The anterior approach for the treatment of posterior osteochondral lesions of the talus: comparison of different surgical techniques

Abstract

The removal of a tibial bone block and its subsequent replacement is a useful technique to access osteochondral talar lesions for osteochondral transplantation for which arthroscopic interventions have failed. The results are comparable to other anterior approaches described in the literature.

Articular Talar Injuries in Athletes

“…A number of surgical techniques have been described for these injuries, including excision of loose fragments and debridement of the lesion, "chondroplasty," 7,11,23,28 reduction and fixation of the involved fragment, 7,9,25 antegrade or retrograde drilling, 15,18,26 MF,5,11,21,28 bone grafting, 8,14 chondrocyte implantation, 29 and osteochondral autograft or allograft transplantation. [2][3][4][10][11][12]16 Thorough study of patients' activity levels such as athletics and the time it takes to return to these activities has not been well documented with talar lesions before our study. Furthermore, there has not been a consensus as to defining what actual RTA is.…”

Osteochondral Lesions of the Talus: Retrograde Drilling with High-Field-Strength MR Guidance

“…Furthermore, many lesions are located in the posterior part of the talar dome. Thus, they are difficult to depict and access with anterior arthroscopy (13). Moreover, the complex anatomy of the ankle joint makes exact retrograde drilling of the ankle without damaging the articular cartilage technically demanding; therefore, various navigation methods have been developed.…”

“…In addition, a substantial disadvantage of all antegrade drilling techniques is that the hyaline cartilage must be drilled, and therefore damaged. With the transmalleolar antegrade drilling technique, the malleolar joint cartilage is also damaged (13). To overcome these potential problems, retrograde drilling techniques have been developed; however, the complex anatomy of the ankle makes precise retrograde drilling without perforation of the joint cartilage technically demanding (12).…”

“…Arthroscopic drilling is an effective and minimally invasive treatment. However, dorsomedial talar dome lesions are frequently inaccessible with antegrade drilling techniques (13). In addition, a substantial disadvantage of all antegrade drilling techniques is that the hyaline cartilage must be drilled, and therefore damaged.…”

Branching Patterns of the Superficial Peroneal Nerve: Implications for Ankle Arthroscopy and for Anterolateral Surgical Approaches to the Ankle

“…Of these, 6 patients had minor perioperative complications, 1 of which (16.7% of all perioperative complications) was a superficial peroneal nerve laceration (24). In a 2004 study of 13 patients undergoing treatment of posterior osteochondral lesions of the talus by an anterior approach to the ankle, 1 patient (7.7% of all patients and 33% of total postoperative complications in the study) reported disturbing tingling on the dorsum of the foot due to iatrogenic injury to the SPN (25).…”