I'm having surgery on my ankle to repair some holes in the cartilage that go down to the bone. The surgeon is planning to use donor bone. Evidently the location of the damage is a tough spot to repair. It's called the "talar shoulder". I saw where it is on the X-rays. Tell me what you can about this procedure.
Holes or defects in the surface of a joint that extend down through the cartilage to the bone are called osteochondral lesions. Various treatment approaches have been tried for this problem with some success. One particularly challenging area of the body to treat these defects is the talus bone of the ankle.
The very complex ankle joint with its many bones makes it difficult to reach areas of osteochondral lesions. The talus is one of those problem areas. It is sandwiched in between the calcaneus (heel bone) and the tibia-fibula bones of the lower leg.
The tibia (larger bone of the lower leg) sits over the top of the talus and extends down along one side of the talus creating an area referred to as the talus shoulder. Repairing osteochondral lesions of the talar shoulder is the topic of this study.
Damaged cartilage in older adults doesn't make new chondrocytes (cartilage cells) and can't seem to repair itself. Therefore, the use of bone graft material has been studied as one possible treatment approach. Using fresh bone graft placed into the defects along the talar shoulder seems to have good results.
The defect must be large enough to warrant this type of treatment but not so large that a bone replacement is required. The shape of the talar shoulder makes it unlikely that bone plugs inserted into the holes will work (another repair method) -- there just isn't enough structural support for this approach.
Problems the surgeon will watch for are graft failures (e.g., body resorbs the graft without making new bone, graft breaks up into small pieces, body rejects the donor tissue). Another potential problem is the defect filling in with fibrous scar tissue instead of bone.
The beauty of bone graft to treat this problem is that the procedure can be done again before considering other more invasive or permanent procedures. Treating osteochondral lesions of the talar shoulder with fresh allograft delays the need for ankle replacement or fusion.
Samuel B. Adams, Jr, MD, et al. Midterm Results of Osteochondral Lesions of the Talar Shoulder Treated with Fresh Osteochondral Allograft Transplantation. In The Journal of Bone and Joint Surgery. April 2011. Vol. 93. No. 7. Pp. 648-654.
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