The anterior approach for the treatment of posterior osteochondral lesions of the talus: comparison of different surgical techniques.
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.
Kreuz
Peter Cornelius
PC
Department of Orthopaedic Surgery, Albert Ludwig University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany. kreuz@ch11.ukl.uni-freiburg.de
Steinwachs
Matthias
M
Edlich
Max
M
Kaiser
Timm
T
Kaiser
Tim
T
Mika
Jörg
J
Lahm
Andreas
A
Südkamp
Norbert
N
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*