A transligamentous approach for lateral osteochondral defect: A case report

Abstract

Osteochondral defects of the talus are insidious yet common post operative sequela of ankle trauma. Nondisplaced osteochondral lesions are first treated conservatively. If this option fails, surgical intervention is often warranted. In larger lesions, uncontained shoulder lesions, or lesions that have failed arthroscopic intervention, an open enbloc osteochondral bone graft treatment may be indicated. Conventional anterior and medial malleolar osteotomy approaches do not allow access to the posterolateral talus for bulk allograft procedures. This case report provides the first known in vivo description of a transligamentous approach for lesions of the lateral and posterolateral talar dome. A 31-year-old male presented to our institution with a sizable osteochondral fracture along the mid to posterolateral margin of the talar dome. A single incision, lateral transligamentous approach was utilized to visualize the lesion which was resected in its entirety with a sagittal saw. A size matched fresh talar allograft was then cut with a sagittal saw to obtain a size matched bony allograft. This was then press fit into the defect within the patient's talar dome and fixed with a partially threaded, headless 3.0 screw buried deep to the cartilage. The patient remained non weight bearing for 12 weeks followed by protected weightbearing in a removal cast boot for 2 weeks and then full weight bearing in a shoe at 14 weeks post op. At final follow up 15 months post-operative the patient remained pain free. Final radiographs reveal a well incorporated bulk talar allograft with physical exam demonstrating a stable ligamentous complex and full range of tibiotalar motion without pain.

Level of clinical evidence

IV-Case Report