatment alternative. The purpose of this study was to evaluate the clinical outcome of osteochondral lesions of the talus treated with a fresh osteochondral allograft.

Methods: 

We performed a transfer of fresh osteochondral allograft in forty-two patients with a symptomatic, refractory osteochondral lesion of the talus. Complete postoperative follow-up was achieved for thirty-eight patients with an average age of 44.2 years. Clinical evaluation was performed with use of the American Orthopaedic Foot & Ankle Society ankle-hindfoot score and a visual analog pain scale. All scores were obtained from either a retrospective chart review or a direct patient interview. All patients were also asked about their subjective satisfaction with the procedure. Magnetic resonance images were acquired for fifteen patients, to assess graft incorporation, subsidence, articular cartilage congruity, osteoarthritis, and stability with use of the De Smet criteria.

Results: 

The average duration of follow-up after osteochondral allograft transplantation was 37.7 months. Graft failure occurred in four patients. With the inclusion of scores before revision for those with graft failure, the mean visual analog pain scale score improved from 8.2 to 3.3 points, and the mean American Orthopaedic Foot & Ankle Society ankle-hindfoot score improved from 52 to 79 points. Patient satisfaction with the outcome was rated as excellent, very good, or good by twenty-eight of the thirty-eight patients and as fair or poor by ten patients. Of the fifteen magnetic resonance imaging scans, most showed minimal graft subsidence, reasonable graft stability, and persistent articular congruence.

Conclusions: 

In our experience, transplantation of fresh osteochondral allograft is a viable and effective method for the treatment of osteochondral lesions of the talus as evidenced by improvements in pain and function.

Level of Evidence: 

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

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    References

    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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