Structural Allograft Transplantation for Osteochondral Lesions of the Talus

[Introduction][1] We describe the technique for structural allograft transplantation to treat large talar shoulder lesions. [Step 1: Patient Selection and Education][2] The patient and surgeon must be prepared for a waiting time of unknown length and have a flexible schedule for when the graft is ready for implantation. ![Figure][3] [Step 2: Preoperative Planning and Approval][4] Inspect the graft for the correct approximate size, operative side, and quality of the cartilage surface prior to proceeding with surgery. [Step 3: Surgical Approach and Osteotomy][5] Make sure that the proposed osteotomy site exits into the tibial plafond and not at the axilla as this allows for easier access to the lesion. ![Figure][3] ![Figure][3] [Step 4: Prepare Recipient Site][6] Measure the dimensions of the talar defect and its location from anterior to posterior along the talar shoulder at least twice. ![Figure][3] [Step 5: Harvest Graft from Donor Talus][7] Err on the side of creating too large a graft that later can be trimmed instead of a graft that is initially too small. ![Figure][3] [Step 6: Implant and Secure Graft into Recipient Site][8] Secure the graft with one or two 1.5 or 2.0-mm-diameter solid screws. ![Figure][3] [Step 7: Reduce Osteotomy Site and Close][9] Ensure that there is no intra-articular step-off. [Step 8: Postoperative Care][10] After transitioning to a boot-brace, the patient should remove it to perform ankle range-of-motion exercises four to five times per day. ![Figure][3] [Results][11] In our series, there were eight patients with a mean age of thirty-one years (range, seventeen to forty-four years). [What to Watch For][12] [Indications][13] [Contraindications][14] [Pitfalls & Challenges][15] [Introduction][1] We describe the technique for structural allograft transplantation to treat large talar shoulder lesions. [Step 1: Patient Selection and Education][2] The patient and surgeon must be prepared for a waiting time of unknown length and have a flexible schedule for when the graft is ready for implantation. ![Figure][3] [Step 2: Preoperative Planning and Approval][4] Inspect the graft for the correct approximate size, operative side, and quality of the cartilage surface prior to proceeding with surgery. [Step 3: Surgical Approach and Osteotomy][5] Make sure that the proposed osteotomy site exits into the tibial plafond and not at the axilla as this allows for easier access to the lesion. ![Figure][3] ![Figure][3] [Step 4: Prepare Recipient Site][6] Measure the dimensions of the talar defect and its location from anterior to posterior along the talar shoulder at least twice. ![Figure][3] [Step 5: Harvest Graft from Donor Talus][7] Err on the side of creating too large a graft that later can be trimmed instead of a graft that is initially too small. ![Figure][3] [Step 6: Implant and Secure Graft into Recipient Site][8] Secure the graft with one or two 1.5 or 2.0-mm-diameter solid screws. ![Figure][3] [Step 7: Reduce Osteotomy Site and Close][9] Ensure that there is no intra-articular step-off. [Step 8: Postoperative Care][10] After transitioning to a boot-brace, the patient should remove it to perform ankle range-of-motion exercises four to five times per day. ![Figure][3] [Results][11] In our series, there were eight patients with a mean age of thirty-one years (range, seventeen to forty-four years). [What to Watch For][12] [Indications][13] [Contraindications][14] [Pitfalls & Challenges][15] [1]: #sec-12 [2]: #sec-13 [3]: pending:yes [4]: #sec-14 [5]: #sec-15 [6]: #sec-16 [7]: #sec-17 [8]: #sec-18 [9]: #sec-19 [10]: #sec-20 [11]: #sec-21 [12]: #sec-22 [13]: #sec-23 [14]: #sec-24 [15]: #sec-25