Anterior distal tibia plafondplasty for exposure of the talar dome

It may be possible to avoid malleolar osteotomy for treatment of osteochondral talar lesions with chondrocyte transplantation techniques, where perpendicular approach to the talar surface is not required. We hypothesized that limited anterior distal tibial plafondplasty would allow access to most of the talar surface. We compared talar access with soft tissue exposure versus plafondplasty.

Two soft tissue exposures (anteromedial and anterolateral) and two limited anterior distal tibial plafondplasties (anteromedial and anterolateral) were used on 12 cadaver lower-extremity specimens. Digital analysis was used to assess the accessible area.

Percentage of total talar dome surface area access increased significantly between soft tissue exposure and limited plafondplasty medially (22.3 +/- 6.3% versus 37.9 +/- 4.6%; p < 0.001) and laterally (22.4 +/- 7.7% versus 37.9 +/- 7.7%; p < 0.001). Percentage sagittal plane access also increased significantly between soft tissue exposure and limited plafondplasty medially 54.4 +/- 12.0% versus 81.3 +/- 9.7%; p < 0.001) and laterally (53.3 +/- 14.5% versus 80.9 +/- 12.8%; p < 0.001). Limited exposure to an additional 14.2 +/- 5% of the total talar surface area was possible. The posterior 10.6 +/- 8% was inaccessible.

A soft tissue approach with limited plafondplasty provided adequate exposure for the majority of the medial and lateral talar surface. Only the central posterior 10% of the talus was not accessed by this method.

It may be possible to avoid malleolar osteotomy by using limited plafondplasty to access the talar dome for treatment of osteochondral lesions if perpendicular access to the talus is not required.