Bipolar Osteochondral Allograft Transplantation of the Tibiotalar Joint for Ankle Arthritis.

[Introduction][1] Bipolar osteochondral allografting is a technically complex procedure envisioned as an alternative to arthrodesis or arthroplasty[1][2] in carefully selected young patients with advanced tibiotalar arthritis, usually as a result of trauma. [Step 1: Preoperative Planning][3] Confirm that the grafts are not damaged and that the side (left or right) and size (not too small) are properly matched to the donor. [Step 2: Placement of the External Fixator][4] Place an external fixator across the ankle joint using fluoroscopy and distract the ankle prior to incision. ![Figure][5] [Step 3: Anterior Approach to the Ankle][6] Perform a standard anterior approach to the ankle joint. ![Figure][5] ![Figure][5] [Step 4: Positioning of the Cutting Jig][7] Mount the jig on the ankle and confirm the cutting block position both visually and fluoroscopically. ![Figure][5] ![Figure][5] [Step 5: Bone Resection][8] Using a reciprocating saw and careful technique to protect the tendons and neurovascular structures, perform osseous resection of the distal part of the tibia and the talar dome. ![Figure][5] [Step 6: Preparation of the Allograft][9] Prepare the tibial and talar allografts from the donor tissue to match the resection gap created in Step 5. ![Figure][5] ![Figure][5] ![Figure][5] [Step 7: Insertion and Fixation of the Allograft][10] Insert and fix the allograft construct and remove the external fixator. ![Figure][5] ![Figure][5] ![Figure][5] [Step 8: Rehabilitation][11] Postoperative care is straightforward, including initial immobilization and a three-month period of non-weight-bearing. [Results][12] In our recent clinical study[2][13], we used our clinical outcomes database to identify eighty-four consecutive patients (eighty-eight ankles) who underwent bipolar osteochondral allograft transplantation of the tibiotalar joint, had surgery in 1999 or later, and had not had a previous arthroplasty or osteochondral allograft transplantation involving the tibial plafond and/or talus. [Indications][14] [Contraindications][15] [Pitfalls & Challenges][16] [Introduction][1] Bipolar osteochondral allografting is a technically complex procedure envisioned as an alternative to arthrodesis or arthroplasty[1][2] in carefully selected young patients with advanced tibiotalar arthritis, usually as a result of trauma. [Step 1: Preoperative Planning][3] Confirm that the grafts are not damaged and that the side (left or right) and size (not too small) are properly matched to the donor. [Step 2: Placement of the External Fixator][4] Place an external fixator across the ankle joint using fluoroscopy and distract the ankle prior to incision. ![Figure][5] [Step 3: Anterior Approach to the Ankle][6] Perform a standard anterior approach to the ankle joint. ![Figure][5] ![Figure][5] [Step 4: Positioning of the Cutting Jig][7] Mount the jig on the ankle and confirm the cutting block position both visually and fluoroscopically. ![Figure][5] ![Figure][5] [Step 5: Bone Resection][8] Using a reciprocating saw and careful technique to protect the tendons and neurovascular structures, perform osseous resection of the distal part of the tibia and the talar dome. ![Figure][5] [Step 6: Preparation of the Allograft][9] Prepare the tibial and talar allografts from the donor tissue to match the resection gap created in Step 5. ![Figure][5] ![Figure][5] ![Figure][5] [Step 7: Insertion and Fixation of the Allograft][10] Insert and fix the allograft construct and remove the external fixator. ![Figure][5] ![Figure][5] ![Figure][5] [Step 8: Rehabilitation][11] Postoperative care is straightforward, including initial immobilization and a three-month period of non-weight-bearing. [Results][12] In our recent clinical study[2][13], we used our clinical outcomes database to identify eighty-four consecutive patients (eighty-eight ankles) who underwent bipolar osteochondral allograft transplantation of the tibiotalar joint, had surgery in 1999 or later, and had not had a previous arthroplasty or osteochondral allograft transplantation involving the tibial plafond and/or talus. [Indications][14] [Contraindications][15] [Pitfalls & Challenges][16] [1]: #sec-11 [2]: #ref-1 [3]: #sec-12 [4]: #sec-13 [5]: pending:yes [6]: #sec-14 [7]: #sec-15 [8]: #sec-16 [9]: #sec-17 [10]: #sec-18 [11]: #sec-19 [12]: #sec-20 [13]: #ref-2 [14]: #sec-22 [15]: #sec-23 [16]: #sec-24