CME OnDemand: 2022 AOFAS Annual Meeting-Articular Regional Reconstruction (ARR) for Large Osteochondral Lesions of the Talus using Viable Osteochondral Allograft Combined with Autograft: Technique Description and Case Series

Articular Regional Reconstruction (ARR) for Large Osteochondral Lesions of the Talus using Viable Osteochondral Allograft Combined with Autograft: Technique Description and Case Series

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Pdf Summary

Articular Regional Reconstruction (ARR) is a technique for treating large osteochondral lesions of the talus with bony defects. Current treatment options for these lesions are often limited and may require the removal of significant amounts of healthy bone. ARR combines viable osteochondral allograft with morselized autograft bone to restore the talar body structure and promote healing.<br /><br />In a case series of 11 patients, ARR was performed on patients with large unstable osteochondral lesions of the talus. The procedure involved arthroscopic confirmation of the lesions, followed by open surgery. Medial malleolar osteotomies were used for access when necessary. The damaged cartilage and nonstructural material were removed from the lesions, and the talar body structure was restored using autograft bone. The viable osteochondral allograft was shaped to match the talar morphology and secured over the autograft.<br /><br />The patients who underwent ARR had an average age of 40 and a mean follow-up of 19 months. The PROMIS-physical function (PROMIS-PF) and PROMIS-pain interference (PROMIS-PI) scores improved postoperatively, indicating an improvement in pain and physical function. The average SANE score also showed improvement. There were no complications or revision surgeries required, and all patients reported they would undergo the procedure again.<br /><br />ARR has the potential to be an alternative to structural graft salvage procedures for patients who have failed prior surgeries. However, further studies are needed to establish the indications, prognosis, and long-term outcomes of ARR for talus osteochondral lesions.<br /><br />In summary, Articular Regional Reconstruction (ARR) is a promising technique for the treatment of large osteochondral lesions of the talus with bony defects. It combines viable osteochondral allograft with morselized autograft bone to restore the talar body structure and improve pain and physical function. Further research is needed to validate the procedure and determine its long-term outcomes.

Asset Subtitle

James Lendrum, Michael A. Hewitt, BA, Sikora Cain, Kenneth J. Hunt, MD, Daniel K. Moon, MD, MS, MBA

Keywords

Articular Regional Reconstruction

ARR

osteochondral lesions

talus

bony defects

treatment technique

viable osteochondral allograft

morselized autograft bone

pain relief

improved physical function