Posteromedial Approach for Osteochondral Lesions of the Talus

Abstract

Background: Medial malleolar osteotomy is an established procedure for accessing the medial localized osteochondral lesions of the talus. The purpose of this study was to describe a single approach, which allows perpendicular access to the lesion without a malleolar osteotomy. Methods: Six patients were treated surgically for medial localized talar osteochondral lesions. Four patients had stage III and 2 patients had stage IV lesions. A single posteromedial approach was used for accessing the medial talar dome. Results: The method of treatment was mosaicplasty in 4 patients and osteochondral fragment fixation in 2 patients. One patient who was treated with a fragment fixation procedure showed screw loosening. Incorporation of the osteochondral grafts was proved by magnetic resonance imaging in all mosaicplasty cases. Conclusion: A single posteromedial approach was sufficient in the posteromedial localized osteochondral lesion of the talus. As the lesion was approached by soft tissue exposure only, a malleolar osteotomy was not required. Thus, osteotomy-related complications were avoided. Level of Evidence: Level IV, retrospective case series.

Effect analysis of iliac bone autografting for Hepple V osteochondral lesions of the talus

“…The two common types of OLT are anterolateral and posteromedial. Anterolateral OLT occurs in about 42% of cases and has an acute onset, mostly due to inversion sprain of the ankle during dorsiflexion, resulting in an oval shallow lesion; posteromedial OLT (about 58%) is caused by repetitive microtrauma or overload, mostly due to inversion sprain during plantarflexion, resulting in a cup-shaped deep lesion [ 6 – 10 ].…”

Use of Small-Pin Distraction and Low-Speed, High-Torque Burring for Talar Osteochondral Allografts: Technique Tip

“…However, osteotomies disrupt intact distal joint surfaces, create another region of bony injury that can result in nonunion and arthritis, and require additional hardware that can become symptomatic. 2,3,7,18,19 To avoid osteotomy, there has been interest in application of a posteromedial approach to the talus, both in isolation and in combination with anterior approaches. 17 Nonetheless, even after approaching the talus from concurrent anterior and posterior medial approaches, nearly 20% of the talus remains inaccessible.…”

Medial Transmalleolar Portal Technique for Ankle Arthroscopic Headless Screw Fixation of Talar Osteochondritis Dissecans Lesions

“…This approach gives access to lesions in this location without a medial malleolar osteotomy; however, it requires a 6cm longitudinal incision and runs the risk of damaging the posterior tibial artery and tibial nerve. 11 Combined posteromedial and posterolateral arthroscopic portals have also been described that give access to the posterior process of the talus, zones 7 to 9, and more posteriorly located lesions in zones 4 to 6. 12,13 This technique offers the advantage of avoiding complications associated with posteromedial and posterolateral arthrotomies.…”

“…This technique also circumvents the need for extensive soft tissue dissection and avoids potential complications associated with open techniques. 11,17,19,20 Fixation of talus OCD with screws is ideal for nondisplaced or minimally displaced lesions with intact cartilage. 21,22 Other techniques such osteochondral autograft may be possible through the medial transmalleolar portal.…”