Bipolar Osteochondral Allograft Transplantation of the Tibiotalar Joint for Ankle Arthritis

February 12, 2014

Bipolar Osteochondral Allograft Transplantation of the Tibiotalar Joint for Ankle Arthritis

by William D. Bugbee, MD; Michael E. Brage, MD


Bipolar osteochondral allografting is a technically complex procedure envisioned as an alternative to arthrodesis or arthroplasty1 in carefully selected young patients with advanced tibiotalar arthritis, usually as a result of trauma.

Step 1: Preoperative Planning

Confirm that the grafts are not damaged and that the side (left or right) and size (not too small) are properly matched to the donor.

Step 2: Placement of the External Fixator

Place an external fixator across the ankle joint using fluoroscopy and distract the ankle prior to incision.

Step 3: Anterior Approach to the Ankle

Perform a standard anterior approach to the ankle joint.

Step 4: Positioning of the Cutting Jig

Mount the jig on the ankle and confirm the cutting block position both visually and fluoroscopically.

Step 5: Bone Resection

Using a reciprocating saw and careful technique to protect the tendons and neurovascular structures, perform osseous resection of the distal part of the tibia and the talar dome.

Step 6: Preparation of the Allograft

Prepare the tibial and talar allografts from the donor tissue to match the resection gap created in Step 5.

Step 7: Insertion and Fixation of the Allograft

Insert and fix the allograft construct and remove the external fixator.

Step 8: Rehabilitation

Postoperative care is straightforward, including initial immobilization and a three-month period of non-weight-bearing.


In our recent clinical study2, we used our clinical outcomes database to identify eighty-four consecutive patients (eighty-eight ankles) who underwent bipolar osteochondral allograft transplantation of the tibiotalar joint, had surgery in 1999 or later, and had not had a previous arthroplasty or osteochondral allograft transplantation involving the tibial plafond and/or talus.