Unipolar allograft reconstruction for post-traumatic avascular necrosis of the distal tibia: A review of the literature,technique, and case series

BackgroundAvascular necrosis of the distal tibial plafond following ankle trauma is an underreported and potentially devastating phenomenon. Beyond conservative treatment options, surgical intervention has been limited to ankle arthrodesis, which sacrifices motion and may have longterm sequellae for adjacent hindfoot joints. Total ankle replacement has been historically contraindicated. Unipolar allograft reconstruction provides an option for joint salvage. We present a literature overview, implantation technique, and two cases utilizing matched unipolar distal tibial allograft.MethodsTwo younger patients underwent distal tibia allograft reconstruction for tibial plafond collapse due to post-traumatic avascular necrosis. They were followed to assess for clinical improvement and radiographic graft subsidence.ResultsBoth patients returned to work and activity. One patient had no graft subsidence at four years, but the other patient became symptomatic with graft subsidence at one year.ConclusionsDistal tibia allograft reconstruction can be utilized as a joint salvage surgery for post-traumatic avascular necrosis with collapse of the tibial plafond in younger patients that prefer an alternative to arthrodesis. Results may be mixed and necessitate an engaged, activated patient.Level of evidence: IV.