Medial approaches to osteochondral lesion of the talus without medial malleolar osteotomy

  • Ki Won Young
  • Jonathan T. Deland
  • Kyung Tai Lee
  • Young Koo LeeEmail author


The purpose of this study was to determine the area of the talus that can be reached through combined anterior and posterior arthrotomy without medial malleolar osteotomy. Five fresh-frozen cadaver foot-ankle specimens were examined using posteromedial approach and anteromedial approach. We calculated the size of the marked area beginning from the posteromedial corner of the talus in the posteromedial approach and beginning from the anteromedial corner in the anteromedial approach. From the posteromedial talus, we can access 33% of the talus’ AP length and 30% of its medial to lateral length through a posteromedial approach. From the anteromedial arthrotomy, 50% of the AP length and 31% of the medial to lateral length can be reached. This leaves approximately 20% that is not accessible. If the osteochondral lesion is within the accessible area through either a posteromedial or anteromedial approach as viewed on MRI/CT, it can be safely reached without a medial malleolar osteotomy.


Osteochondral lesion of talus Medial malleolar osteotomy Surgical approach 


  1. 1.
    Alexander AH, Lichtman DM (1980) Surgical treatment of transchondral talar-dome fractures (osteochondritis dissecans). Long-term follow-up. J Bone Joint Surg Am 62:646–652PubMedGoogle Scholar
  2. 2.
    Angermann P, Jensen P (1989) Osteochondritis dissecans of the talus: long-term results of surgical treatment. Foot Ankle 10:161–163PubMedGoogle Scholar
  3. 3.
    Bauer M, Jonsson K, Linden B (1987) Osteochondritis dissecans of the ankle. A 20-year follow-up study. J Bone Joint Surg Br 69:93–96PubMedGoogle Scholar
  4. 4.
    Berndt AL, Harty M (1959) Transchondral fractures (osteochondritis dissecans) of the talus. J Bone Joint Surg Am 41-A:988–1020PubMedGoogle Scholar
  5. 5.
    Canale ST, Belding RH (1980) Osteochondral lesions of the talus. J Bone Joint Surg Am 62:97–102PubMedGoogle Scholar
  6. 6.
    Flick AB, Gould N (1985) Osteochondritis dissecans of the talus (transchondral fractures of the talus): review of the literature and new surgical approach for medial dome lesions. Foot Ankle 5:165–185PubMedGoogle Scholar
  7. 7.
    Gautier E, Kolker D, Jakob RP (2002) Treatment of cartilage defects of the talus by autologous osteochondral grafts. J Bone Joint Surg Br 84:237–244CrossRefPubMedGoogle Scholar
  8. 8.
    Kumai T, Takakura Y, Higashiyama I, Tamai S (1999) Arthroscopic drilling for the treatment of osteochondral lesions of the talus. J Bone Joint Surg Am 81:1229–1235PubMedGoogle Scholar
  9. 9.
    Mendicino RW, Hallivis RM, Cirlincione AS, Catanzariti AR, Krause N (2000) Osteochondral autogenous transplantation for osteochondritis dissecans of the ankle joint. J Foot Ankle Surg 39:343–348CrossRefPubMedGoogle Scholar
  10. 10.
    O’Farrell TA, Costello BG (1982) Osteochondritis dissecans of the talus. The late results of surgical treatment. J Bone Joint Surg Br 64:494–497PubMedGoogle Scholar
  11. 11.
    Parisien JS (1986) Arthroscopic treatment of osteochondral lesions of the talus. Am J Sports Med 14:211–217CrossRefPubMedGoogle Scholar
  12. 12.
    Scharling M (1978) Osteochondritis dissecans of the talus. Acta Orthop Scand 49:89–94PubMedCrossRefGoogle Scholar
  13. 13.
    Schimmer RC, Dick W, Hintermann B (2001) The role of ankle arthroscopy in the treatment strategies of osteochondritis dissecans lesions of the talus. Foot Ankle Int 22:895–900PubMedGoogle Scholar
  14. 14.
    Shea MP, Manoli A 2nd (1993) Osteochondral lesions of the talar dome. Foot Ankle 14:48–55PubMedGoogle Scholar
  15. 15.
    Thompson JP, Loomer RL (1984) Osteochondral lesions of the talus in a sports medicine clinic. A new radiographic technique and surgical approach. Am J Sports Med 12:460–463CrossRefPubMedGoogle Scholar
  16. 16.
    Tol JL, Struijs PA, Bossuyt PM, Verhagen RA, van Dijk CN (2000) Treatment strategies in osteochondral defects of the talar dome: a systematic review. Foot Ankle Int 21:119–126PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Ki Won Young
    • 1
  • Jonathan T. Deland
    • 2
  • Kyung Tai Lee
    • 1
  • Young Koo Lee
    • 3
    Email author
  1. 1.Foot and Ankle Service, Department of Orthopedic Surgery, Eulji Hospital, School of MedicineEulji UniversitySeoulRepublic of Korea
  2. 2.Foot and Ankle Service, Hospital for Special SurgeryConell UniversityNew YorkUSA
  3. 3.Department of Orthopedic Surgery, Bucheon HospitalSoonchunhyang UniversityBucheon-SiRepublic of Korea

Personalised recommendations