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Osteochondral Lesions of the Talus: Approach Through Medial Malleolar Osteotomies
Medial malleolar osteotomies are done to obtain improved exposure of the ankle joint, allowing visualization across the dome of the talus from medial to lateral. Patients who may require a medial malleolar osteotomy include those who are undergoing a grafting procedure to manage a medial talar dome osteochondral defect. Most talar osteochondral lesions are initially managed with curettage and microfracture. However, patients with larger lesions or in whom microfracture treatment has failed may require grafting. Although the current literature is unclear as to whether osteochondral autograft transplantation, fresh osteochondral allograft, or some type of autologous chondrocyte implantation is optimal, almost all of these procedures require perpendicular access to the defect. Most of these lesions are located along the medial talar dome, usually centrally or posteriorly. The only way to obtain adequate perpendicular access is with a medial malleolar osteotomy unless the lesion is in an anterior location, which is unusual. This chapters reviews the surgical steps for performing a step-cut medial malleolar osteotomy, a technically easy procedure that offers rigid fixation with minimal risk of loss of reduction during the healing process.