Reconstruction of Complex Osteochondral Lesions of the Talus With Cylindrical Sponge Allograft and Particulate Juvenile Cartilage Graft

Abstract

Osteochondral lesions of the talus can be a challenging injury to treat for even the most experienced foot and ankle surgeon. Although the advances in imaging have made the diagnosis of chondral lesions more accurate, surgeons are still struggling to find ways to reliably treat advanced lesions with subchondral bone damage. This article looks at the use of allograft bone and particulate juvenile cartilage in patients with advanced subchondral bone damage and osteochondral lesions of the talus.

DeNovo NT Allograft

“…41 A case series of 7 patients who underwent repair of osteochondral lesions of the talar dome with cylindrical demineralized cancellous allograft bone covered with particulated juvenile cartilage allograft demonstrated significant improvements in pain and function at 6 months. 39 Many areas of study, however, still remain unreported. There is limited data on the histology of this allograft tissue after healing.…”

“…[32][33][34][35][36][37][38] Thus far, this technique seems to yield reasonably good results and yet is a relatively straightforward single-stage procedure. 12,31,[39][40][41] It is not yet clear what role this technique may play in the setting of osteochondral lesions with osseous defects, but the authors and others have utilized DeNovo NT with associated subchondral bone loss or cystic change less than 5-6 mm. Appropriate lesion size also has so far been poorly defined.…”

Development of an improved bone washing and demineralisation process to produce large demineralised human cancellous bone sponges

“…Clinically, DBM sponges have been used to treat osteochondral lesions of the talus and have been reported to cause no complications or immune reactions and have been reported to aid in alleviation of pain and disability (Bleazey and Brigado 2012;Galli et al 2014). NHS Blood and Transplant have developed a method of producing DBM sponges, Cell Tissue Bank using mineralised cancellous bone cubes as the starting material, which are compressible, non-cytotoxic and are osteoinductive when implanted intramuscularly into mice .…”

Arthroscopic Particulated Juvenile Cartilage Allograft Transplantation for the Treatment of Osteochondral Lesions of the Talus

“…Case series of open ankle PJCAT show promising results 10,11 ; however, there are few reports in the literature on arthroscopic ankle PJCAT. Recently, Coetzee et al 12 presented a retrospective case series of 23 patients (24 ankles) treated with PJCAT at a mean follow-up of 16.2 months.…”