Podium Presentation Allografts

16.3.9 - Midterm Prospective Evaluation of Structural Allograft Transplantation for Osteochondral Lesions of the Talar Shoulder

Presentation Topic
Allografts
Date
14.04.2022
Lecture Time
12:18 - 12:27
Room
Potsdam 1
Session Name
16.3 - Allografts
Session Type
Free Papers
Speaker
  • S. Adams (Morrisville, US)
Authors
  • A. Fletcher (Durham, US)
  • S. Adams (Morrisville, US)
  • L. Johnson (Durham, US)
  • M. Easley (Durham, US)
  • J. Nunley (Durham, US)
Disclosure
Lindsey Grace Johnson, BS, MBA Nothing to disclose. Amanda Nicole Fletcher, MSc, MD Nothing to disclose. Samuel Bruce Adams Jr, MD, FAAOS American Orthopaedic Foot and Ankle Society: Board or committee member Conventus/Flower: Paid consultant DJO: Paid consultant Exactech, Inc: Paid consultant Medshape: Stock or stock Options Orthofix, Inc.: Paid consultant Regeneration Technologies, Inc.: Paid consultant Stryker: Paid consultant Mark E Easley, MD, FAAOS (Durham, NC) Exactech, Inc: IP royalties; Paid consultant; Paid presenter or speaker Journal of Bone and Joint Surgery - American: Editorial or governing board Medartis: Paid consultant; Research support Mirus: Unpaid consultant Saunders/Mosby-Elsevier: Publishing royalties, financial or material support Springer: Publishing royalties, financial or material support Wolters Kluwer Health - Lippincott Williams & Wilkins: Publishing royalties, financial or material support James Albert Nunley II, MD, FAAOS Acumed, LLC: Research support Breg: Research support Bristol-Myers Squibb: Stock or stock Options Exactech, Inc: IP royalties; Paid consultant Integra: Research support Mirus: Paid consultant Springer, Datatrace: Publishing royalties, financial or material support Treace Medical: Paid presenter or speaker Trimed: Paid presenter or speaker

Abstract

Purpose

In cases of large osteochondral lesions of the talus (OLT), fresh structural or bulk osteochondral allograft transplantation has yielded favorable outcomes in several case series. The purpose of this study was to prospectively evaluate patients who received fresh, structural allograft transplantation of the talar shoulder.

Methods and Materials

A prospective evaluation of patients who received a fresh, structural allograft of an osteochondral lesion of the talus (OCLT) was performed. Preoperative imaging with magnetic resonance imaging (MRI) and/or computed tomography (CT) with plain radiographs were obtained. Patient-reported outcome questionnaires were administered preoperatively and annually postoperatively to include: 100-mm visual analog scale (VAS) pain scale, American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Scale, Short Form 36 (SF-36), and the Short Musculoskeletal Functional Assessment (SMFA). Imaging was evaluated for allograft assimilation, arthritic changes or functional range of motion abnormalities.

Results

Thirty-one patients with an average age of 41.4 (± 14.1), 17 being female patients (54.8%) and 14 (46.2%) being male patients, with a mean follow-up of 56.2 months (± 36.1) underwent structural fresh osteochondral allograft transplantation to the talar shoulder from January 1, 2007 to August 1, 2019. The mean lesion size on CT scan was 1,879 mm3 (n=27) and 3,877 mm3 (n= 21) on MRI. There was a significant improvement in the mean preoperative VAS score (<0.0001), AOFAS score (<0.0001), SF-36 score (<0.0005), SMFA Bother index (<0.0015), and the SMFA Function index (<0.0001) at final follow-up. A total of 15 (48.4%) patients underwent an additional surgery following their osteochondral allograft transplant most commonly arthroscopy or removal of hardware. The overall graft survival rate was 96.8% at an average of 4.5 years postoperatively.

Conclusion

Fresh, structural allograft transplantation in cases of large OLT resulted in a significant improvement in postoperative pain and function. This procedure offers a promising alternative for significant osteochondral lesions of the talar shoulder.

Collapse