Page 30 - ISAKOS 2018 Winter Newsletter

CURRENT CONCEPTS
Talar Osteoperiosteal Grafting From the Iliac Crest (TOPIC): A Novel Surgical Technique for Large Primary and Secondary Osteochondral Defects of the Talus
Postoperative Management and Rehabilitation
The patient wears a below-the-knee cast for 6 weeks postoperatively. At 6 weeks, radiographs of the ankle are made at our outpatient clinic to assess consolidation of the medial malleolar osteotomy site.
At this visit, the cast is changed to a walking boot, which is worn for another 6 weeks. At 12 weeks postoperatively, the inserted graft is radiologically assessed by an experienced musculoskeletal radiologist and the orthopaedic surgeon on a computed tomography (CT) scan.
The scan is checked to confirm consolidation and bone growth into the inserted autograft as well as to assess whether remodeling of the talus has taken place. At 6 months and 1 year postoperatively, the patient is seen in our outpatient clinic again in order to closely assess progress, including with regard to return to sporting activities. The patient is referred to a physiotherapist to guide and stimulate clinical progress and to aid in the rehabilitation and return-to- sports process. At all follow-up visits, the patient is checked for potential complications (e.g., infections, neurovascular injury, synovitis, allergic reactions, donor-site morbidity, etc.).
Discussion
Current surgical methods to treat primary and secondary talar osteochondral defects may have limited clinical efficacy because of high reported rates of donor-site morbidity, inherent complications, the complexity of the surgery, the non-matching curvature of the harvesting site, and the immunological reaction to an allograft. In this article, we describe a newly developed OATS technique (the TOPIC technique) that can overcome these clinical disadvantages and provide patients with pain relief and return to sporting and working activities.
The advantages of this novel surgical procedure include the simplicity of the technique; the limited operative time required; and the relatively low costs of the procedure in comparison with allograft procedures, chondrogenesis- inducing therapies, autologous chondrocyte implantation techniques, and others.
An additional clinical advantage is that the iliac crest (the site from which the autograft is harvested) matches the surface geometry of the talar body with regard to curvature. Moreover, research has shown that the periosteum of the iliac crest possesses the potential to regenerate articular cartilage- like tissue because the cambium layer contains chondrocyte precursor cells. Prospective clinical and radiological studies are underway to evaluate the clinical efficacy of this new surgical technique. Short- and intermediate-term results appear promising and will be published in the future.
28 ISAKOS NEWSLETTER 2018: VOLUME I
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