The Use of Allograft

Abstract

Whereas literature agrees on conservative treatment for asymptomatic osteochondral lesions, there is considerable controversy surrounding the treatment of symptomatic lesions, and especially for the large ones (larger than 15 mm of diameter and deeper than 10 mm). The current indications concerning small lesions include removal or fixation of loose bodies, curettage and micro-fractures of the subchondral bone. Surgical management of the large lesions is more controversial and includes different options, such as bone filling (above all cystic lesion), cartilage regeneration techniques (ACI, MACI, AMIC), synthetic cartilage replacements and osteochondral autografts (OATS) or allograft transplantations. Indication for osteochondral transplants is restricted to lesions larger than 15 mm and deeper than 8 mm. The therapeutic principle is to restore the hyaline cartilage and subchondral bone functional unit. The allograft is harvested from a donor talus that can be fresh or frozen bone. The treatment of osteochondral lesions with allograft is usually an open procedure and arthroscopy can be performed before the open approach to confirm the site and the size of the lesion. In this chapter we describe surgical technique with its pittfalls and tricks.