Early Clinical Experience with a Fresh Talar Transplant Inlay Allograft for the Treatment of Osteochondral Lesions of the Talus

Background: Management of osteochondral defects of the talus remains a challenge, and many lesions do not respond to traditional treatments. The use of fresh allografts is a promising alternative. Methods: A freehand inlay surgical technique for reconstructing osteochondral defects of the talus with fresh osteochondral allografts fixated with bioresorbable chondral darts is described. A retrospective review of a consecutive series of 15 patients (eight males and seven females; mean age, 42.2 years) with stage IV osteochondral defects who underwent this procedure is presented. Seven patients reported a history of trauma. The mean lesion diameter was 1.7 cm. Results: Mean follow-up was 1.6 years. The Foot and Ankle Outcome Score subscale mean scores obtained at the most recent follow-up were as follows: 66.0 (pain), 64.8 (other symptoms), 71.2 (activities of daily living), 50.7 (sport and recreation function), and 42.1 (quality of life). Nine lesions had no evidence of lucency, and six demonstrated mild lucency, indicating that no allograft had been absorbed. Most patients exhibited no step-off deformity or arthrosis. No graft-related complications occurred. No subsequent surgical procedures were required. Conclusions: Early results suggest that this technique is a viable option for treating large osteochondral defects of the talus, as evidenced by the favorable patient assessment and radiographic outcomes and the lack of postoperative complications and subsequent procedures. Unlike previous allograft techniques, hardware complications did not occur. Based on these results, this technique will continue to be used. (J Am Podiatr Med Assoc 100(1): 25-34, 2010)