Evaluating a Surgical Treatment for Large Osteochondral Lesions of the Talus

In most cases – up to 85% – osteochondral lesions of the talus (OLTs) occur after an ankle sprain or traumatic injury. The lesions may soften the cartilage layers, cause cyst-like lesions, or fracture the cartilage and bone layers, causing ankle pain, swelling, catching, or instability.

Structural fresh osteochondral allograft transplantation of the talar shoulder was developed to surgically manage large, challenging OLTs, and good outcomes have been reported retrospectively.

Prospective Evaluation

To better understand patient outcomes, researchers at Duke University Medical Center prospectively evaluated 31 patients who had undergone the procedure between 2007 and 2019. Their evaluation included:

  • Preoperative imaging with an MRI or CT scan plus radiographs
  • Postoperative patient questionnaires administered yearly, including the 36-Item Short-Form Health Survey (SF-36), the visual analog scale (VAS) for pain, and the Short Musculoskeletal Functional Assessment (SMFA)
  • Postoperative imaging to check for allograft assimilation, arthritic changes, and range of motion

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“Our research team set out to determine the results of cadaver bone transplantation for large osteochondral lesions of the talus,” said Samuel B. Adams, MD, director of foot and ankle research at Duke University Medical Center and senior author of the study.

“Although these large lesions are not common, they can be very painful and decrease quality of life. This is one of the few procedures available to surgeons to treat this pathology.”

Study Findings

The researchers found that by 6 months after fresh, structural allograft transplantation, patients with large OLTs experienced pain relief and restored function, as indicated by significant improvement in the mean preoperative VAS score, SF-36 score, SMFA bother index, and SMFA function index. These improvements were maintained at an average of 4.5 years postoperatively.

About half of patients needed an additional operation, primarily for arthroscopic debridement or removal of hardware. Only 1 patient required total ankle arthroplasty. The researchers reported overall graft survival at 96.8%.

The findings were recently published in Foot & Ankle International.

Dr. Adams noted that data supporting the success of this procedure are very important as it is still considered experimental by many insurance companies and is not widely performed by foot and ankle orthopaedic surgeons.

“This study shows that, in the hands of skilled surgeons, patients can expect good outcomes treating the challenging problem of a painful, large focal loss of ankle bone and cartilage,” said Charles L. Saltzman, MD, Editor-in-Chief of Foot & Ankle International.


Fletcher AN, Johnson LG, Easley ME, Nunley JA, Adams SB. Midterm prospective evaluation of structural allograft transplantation for osteochondral lesions of the talar shoulder. Foot Ankle Int. 2022 Jul;43(7):899-912. doi: 10.1177/10711007221088033. Epub 2022 May 2.

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