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Categories: Abstracts, 2022, Poster

Access to the talar articular surface without osteotomy to treat osteochondral lesions of the talus using autologous membrane induced chondrogenesis (AMIC) and autologous bone graft

M. Farndon, J. Sharpe

1Harrogate & District NHS Foundation Trust, Orthopaedic Department, Harrogate, United Kingdom

2Harrogate & District NHS Foundation Trust, Radiology Department, Harrogate, United Kingdom

Introduction: Recent cadaveric studies appear to provide conflicting opinions regarding possible access to some zones of the talar articular surface without the use of an osteotomy and / or ligament release in the approach. We report a series of cases involving AMIC treatment of larger osteochondral lesions of the talus (OLT) without use of osteotomy or release in talar zones potentially considered inaccesible (zone 4 medially and zone 6 laterally).

Methods: 18 consecutive cases involving potentially inaccessible talar zones were retrospectively identified. All had undergone open treatment of OLT via mini arthrotomy with subsequent autologous bone grafting & AMIC. No osteotomies or ligament releases were performed. Extra-articular distraction was used in all anterior approaches, though no posterior approaches. Pre-op MR scans imaging were reviewed by a single experienced MSK radiologist; zonal involvement, area, volume and AMADEUS (Area Measurement Depth & Underlying Structures) score was recorded in each case.

Results: There were 8 female and 10 male patients with a mean age of 45 years (range 16 to 84). 13/18 (72%) OLT were medial (zone 4) and 5/18 (28%) were lateral (zone 6). The mean AMADEUS score was 46 (range 10 to 65). The mean area was 189mm2 (range 91 to 345) and the mean volume of cystic defects was 423mm(range 180 to 728). All 18 OLT were accessed without osteotomy or ligament release to allow thorough curettage / debridement / nanofracture / autologous bone grafting and AMIC treatment. The approaches utilised were posteromedial 3/18, anteromedial 10/18 and anterolateral 5/18 respectively. None have required further intervention at mean FU 3.2 years from index scan (range 0.4 to 5.2).

Conclusion: Larger OLT in zones 4 and 6, including those with a significant cystic component, can be accessed safely and treated without the need for malleolar osteomy or ligament release.

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