Fresh Osteochondral Grafting in the Treatment of Osteochondritis Dissecans of the Talus

Mark T. Caylor, MD, Albert W. Pearsall IV, MD

Disclosures

J South Orthop Assoc. 2002;11(1) 

In This Article

Abstract and Introduction

We present a review of the literature on classification and treatment of osteochondral defects of the talus. We report the case of an isolated Berndt and Harty grade II lesion treated with a fresh osteochondral allograft. We believe that fresh allograft osteochondral grafting of the talus is an excellent technique for symptomatic Berndt and Harty grade II or higher lesion of the talus without significant tibiotalar arthritis. In selected patients, this procedure can provide excellent functional results.

Osteochondral defects of the talus are rare, and the etiology is largely unknown.[1,2,3,4,5] The treatment of these lesions has been well established and is based on the classic description of Berndt and Harty.[1] Treatment has historically been based on a radiographic classification system. However, difficulty arises when radiographic findings appear normal, yet computed tomography (CT) or arthroscopic evaluation shows a focal chondral defect within the talus. Some authors have recently noted that the arthroscopic grade of the defect is an important factor in selecting appropriate treatment.[3,4,6] Diagnostic arthroscopy of the ankle is now sometimes advocated as part of the treatment protocol for talar osteochondral lesions.[3]

Several surgical procedures have been described for treatment of symptomatic osteochondral lesions. Osteochondral transplantation has also been reported as a surgical option for large chondral defects of the talus.[7,8] The scientific rationale for osteochondral grafting has been well demonstrated in animal models and in clinical studies in the knee.[8,9] Through complex cellular and biomechanical mechanisms, transplanted osteochondral grafts survive with intact hyaline cartilage.[8] Hangody et al[7,9] and Kish et al[8] have reported the use of this technique with good results.[3,4,6] We report the use of a fresh osteochondral allograft for treatment of symptomatic osteochondritis dissecans of the talus.

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