Surgical approaches to osteochondral lesions of the talus

Arthroscopic techniques still represent the treatment of choice in osteocho ndral lesions of the talus (OLT). Open techniques may be used as an alterna tive or may be complementary to arthroscopic treatments. They are especiall y indicated in cases of large osteochondral lesions, difficult localisation s and in cases of recurrent interventions. In addition to the type of treatment for the lesion itself, the choice of a n ideal surgical approach is of paramount importance. Indications, operativ e technique, possible complications and rehabilitation are described in det ail for each approach. Anterolateral, anteromedial posterolateral and poste romedial soft-tissue approaches as well as medial and lateral malleolar ost eotomies are discussed. If a distraction is not desired with arthroscopy, p osteromedial and posterolateral soft-tissue approaches offer a good alterna tive for the treatment of posterior OLT. Osteotomy of the (medial) malleolu s offers good visualisation of the medial talar dome. With the introduction of new techniques of osteochondral transplantations, the use of this appro ach is becoming more popular. However, it is an invasive technique and the risk of secondary osteoarthrit is after malleolar osteotomy still needs to be determined.