Review of Mechanical, Processing, and Immunologic Factors Associated With Outcomes of Fresh Osteochondral Allograft Transplantation of the Talus

Foot Ankle Int. 2017 Jul;38(7):808-819. doi: 10.1177/1071100717697649. Epub 2017 Apr 6.

Abstract

Osteochondral lesions of the talus (OLTs) are an increasingly implicated cause of ankle pain and instability. Several treatment methods exist with varying clinical outcomes. Due in part to successful osteochondral allografting (OCA) in other joints, such as the knee and shoulder, OCA has gained popularity as a treatment option, especially in the setting of large lesions. The clinical outcomes of talar OCA have been inconsistent relative to the positive results observed in other joints. Current literature regarding OCA failure focuses mainly on 3 factors: the effect of graft storage conditions on chondrocyte viability, graft/lesion size, and operative technique. Several preclinical studies have demonstrated the ability for bone and cartilage tissue to invoke an immune response, and a limited number of clinical studies have suggested that this response may have the potential to influence outcomes after transplantation. Further research is warranted to investigate the role of immunological mechanisms as an etiology of OCA failure.

Level of evidence: Level V, expert opinion.

Keywords: fresh osteochondral allograft; immune-mediated failure; osteochondral lesion; talus.

MeSH terms

  • Allografts / physiopathology*
  • Arthralgia / physiopathology*
  • Bone Transplantation / methods*
  • Cartilage, Articular / physiology*
  • Chondrocytes / physiology*
  • Humans
  • Immunologic Factors / chemistry
  • Immunologic Factors / physiology*
  • Talus / diagnostic imaging
  • Talus / injuries
  • Talus / surgery*
  • Talus / transplantation*
  • Transplantation, Homologous / methods*
  • Treatment Outcome

Substances

  • Immunologic Factors