Fresh Osteochondral Allograft Resurfacing of the Ankle

Many basic scientific and clinical studies support the utility of small fragment allografting in addressing an extensive spectrum of osteoarticular pathology, with its use in the tibiotalar joint still an evolving application. The operative procedure in the ankle is technically straightforward but demands precision to achieve reproducible results and to minimize early graft failures related to surgical technique. Fresh osteochondral allografting of the tibiotalar joint is best understood as a management strategy in the patient that presents with a symptomatic OLT, or advanced ankle arthropathy at an age or activity level not optimally suited for total joint replacement or arthrodesis. The treatment goal of joint-sparing biologic reconstruction is to relieve pain and maintain function to delay the need for ankle fusion or total replacement indefinitely, while at the same time not restricting future treatment options. The emergence of fresh osteochondral allografting for the ankle has demonstrated encouraging results, but its remaining shortcomings are also testament to the lack of viable treatment options in this challenging patient population.