Vascularized Bone Graft for Extended Osteochondral Lesion of Talus

Large osteochondral lesions (OCLs) that are bigger than one third of the articular surface in at least one plane (sagittal and/or coronal)

A history of persistent pain for >1 year after conservative treatment or previous surgical treatment

Careful and thorough assessment of history and complaints, in particular

• Previous injuries and surgeries

• Disability in daily activities and sports

• Impairment by pain

• Effect of previous conservative measures

Careful clinical assessment of

• Ankle alignment when standing

• Ankle range of motion with the patient sitting and standing

• Ankle stability with the patient sitting and feet hanging

• Pain using a visual analog scale of 0–10 points

Plain weight-bearing radiographs, including anteroposterior views of the foot and ankle, lateral view of the foot, and alignment view, should be used to rule out

• Articular configuration and integrity of the ankle joint

• Primary or secondary deformity of the foot

• Presence of malformation

• Presence of arthrotic changes ( Fig. 49.1 )

  

Computed tomography (CT) scans, if possible while weight bearing, are initiated to

• Determine location and size of the lesion

• Assess the lesion pattern, e.g., the condition of the bone in and around the lesion

• Detect cyst formation

• Detect loose bodies

• Detect other bony abnormalities ( Fig. 49.2 )

  

Magnetic resonance imaging can be used to

• Determine the activity of the lesions, e.g., presence and extent of perifocal edema

• Assess the lesion pattern, e.g., the condition of the bone in and around the lesion

• Detect cyst formation

• Detect other joint abnormalities ( Fig. 49.3 )

  

Single-photon emission computed tomography with superimposed bone scan may be used to visualize

• Morphologic pathologies and associated activity process ( Fig. 49.4 )

  

Doppler sonography or angiography may be used in the case of uncertain blood flow through the tibial artery

OCLs of the medial talus necessitates a transmalleolar approach through osteotomy for exposure.

OCLs of the lateral talus are accessible by anterolateral subluxation of the talus after detachment of lateral ankle ligaments.

The medial condyle of femur is easily accessible, has a constant afferent artery, and an ideal contour with periosteal cover vascularized.