Introduction: We describe the technique for structural allograft transplantation to treat large talar shoulder lesions.
Step 1 patient selection and education: The patient and surgeon must be prepared for a waiting time of unknown length and have a flexible schedule for when the graft is ready for implantation.
Step 2 preoperative planning and approval: Inspect the graft for the correct approximate size, operative side, and quality of the cartilage surface prior to proceeding with surgery.
Step 3 surgical approach and osteotomy: Make sure that the proposed osteotomy site exits into the tibial plafond and not at the axilla as this allows for easier access to the lesion.
Step 4 prepare recipient site: Measure the dimensions of the talar defect and its location from anterior to posterior along the talar shoulder at least twice.
Step 5 harvest graft from donor talus: Err on the side of creating too large a graft that later can be trimmed instead of a graft that is initially too small.
Step 6 implant and secure graft into recipient site: Secure the graft with one or two 1.5 or 2.0-mm-diameter solid screws.
Step 7 reduce osteotomy site and close: Ensure that there is no intra-articular step-off.
Step 8 postoperative care: After transitioning to a boot-brace, the patient should remove it to perform ankle range-of-motion exercises four to five times per day.
Results: In our series, there were eight patients with a mean age of thirty-one years (range, seventeen to forty-four years).
What to watch for: IndicationsContraindicationsPitfalls & Challenges.