Arthroscopic Management of Osteochondral Lesion of Plantar Medial Talar Head

Abstract

Osteochondral lesions of the talar head can be classified into 4 types: type 1 is located at the anterior part of the talar head, type 2 is at the plantar side of the talar head, type 3 is at the plantar lateral side of the talar head, and type 4 is at the plantar medial aspect of the talar head. The purpose of this Technical Note is to describe the details of arthroscopic management of an osteochondral lesion of the plantar medial talar head. It includes arthroscopic synovectomy of the medial recess of the anterior subtalar joint, debridement, and microfracture of the osteochondral lesion.

Osteochondral lesions of the talar head – A case report, review of the literature, and novel surgical technique utilizing nano-arthroscopy and biologics

“…A report in 2019 detailed locations of talar head OCD lesions and optimal approaches to visualize the intra-articular aspects of these lesions. 48 The authors classified talar head lesions as Type 1 if located dorsal, Type 2 if located plantar, Type 3 if located plantar lateral, and Type 4 if plantar medial. 48 After patients failed conservative modalities, they suggested Type 1 lesions should be treated with talonavicular arthroscopy, Type 2 with both anterior subtalar and medial subtalar arthroscopy with possible spring ligament repair, Type 3 with anterior subtalar or calcaneocuboid arthroscopy with possible resection of any calcaneus anterior process impingement, and Type 4 with medial subtalar arthroscopy.…”

“…48 The authors classified talar head lesions as Type 1 if located dorsal, Type 2 if located plantar, Type 3 if located plantar lateral, and Type 4 if plantar medial. 48 After patients failed conservative modalities, they suggested Type 1 lesions should be treated with talonavicular arthroscopy, Type 2 with both anterior subtalar and medial subtalar arthroscopy with possible spring ligament repair, Type 3 with anterior subtalar or calcaneocuboid arthroscopy with possible resection of any calcaneus anterior process impingement, and Type 4 with medial subtalar arthroscopy. 48 The present case report demonstrates an OCD lesion that is closer to the dorsal surface of the talar head than to the plantar surface.…”

“…48 After patients failed conservative modalities, they suggested Type 1 lesions should be treated with talonavicular arthroscopy, Type 2 with both anterior subtalar and medial subtalar arthroscopy with possible spring ligament repair, Type 3 with anterior subtalar or calcaneocuboid arthroscopy with possible resection of any calcaneus anterior process impingement, and Type 4 with medial subtalar arthroscopy. 48 The present case report demonstrates an OCD lesion that is closer to the dorsal surface of the talar head than to the plantar surface. It would therefore be classified as Type 1 in this classification scheme and should be treated with talonavicular arthroscopy, as was done in this case.…”

Arthroscopic Debridement and Microfracture of Osteochondral Lesion of the Talar Head

“…Accurate localization of the osteochondral lesion by preoperative imaging is very important for making the proper choice of arthroscopic approach. The reported approach is not workable for a lesion at the medial, lateral, or plantar part of the talar head, which requires medial subtalar arthroscopy, anterior subtalar arthroscopy, or calcaneocuboid arthroscopy 8, 11, 12, 13, 14, 15, 16, 17, 18…”

“…Osteochondral lesions of the talar head are rare 1, 2, 3, 4, 5, 6, 7. They can be classified into 4 types according to their location 8 . A type 1 lesion is located at the anterior part of the talar head 2 .…”