Surgical approaches to osteochondral lesions of the talus

Abstract

Arthroscopic techniques still represent the treatment of choice in osteochondral lesions of the talus (OLT). Open techniques may be used as an alternative or may be complementary to arthroscopic treatments. They are especially indicated in cases of large osteochondral lesions, difficult localisations and in cases of recurrent interventions. In addition to the type of treatment for the lesion itself, the choice of an ideal surgical approach is of paramount importance. Indications, operative technique, possible complications and rehabilitation are described in detail for each approach. Anterolateral, anteromedial, posterolateral and posteromedial soft-tissue approaches as well as medial and lateral malleolar osteotomies are discussed. If a distraction is not desired with arthroscopy, posteromedial and posterolateral soft-tissue approaches offer a good alternative for the treatment of posterior OLT. Osteotomy of the (medial) malleolus offers good visualisation of the medial talar dome. With the introduction of new techniques of osteochondral transplantations, the use of this approach is becoming more popular. However, it is an invasive technique and the risk of secondary osteoarthritis after malleolar osteotomy still needs to be determined.

Die Behandlung von dorsalen osteochondralen Defekten des Talus �ber einen erweiterten Zugang

“…Pseudarthroses as reported after medial malleolar osteotomy by several authors [4,9,11,[15][16][17] have obviously not been observed after refixation of the tibial bone block by Sammarco & Makwana and us.…”

“…Tibial wedge osteotomy · Osteochondritis dissecans · Osteochondral defect · Cartilage regeneration flexorum zu einer Subluxation oder einem Impingement der Sehnen mit entsprechend verzögerter oder unbefriedigender Rehabilitation, zu einer Dehnung des Gefäß-Nerven-Bündels oder einer Pseudarthrose, aber auch zu Inkongruenzen im Gelenkbereich mit nachfolgender Arthrose führen [4,9,11,[15][16][17] ation or impingement of the tendons interfering with rehabilitation, stretching of the neurovascular bundle and nonunion but also to incongruity of the articular surface with subsequent osteoarthritis [4,9,11,[15][16][17]. For these reasons a new approach has been developed without involving the malleoli: the temporary removal of a bone block from the weight-bearing anterior part of the distal tibia.…”

Computer based systems in foot and ankle surgery at the beginning of the 21st century

“…Arthroscopically guided drillings are limited to those lesion that could be arthroscopically identified [60]. In the remaining cases, open procedures are justified [57]. Based on these principles, CT-based computer assisted surgery (CAS) guided retrograde drilling of osteochondral lesions has been described with promising results as a new technique [19,52].…”

Navigierte retrograde Anbohrung bei Osteochondrosis dissecans (OCD) des Talus

“…Eine weitere Option ist die röntgenbildverstärker-gestützte retrograde Anbohrung, die aber aufgrund der schlechten Visualisierung wenig Erfolg versprechend ist [15]. Daher sehen einige Autoren auch die Indikation für ein offenes Vorgehen [19]. Dafür ist aber häufig ein ausgedehnter Zugang mit Osteotomie nötig [19].…”

“…Daher sehen einige Autoren auch die Indikation für ein offenes Vorgehen [19]. Dafür ist aber häufig ein ausgedehnter Zugang mit Osteotomie nötig [19]. Zur genaueren und weniger schädigenden retrograden Bohrung wurde die Computertomographie (CT)-basierte computerassistierte Chirurgie (CAS)-gesteuerte Technik beschrieben [2,7,10,18].…”