Autologous osteochondral transplantation for osteochondral lesions of the talus
Autologous osteochondral transplantation is used in the management of osteochondral lesions of the talus that are not responsive or amenable to arthroscopic debridement or bone marrow stimulation. Therefore, the technique is indicated for large (>100-150mm2) or cystic lesions. Technical success of the procedure is predicated on the ability to achieve perpendicular access to the lesion. Several methods exist to achieve this, including alterations in foot positioning with medial or lateral arthrotomy, as well as malleolar or tibial osteotomy. Graft implantation should be flush with the native articular surface. Good outcomes have been demonstrated in the short to medium term, and the results do not appear to depreciate over time. These results can be expected in patients with focal disease in which the lesion is contained. Donor cartilage is obtained from the lateral femoral condyle, intercondylar notch, or trochlea of the knee. Donor site knee pain and postoperative cyst formation have been reported in some series, and these risks should be weighed against the indications and clinical outcomes in the literature.
Ross, KA; Robbins, J; Easley, ME; Kennedy, JG
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