The Use of HemiCAP for the Treatment of Osteochondral Lesions

Osteochondral defects of the talus are located on the medial talar dome in most cases. Arthroscopic debridement and microfracture is the preferred primary treatment for defects up to 15 mm. The optimal secondary treatment for osteochondral defects of the talus after failed primary surgical treatment has yet to be determined. Current methods such as osteochondral autograft transfer have disadvantages including donor site morbidity. A metal resurfacing inlay implant with a diameter of 15 mm (HemiCAP) was developed for treatment of osteochondral defects of the medial talar dome. The operative approach by means of a medial malleolar osteotomy and the implantation technique is reproducible. Intra-articular contact stresses are acceptable with proper implantation, that is, recessed relative to the adjacent cartilage level. A prospective study evaluated the clinical effectiveness. Overall, 20 consecutive patients were studied for a mean period of 3 years (range: 2-5 years). There was statistically significant reduction of pain and improvement of validated ankle outcome scores and quality of life scores. One patient required a reoperation for the osteochondral defect. The promising clinical outcomes indicate that the metal implantation technique is a reasonable alternative to current secondary treatment methods for osteochondral defects of the medial talar dome after failed previous treatment.