Hi there, my name's James Lendrum, one of the chief residents out of the University of Colorado. Very excited today to present our research on articular regional reconstruction for large osteochondral lesions of the talus using viable osteochondral allograft combined with an autograft. Here we'll be describing our technique as well as a small case series. Thank you to my co-authors. As we all know, osteochondral lesions of the talus can be quite challenging to treat, particularly those lesions that are large, failed prior surgeries, or those that have substantial bony defects underneath. There have been many techniques described in order to help treat these. These range from bony stimulation and microfracture as some of the original procedures to those structural and non-structural allografts and autografts. Each of these has their pros and cons and particular clinical scenarios that one might be used over the other. However, there's not a great solution at this point for large lesions that have significant bony involvement underneath. So we're here presenting articular regional reconstruction, a novel technique combining both autograft as well as viable osteochondral allograft. And this can be used for either contained or uncontained lesions. Patient were chosen based on clinical history as well as imaging, including MRI and CT scans that showed a large, unstable osteochondral defect. And again, these can be contained or uncontained. Going through our technique, these lesions after a brief arthroscopic tour and assessment were typically converted to an open procedure and aminomalleolar osteotomies were used when necessary based on the location of the lesion. After a stable bony margin and cartilage rim were reached, as was via various rungers and small curettes, we were able to start the grafting procedure. We used bony restoration with autograft. This would be either local autograft from calcaneus or from the iliac crest, depending on the patient's body habitus and various other factors. The viable osteochondral allograft was then shaped to help restore the tailor morphology. And the nice thing, as you can see in some of the pictures, is this can be contoured to whatever size you have. You trim away the edges and then secure it down using suture anchors at the periphery of the intact bone. You can see in figure C is this large lesion, which correlates to the MRI photos. After debridement, figure D is after the autograft. And then you can see the allograft with the mesh holes in it, which you simply tie the suture anchors to. And then maximal dorsiflexion and plantar flexion, respectively, in F and E. We were then able to look at patient outcome scores for our 11 patients that underwent this procedure. The average age was 40 with a mean follicle of 19 months. Based on preoperative imaging, the average surface area was 1.95 square centimeters with a depth of 7.25 millimeters. Four of them were uncontained corner lesions, which we all know can be quite difficult to treat. What we found is at final follow-up, these PROMIS scores and SANE scores all improved. The PROMIS physical function was statistically significant from 41 to 47. The pain interference decreased from 60 to 53, and the SANE score has improved from 60 to 69. As far as surgical complications, we did not find any specific to the osteochondral lesion surgery. There were three patients that had returned to OR2 for screw removal and one for a postoperative impingement lesion debridement. During these, quote, second looks, the cartilage and OLT grafting all appeared intact. And all patients said in a survey that they would undergo the procedure again. So in summary, articular regional reconstruction is a reproducible procedure that's demonstrated potential for both improving pain as well as physical function in patients who either have recurrent or recalcitrant large OLT lesions with bony defects and can also be used for patients that have failed prior surgeries, as five of our patients had had previous surgeries. I wanna thank everybody for our time. We can see our references and look forward to future studies using this technique. Thank you.

articular regional reconstruction

osteochondral lesions

talus

viable osteochondral allograft

autograft