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Arthroscopic Management of Talar Dome Lesions Using a Transmalleolar Approach

John Grady, DPM ^* and David Hughes, DPM 

^* Department of Podiatry, Department of Veterans Affairs Chicago, Westside, Chicago, IL.
Foot and Ankle Treatment Center of San Antonio, San Antonio, TX.

Corresponding author: David Hughes, DPM, Foot and Ankle Treatment Center of San Antonio, 10130 Huebner Rd, San Antonio, TX 78240.

Abstract

Surgical treatment of posteromedial talar dome lesions is frequently necessary for Berndt and Harty grade IV osteochondral defects and nondisplaced osteochondral fragments resistant to conservative modalities. When operative intervention is indicated, the approach and management can be complicated by the location and extent of the injury. The operative technique we advocate allows direct exposure of the lesion and minimizes damage to healthy articular cartilage and surrounding soft tissue. Use of a drill guide assists the surgeon in precisely placing a transmalleolar portal through the tibia for subchondral drilling of osteochondral defects when the lesions are inaccessible through traditional arthroscopic portals. (J Am Podiatr Med Assoc 96(3): 260–263, 2006)