So, do patients return to sport or recreational activity after osteochondral allograft of the talus? Spoiler alert, they do. So osteochondral allografting is used for osteochondral lesions of the talus, or OLTs. OLTs are an uncommon but also unrecognized source of ankle morbidity. A military study from 2011 showed the incidence to be about 27 out of 100,000, and this is a very young, healthy, active population. So the indications for grafting such lesions would be a large volume cystic lesion, a salvage of a prior procedure, osteonecrosis of the talus, traumatic defects, unusual tibial lesions, or post-traumatic arthritis in young patients. So several advantages to osteochondral allografting, one, you restore mature highland cartilage to the donor site. There's no requirement for tissue differentiation. There's no second surgery, and you essentially get a bone healing or a fracture healing paradigm because you're compressing bone to bone. You replace abnormal subchondral bone and cartilage, and you can think of it as an organ replacement of the talus. It also has a pretty fast, relatively, and simpler rehab. Also you're not limited by the size or geometry of the lesion at all. The process is such that you get an age-matched, size-matched donor usually based on a CT scan. And when this donor becomes available, you have about, or I have about 28 days to implant it. Kind of one of the harder parts about it is there's a lack of patient convenience. They have to be ready to have the surgery as soon as their allograft is available. Because these are fresh grafts, they're kept above 4 degrees Celsius, you can't freeze them. So they kind of have to drop everything to do it. The surgical technique, it can be done in one of a couple ways. Kind of the workhorse technique is to do it from a direct anterior approach between tibialis anterior and EHL, much like you would do a total ankle. You get down to the lesion and then use a microsagittal saw. There is a single-sided reciprocating microsagittal saw that you can make, that you can use to make the vertical cut. And then just use a regular TPS to make the anterior to posterior cut. I have done it through a medial malleolar osteotomy for a predominantly medial lesion. I find there's a little less stiffness sometimes when you do it that way. But the location of the lesion definitely dictates how you get at it. If you do it from the direct anterior approach, you do have to use a pin distractor, some kind of distracting technique to open up the joint so you can get access to the lesion. I use demineralized bone matrix mixed with a bone marrow aspirate as well as recombinant platelet-derived growth factor. It creates like a, it almost creates like a mortar for a brick, so to speak, and it fills the imperfections from saw blade kerf. And you get osteogenic potential. So in this study, between 1998 and 2019, 36 ankles and 34 patients were identified. 64% were well-trained or highly-trained competitive athletes. The mean age was 36%, and it was an even 50-50 split, men versus women. Participation in sports or recreational activity pre-injury and post-operatively was obtained along with patient post-operative pain function and satisfaction. So patients were asked about their participation in sports or recreational activity following the surgery, if they had attempted their pre-injury sport, and if they were able to participate in regular exercise. They were also asked if their ankles affected their participation in sport. They were asked to fill out three questionnaires, the AOFAS Hindfoot Score, the FAAM, FAM, and then we gave them a sport and recreational activity survey as follows, as eight questions. The patient demographics were as follows. Like I said, it was a BMI of 28, age 36. Two-thirds of the lesions were medial, and 52% were fixed with a metal screw. So this is the patient-reported outcomes, 66% participated in sports or recreational activity at any point following the surgery, and 51% were currently sporting. And a subgroup analysis found that for those that returned to sport, 71% classified themselves as highly trained or competitive athletes. And so those patients returned to sport at a higher rate than those who weren't considered highly trained or competitive athletes. The finding that reached statistical significance was that those who classified themselves as highly trained athletes were more likely to be currently sporting. So this is just a sampling of the activities that people returned back to sport to. What always catches my eye is Taekwondo after ankle surgery. This is a result of their clinical scores. So there was an improvement in FAMS scores as well as AOFA's High Input Scores. 79% of patients said that they were extremely satisfied. 88% of the patients had less pain. And 95% of the patients said that they were participating in regular exercise. So even if they weren't able to get back to sport, they were still active. This is a Kaplan-Meier survivorship graph. 94% of the graphs were still functioning at 5 years, and 85% were functioning at 10. Four out of 36 required revision, either revision OCA or ankle arthrodesis, and two underwent reoperation. So conclusions are that fresh OCA transplantation is a reasonable surgical option for young active patients who have failed non-op treatment. 66% of patients returned to sport or recreational activity. 95% of patients are able to participate in regular exercise. And it seems that the more highly trained or competitive the person is prior to surgery, that portends a better outcome to return to sport or to be currently sporting. Thank you.

osteochondral allografting

osteochondral lesions of the talus

ankle morbidity

surgical technique

patient-reported outcomes