Talar OsteoPeriostic grafting from the Iliac Crest (TOPIC) for large medial talar osteochondral defects : Operative technique.

G. M. M. J. Kerkhoffs,S. A. S. Stufkens,J. N. Altink,J. Dahmen

doi:10.1007/s00064-020-00673-9

Abstract

ObjectiveProvision of a natural scaffold, good quality cells, and growth factors in order to facilitate the replacement of the complete osteochondral unit with matching talar curvature for large medial primary and secondary osteochondral defects of the talus.IndicationsSymptomatic primary and secondary medial osteochondral defects of the talus not responding to conservative treatment; anterior–posterior or medial–lateral diameter >10 mm on computed tomography (CT); closed distal tibial physis in young patients.ContraindicationsTibiotalar osteoarthritis grade III; multiple osteochondral defects on the medial, central, and lateral talar dome; malignancy; active infectious ankle joint pathology.Surgical techniqueA medial distal tibial osteotomy is performed, after which the osteochondral defect is excised in toto from the talar dome. The recipient site is microdrilled in order to disrupt subchondral bone vessels. Then, the autograft is harvested from the ipsilateral iliac crest with an oscillating saw, after which the graft is adjusted to an exact fitting shape to match the extracted osteochondral defect and the talar morphology as well as curvature. The graft is implanted with a press-fit technique after which the osteotomy is reduced with two 3.5 mm lag screws and the incision layers are closed. In cases of a large osteotomy, an additional third tubular buttress plate is added, or a third screw at the apex of the osteotomy.Postoperative managementNon-weight bearing cast for 6 weeks, followed by another 6 weeks with a walking boot. After 12 weeks, a CT scan is performed to assess consolidation of the osteotomy and the inserted autograft. The patient is referred to a physiotherapist.ResultsTen cases underwent the TOPIC procedure, and at 1 year follow-up all clinical scores improved. Radiological outcomes showed consolidation of all osteotomies and all inserted grafts showed consolidation. Complications included one spina iliaca anterior avulsion and one hypaesthesia of the saphenous nerve; in two patients the fixation screws of the medial malleolar osteotomy were removed.

Highlights

Osteochondral defects of the talus are defined as damage to the talar articular cartilage and its subchondral bone
Talar OsteoPeriostic grafting from the Iliac Crest (TOPIC) for large medial talar osteochondral defects
Even though the osteochondral autograft transfer system (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]

Summary

Introduction

Osteochondral defects of the talus are defined as damage to the talar articular cartilage and its subchondral bone. In order to overcome the aforementioned disadvantages, we developed a new surgical technique for the treatment of large talar osteochondral defects or secondary lesions: the Talar OsteoPeriostic grafting from the Iliac Crest (TOPIC) procedure.

Results

Conclusion