Access to the talar dome through the medial posterolateral approach: an anatomical study.

Abstract

Background: The osteochondral grafting has become a popular procedure for treating challenging talar dome lesions. However, the vast majority are treated through medial malleolus osteotomy. The aim of this study was to determine the posteromedial area of the talus that can be reached without malleolar osteotomy through the posteromedial approach. Study Design: Descriptive laboratory study. Evidence Level 4 Methods: Fifteen human cadaveric ankles were dissected in a standard fashion to expose the posteromedial talar dome. Seven approaches were used on the cadaver's left limb (46.7%). We did not observe any significant difference between the evaluated sides (chi-square test, p = 0.715).  Results: On average, 2,09 cm2 (range, 1,72-2,69) of the posteromedial talus dome or 15,27 % (range 12-20) of total talus dome can be accessed without osteotomy. Conclusion: If the osteochondral lesion is within the area accessible through PM approach (mean 2 cm2), as seen on magnetic resonance imaging, it is possible that it can be treated without a medial malleolus osteotomy. Keywords: talus; osteochondral lesions; osteotomy; arthrotomy; surgery