• Justin D Orr, John C Dunn, Kenneth A Heida, Nicholas A Kusnezov, Brian R Waterman, and Philip J Belmont.
• Department of Orthopaedic Surgery, William Beaumont Army Medical Center, Texas Tech University Health Sciences Center, El Paso, Texas.
• Foot Ankle Spec. 2017 Apr 1; 10 (2): 125-132.

IntroductionStructural fresh osteochondral allograft transfer is an appropriate treatment option for large osteochondral lesions of the talus (OLTs), specifically lesions involving the shoulder of the talus. Sparse literature exists regarding functional outcome following this surgery in high-demand populations.Materials And MethodsOver a 2-year period, a single surgeon performed 8 structural allograft transfers for treatment of large OLTs in an active duty US military population. Lesion morphology and magnetic resonance imaging (MRI) stage were recorded. Preoperative and latest postoperative American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot-ankle and pain visual analog scores were compared.ResultsEight male service members with mean age 34.4 years underwent structural allograft transfer for OLTs with mean MRI stage of 4.9 and a mean lesion volume of 2247.1 mm3. Preoperative mean AOFAS hindfoot-ankle score was 49.6, and mean pain visual analog score was 6.9. At mean follow-up of 28.5 months, postoperative mean AOFAS score was 73, and mean pain visual analog score was 4.5, representing overall improvements of 47% and 35%, respectively. Three patients were considered treatment failures secondary to continued ankle disability (2) or graft resorption requiring ankle arthrodesis.ConclusionsDespite modest improvements in short-term functional outcome scores, large osteochondral lesions requiring structural allograft transfer remain difficult to treat, particularly in high-demand patient populations. Surgeons should counsel patients preoperatively on realistic expectations for return to function following structural allograft transfer procedures.Levels Of EvidenceLevel IV: Retrospective study.

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