Bipolar Fresh Osteochondral Allograft of the Ankle

Abstract

The use of BFOA represents an intriguing alternative to arthrodesis or arthroplasty. We believe precise allograft sizing, stable fitting and fixation and delayed weightbearing were key factors for a successful outcome. Further research regarding the immunological behavior of transplanted cartilage is needed.

Fresh bipolar osteochondral allograft of the ankle. Review of the literature and case report of a young patient with bilateral post-traumatic osteoarthritis

“…2,9 A meticulous rehabilitation protocol is essential to achieving an adequate amplitude of movements. Our patient followed the protocol described by Giannini et al 18 : two weeks with plaster, beginning continuous passive mobility immediately after removing the plaster; non-weight-bearing walking with crutches for the three first months; on the fourth month, start partial support once early signs of consolidation become apparent, allowing full support between 6 and 8 months after the surgery. At this time, the patient can be allowed to cycle and swim, with all high-impact sports prohibited for the first year.…”

“…At this time, the patient can be allowed to cycle and swim, with all high-impact sports prohibited for the first year. 9 These same authors 18 have conducted a post-operative evaluation of their patients by means of arthroscopy and biopsy; one year after implantation, the histological study showed few proteoglycans with disorganized collagenous fibers, but with more than 90% of the chondrocytes being viable. 9,18 If failure is defined as having to remove the allograft from the ankle, Kim et al 20 obtained a 100% survival rate at 21 months; Meehan et al 23 achieved a survival rate of 54% at two years; Giannini et al 19 , at 31 months, attained 81% survival.…”

“…The early failures were attributed to a suboptimal adaptation of the implant size and to technical mistakes, which tended to lead to fragmentation and collapse in this biomechanically highly demanding environment. 18,19 There are other complications associated with the technique, such as intra-operative fractures (of the graft or of the fibula), poor implant fixation, sub-luxation, infection, and osteolysis. Structural failures usually occur in the first 6---12 months.…”

Ankle Arthritis: An Evolution from Arthrodesis to Joint and Mobility Preservation

“…It involves replacing all or part of the arthritic ankle joint with a cadaveric OC allograft. This is a technically demanding procedure that requires an anatomically matching allograft in terms of side and size to host bone [59][60][61][62][63]. It is usually indicated for young active patients that are not suitable for total ankle arthroplasty.…”

“…There were 6 failure cases of which 4 cases underwent ankle fusion, 1 case had arthroscopic ankle debridement, removal of detached cartilage and osteophytes and the last case had ankle fusion after resolution of infection by antibiotic therapy. The authors concluded that precise allograft sizing, correct fitting, stable fixation and delayed weight bearing are the key factors to a successful outcome [63].…”