A Novel Medial Malleolar Osteotomy Technique for the Treatment of Osteochondral Lesions of the Talus

Abstract

Background: The current techniques for medial malleolar osteotomy may lead to posterior tibial tendon injury and have a high rate of malunion. Purpose: To describe a novel partial step-cut medial malleolar osteotomy technique and evaluate its technical feasibility and its advantages compared with traditional methods. Study Design: Case series; Level of evidence, 4. Methods: The novel technique consisted of osteotomy of the anterior one-third to two-thirds of the medial malleolus. A total of 19 ankles (18 patients) with osteochondral lesions of the talus underwent the novel osteotomy technique before osteochondral reconstruction. All patients were evaluated for more than 2 years. Radiographs were analyzed for postoperative displacement and malunion, and postoperative ankle function was evaluated according to the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale and the visual analog scale (VAS) for pain. Results: The partial step-cut osteotomy technique was able to provide adequate intra-articular exposure without disturbing the posterior tibial tendon. The 19 ankles healed at a mean of 7.3 ± 1.5 weeks (range, 6-12 weeks). There was slight incongruence in 4 ankles, with a displacement of 1.0 ± 0.1 mm proximally and 0.3 ± 0.1 mm medially. The mean postoperative AOFAS and VAS scores improved compared with preoperatively, from 54.2 ± 12.1 to 84.6 ± 6.6 and from 6.4 ± 1.0 to 1.8 ± 1.3, respectively ( P < .001 for both). No intraoperative tendon injuries were observed. Conclusion: Results indicated that partial step-cut osteotomy is a reliable and effective method for providing enough exposure, avoiding displacement after reduction, and not disturbing the anatomic structures behind the medial malleolus.

The Frequency and Severity of Complications in Surgical Treatment of Osteochondral Lesions of the Talus: A Systematic Review and Meta-Analysis of 6,962 Lesions

“…Scoring the methodological quality of the 134 non-comparative studies resulted in an average score of 10.1 (range: 5-13) out of 16 points. 11,14,15,17,27 -29,36 …”

“… f Multiple studies: 15,36,39,47,48,50,60,68,70,71,74,75,83,84,87 -90,95 -97,100,105,106,108,110,120,126,128,129,132,136,138,148,151,152,154,156,159 -161,163,171 -175,178,184,188,191,193,194,197,203 . …”

“…29,38,40,49,58,65,72,77,82,94,98,101,130,139,140,142,144,145,155,157,162,166,169,181,189,192,195,201,204 e Significantly different from metal implants (Q = 3.95, P = 0.0468). 14,41,45,46,51,64,76,[78][79][80]86,99,103,107,112,114,115,124,133,147,179 f Multiple studies: 15,36,39,47,48,50,60,68,70,71,74,75,83,84,[87][88][89][90][95][96][97]100,105,106,108,110,120,126,128,…”

Arthroscopic management of large subchondral talar cyst: a novel treatment strategy

“…Conversely, larger lesions that measure 150 mm 2 or greater are at risk of articular collapse, and the treatment strategy would involve reinforcing subchondral structural support with a bone graft. These lesions are difficult to treat arthroscopically and require open surgery with a medial or lateral malleolar osteotomy to access the lesion [ 3 ]. However, open surgical techniques carry approach-related complications such as infection, risk of neurovascular injury, delayed or non-union of osteotomy site, wound healing complications and implant-related complications.…”

“…Conventional open surgical techniques carry approach-related morbidity, and arthroscopic techniques are restricted to repairing small lesions (i.e. those <150 mm 2 ) [ 3 ].…”