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Scientific Articles   |    
Midterm Results of Osteochondral Lesions of the Talar Shoulder Treated with Fresh Osteochondral Allograft Transplantation
Samuel B. Adams, Jr., MD1; Nicholas A. Viens, MD1; Mark E. Easley, MD1; Sandra S. Stinnett, DrPH1; James A. Nunley, II, MD1
1 Division of Orthopaedic Surgery (S.B.A. Jr., N.A.V., M.E.E., and J.A.N. II) and Department of Ophthalmology (S.S.S.), Duke University Medical Center, Durham, NC 27710. E-mail address for S.B. Adams Jr.: samueladamsmd@gmail.com. E-mail address for J.A. Nunley II: nunle001@mc.duke.edu
View Disclosures and Other Information
Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.

Investigation performed at Duke University Medical Center, Durham, North Carolina

Copyright © 2011 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2011 Apr 06;93(7):648-654. doi: 10.2106/JBJS.J.00141
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Abstract

Update 

This article was updated on May 4, 2011, because of a previous error. On page 648, in the Conclusions section of the Abstract, the text had previously read "These midterm results in a small group of patients indicate that structural fresh-frozen allograft transplantation can be a successful surgical option in the treatment of large osteochondral defects of the talar shoulder." The text now reads "These midterm results in a small group of patients indicate that structural fresh allograft transplantation can be a successful surgical option in the treatment of large osteochondral defects of the talar shoulder."

Background: 

With osteochondral lesions of the talar shoulder, their size, the articular cartilage geometry, and the loss of the medial or lateral articular buttress often preclude treatment with traditional osteochondral autograft techniques. We hypothesized that fresh, large osteochondral allograft transplantation is a viable treatment option for patients with such lesions.

Methods: 

A retrospective review was conducted of patients who underwent fresh talar shoulder allograft transplantation between 2000 and 2007. All patients failed initial conservative management. Preoperatively, a visual analog pain scale of 0 to 10 (with 0 denoting no pain and 10 denoting the worst pain imaginable) and the Lower Extremity Functional Scale were administered. At the time of most recent follow-up, the visual analog pain scale, the Lower Extremity Functional Scale, the American Orthopaedic Foot & Ankle Society ankle-hindfoot scale, and the Short Musculoskeletal Function Assessment questionnaire were administered. Radiographs were assessed for allograft incorporation and joint deterioration.

Results: 

Eight patients with a mean age of thirty-one years and a mean follow-up of forty-eight months were included. There was a significant decrease (p < 0.05) in pain, from a mean of 6 points (range, 5 to 8 points) preoperatively to a mean of 1 point (range, 0 to 2 points) postoperatively. The mean Lower Extremity Functional Scale score improved from 37 points initially (range, 24 to 52 points) to 65 points (range, 31 to 75 points; p < 0.05) at the time of final follow-up. The mean postoperative American Orthopaedic Foot & Ankle Society ankle-hindfoot score was 84 points. The mean Short Musculoskeletal Function Assessment dysfunction index score was 13.3 points and the mean bother index score was 14.3 points. Radiographic lucencies at the graft-host interface were seen in five patients. Four patients required an additional surgical procedure. No patients needed to undergo subsequent arthrodesis or arthroplasty.

Conclusions: 

These midterm results in a small group of patients indicate that structural fresh allograft transplantation can be a successful surgical option in the treatment of large osteochondral defects of the talar shoulder.

Level of Evidence: 

Therapeutic Level IV. See Instructions to 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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