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.