Keun-Bae Lee1, Hyun-Kee Yang, Eun-Sun Moon, Eun-Kyoo Song. 1. Department of Orthopedic Surgery, Chonnam National University Medical School & Hospital, 8 Hakdong, Donggu, Gwangju, 501-757, Korea. kbleeos@chonnam.ac.kr
Abstract
BACKGROUND: Osteochondral grafting for the treatment of osteochondral lesions of the talus (OLT) usually requires a medial malleolar osteotomy (MMO) to achieve adequate intraarticular exposure. This study describes the technique used and the results obtained using a modified step-cut MMO for osteochondral grafting of talar dome lesions. MATERIALS AND METHOD: Eleven feet in ten patients underwent modified step-cut MMO prior to osteochondral grafting for OLT. The patients included three women and seven men with a mean age of 40 (range, 20 to 51) years. Modified step-cut MMO consisted of an oblique osteotomy, which was made at approximately 45 degrees to the transverse plane of the proposed traditional step-cut osteotomy, and a vertical osteotomy to the axilla on the medial tibial plafond. RESULTS: In all patients, modified step-cut MMO provided better perpendicular access to lesions than traditional step-cut osteotomy. In all cases, the osteochondral graft plug was accurately set perpendicular to the defect area, and all ten patients experienced uncomplicated osteotomy healing at a mean 8 weeks postoperatively without loss of reduction or malreduction. CONCLUSION: Modified step-cut MMO is an excellent, reproducible method for perpendicular access to a talar dome lesion.
BACKGROUND: Osteochondral grafting for the treatment of osteochondral lesions of the talus (OLT) usually requires a medial malleolar osteotomy (MMO) to achieve adequate intraarticular exposure. This study describes the technique used and the results obtained using a modified step-cut MMO for osteochondral grafting of talar dome lesions. MATERIALS AND METHOD: Eleven feet in ten patients underwent modified step-cut MMO prior to osteochondral grafting for OLT. The patients included three women and seven men with a mean age of 40 (range, 20 to 51) years. Modified step-cut MMO consisted of an oblique osteotomy, which was made at approximately 45 degrees to the transverse plane of the proposed traditional step-cut osteotomy, and a vertical osteotomy to the axilla on the medial tibial plafond. RESULTS: In all patients, modified step-cut MMO provided better perpendicular access to lesions than traditional step-cut osteotomy. In all cases, the osteochondral graft plug was accurately set perpendicular to the defect area, and all ten patients experienced uncomplicated osteotomy healing at a mean 8 weeks postoperatively without loss of reduction or malreduction. CONCLUSION: Modified step-cut MMO is an excellent, reproducible method for perpendicular access to a talar dome lesion.
Authors: Christiaan J A van Bergen; Gabriëlle J M Tuijthof; Inger N Sierevelt; C Niek van Dijk Journal: Arch Orthop Trauma Surg Date: 2010-12-17 Impact factor: 3.067