Fresh Osteochondral Allograft for Large Talar Osteochondral Lesions.

Osteochondral lesions of the talus are being recognized as an increasingly common injury. Large osteochondral lesions have significant biomechanical consequences and often require resurfacing with both boney and cartilaginous graft. The current treatment options include osteochondral autograft transfer, mosaicplasty, autologous chondrocyte implantation, or osteochondral allograft transplantation. Allograft procedures have the advantage of no donor site morbidity and ability to match the defect line to line. Careful transportation, storage, and handling of the allograft are critical to success. The failure of nonoperative management, failure of arthroscopic treatment, or large defects are an indication for resurfacing.

Intra-articular Calcaneus Fractures: Current Concepts Review.

Calcaneal fractures are the most common fracture of the tarsal bones and represent 1% to 2% of all fractures. Roughly 75% of these fractures include intra-articular involvement of the posterior facet of the calcaneus. Intra-articular calcaneal fractures are challenging injuries to manage for both patients and surgeons given their association with both early and late complications. This article aims to review the management, classification systems, surgical approaches, and care regarding intra-articular calcaneal fractures. A review of the current literature yielded treatment strategies that aim to reduce complications such as soft tissue injury or loss of articular reduction while maintaining satisfactory clinical outcomes. The purpose of this article is to review these current concepts in the management of intra-articular calcaneal fractures. Level of Evidence: Level V, expert opinion.

Tibial slope in total ankle arthroplasty: Anterior or lateral approach.

BACKGROUND: A new total ankle arthroplasty (TAA) system performed through a lateral approach provides direct visualization of the centre of rotation, allowing for accurate reconstruction of the joint alignment and less bone resection. Radiographic references are needed to describe deformities and plan the surgical procedures. The tibial slope is an important factor when treating malalignment. The aim of this study is to show if there is any difference regarding the post-operative tibial slope (ß angle) measurement comparing a fixed-bearing TAA through a lateral approach and a mobile-bearing TAA through an anterior approach. METHODS: The study included 217 ankles. Between May 2011 and April 2015, 77 patients underwent a TAA with a mobile-bearing implant through an anterior approach and 45 with a fixed-bearing implant through a lateral approach: in these patients the ß angle was measured 2 and 12 months postoperatively. 95 subjects with unilateral post-traumatic ankle arthritis composed the control group: in these patients we measured the anterior distal tibial angle (ADTA) of the controlateral, non arthritic tibiotalar joint. RESULTS: In the mobile-bearing group, the mean ß angle at 2 and 12 months postoperatively was 86.4±3.1 and 86.8±3.1 (p-value=0.12). In the fixed-bearing group, the mean ß angle at 2 and 12 months postoperatively was 83.1±5.4 and 83.9±6.5 (p-value=0.26). A statistically significant difference was found between the ß angle of the two groups. In the control group the mean ADTA was 84.9±2.5. A non-statistically significant difference was observed only between ß angle of the fixed-bearing group and the ADTA of the control group. CONCLUSIONS: Regarding the tibial slope, fixed-bearing TAA through a lateral approach showed a more anatomic placement. In contrast, ß angle in mobile-bearing group appeared more reproducible than fixed-bearing group.

Clinical Outcome and Fusion Rate Following Simultaneous Subtalar Fusion and Total Ankle Arthroplasty.

BACKGROUND: Patients with arthritis or severe dysfunction involving both the ankle and subtalar joints can benefit from tibiotalocalcaneal (TTC) arthrodesis or total ankle replacement and subtalar fusion. TTC fusion is considered by many as a salvage operation resulting in a stiff ankle and hindfoot, considerably limiting global foot function. With the evolution of prosthetic design and operative techniques, total ankle replacement (TAR) has become a reasonable alternative to arthrodesis. The aim of this study was to investigate the fusion rate of the subtalar joint in patients simultaneously treated with total ankle replacement (TAR) and subtalar joint fusion. METHODS: This study included 25 patients who underwent primary TAR and simultaneous subtalar fusion between May 2011 and November 2014. Sixteen males (64%) and 9 females (36%) were enrolled with a mean age of 58 years (25-82). Patients were clinically assessed preoperatively and at 6 and 12 months postoperatively. Total follow-up time was 24.2 ± 11.6 months. Radiographic examination included a postoperative computed tomographic (CT) scan obtained 12 months after surgery. Three surgeons independently reviewed the CT scans and interobserver reliability was calculated. Functional scores were also assessed. RESULTS: At 12 months postoperatively, the subtalar fusion rate in patients treated with TAR and simultaneous subtalar fusion was 92%. There was a statistically significant increase in American Orthopaedic Foot & Ankle Society ankle/hindfoot score from 27.9 to 75.1. Ankle range of motion significantly increased from 12 to 32.8 degrees. Additionally, there was a statistically significant decrease in visual analog scale pain score from 8.6 to 2.1. CONCLUSIONS: TAR and simultaneous subtalar joint fusion were reliable procedures for the treatment of ankle and subtalar joint arthritis. Furthermore, CT scans showed an excellent reliability among orthopedic surgeons in determining the degree of successful fusion of subtalar arthrodesis. LEVEL OF EVIDENCE: Level IV, case series.