autograft

Definition

Defect of cartilage +/bone

Typically on talus

Options

Distal Tibial Allograft

Indication

Bony defects > 30 %

Options

- Latarjet - may be insufficient for lesions in the region of 50%

- Iliac crest - associated with high incidence of OA
- distal tibial allograft - radius of curvature matches glenoid highly

Bone Healing

Bone healing requires 3 things

- osteoconduction - scaffold / matrix

- osteoinduction - growth factors

- osteogenesis - cells  to produce osteoid

Osteoconduction

Definition

- property of a matrix that supports the attachment of bone forming cells for subsequent bone formation

Substances

Scenarios

1.  Isolated LCL injury

2.  Isolated Posterolateral Corner

3.  PCL + posterolateral corner

4.  ACL / posterolateral corner

5.  ACL / PLC / posterolateral corner

Repair versus Reconstruction

Levy et al. Am J Sports Med 2010

- failure in 4/10 knees treated with acute primary repair

Harvest graft

Graft selection

A.  Synthetic Grafts

Good initial results but unacceptably high failure rate with longer follow-up

Problems

1.   Too stiff (low ultimate strain) 

- poor resistance to abrasion

- ligament failure by attrition most common

2.  Recurrent synovitis, infection, loosening and osteolysis

B.  Autograft