Talus Cartilage Injuries: Repair With a Bone Plug

Talus Cartilage Injuries: Repair With a Bone Plug

This cadaveric surgical video demonstrates an osteochondral allograft transplantation, or OATS procedure, used to repair a cartilage injury of the talus bone of the ankle with a bone plug. In this procedure, a cartilage graft is taken from a cadaver donor and placed over the area of the patient's cartilage defect. Here, we see a right ankle with the inner side of the ankle facing the screen. The surgeon has already marked out where the incision will be made.

This incision is a little bigger than what would normally be done in the operating room for the purpose of this demonstration. The surgeon begins by cutting through the skin and soft tissue on the inner side of the ankle. The first step of the procedure is to cut away a piece of bone from the end of the tibia, or shinbone, to better access the talus bone of the ankle. The surgeon inserts a wire into the end of the shinbone, seen here on x-ray. Then, the surgeon drills a tunnel up into the bottom of the shinbone.

These drilled areas will guide the cuts that the surgeon will make with a small saw. Here, we see the piece of bone that was separated from the end of the shinbone, revealing a cartilage injury on the top of the talus bone. The surgeon uses a sizing instrument to measure the size and uses a reamer to cleanly cut out a round section of cartilage and bone around the cartilage injury. This makes a hole or socket that will allow a piece of cartilage and bone, called a plug, to neatly fit into.

Here, we see a talus bone covered in articular cartilage from a cadaver donor. The surgeon secures the donor talus in a workstation and uses a reamer to cut out and remove a cartilage and bone plug. The surgeon measures and shapes the graft to match the size of the prepared socket. The graft may be soaked in a solution made from the patient's own blood or blood components, which are rich in compounds that can help improve healing.

In this procedure, bone gel is placed over the exposed bone in the socket to further help with healing. The surgeon positions the graft over the prepared socket and taps it into place to fill in the gap. The surgeon will reposition the bone that was cut away from the end of the shinbone and fix it back together with a metal plate and screws, seen here on x-ray. The surgeon will use sutures to close the skin incisions and the procedure is now complete.