Fresh Osteochondral Allografting for Osteochondral Lesions of the Talus

Background: Osteochondral lesions of the talus (OLT) are relatively common sequelae of traumatic injuries involving the talus. We report on clinical outcomes of osteochondral allografting (OCA) of the talus for refractory, symptomatic OLT. Materials and Methods: OCA was performed in 12 ankles in 11 patients with OLT. All involved partial, unipolar grafts of the talar dome, implanted through an anterior approach without osteotomy, under temporary distraction. Clinical evaluation was performed utilizing the Olerud-Molander Ankle Score (OMAS). Subjective outcome measures included patient questionnaires evaluating pain, function, and satisfaction. Eleven patients (seven males, four females) had a mean age of 35.5 (range, 26 to 57) years. One patient had bilateral involvement. Six OLT affected the medial, six the lateral talar dome. Patients had an average of 1.8 previous surgeries (range, 1 to 5). Mean followup was 38 (range, 24 to 107) months. Results: Mean OMAS improved from 28 to 71 points (p < 0.05). Three had further surgery; overall graft survival rate was 10/12. Of surviving grafts, 30% recorded excellent (OMAS: 100 to 91 points), 20% good (OMAS: 90 to 61 points), 30% fair (OMAS: 60 to 31 points), and 20% poor (OMAS: 30 to 0 points) outcomes. All non-failing patients completed questionnaires; 90% were satisfied, 80% reported reduced pain, and 60% improved function. Conclusion: OCA achieved good to excellent results in five of 12 patients, resulting in significant improvement in function and pain with good patient satisfaction. All but one patient avoided arthrodesis. Partial talus OCA is a reasonable treatment option for appropriately selected patients with unipolar OLT. Level of Evidence: IV, Retrospective Case Series