Original research
Fresh-frozen Osteochondral Allograft Reconstruction of a Giant Cell Tumor of the Talus

https://doi.org/10.1053/j.jfas.2006.10.004Get rights and content

The use of fresh-frozen osteochondral allografts has been reported for the treatment of talar fractures, osteochondral lesions, and tumors of the calcaneus. Currently, we are unaware of any reports in the literature addressing the use of fresh-frozen osteochondral allograft for the treatment of giant cell tumors in the talus. We report our attempt to eradicate an aggressive giant cell tumor of the talus while minimizing morbidity and loss of function via reconstruction with a fresh-frozen osteochondral allograft. This is the first report in the literature to propose such a treatment option for giant cell tumors in the talus. The patient was informed that a report of this case would be submitted for publication.

Section snippets

Case Report

A 34-year-old woman presented to a fellowship-trained orthopaedic oncologist (M. C. L.) after 2 failed procedures for giant cell tumor of the right talus. The tumor had been diagnosed a year earlier and failed 2 prior attempts at curettage and bone grafting. At the time of presentation to the orthopaedic oncologist, the patient had complaints of significant pain and limitation of ankle, as well as subtalar, motion. Because of the aggressive nature of the lesion, it was suggested that a more

Discussion

Giant cell tumor of the talus is a rare entity that has only been reported a handful of times in the orthopaedic literature (1, 2, 3, 4, 6, 12, 13). Nonetheless, it presents a difficult problem because the lesion is locally destructive, recurs even in the face of aggressive surgery, and, on occasion, may even metastasize. Murari et al found giant cell tumors to be the most common benign primary osseous neoplasms in the foot, comprising 19% of all lesions (12). The tumor is frequently found in

References (13)

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    In order to overcome the insufficient mechanical strength, cortical bone graft or fibular graft can be used [6]. Fresh-frozen osteochondral allograft reconstruction has also been used for GCTB of the talus [14], however the availability of the treatment is limited. β-TCP is a highly porous ceramic and has been developed as a bone substitute [15].

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    2015, Journal of Foot and Ankle Surgery
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    However, curettage alone has had a high rate of recurrence, and the use of adjuvant agents such as methyl methacrylate (bone cement), cryotherapy, and phenol have been reported. Several procedures, including fresh frozen osteochondral allografts (11), partial (3) or total excision (3,10) of the talus, and arthrodesis (3), have also been reported. The classic treatment of choice has been intralesional curettage.

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    2015, Foot
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    Arthrodesis is essential after resection of all the tarsal bones except the calcaneum [9]. Fresh-frozen osteochondral allograft reconstruction has also been described for aggressive GCT of the talus, but the availability of the literature on this modality of treatment is limited [10]. We reviewed six cases of benign tumors of the talus for which talectomy and arthrodesis had been avoided.

  • Matrix-associated Autologous Chondrocyte Transplantation Combined with Iliac Crest Bone Graft for Reconstruction of Talus Necrosis due to Villonodular Synovitis

    2012, Journal of Foot and Ankle Surgery
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    When reviewing the recent literature, we found several case reports about talar cartilage lesions, for example, those caused by osteochondrosis dissecans, and reports that discussed therapy with autologous chondrocyte transplantation (3,4). There were also several cases that reported on the treatment of talar osteonecrosis with bone allografts (5). We report a case of villonodular synovitis with an osteochondral defect characterized by persistent pain after an ankle distortion.

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1

Clinical Instructor, Department of Orthopaedic Surgery, Northeastern Ohio Universities College of Medicine, Resident, Department of Orthopaedic Surgery, Akron General Medical Center, Akron, OH

3

Associate Professor, Department of Orthopaedic Surgery, Northeastern Ohio Universities College of Medicine, Residency Director, Department of Foot and Ankle Surgery, Saint Vincent’s Charity Hospital, Cleveland, OH, Attending Faculty, Department of Orthopaedic Surgery, Akron General Medical Center, Akron, OH

2

Professor and Chair, Department of Orthopaedic Surgery, Northeastern Ohio Universities College of Medicine, Attending Faculty and Chairman, Department of Orthopaedic Surgery, Akron General Medical Center, Akron, OH

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