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Osteochondral Lesion of the Ankle: OATS Procedure


Osteochondral autograft transfer system (OATS) procedure consists of transplanting one or various osteochondral cylinders from a donor site to a osteochondral defect to supply the smoothness and support of the articular surface that has been lost.

Indications

  • Stage III–IV osteochondral lesions of the talus

  • Diameter of <10 mm

  • Previous failure of microfracturing or retrograde grafting

Indications Pitfalls

  • Panarticular arthritis conditions

  • Smokers

  • Patients >50 years old

  • Donor site with previous pathology

  • Adjacent medial or lateral wall defect

Indications Controversies

  • Diameter of the lesion between 11 and 15 mm

  • Active >50 years old

  • Fresh osteochondral frozen graft: is a good option to avoid donor site complications, but has a slow incorporation timing and a high collapse rate

  • Single 10-mm block versus two small blocks

Examination/Imaging

Treatment Options

  • Autologous talar graft

  • Autologous knee graft

  • Allograft

  • Microfracture

  • Matrix-induced autologous chondrocyte implantation

Surgical Anatomy

Positioning

  • Decubitus supinus ( Fig. 48.7 )

    FIG. 48.7

  • Knee slightly flexed

  • Bean pillow under the leg

Positioning Pearls

  • Use a radiolucent operating bed.

  • Image intensifier must be available at all times.

Positioning Pitfalls

  • With no pillow under the leg, it is difficult to externally rotate the ankle and thus approach the lateral side (for lateral ligament reconstruction).

Positioning Equipment

  • Arthroscopy tower at the contralateral ankle side

  • C-arm at the same ankle side

  • Ankle traction equipment

Positioning Controversies

  • Lateral decubitus if the lesion is lateral or a ligament repair is needed.

  • Prone decubitus if the lesion is purely central and posterior, or there is a kissing lesion at the tibial posterior site.

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