TALAR ALLOGRAFTING FOR OSTEOCHONDRAL LESIONS OF THE TALUS (OLT)
IN YOUNG ACTIVE PATIENTS

OLT are defects (potholes or craters) of the cartilage surface of the talus (the large bone of the foot) which usually occur in patients < 50 years old, who have good range of motion in the ankle joint, but have significant pain and swelling. The most common cause of OLT are ankle sprains and fractures, chronic laxity (looseness), or trauma that interrupts the blood supply to the talus bone. Because joint cartilage has a poor ability to repair itself, these lesions can develop chronic pain which ultimately evolve into arthritis of the ankle joint.

OLT present one of the biggest challenges for treating physicians. The problem is that because they rarely show up on x-rays initially and symptoms may appear several months to a year after the initial injury. Also they occur in young patients (age 25-45 years old) who are still very active and have good motion. The treatment alternatives are limited to surgery. If the lesion is large, then conventional surgical treatment (scraping and drilling holes in the lesion) are generally unsuccessful. These patients are too young for a total ankle replacement but fusing the joint results in loss of up/down motion.

Over the last year Dr. Coleman has performed a procedure that has shown positive early results for this very difficult problem. At present he is the only orthopaedist in northwest Indiana who has performed this surgery.

The procedure entails obtaining a CT and/or MRI of the talus, then sending the measurements off to ARTHREX, a company that supplies various orthopaedic devices. Arthrex finds an allograft (cadaver replica) of a talus that is the same size as the patient’s talus. Finding the exact size can take from 1-4 months to occur. After a match is found, surgery occurs within two weeks.

In surgery, the OLT is identified and exposed in the ankle. The lesion is measured and a precise piece with the same measurements are removed from the cadaveric talus and fitted like a “piece of a puzzle” into the patient’s talus. The piece is held in place with chondral darts. Please refer to the above link for details of the procedure.

The results in the first year are very encouraging. Cartilage replacement surgery for early arthritis and OLT in younger patients could provide an excellent alternative in treating a difficult problem.

 

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