Talar OsteoPeriostic grafting from the Iliac Crest (TOPIC) for large medial talar osteochondral defects
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M. M. J. Kerkhoffs1,2,3 · J. N. Altink1,2,3 · S. A. S. Stufkens1,2,3 · J. Dahmen1,2,3 1
Amsterdam UMC, Location AMC, University of Amsterdam, Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam, The Netherlands 2 Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam, The Netherlands 3 Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc International Olympic Committee (IOC) Research Center, Amsterdam, The Netherlands
Talar OsteoPeriostic grafting from the Iliac Crest (TOPIC) for large medial talar osteochondral defects Operative technique
Introductory remarks Osteochondral defects of the talus are defined as damage to the talar articular cartilage and its subchondral bone. The origin of this injury may be due to ankle fractures and ankle sprains, an avascular episode, and possibly a genetic predisposition [1, 15, 25, 50]. The injuries have a severe impact on the quality of life of active patients, due to deep ankle pain during weight-bearing and sporting activities [4, 5, 22]. Primary management of these defects is conservative; surgery is considered in cases of persistent symptoms [52]. For small primary defects, common first-line surgical management options consist of (arthroscopic) bone marrow stimulation and retrograde drilling [11–13, 30, 43]. For fixable defects, arthroscopic and open internal fixation procedures are amenable options and have proven to be effective for pediatric and adult patient populations [28, 29, 31, 45, 46]. In case of large defects or in case of failure of firstline surgical treatment, more extensive and invasive surgery can be considered a necessary step in the management process [30]. The more common treatment strategies currently include osteochondral allograft procedures, osteochondral autograft transfer system (OATS) procedures, and classic and matrix-associated
chondrocyte implantation (ACI, MACI) [20, 21, 32, 39, 55, 56]. Even though the OATS procedure is regarded as an effective surgical management option with a 90% success rate reported in the literature, donor-site morbidity has been reported to occur relatively frequently with incidence rates ranging from 11 to 35% when the graft was harvested from the ipsilateral femoral condyle [13, 16, 19, 23, 24, 26, 44, 57]. As an alternative to an OATS procedure harvesting the graft from the knee, an autologous osteoperiosteal cylinder graft can be harvested from the iliac crest. This technique has been described by Hu et al. [26] and Chen et al. [10]. This surgical treatment yielded highly promising results with good clinical follow-up scores and radiological outcomes. However, both author groups utilized cylindrical grafts, thereby compromising optimal individualized treatment for large talar osteochondral defects as it is known that that the size of the cylinder autograft is static and determined preoperatively. In order to overcome the aforementioned disadvantages, we developed a new surgical technique for the treatment of large talar osteochondral defects or secondary lesions: th
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