TY - JOUR
T1 - Limitations of accessibility of the talar dome with different open surgical approaches
AU - Sripanich, Yantarat
AU - Dekeyser, Graham
AU - Steadman, Jesse
AU - Rungprai, Chamnanni
AU - Haller, Justin
AU - Saltzman, Charles L.
AU - Barg, Alexej
N1 - Publisher Copyright:
© 2020, European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA).
PY - 2021/4
Y1 - 2021/4
N2 - Purpose: The aim of this study is to systematically review the current, relevant literature and provide a thorough understanding of the various open surgical approaches utilized to gain access to the talar dome for treatment of osteochondral lesions. Realizing the limits of access from soft tissue exposures and osteotomies, with and without external distraction, will help surgeons to select the appropriate approach for each individual clinical situation. Methods: A literature search was performed using three major medical databases: PubMed (MEDLINE), Scopus, and Embase. The Quality Appraisal for Cadaveric Studies (QUACS) scale was used to assess the methodological quality of each included study. Results: Of 3108 reviewed articles, nine cadaveric studies (113 limbs from 83 cadavers) evaluating the accessibility of the talar dome were included in the final analysis. Most of these (7/9 studies) investigated talar dome access in the context of treating osteochondral lesions of the talus (OLTs) requiring perpendicular visualization of the involved region. Five surgical approaches (anteromedial; AM, anterolateral; AL, posteromedial; PM, posterolateral; PL, and direct posterior via an Achilles tendon splitting; DP), four types of osteotomy (anterolateral tibial, medial malleolar, distal fibular, and plafondplasty), and two methods of distraction (Hintermann retractor and external fixator) were used among the included studies. The most commonly used methods quantified talar access in the sagittal plane (6/9 studies, 66.7%). The greatest exposure of the talar dome can be achieved perpendicularly by performing an additional malleolar osteotomy (90.9% for lateral, and 100% for medial). The methodological quality of all included studies was determined to be satisfactory. Conclusion: Gaining perpendicular access to the central portion of the talar dome, measured in the sagittal plane, has clear limitations via soft tissue approaches either medially or laterally from the anterior or posterior aspects of the ankle. It is possible to access a greater talar dome area in a non-perpendicular fashion, especially from the posterior soft tissue approach. Various types of osteotomies can provide greater accessibility to the talar dome. This systematic review can help surgeons to select the appropriate approach for treatment of OLTs in each individual patient preoperatively. Level of evidence: Level IV.
AB - Purpose: The aim of this study is to systematically review the current, relevant literature and provide a thorough understanding of the various open surgical approaches utilized to gain access to the talar dome for treatment of osteochondral lesions. Realizing the limits of access from soft tissue exposures and osteotomies, with and without external distraction, will help surgeons to select the appropriate approach for each individual clinical situation. Methods: A literature search was performed using three major medical databases: PubMed (MEDLINE), Scopus, and Embase. The Quality Appraisal for Cadaveric Studies (QUACS) scale was used to assess the methodological quality of each included study. Results: Of 3108 reviewed articles, nine cadaveric studies (113 limbs from 83 cadavers) evaluating the accessibility of the talar dome were included in the final analysis. Most of these (7/9 studies) investigated talar dome access in the context of treating osteochondral lesions of the talus (OLTs) requiring perpendicular visualization of the involved region. Five surgical approaches (anteromedial; AM, anterolateral; AL, posteromedial; PM, posterolateral; PL, and direct posterior via an Achilles tendon splitting; DP), four types of osteotomy (anterolateral tibial, medial malleolar, distal fibular, and plafondplasty), and two methods of distraction (Hintermann retractor and external fixator) were used among the included studies. The most commonly used methods quantified talar access in the sagittal plane (6/9 studies, 66.7%). The greatest exposure of the talar dome can be achieved perpendicularly by performing an additional malleolar osteotomy (90.9% for lateral, and 100% for medial). The methodological quality of all included studies was determined to be satisfactory. Conclusion: Gaining perpendicular access to the central portion of the talar dome, measured in the sagittal plane, has clear limitations via soft tissue approaches either medially or laterally from the anterior or posterior aspects of the ankle. It is possible to access a greater talar dome area in a non-perpendicular fashion, especially from the posterior soft tissue approach. Various types of osteotomies can provide greater accessibility to the talar dome. This systematic review can help surgeons to select the appropriate approach for treatment of OLTs in each individual patient preoperatively. Level of evidence: Level IV.
KW - Access
KW - Approach
KW - Dome
KW - Open
KW - Osteochondral lesions
KW - Talus
UR - http://www.scopus.com/inward/record.url?scp=85087127970&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85087127970&partnerID=8YFLogxK
U2 - 10.1007/s00167-020-06113-2
DO - 10.1007/s00167-020-06113-2
M3 - Review article
C2 - 32596777
AN - SCOPUS:85087127970
SN - 0942-2056
VL - 29
SP - 1304
EP - 1317
JO - Knee Surgery, Sports Traumatology, Arthroscopy
JF - Knee Surgery, Sports Traumatology, Arthroscopy
IS - 4
ER -