William D Bugbee1, Michael E Brage2. 1. Division of Orthopaedic Surgery, Scripps Clinic, 10666 North Torrey Pines Road, La Jolla, CA 92037. E-mail address: Bugbee.william@scrippshealth.org. 2. Department of Orthopaedic Surgery and Sports Medicine, University of Washington, Harborview Medical Center, 3325 Ninth Avenue, Box 359799, Seattle, WA 98104.
Abstract
INTRODUCTION: Bipolar osteochondral allografting is a technically complex procedure envisioned as an alternative to arthrodesis or arthroplasty1 in carefully selected young patients with advanced tibiotalar arthritis, usually as a result of trauma. STEP 1 PREOPERATIVE PLANNING: Confirm that the grafts are not damaged and that the side (left or right) and size (not too small) are properly matched to the donor. STEP 2 PLACEMENT OF THE EXTERNAL FIXATOR: Place an external fixator across the ankle joint using fluoroscopy and distract the ankle prior to incision. STEP 3 ANTERIOR APPROACH TO THE ANKLE: Perform a standard anterior approach to the ankle joint. STEP 4 POSITIONING OF THE CUTTING JIG: Mount the jig on the ankle and confirm the cutting block position both visually and fluoroscopically. STEP 5 BONE RESECTION: Using a reciprocating saw and careful technique to protect the tendons and neurovascular structures, perform osseous resection of the distal part of the tibia and the talar dome. STEP 6 PREPARATION OF THE ALLOGRAFT: Prepare the tibial and talar allografts from the donor tissue to match the resection gap created in Step 5. STEP 7 INSERTION AND FIXATION OF THE ALLOGRAFT: Insert and fix the allograft construct and remove the external fixator. STEP 8 REHABILITATION: Postoperative care is straightforward, including initial immobilization and a three-month period of non-weight-bearing. RESULTS: In our recent clinical study2, we used our clinical outcomes database to identify eighty-four consecutive patients (eighty-eight ankles) who underwent bipolar osteochondral allograft transplantation of the tibiotalar joint, had surgery in 1999 or later, and had not had a previous arthroplasty or osteochondral allograft transplantation involving the tibial plafond and/or talus.IndicationsContraindicationsPitfalls & Challenges.
INTRODUCTION: Bipolar osteochondral allografting is a technically complex procedure envisioned as an alternative to arthrodesis or arthroplasty1 in carefully selected young patients with advanced tibiotalar arthritis, usually as a result of trauma. STEP 1 PREOPERATIVE PLANNING: Confirm that the grafts are not damaged and that the side (left or right) and size (not too small) are properly matched to the donor. STEP 2 PLACEMENT OF THE EXTERNAL FIXATOR: Place an external fixator across the ankle joint using fluoroscopy and distract the ankle prior to incision. STEP 3 ANTERIOR APPROACH TO THE ANKLE: Perform a standard anterior approach to the ankle joint. STEP 4 POSITIONING OF THE CUTTING JIG: Mount the jig on the ankle and confirm the cutting block position both visually and fluoroscopically. STEP 5 BONE RESECTION: Using a reciprocating saw and careful technique to protect the tendons and neurovascular structures, perform osseous resection of the distal part of the tibia and the talar dome. STEP 6 PREPARATION OF THE ALLOGRAFT: Prepare the tibial and talar allografts from the donor tissue to match the resection gap created in Step 5. STEP 7 INSERTION AND FIXATION OF THE ALLOGRAFT: Insert and fix the allograft construct and remove the external fixator. STEP 8 REHABILITATION: Postoperative care is straightforward, including initial immobilization and a three-month period of non-weight-bearing. RESULTS: In our recent clinical study2, we used our clinical outcomes database to identify eighty-four consecutive patients (eighty-eight ankles) who underwent bipolar osteochondral allograft transplantation of the tibiotalar joint, had surgery in 1999 or later, and had not had a previous arthroplasty or osteochondral allograft transplantation involving the tibial plafond and/or talus.IndicationsContraindicationsPitfalls & Challenges.
Authors: William D Bugbee; Gaurav Khanna; Marco Cavallo; Julie C McCauley; Simon Görtz; Michael E Brage Journal: J Bone Joint Surg Am Date: 2013-03-06 Impact factor: 5.284
Authors: Choll W Kim; Amir Jamali; William Tontz; F Richard Convery; Michael E Brage; William Bugbee Journal: Foot Ankle Int Date: 2002-12 Impact factor: 2.827