Modified step-cut medial malleolar osteotomy for osteochondral grafting of the talus.
BACKGROUND
Osteochondral grafting for the treatment of osteochondral lesions of the talus (OLT) usually requires a medial malleolar osteotomy (MMO) to achieve adequate intraarticular exposure. This study describes the technique used and the results obtained using a modified step-cut MMO for osteochondral grafting of talar dome lesions.


METHODS
Eleven feet in ten patients underwent modified step-cut MMO prior to osteochondral grafting for OLT. The patients included three women and seven men with a mean age of 40 (range, 20 to 51) years. Modified step-cut MMO consisted of an oblique osteotomy, which was made at approximately 45 degrees to the transverse plane of the proposed traditional step-cut osteotomy, and a vertical osteotomy to the axilla on the medial tibial plafond.


RESULTS
In all patients, modified step-cut MMO provided better perpendicular access to lesions than traditional step-cut osteotomy. In all cases, the osteochondral graft plug was accurately set perpendicular to the defect area, and all ten patients experienced uncomplicated osteotomy healing at a mean 8 weeks postoperatively without loss of reduction or malreduction.


CONCLUSIONS
Modified step-cut MMO is an excellent, reproducible method for perpendicular access to a talar dome lesion.
Lee
Keun-Bae
KB
Department of Orthopedic Surgery, Chonnam National University Medical School & Hospital, 8 Hakdong, Donggu, Gwangju, 501-757, Korea. kbleeos@chonnam.ac.kr
Yang
Hyun-Kee
HK
Moon
Eun-Sun
ES
Song
Eun-Kyoo
EK
D000328:Adult; D016025:Bone Transplantation; D015331:Cohort Studies; D005260:Female; D005269:Femur / Q000637:transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D010008:Osteochondritis Dissecans / Q000601:surgery*; D010027:Osteotomy / Q000379:methods*; D012189:Retrospective Studies; D013628:Talus; D013977:Tibia / Q000601:surgery*; D014182:Transplantation, Autologous; D055815:Young Adult