1 3 Arch Orthop Trauma Surg (2014) 134:843–852 DOI 10.1007/s00402-014-1991-y ARTHROSCOPY AND SPORTS MEDICINE Osteochondral transplantation for the treatment of osteochondral defects at the talus with the Diamond twin system ® and graft harvesting from the posterior femoral condyles Wolf Petersen · Pouria Taheri · Benedikt Schliemann · Andrea Achtnich · Cara Winter · Phillip Forkel Received: 10 November 2013 / Published online: 18 April 2014 © Springer-Verlag Berlin Heidelberg 2014 was stable with surrounding cartilage. The average ICRS Cartilage Repair Assessment was 10.1 points (±1.3). All malleolar osteotomies healed radiologically. In 15 patients, a synovectomy and local debridement of the ankle were performed at second-look arthroscopy. Ankle pain at walk- ing, running and stair climbing as measured by a visual analog scale (10-0) decreased significantly from preopera- tively to the first follow-up (mean 12.6 months) and to the second follow-up (mean 25.8 months). The ankle-related quality of life increased significantly from preoperatively to postoperatively. There was no significant change in the Lysholm score. The activity measured with the Tegner activity scale increased significantly from preoperatively to the last follow-up, but only two out of nine patients contin- ued pivoting sports. Conclusions Autologous osteochondral grafting with the Diamond twin system is a reliable treatment option for symptomatic osteochondral defects of the talus. After 1 year, the majority of patients had still some complaints. However, after screw removal and second-look arthroscopy, the pain and ankle-related quality of life further improved. Clinical relevance The donor site morbidity after graft harvesting from the posterior aspects of the femoral con- dyles is lower than previously reported. Keywords Osteochondral lesion · Tricalcium phosphate · Ceramic bone substitute · Activity · Donor site morbidity · Osteoarthritis · Cartilage repair · Subchondral bone plate Introduction Osteochondral grafting is a treatment option for stage IV osteochondral defects of the talus. Several techniques for osteochondral grafting have been described in the literature Abstract Background The aim of this study is to analyze clinical results after osteochondral cylinder transplantation for oste- ochondral defects at the medial or lateral talar dome using the Diamond twin system (Karl Storz). We hypothesize that grafts harvesting from the posterior femoral condyles are associated with less donor site morbidity than reported by previous studies. Methods We have surgically treated 20 patients with an osteochondral defect of the talus by osteochondral trans- plantation with the Diamond twin system via an osteotomy of the ankle. The osteochondral cylinders were harvested from the posterior aspects of the femoral condyles of the ipsilateral knee. The defects at donor site were filled with a bone substitute of tricalcium phosphate (Synthricer, Karl Storz). The mean age was 25.4 years. After a mean time of 12.6 months, the screws at the medial malleolus were removed and an arthroscopy was performed. The func- tional outcome was evaluated with the visual analog scale for pain at walking, running, stair climbing, quality of life at the time of implant removal and at a mean follow-up of 25.8 months. Activity was assessed with the Tegner scale. Knee function was evaluated with the Lysholm score. Results In one case, the osteochondral cylinder did not heal and an osteochondral fragment was removed arthro- scopically. In all other cases, the osteochondral cylinder W. Petersen (*) · P. Taheri · A. Achtnich · C. Winter · P. Forkel Department of Orthopaedic and Trauma Surgery, Martin Luther Hospital, Grunewald, Caspar Theyss Strasse 27-31, 14193 Berlin, Germany e-mail: w.petersen@mlk-berlin.de B. Schliemann Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany