Search

Background Access to the talar dome for the treatment of osteochondral lesions (OCLs) can be achieved via several different approaches to the ankle joint. The recent description of an anatomical nine-grid scheme of the talus has proven useful to localise OCLs but no studies have demonstrated which approaches are indicated to access each of these zones. The aim of this study is to demonstrate the access afforded to each zone by each approach. Methods Four standard soft tissue ankle approaches were performed simultaneously in ten fresh-frozen cadavers (anterolateral — AL, anteromedial — AM, posterolateral — PL, posteromedial — PM). The area of the talus, which was accessible with an instrument perpendicular to the surface was documented for each of the approaches. Using ImageJ software the surface area exposed with each approach was calculated. The talar dome was then divided using a nine-grid scheme and exposure to each zone was documented. Results The AL, AM, PL and PM approaches allow for exposure of 24%, 25%, 5%, 7% of the talar dome respectively. The AL gives access to zones 3 (completely) and 2, 5, 6 (partially); the AM to zones 1 (completely) and 2, 4, 5 (partially); the PL to zones 9 and 8 (partially); and the PM to zones 7 and 8 (partially). Conclusions A large area of the talar dome cannot be easily accessed with the use of standard soft tissue approaches (39%). Minimal or no access is achieved for grid zones 4–6 and 8. In those instances careful preoperative planning is necessary and extended exposure can be achieved with the use of osteotomies, section of the ATFL or through modified approaches.

Introduction Posterior ankle impingement is a clinical syndrome characterized by posterior ankle pain that is mainly presented on plantar flexion. The aim of this study is to compare and evaluate the results of posterior ankle impingement treated by endoscopic hindfoot posterior portals. Materials and methods Between 2004 and 2009, a total of 38 endoscopic hindfoot procedures were performed to treat posterior ankle impingement. The indication for procedure was posterior ankle impingement syndrome in all cases. There were 38 patients, 17 females and 21 males. Mean age was 27.6 years (16–59 years). Mean follow-up was 27.6 months (12.5–52 months). The results were evaluated following the AOFAS score. Data statistical analysis was performed using the Student's t -test. Results The main preoperative AOFAS score increased from 67.42 (range 41–91) to 97.13 (range 84–100) at follow-up. No complications were reported in any case. Conclusion Hindfoot endoscopy is a reproducible and safe procedure which offers excellent outcomes in posterior ankle impingement syndrome.