title: Modified step-cut medial malleolar osteotomy for osteochondral grafting of the talus.
abstract: 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.
authors.affiliation: Department of Orthopedic Surgery, Chonnam National University Medical School & Hospital, 8 Hakdong, Donggu, Gwangju, 501-757, Korea. kbleeos@chonnam.ac.kr
authors.forename: Keun-Bae
authors.initials: KB
authors.lastname: Lee
authors.forename: Hyun-Kee
authors.initials: HK
authors.lastname: Yang
authors.forename: Eun-Sun
authors.initials: ES
authors.lastname: Moon
authors.forename: Eun-Kyoo
authors.initials: EK
authors.lastname: Song
mesh_terms: 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