Name: Talus Allograft OATS® Surgical Technique
Uploaded: 2026-05-28T00:00:00Z
Channel: Arthrex
Description: Kaitlin Neary, MD (Boise, ID), demonstrates the surgical technique and procedural pearls for the talus allograft OATS® system, which provides precise and comprehensive instrumentation to treat large osteochondral defects of the talus.

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Kaitlin Neary, MD (Boise, ID), demonstrates the surgical technique and procedural pearls for the talus allograft OATS® system, which provides precise and comprehensive instrumentation to treat large osteochondral defects of the talus.

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VID1-008019-en-US | A | Talus Allograft OATS® Surgical Technique

Kaitlin C. Neary

A video recording of a surgical technique on a live patient in an operating room setting or a cadaveric demonstration.

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Talus Allograft OATS® Surgical Technique

Speaker  Hi, I'm Doctor Caitlin Neary and I practice at Catalyst Orthopedics in Boise, Idaho. And we are going through a surgical technique for talus osteochondral allograft transplantation with a fresh talus allograft. The first thing I want to introduce is the allograft otes workstation. Specifically, I'd like to go through the components of the workstation. The first component that you should know about are these. And this is a V block and a flat block. And what's nice about these is they have ribbed surfaces which really allow good grabbing and good stability of the talus. Also, if you'd like, you can actually swap out the V block for another flat block to really get that perfect fit. Another highlight is this is a vise grip type workstation. So you can actually turn this T handle bar to bring the arms closer together to really get an adequate grip of your talus before harvesting the graft. The next component I'd like to show are there are two different heights of bars that actually can help you elevate your talus as high as you need to elevate in order to adequately harvest the graft. These are placed right on the base of the workstation strategically beneath your talus. The next component of the workstation that I want to highlight is the boom arm. And what you can do is actually loosen this hex bolt, and the boom arm will now move in three planes. It will move up and down. It will move side to side, and it will also rotate. Speaker  And that really allows you to achieve the perfect trajectory to your graft. There's another component to the boom arm, which is the bushing. And these are various diameters and sizes. They size match the recipient site. So you can see this is 12mm, and you'll actually place this in the boom arm and thread it into place before harvesting your allograft plug. Once this is threaded into place, you can loosen the hex bolt, move the boom arm up and down side to side. Rotate until you truly find and achieve your perfect trajectory. You're going to do a temporary tightening of the hex bolt. You're then going to take this cheater bar to really achieve your final tightening tightening of the hex bolt and the construct. Other key instruments from the tray include the Allograft oats sizers, which help size your osteochondral defect. The recipient site Reamers, which help to prep the recipient site and then finally, the donor site coring Reamers, which help to retrieve the allograft core. Another nice feature that I really like from this system is that it's all color coded to match the various sizes. So next I want to discuss the anterolateral approach to the ankle. You can see I've planned my incision here and it's essentially centered between the tibial crest medially and the fibula, which I've drawn out laterally. As you plan your incision, you want to be just lateral to the extensor tendons and the anterior compartment musculature. Speaker  You bring your incision distally, and then you want to course it down towards the base of the fourth metatarsal. Inevitably, there's always a crossing branch of the superficial peroneal nerve. So after you make your incision, you want to make sure to identify the nerve, dissect it free and protect it for the remainder of the case. So I don't necessarily scope all Oates procedures, but I have found the Nanoscope to be really useful whenever I have a potentially tough to reach lesion, and I'm trying to decide whether or not an osteotomy is going to be warranted. So I found it really, really useful to be able to pop in the nanoscope, get a good debridment of the joint, and then start to assess the defect and the location. So as you can see here, this is the front of the joint. As we plan or flex the talus, the anterolateral talus osteochondral defect comes into view. It's a large lesion. It's well contained. But most importantly what I'm evaluating is that sure enough, I can plantarflex the foot far enough to gain full access to the lesion without requiring an osteotomy. It's also beneficial while you have access to the lesion arthroscopically to perform your initial debridement. This really helps to evaluate the diameter of the lesion, whether or not there's any subchondral cystic change or or change in structure of the subchondral bone. And it also just gives you an idea of the size of the diameter of a plug you're going to need to harvest. Speaker  One important tip to remember is when you're planning your anterolateral portal placement, Make sure you plan it in line with your Anterolateral approach. That's why I will always draw out the anterolateral incision prior to proceeding with arthroscopy, so I can ensure that my anterolateral portal is right in line with the incision to avoid multiple incisions in close proximity. Now you can see I've completed the anterolateral approach to the ankle. We've got the superficial peroneal nerve that we've identified and dissected free. And we'll be able to protect for the rest of the case. We've got your extensor tendons here as well as Peroneus Tertius, which can easily be retracted medially. We've done a capsulotomy and elevated the capsule off the joint, and now we have great access to the anterolateral osteochondral defect. So the next step is to size the defect. As we discussed previously, there are multiple cannulated sizes ranging in diameter from 6 to 15mm, and the goal is just to get a nice fit and nice coverage circumferentially around the lesion. Here I've chosen a ten millimetres sizer, and when I place this completely perpendicular to the defect, you can see that it gives good circumferential coverage around the lesion. Now, my goal isn't to get a perfect fit. I actually want to usually go about 1 to 2mm more in terms of the width of diameter, to ensure that you're really getting the entirety of the defect when you remount the recipient site. Speaker  In this case, ten millimeters seems to be the perfect fit. The next step would then be to place the 2.4mm guide pin through the central cannulation of the sizing guide. So as you can see here, we've now drilled a K wire, a 2.4mm guide pin through the central aspect of the defect, and this was done through the Cannulated sizing guide. Once the k wire, the guide pin is in place, the next step is to now ream the defect to prep the recipient site for the donor allograft. So we'll bring the reamer down. And as we're reaming, the goal is to get at least 8 to 10, maybe even 12mm deep into the graft. With that said, I also have a goal of really just being able to get back to healthy underlying bleeding bone, bypassing any bone marrow edema or underlying cystic change. So at a minimum, my goal is always to bury the reamer head, but we also might go a few more millimeters just to make sure we've gotten down to healthy bone. Now as we're reaming, we go slowly. We want to irrigate the reamer to make sure that we aren't getting any thermal necrosis. So you can see we're reaming here. The talus is really hard bone. So it's important to go slowly. And once again keep the reamer cool. There we go. Let's get some suction in there. Okay, let's stop there. Speaker  Now here you can see and I'm going to clean up around the reamer. We've been able to bury the reamer almost ten millimeters into the Taylor head. I think it might be worth going just a little bit farther to make sure we've at least achieved ten millimeters. So let's make sure to get that head buried. Go for it. There we go. And now when you look, we've got the reamer head buried. We've bypassed any bone marrow edema or underlying cystic change. And we've got a good base for the transfer of the donor allograft. What I actually like to do is mark the north position of the defect to keep my orientation consistent throughout the rest of the case. The next step is to measure at the north, south, east and west quadrants. There's really two ways to do that. The first is to use this depth gauge, and you actually just place it in the base of the defect. While this is useful, I found it to be a bit challenging sometimes to get accurate measurements. So my workaround is actually to take a ruler and cut it into this flag type configuration. So when we go to the north quadrant, we seat the ruler up against the wall. And sure enough, we're at about ten millimeters as previously reamed. Then we go south, same thing, advance to the base of the defect and we're at about ten millimeters. The next step is to go east. Speaker  And as we advance the ruler down, we are at about ten millimeters east. And then we come west and we are one millimeter more about 11mm. So that's how you measure the four quadrants of the osteochondral defect. So now you can see we've got the talus completely secured to the workstation. I've been able to move the boom arm into position. The bushing is fastened into place, and I can use the Cannulated sizing guide to get a good idea of the trajectory of the allograft plug. When I'm happy with the position of the boom arm, you then use this cheater bar and really tighten down the system so that it's good and stable at that point. You then take this collared pin you can see here and load it into the coring reamer, and that will really help with seamless harvest of the graft. So the next step is to harvest the allograft plug. I'm going to take the coring reamer. And we're going to advance it through the bushing and center it into position. I like to really get into a perpendicular spot. So I'm matching the orientation of the recipient site. You then back off the bone 1 to 2mm and start reaming. As we're reaming, we go slow with lots of irrigation to keep the bone nice and cool. And we keep irrigating and we keep reaming all the way down to the bottom of the talus. Once I feel like I'm getting close to the bottom, I'll actually look at the trajectory and where the reamer is going to exit the plantar aspect of the talus, and I'll just knock out the block that's on that side so that I truly can punch through the plantar cortex. Speaker  And then we just complete our reaming. So now it's time to retrieve the allograft plug. You can see we've disconnected from the power. We've got the coring reamer that has the allograft plug inside, and we've got the collared pin that we're going to use essentially as a tamp. So what I do, and you have to do this very carefully with light taps, but you start tapping the colored pin. You can see that the graft is starting to exit from the coring reamer distally, and we just keep going until the entire graft is harvested. So one tip is, after you harvest the allograft plug, it can be really difficult to lose your orientation. And you really have to keep track of what's north, south, east and west. So one thing I'll do is actually come back to the allograft. We will replace the harvested plug into the graft. As you can see here. I'll let it kind of fall down and I'll get to a point where it matches the contour so we know where it previously sat. I'll pop it back up just a few millimeters and then have my assistant mark exactly where north would be. We'll mark where north would be. Speaker  And that helps you to orient when you're placing this into the recipient site. So the next step is to mark your prior measurements in all four quadrants of the allograft plug. This includes north, south, east and west. For the purposes of this demonstration, we're just going to show you one of the markings. Here's our prior marking from the north orientation. So from the cartilage surface we measure approximately ten millimeters, which is what we had previously measured. And we make a single dot at the ten millimeter mark. We then complete the other three dots for south, east and west, and we connect the four dots with one single line. So now it's time to resect the unneeded base of the allograft plug. As you can see, we've made the four dots at the four quadrants and connected each of the dots with a longitudinal line. There's a really nice graft clamp, as you can see here, and I'll actually place that directly over the purple marked line. You want to make sure that on one side, the clamp tines are lined up with the purple line. Flip it over and same thing on the other side. Want to make sure the tines are lined up? There's then a bushing here that you can advance until everything is stable. What's nice about the graft clamp is it's actually flat, so you can use this as a saw guide. So I have my assistant hold the clamp and we hold that stable and then I can take a saw. Speaker  Seed it down nicely onto the flat part of the graft clamp. And now we just resect the remainder of the base. So once you've resected the unnecessary base of the graft, it's time to fine tune the graft. There's a rasp that comes in the kit that you can use to really remove any remaining prominences or portions of the graft that remain. The other option is to actually bevel the side of the graft, using a Ranger to help make insertion easier. Once you've achieved a perfect shape of your graft, the next step is to clean the graft. What I do is pulsatile lavage for approximately 2 to 3 minutes to make sure you get a really good wash, but I have some colleagues who will irrigate up to 1500ml, so it's really up to surgeon preference. But the ultimate goal is to clean the graft. So the next step is to add biology to the graft. You can do this with either PRP or BMC, which we've harvested here, but the ultimate goal is to add biology to the graft so that it increases the odds of graft incorporating to the surrounding native bone. What I do is just place the graft into the harvested BMC, and we'll let it soak for 5 to 10 minutes. So now that we've harvested and shaped our allograft plug. The final step is to implant the plug into the recipient site. Before I do that, I actually prefer to bone graft the base of the defect. Speaker  Here you can see we have Allo sink pure, and we're just going to place a little bit into the base of the defect. Once the graft has been placed in the defect, I'll use a freer elevator to really impact around the base of the defect and around the walls. This helps to fill in the potential space at the base of the defect, as well as help improve the press fit of the graft into the recipient site. Now that we've finished grafting the defect, it's time to implant the allograft plug. Don't forget to line up our north marking on the allograft plug with the north marking on the recipient site. I will just place the graft in manually. We're very careful and get an initial snug fit. Then you can actually use this Tamp or very gentle with our taps, so we don't injure the chondrocytes and we slowly tap and advance the graft until it is flush with surrounding tissue. This is essentially flush. We could probably go maybe one more millimeter. We've got a perfect fit. The graft is flush with the surrounding native cartilage. Circumferentially. My final step is I will actually take the ankle through dorsiflexion and plantar flexion, and make sure that the graft tracks appropriately without any impingement. And you can see here we've got a great arc of motion. It tracks and it's flush with the surrounding cartilage.

Talus OATS® Set