Talar Dome Access for Osteochondral Lesions

Abstract

Background Recently, osteochondral grafting has become a popular procedure for treating challenging talar dome lesions. However, no guidelines exist for selection of the surgical approach to obtain perpendicular access to the talar dome. Hypothesis The majority of the talar dome can be accessed for perpendicular resurfacing procedures without need for osteotomy. Study Design Descriptive laboratory study. Methods Nine human cadaveric ankles were dissected in a standard fashion to expose the talar dome. Seven approaches were used, including 4 arthrotomies (anteromedial, anterolateral, posteromedial, and posterolateral) and 3 osteotomies (anterolateral [Chaput], distal fibula, and medial malleolar). The area available for perpendicular access to the dome was determined for each approach. Results On average, 17% (range, 10%-24%) of the medial talar dome and 20% (range, 16%-25%) of the lateral talar dome could not be accessed without osteotomy. On the lateral aspect of the superior talar dome surface, an anterolateral osteotomy adds a mean of 22% to sagittal plane exposure. Malleolar osteotomies, when performed using the method described, provide access to the entire medial and lateral sides; however, there remains a mean residual 15% (range, 11%-38%) of the central talar dome that cannot be accessed in a perpendicular manner with any approach. Conclusion Most of the talar dome can be accessed perpendicularly for resurfacing without malleolar osteotomy. Osteotomies substantially increase the access and are needed for extensive lesions. Part of the central portion of the talar dome is inaccessible to perpendicular resurfacing techniques with any standard approach. Clinical Relevance This study generated clear clinical guidelines to help decision making regarding the surgical approach to resurface the talar dome with osteochondral techniques. The majority of the talar dome can be accessed without osteotomy.