Autologous osteochondral transplantation for talar lesions

Objective. Replacement of cartilaginous defects of the talus by autologous osteochondral cylinders allowing restoration of form and function of ankle. Elimination of pain and joint irritation, delay of osteoarthritis. Indications. Localized osteochondral defects not exceeding a diameter of 2 cm. Circumscribed cartilage damage of grade III and IV according to Bauer & Jackson. Osteochondritis dissecans of grade III and IV. Localized avascular necrosis not exceeding a diameter of 2 cm. Contraindications. Osteoarthritis involving the entire ankle. Defects exceeding 2 cm in diameter. Surgical Technique. Transmalleolar approach, either medial or lateral. Determination of size of defect, removal of defect with a punch covering the entire lesion. Harvesting of osteochondral cylinder from the ipsilateral lateral femoral condyle, its diameter exceeding the diameter of the defect zone by 0.3 mm. The harvested cylinder is press-fit into the surgical defect. Results. In a prospective study between 04/1997 and 12/2000, this technique was used in 39 patients (20 men, 19 women, average age 28.7 [16-57] years). Involvement of the medial aspect of the talar dome 31 times, of the lateral six times, and of the tibial articular surface twice. At average follow-up of 15.9 months, Lysholm score improved from an average of 62 points to an average of 92 points. Postoperative MRIs with gadolinium i.v. showed perfect incorporation of the cylinders in all patients. Complications: transient patellofemoral symptoms at the area of harvesting, slight pain over the osteotomy site of the medial malleolus which disappeared after implant removal. One instance of synovitis; a wound infection proved to be transient.