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A quantitative comparison of surgical approaches for posterolateral osteochondral lesions of the talus.

Publication ,  Journal Article
Garras, DN; Santangelo, JA; Wang, DW; Easley, ME
Published in: Foot Ankle Int
April 2008

BACKGROUND: Exposure of the posterolateral talar dome for osteochondral autograft transfer can be challenging. The purpose of this study is to compare surgical exposures for perpendicular access to the posterolateral talar dome using osteochondral transfer instrumentation. MATERIALS AND METHODS: Five surgical approaches were performed on each of eight cadaveric ankles. The sequence was: (1) Anterolateral arthrotomy with ATFL release, (2) Anterolateral tibial osteotomy, (3) Fibular osteotomy with ATFL intact, (4) Fibular osteotomy with ATFL release, and (5) Fibular osteotomy with ATFL/CFL release. (ATFL repaired between 1 and 2). While maintaining the orientation of the harvester perpendicular to the talar dome articular surface, osteochondral plugs were harvested as far posteriorly as possible using a 6-mm harvester. Distances from the anterior talar articular surface to the posterior aspect of the recipient site were measured. Statistical analysis used ANOVA and Fisher post hoc tests. RESULTS: Average AP exposure (mm) and percentage of AP talar dome dimensions exposed: (1) Anterolateral arthrotomy with ATFL release: 21.2 mm (43.3%), (2) Anterolateral tibial osteotomy: 33.7 mm (68.5%), (3) Fibular osteotomy(ATFL intact): 43.2 mm (87.8%), (4) Fibular osteotomy with ATFL release: 44.9 mm (91.2%), and (5) Fibular osteotomy with ATFL/CFL release: 46.6 mm (94.6%). All osteotomies provided greater exposure than anterolateral arthrotomy with ATFL release (p < 0.0001). A significant difference was obtained between each of the fibular osteotomies and tibial osteotomy (p < 0.0001). Differences between the fibular osteotomy approaches (3 to 5) were not significant. CONCLUSION: Fibular osteotomy provides the greatest perpendicular exposure to the posterolateral talar dome. Anterolateral tibial osteotomy provides greater exposure than arthrotomy alone. CLINICAL RELEVANCE: This study provides a guide for surgical exposures to the posterolateral talar dome for osteochondral autograft transfer.

Duke Scholars

Published In

Foot Ankle Int

DOI

ISSN

1071-1007

Publication Date

April 2008

Volume

29

Issue

4

Start / End Page

415 / 420

Location

United States

Related Subject Headings

  • Tibia
  • Talus
  • Osteotomy
  • Osteochondritis
  • Orthopedics
  • Lateral Ligament, Ankle
  • Humans
  • Fibula
  • Cadaver
  • Bone Transplantation
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Garras, D. N., Santangelo, J. A., Wang, D. W., & Easley, M. E. (2008). A quantitative comparison of surgical approaches for posterolateral osteochondral lesions of the talus. Foot Ankle Int, 29(4), 415–420. https://doi.org/10.3113/FAI.2008.0415
Garras, David N., James A. Santangelo, David W. Wang, and Mark E. Easley. “A quantitative comparison of surgical approaches for posterolateral osteochondral lesions of the talus.Foot Ankle Int 29, no. 4 (April 2008): 415–20. https://doi.org/10.3113/FAI.2008.0415.
Garras DN, Santangelo JA, Wang DW, Easley ME. A quantitative comparison of surgical approaches for posterolateral osteochondral lesions of the talus. Foot Ankle Int. 2008 Apr;29(4):415–20.
Garras, David N., et al. “A quantitative comparison of surgical approaches for posterolateral osteochondral lesions of the talus.Foot Ankle Int, vol. 29, no. 4, Apr. 2008, pp. 415–20. Pubmed, doi:10.3113/FAI.2008.0415.
Garras DN, Santangelo JA, Wang DW, Easley ME. A quantitative comparison of surgical approaches for posterolateral osteochondral lesions of the talus. Foot Ankle Int. 2008 Apr;29(4):415–420.
Journal cover image

Published In

Foot Ankle Int

DOI

ISSN

1071-1007

Publication Date

April 2008

Volume

29

Issue

4

Start / End Page

415 / 420

Location

United States

Related Subject Headings

  • Tibia
  • Talus
  • Osteotomy
  • Osteochondritis
  • Orthopedics
  • Lateral Ligament, Ankle
  • Humans
  • Fibula
  • Cadaver
  • Bone Transplantation