title: The anterior approach for the treatment of posterior osteochondral lesions of the talus: comparison of different surgical techniques.
abstract: BACKGROUND
  Most of all osteochondral talar lesions are located in the middle and posterior area of the talar surface. Malleolar osteotomy is often used to access the defect but may be associated with malunion or secondary osteoarthritis. We present an alternative approach to the talus with temporary removal and replacement of a tibial bone block and compare it with other anterior approaches described in the literature.
  
  
  METHODS
  Thirteen patients (5 males, 8 females) with an average age of 27.2 years and an osteochondral talar lesion were included in our study. All patients were previously operated on the same ankle. Ten lesions were caused by a sports injury. The average follow up was 45 months. The patients were evaluated before and after surgery using the ankle and hindfood score (AOFAS). For the analyses baseline clinical data were compared with follow up data using the Wilcoxon test.
  
  
  RESULTS
  The overall improvement between the preoperative and postoperative AOFAS scores was an average of 34.9 points (P=0.0002). No complications occurred at the site of the tibial bone block and the donor site at the talus. There were no patients with recurrence or an ankle osteoarthrosis in the follow up period.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Orthopaedic Surgery, Albert Ludwig University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany. kreuz@ch11.ukl.uni-freiburg.de
authors.forename: Peter Cornelius
authors.initials: PC
authors.lastname: Kreuz
authors.forename: Matthias
authors.initials: M
authors.lastname: Steinwachs
authors.forename: Max
authors.initials: M
authors.lastname: Edlich
authors.forename: Timm
authors.initials: T
authors.lastname: Kaiser
authors.forename: Tim
authors.initials: T
authors.lastname: Kaiser
authors.forename: Jörg
authors.initials: J
authors.lastname: Mika
authors.forename: Andreas
authors.initials: A
authors.lastname: Lahm
authors.forename: Norbert
authors.initials: N
authors.lastname: Südkamp
mesh_terms: D000293:Adolescent; D000328:Adult; D000843:Ankle Joint / Q000601:surgery*; D002357:Cartilage Diseases / Q000601:surgery*; D002358:Cartilage, Articular; D005260:Female; D006801:Humans; D007592:Joint Diseases / Q000601:surgery*; D008297:Male; D019637:Orthopedic Procedures / Q000379:methods*