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

Case Report

A 16-year-old girl was referred for treatment of an osteochondral defect of the talus. She described having twisted her ankle 3 years before our evaluation, and she reported continued pain and inability to participate in sports since the injury. On physical examination, the patient was noted to walk with an antalgic gait on the left. Her ankle plantarflexion was symmetric with the contralateral side; however, she lacked approximately 10° of dorsiflexion compared with the right. Nonsteroidal anti-inflammatory medications and physical therapy failed to alleviate the symptoms. Radiographs and magnetic resonance imaging of the left ankle showed a large posteromedial osteochondral defect (Fig 1). After discussion, the patient elected to have fresh allograft talar osteochondral transplantation.

Preoperative radiograph shows posteromedial osteochondral defect.

Under fluoroscopic guidance, a medial malleolar osteotomy was done to expose the medial talus. An area of approximately 18 x 18 mm of delaminated articular cartilage was found on the posteromedial talus. Two plugs (10 mm and 8 mm) were harvested from a fresh femoral allograft and press fit into the prepared defect using a mosaicplasty technique. The osteotomy was secured with two 4.0 mm partially threaded cancellous screws, and the wound was closed.

The patient was kept non-weight-bearing in a removable splint for 6 weeks and then was allowed only partial weight bearing for an additional 6 weeks. Ankle range of motion exercises were begun approximately 2 weeks after surgery. At 12 weeks, she was allowed full weight-bearing, and she returned to unlimited activities at approximately 5 months postoperatively.

At 1 year, the patient had no pain in the left ankle and could participate in all activities without limitations. Examination at that time revealed symmetric ankle strength. There was a loss of 10° of dorsiflexion, which was equal to the preoperative range of motion. Postoperatively, CT confirmed anatomic placement of the grafts (Fig 2). Plain radiographs 1 year after surgery showed incorporation of both graft plugs (Fig 3).

Postoperative computed tomography confirmed anatomic placement of grafts.

Anteroposterior and lateral radiographs 1 year after fresh allograft osteochondral grafting of talus show incorporation of both graft plugs.

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