A comparison of surgical exposures for posterolateral osteochondral lesions of the talar dome

Abstract

Background: Perpendicular access to the posterolateral talar dome for the management of osteochondral defects is difficult. We examined exposure available from each of four surgical approaches.

Materials and methods: Four surgical approaches were performed on 9 Thiel-embalmed cadavers: anterolateral approach with arthrotomy; anterolateral approach with anterior talo-fibular ligament (ATFL) release; anterolateral approach with antero-lateral tibial osteotomy; and anterolateral approach with lateral malleolus osteotomy. The furthest distance posteriorly allowing perpendicular access with a 2mm k-wire was measured.

Results: An anterolateral approach with arthrotomy provided a mean exposure of the anterior third of the lateral talar dome. A lateral malleolus osteotomy provided superior exposure (81.5% vs 58.8%) compared to an anterolateral tibial osteotomy.

Conclusions: Only the anterior half of the lateral border of the talar dome could be accessed with an anterolateral approach without osteotomy. A fibular osteotomy provided best exposure to the posterolateral aspect of the talar dome.

Keywords: Osteochondral defect; Osteochondral lesion; Surgical approach; Talus.