Osteochondral Allograft Transfer for Treatment of Osteochondral Lesions of the Talus: A Systematic Review

Purpose The purpose of this study is to present a systematic review of the literature regarding the use of fresh bulk osteochondral allograft transfer for treatment of large osteochondral lesions of the talus (OCLT) in an effort to characterize the functional outcomes, complications, and reoperation rates. Methods A search of the PubMed, CINAHL, Embase, and Cochrane Databases was performed between January 1, 1990, and March 1, 2016, and included all articles related to outcomes after fresh talar allograft transplantation for OCLT. Inclusion criteria were series (1) published in the English language, (2) using fresh talar allograft, and (3) reporting at least one outcome measure of interest including American Orthopaedic Foot and Ankle Society (AOFAS) score, pain visual analog scale (VAS) score, reoperation rate, and rate of allograft collapse. Weighted averages of outcome data were used. Results Five studies involving 91 OCLT met the inclusion criteria. The mean age of the cohort was 39 years (range, 15 to 74), and 53% were male. Fresh talar allograft was transplanted into 71 medial, 18 lateral, and 2 central OCLT. At a mean follow-up of 45 ± 3.3 (range, 6 to 91) months, AOFAS scores improved from 48 preoperatively to 80 postoperatively. Pain VAS scores improved from 7.1 preoperatively to 2.7 postoperatively. Twenty-three of the 91 (25%) patients required at least one reoperation, for a total of 28 operations. The most common indications for reoperation were development of moderate to severe osteoarthritis (14%), pain due to hardware (9%), extensive graft collapse (3%), and delayed or nonunion of osteotomy site (1%). Ultimately 12 (13.2%) of the cases were considered failures, with 8 (8.8%) resulting in tibiotalar arthrodesis or ankle replacement. Conclusions Fresh bulk allograft transplantation can substantially improve functional status as well as effectively prevent or delay the eventual need for ankle arthrodesis or replacement. However, patients must be carefully selected and counseled on the morbidity of the procedure as well as the high incidence of clinical failure (13%) and need for reoperation (25%) and revision surgery (8.8%). Level of Evidence Level IV, systematic review of Level IV studies.