28446 Open osteochondral autograft, talus (includes obtaining graft[s])

Name of the Procedure:

Open Osteochondral Autograft, Talus (Includes Obtaining Graft[s])

Summary

An open osteochondral autograft for the talus is a surgical procedure to repair damaged cartilage and the underlying bone in the ankle joint. It involves taking a healthy cartilage and bone graft from another part of the patient's body, usually the knee, and transplanting it to the damaged area on the talus (a bone in the ankle).

Purpose

This procedure aims to treat osteochondral defects (OCD) of the talus, which are injuries or lesions to the cartilage and the bone underneath in the ankle joint. The goals are to reduce pain, improve function, and prevent further joint damage, ultimately improving the patient's quality of life and ability to perform daily activities.

Indications

• Persistent ankle pain after conservative treatments (e.g., medications, physical therapy).
• Ankle instability or locking.
• Diagnosis of osteochondritis dissecans (OCD) or other cartilage lesions confirmed through imaging.
• Suitable candidates often include those with localized cartilage damage and good overall joint health.

Preparation

• Fasting as required by the anesthesia team, typically starting the night before the surgery.
• Adjustments to medications, particularly blood thinners, as instructed by the healthcare provider.
• Pre-operative imaging studies such as MRI or CT scans to assess the defect.
• Physical examination and pre-anesthetic assessment.

Procedure Description

1. The patient is placed under general or regional anesthesia.
2. An incision is made near the ankle to expose the talus.
3. The damaged cartilage and bone are meticulously removed from the talus.
4. A matching graft of healthy cartilage and bone is harvested from a non-weight-bearing area, usually the knee.
5. The graft is shaped to fit the defect and implanted into the prepared site on the talus.
6. The incision is closed with sutures, and a sterile dressing is applied.

Duration

The procedure typically takes about 2 to 3 hours, depending on the complexity of the case.

Setting

The procedure is performed in a hospital operating room or a specialized surgical center.

Personnel

• Orthopedic surgeon
• Anesthesiologist
• Surgical nurses
• Surgical technologists

Risks and Complications

• Infection at the surgical site
• Blood clots
• Graft rejection or failure
• Damage to surrounding nerves or blood vessels
• Post-operative stiffness or restricted motion in the ankle

Benefits

• Pain relief
• Improved ankle function and stability
• Prevention of further joint damage
• Enhanced quality of life Benefits are typically noticed several months after the surgery as the graft integrates and the ankle heals.

Recovery

• Initial immobilization of the ankle with a cast or brace.
• Elevation of the leg to reduce swelling.
• Gradual weight-bearing as advised by the surgeon.
• Physical therapy to restore mobility and strength.
• Full recovery may take several months to a year, with regular follow-up appointments to monitor progress.

Alternatives

• Non-surgical treatments like physical therapy, medications, and lifestyle modifications.
• Arthroscopic debridement and microfracture to stimulate cartilage repair.
• Osteochondral allograft transplantation (using donor tissue).
• Pros and cons vary; non-surgical methods may offer temporary relief but not permanent repair, while allografts carry additional risks related to donor compatibility and infection.

Patient Experience

During the procedure, the patient will be under anesthesia and should not feel any pain. Post-operatively, there will be soreness and discomfort managed with prescribed pain medications. The patient will need to follow specific care instructions to ensure proper healing and will experience a gradual improvement in symptoms over several months.