Introduction We describe the technique for structural allograft transplantation to treat large talar shoulder lesions.
Step 1: Patient Selection and Education 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.
Step 2: Preoperative Planning and Approval 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 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.
Step 4: Prepare Recipient Site Measure the dimensions of the talar defect and its location from anterior to posterior along the talar shoulder at least twice.
Step 5: Harvest Graft from Donor Talus Err on the side of creating too large a graft that later can be trimmed instead of a graft that is initially too small.
Step 6: Implant and Secure Graft into Recipient Site Secure the graft with one or two 1.5 or 2.0-mm-diameter solid screws.
Step 7: Reduce Osteotomy Site and Close Ensure that there is no intra-articular step-off.
Step 8: Postoperative Care After transitioning to a boot-brace, the patient should remove it to perform ankle range-of-motion exercises four to five times per day.
Results 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 Indications
Pitfalls & Challenges
We describe the technique for structural fresh allograft transplantation to treat large talar shoulder lesions.
Osteochondral lesions of the talus are defects of the articular cartilage of the talus and the underlying subchondral bone1–3. They are well recognized as a source of pain …
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