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Access to the talar dome surface with different surgical approaches
Francesc Malagelada1, Miki Dalmau-Pastor2, Jordi Vega3
1Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom; Laboratory of Arthroscopic and Surgical Anatomy, Department of Pathology and Experimental Therapeutics (Human Anatomy and Embryology Unit), University of Barcelona, Barcelona, Spain.
Summary
Standard ankle approaches provide limited access to specific talar dome zones for osteochondral lesion treatment. Preoperative planning is crucial for optimal surgical outcomes.
Area of Science:
- Orthopedic surgery
- Anatomy
- Biomechanics
Background:
- Osteochondral lesions (OCLs) of the talar dome require surgical access.
- A nine-grid scheme aids in localizing OCLs on the talus.
- Current literature lacks data correlating ankle approaches with talar grid zones.
Purpose of the Study:
- To evaluate the accessibility of each talar dome zone via standard ankle approaches.
- To quantify the surface area of the talus exposed by each approach.
Main Methods:
- Four standard soft tissue ankle approaches (anterolateral, anteromedial, posterolateral, posteromedial) were performed on ten cadavers.
- ImageJ software quantified the exposed talar surface area for each approach.
- Talar dome exposure was documented for each zone within the nine-grid scheme.
Main Results:
- The anterolateral (AL) and anteromedial (AM) approaches exposed 24% and 25% of the talar dome, respectively.
- The posterolateral (PL) and posteromedial (PM) approaches exposed 5% and 7%, respectively.
- Specific zones were completely or partially accessed, with minimal access to zones 4-6 and 8.
Conclusions:
- Standard soft tissue approaches leave 39% of the talar dome with limited or no access.
- Zones 4-6 and 8 are particularly difficult to access.
- Osteotomies, ATFL section, or modified approaches may be necessary for extended exposure.
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