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

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.…”

“…Treatment can consist of nonsurgical cast immobilization and non-weightbearing, open arthrotomy with excision and curettement of the lesion, arthroscopic debridement with curettement and drilling, arthroscopic debridement with microfracture (MF), autologous chondrocyte transplantation, and arthrotomy with autograft or allograft using osseous or osteochondral grafts. 1,[6][7][8][9][10][11]15,16,20,22,25 Although studies show these treatments have been used with varying success, the ability to return to activity (RTA), including sports, after treatment of talar dome injuries has not been well documented. 17 Those involved in high-demand and athletic activities may desire documentation and substantiation that surgical treatments can allow them to return to their desired activity level.…”

Effect of Implantation Accuracy on Ankle Contact Mechanics with a Metallic Focal Resurfacing Implant

“…To collect baseline data regarding specimen-specific contact stress distributions, each ankle was first tested in an intact condition (i.e., with the talar dome undisturbed). The specimen was mounted on the loading device and held in 5°of plantar flexion, such that the most typical location of medial talar osteochondral lesions (the central-to-posterior aspect of the talar surface) 39,40 was principally engaged. To maintain physiologic ankle joint apposition without relying on the transected periarticular ligaments, the ankle was aligned relative to the MTS loading axis both mediolaterally and anteroposteriorly, such that moments associated with axial loading could be minimized.…”

Outcomes of arthroscopic bone graft transplantation for Hepple stage V osteochondral lesions of the talus

“…However, in these studies, surgeons obtained grafts from other parts of the patient and performed osteotomy or open surgery on patients to better expose the surgical field, which leads to donor site morbidity, additional damage to the normal tibia, and the need for a second operation to remove the screws used for fixation. It has been reported that malleolus osteotomy may lead to malunion or non-union (25) and avoiding osteotomy would eliminate the risk of altering joint congruity and nonunion or malunion of the osteotomy site (26). Furthermore, a systematic review by Shimozono et al showed that the common complications of AOT for OLT are the morbidity of the donor site as well as nerve damage, symptomatic hardware, anterior ankle impingement, and non-union of the graft or osteotomy site (27).…”