A triplanar osteotomy technique in arthroscopy-assisted ankle mosaicplasty

Abstract

Purpose: Osteochondral lesions of the talus are lesions that are seen particularly in the young age group and are often related to sports injuries and trauma. These lesions, which show late symptoms radiologically, can be determined in the early stages with magnetic resonance imaging. The aim of this study was to present a new osteotomy technique to reduce the complications of mosaicplasty surgery to a minimum and provide an early return to work. Methods: A total of 11 patients who had cartilage lesions due to osteochondritis dissecans in the medial aspect of the talus underwent mosaicplasty after a triplanar osteotomy. The dimensions of the lesion and the depth of the triplanar osteotomy were determined preoperatively. Coronal, sagittal and transverse cuts were made at the depth defined arthroscopically. Following the osteotomy, an osteochondral graft taken from the ipsilateral knee was placed in the prepared area. Osteotomy side was fixed with one or two cannulated screws following mosaicplasty. Results: With this technique, weight-bearing can be immediate in cases with no need for osteotomy in the joint surface. In cases including the joint surface, partial weight-bearing is permitted after 4 weeks and can be increased as tolerated. In the 11 cases treated with this technique, full weight-bearing was achieved at mean 5 weeks (range, 5-8 weeks). No shift (upward displacement of osteotomized fragment) or non-union was seen in any patient. Conclusion: With the triplanar osteotomy technique described here, potential shift complications can be reduced to a minimum. As only the lesion region is targeted, the osteochondral surface formed by the fracture is much less. Study design: Case Series; Level of Evidence, 4.which show late symptoms on X-ray views, can be determined in the early stages with magnetic resonance imaging (MRI). 6,8 Therefore, MRI is applied to many cases with radiological suspicion. More than 60% of OCD lesions are seen in the medial dome of the talus. 6,9 A 9-zone grid plan was described by Raikin et al. for the localization of

Location Distribution of 2,087 Osteochondral Lesions of the Talus

“…After full-text screening, 51 studies were included. 2 , 11 - 60 There was an overall consensus in all cases of article selection between the first 2 authors.…”

“…Due to this underreporting, we were unable to compare individual location sizes within the 9-zone grid with the Student t test. 13 , 16 , 21 , 35 , 36 , 43 , 45 , 52 , 58 , 72 This can be considered a limitation of the review. Future research must focus on including the individual patient OLT-size, in order for a powerful statistical analysis on OLT-size per location to be possible.…”

The Effectiveness of Osteochondral Autograft Transfer in the Management of Osteochondral Lesions of the Talus: A Systematic Review and Meta-Analysis

“…No donor site pain was reported from any patient in the three studies that harvested the autograft from the ipsilateral talus, nor in the one study that harvested the graft from the ipsilateral distal tibia [ 41 - 44 ]. Among the 19 studies that harvested the autograft from the ipsilateral knee, two did not report on donor site pain [ 25 , 45 ], while four reported zero cases of donor site pain, including one which harvested the autograft from the posterior femoral condyle [ 16 , 17 , 22 , 37 ]. Across the remaining 13 studies that harvested the autograft from the ipsilateral knee, a total of 48 out of 532 (9%) patients reported donor site pain at the final follow-up.…”

“…In addition, they did not perform a meta-analysis of their results. Finally, since the publication of that systematic review, a number of studies have been performed and published [14,[16][17][18][19][20][21][22][23][24][25]. Therefore, the aim of this systematic review and meta-analysis was to evaluate the current evidence for the use of OATS in the management of OLT.…”

“…FIGURE 3: Forest Plot Depicting Meta-Analysis of AOFAS Score SD = Standard Deviation; CI = Confidence Interval; AOFAS = American Orthopaedic Foot & Ankle ScoreSource: References[17,20,22,[40][41][42]44,45] …”