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Scientific Articles   |    
Intermediate Outcomes of Fresh Talar Osteochondral Allografts for Treatment of Large Osteochondral Lesions of the Talus
Roger Haene, FRCS(Tr&Orth)1; Erion Qamirani, MD, PhD1; Robert A. Story, MBChB, FRACS(Ortho)1; Ellie Pinsker, BA&Sc, PhD1; Timothy R. Daniels, MD, FRCS(C)1
1 St. Michael’s Hospital, Suite 800, 55 Queen Street East, Toronto, ON M5C 1R6 Canada. E-mail address for R. Haene: roger@haene.org. E-mail address for E. Qamirani: e.qamirani@utoronto.ca. E-mail address for R.A. Story: robstory8@yahoo.co.nz. E-mail address for E. Pinsker: pinskere@smh.ca. E-mail address for T.R. Daniels: danielst@smh.ca
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Disclosure: None 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 any aspect of this work. 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.

  • Disclosure statement for author(s): PDF

St. Michael’s Hospital, Suite 800, 55 Queen Street East, Toronto, ON M5C 1R6 Canada. E-mail address for R. Haene: roger@haene.org. E-mail address for E. Qamirani: e.qamirani@utoronto.ca. E-mail address for R.A. Story: robstory8@yahoo.co.nz. E-mail address for E. Pinsker: pinskere@smh.ca. E-mail address for T.R. Daniels: danielst@smh.ca
Investigation performed at St. Michael’s Hospital, Toronto, Ontario, Canada

Copyright © 2012 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2012 Jun 20;94(12):1105-1110. doi: 10.2106/JBJS.J.02010
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Abstract

Background: 

Large osteochondral defects of the talus present a treatment challenge. Fresh osteochondral allograft transplantation can be used for large lesions without the donor-site morbidity associated with other procedures such as autologous chondrocyte implantation or osteochondral autograft transfer. The goal of this study was to prospectively evaluate the intermediate outcomes of fresh osteochondral allografting for osteochondral lesions of the talus with use of validated outcome measures.

Methods: 

Sixteen patients (seventeen ankles) received a fresh osteochondral allograft, and all sixteen were available for follow-up. Data were prospectively collected with use of the Ankle Osteoarthritis Scale (AOS), Short Form-36 (SF-36), and American Academy of Orthopaedic Surgeons (AAOS) Foot and Ankle Module outcome measures. Postoperative American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot scale scores were also collected. All sixteen patients underwent radiographic and computed tomographic (CT) analyses preoperatively, and fifteen patients had these studies postoperatively.

Results: 

The average duration of follow-up was 4.1 years. The latest follow-up CT evaluation identified failure of graft incorporation in two of sixteen ankles. Osteolysis, subchondral cysts, and degenerative changes were found in five, eight, and seven ankles, respectively. Five ankles were considered failures, and two required a reoperation because of ongoing symptoms. The AOS Disability and the AAOS Foot and Ankle Core Scale scores significantly improved, but there was no significant change in the AOS Pain, AAOS Foot and Ankle Shoe Comfort Scale, or SF-36 scores. Overall, ten patients had a good or excellent result; however, persistent symptoms remained in six of these patients. Only four were symptom-free.

Conclusion: 

The use of a fresh osteochondral allograft is a reasonable option for the treatment of large talar osteochondral lesions. The high reoperation rate (two of seventeen) and failure rate (five of seventeen) must be taken into consideration when one is choosing this procedure for the management of these lesions.

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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