Key Takeaways
- Autologous osteochondral transplantation uses the patient's own cartilage relieve ankle pain from osteochondral lesion of the talus.
- Collaboration across subspecialties enables Duke Orthopaedics to offer this advanced treatment and the full spectrum of orthopaedic therapies.
A decade after a lower extremity injury, a 45-year-old man continued to experience longstanding ankle pain. As the pain limited the patient’s active lifestyle, he came to Duke Orthopaedics, where imaging showed an osteochondral lesion of the talus.
Although most patients can be treated with minimally invasive options, this lesion was deep and highly cystic, and the location was not amenable to arthroscopic techniques. “Arthroscopic procedures are frequently offered as an option that doesn’t ‘burn a bridge,’” says Duke Orthopaedics foot and ankle surgeon Christopher D. Murawski, MD. “However, we try to individualize each treatment plan based on the available research and our experience. At Duke, we strive to deliver the right procedure at the right time for each patient.”
How did Duke Orthopaedics address this patient’s ankle pain and preserve the joint?
Murawski collaborated with Duke Orthopaedics foot and ankle/sports medicine surgeon Conor N. O’Neill, MD, to offer autologous osteochondral transplantation (AOT). Rather than using a cadaver allograft, AOT harvests healthy cartilage from a non-weight-bearing area of the patient’s own knee to replace lost cartilage in the ankle. AOT is a well-established procedure with excellent supporting data in the ankle, and Duke is one of the select international centers offering this expertise.
Four months after surgery, the patient was pain-free and no longer required an orthopaedic boot, ready to progress in physical therapy to return to the activities of daily living.
“Patients often worry about knee pain after this procedure, but that’s uncommon in our experience,” says Murawski. “Collaboration across subspecialties allows us to offer these procedures and take full advantage of the expertise at Duke.”
The Duke Division of Foot and Ankle offers patients clinical excellence and innovation in complex procedures. Mark E. Easley, MD, chief of the foot and ankle division at Duke Orthopaedics, says this case highlights the collaborative approach and specialized expertise of the team: “Dr. Murawski has an extensive background in cartilage procedures and cartilage research and has distinguished himself as a thought leader in cartilage repair. Dr. O’Neill is uniquely positioned as he has dual fellowship training in foot and ankle and sports medicine and is likewise an ankle cartilage expert.”
“We treat all cartilage lesions of the ankle with the full spectrum of treatments, from small-scope debridements to adding biological scaffolds to AOT to fusion or replacement,” says O’Neill.
Early referral can improve outcomes. “If patients already have cystic change or bony involvement under the cartilage, that could progress and further narrow their options, possibly eliminating AOT as a treatment,” O’Neill explains. “If we see patients early on, they may have more treatment options.”
Refer a patient to Duke Orthopaedics or learn more about the Duke Foot & Ankle Program (PDF).