16 - The Use of Bulk Fresh Osteoarticular Allografts in Ankle Reconstruction

Abstract

A role for use of bulk fresh allografts in ankle surgery has been well established. Although the enthusiasm for large fresh allograft osteoarticular ankle replacement has diminished over the past several years, this technique remains an effective approach to reconstruction in the appropriate patient. In our own clinical experience in numerous patients, large bulk osteoarticular replacement grafts of the ankle have lasted more than 12 years with no complications. Such cases, however, constitute the exception rather than the rule, because many of these grafts have failed over time. The decision to use a fresh graft in reconstruction for a massive osteochondral lesion is far easier, because few realistic alternatives are available, and the results with this procedure have been excellent over the years. While the osteoarticular replacement procedure is indicated for patients with arthritis and for whom either an arthrodesis or total ankle replacement is not ideal, one has to follow stringent inclusion criteria.