Trapezoidal fibular osteotomy in the treatment of osteochondral lesions of the talus

Abstract

The osteochondral lesions of the talar dome are a frequent pathology of the ankle, with large transcendence concerning both sportsmen and active patients. The role of the arthroscopy in the treatment of these lesions has been proved useful, allowing to intervene up to the 80% of the dome lesions, being the stimulation of the bone marrow through microfractures the gold-standard technique when lesions measure less than 1,5cm2. Nevertheless, those whose size is bigger or its placement does not allow arthroscopic surgery, an open procedure should be considered. The osteotomy of the tibial malleolus is the technique of election in centromedial and posteromedial lesions. On the other hand, centrolateral and posterolateral lesions have a controversial management. Within the number of osteotomies described –tibial and different kinds of fibular–, the trapezoidal fibular osteotomy must be remarked as a technique that allows a proper access to the lateral zone of the talus in its sagital axis, respecting the ligamentous structures, with low morbidity and a large remanent stability, given that only one screw is enough to perform the ostheosynthesis.