Structural Allograft Transplantation for Osteochondral Lesions of the Talus.
Introduction: We describe the technique for structural allograft transplantation to treat large talar shoulder lesions. Step 1 Patient Selection and Education: The patient and surgeon must be prepared for a waiting time of unknown length and have a flexible schedule for when the graft is ready for implantation. Step 2 Preoperative Planning and Approval: Inspect the graft for the correct approximate size, operative side, and quality of the cartilage surface prior to proceeding with surgery. Step 3 Surgical Approach and Osteotomy: Make sure that the proposed osteotomy site exits into the tibial plafond and not at the axilla as this allows for easier access to the lesion. Step 4 Prepare Recipient Site: Measure the dimensions of the talar defect and its location from anterior to posterior along the talar shoulder at least twice. Step 5 Harvest Graft from Donor Talus: Err on the side of creating too large a graft that later can be trimmed instead of a graft that is initially too small. Step 6 Implant and Secure Graft into Recipient Site: Secure the graft with one or two 1.5 or 2.0-mm-diameter solid screws. Step 7 Reduce Osteotomy Site and Close: Ensure that there is no intra-articular step-off. Step 8 Postoperative Care: After transitioning to a boot-brace, the patient should remove it to perform ankle range-of-motion exercises four to five times per day. Results: In our series, there were eight patients with a mean age of thirty-one years (range, seventeen to forty-four years). What to Watch For: IndicationsContraindicationsPitfalls & Challenges.
Adams, SB; Viens, NA; Easley, ME; Nunley, JA
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