Midterm Results of Osteochondral Lesions of the Talar Shoulder Treated with Fresh Osteochondral Allograft Transplantation

Background: With osteochondral lesions of the talar shoulder, their size, the articular cartilage geometry, and the loss of the medial or lateral articular buttress often preclude treatment with traditional osteochondral autograft techniques. We hypothesized that fresh, large osteochondral allograft transplantation is a viable treatment option for patients with such lesions. Methods: A retrospective review was conducted of patients who underwent fresh talar shoulder allograft transplantation between 2000 and 2007. All patients failed initial conservative management. Preoperatively, a visual analog pain scale of 0 to 10 (with 0 denoting no pain and 10 denoting the worst pain imaginable) and the Lower Extremity Functional Scale were administered. At the time of most recent follow-up, the visual analog pain scale, the Lower Extremity Functional Scale, the American Orthopaedic Foot & Ankle Society ankle-hindfoot scale, and the Short Musculoskeletal Function Assessment questionnaire were administered. Radiographs were assessed for allograft incorporation and joint deterioration. Results: Eight patients with a mean age of thirty-one years and a mean follow-up of forty-eight months were included. There was a significant decrease (p < 0.05) in pain, from a mean of 6 points (range, 5 to 8 points) preoperatively to a mean of 1 point (range, 0 to 2 points) postoperatively. The mean Lower Extremity Functional Scale score improved from 37 points initially (range, 24 to 52 points) to 65 points (range, 31 to 75 points; p < 0.05) at the time of final follow-up. The mean postoperative American Orthopaedic Foot & Ankle Society ankle-hindfoot score was 84 points. The mean Short Musculoskeletal Function Assessment dysfunction index score was 13.3 points and the mean bother index score was 14.3 points. Radiographic lucencies at the graft-host interface were seen in five patients. Four patients required an additional surgical procedure. No patients needed to undergo subsequent arthrodesis or arthroplasty. Conclusions: These midterm results in a small group of patients indicate that structural fresh-frozen allograft transplantation can be a successful surgical option in the treatment of large osteochondral defects of the talar shoulder.