J Korean Foot Ankle Soc.  2023 Jun;27(2):71-74. 10.14193/jkfas.2023.27.2.71.

Supramalleolar Osteotomy Combined with Redo Arthroscopy for a Patient with Persistent Pain after Primary Arthroscopic Microfracture for Medial Osteochondral Lesion of the Talus: A Case Report

• Song TH
• Suh JS
• Choi JY

• KMID: 2543004
• DOI: http://doi.org/10.14193/jkfas.2023.27.2.71

Abstract

A medial opening wedge supramalleolar osteotomy (SMO) introduced by Takakura et al. is a useful realignment procedure for patients with ankle joint arthritis and varus malalignment by shifting the weight-bearing axis laterally and redistributing the loads on the ankle joint. When pain persists after arthroscopic microfracture in patients with medial osteochondral lesion of the talus (OLT), redo arthroscopy, osteochondral autograft transplantation, autologous chondrocyte implantation, or matrix-induced chondrogenesis might be indicated. On the other hand, there is insufficient scientific evidence for realignment surgery through SMO, while the effect of realignment surgery has been studied consecutively for osteochondral lesions of the knee. Therefore, this paper reports a patient with medial OLT who underwent redo arthroscopy combined with SMO for persistent pain after primary arthroscopic microfracture.

Keyword

Ankle; Talus; Osteochondral lesion; Bone marrow stimultation; Supramalleolar osteotomy

Figure

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  Figure 1 On standing anteroposterior (A) and lateral (B) radiographs, no specific abnormal findings were found while the hindfoot valgus alignment was noted on hindfoot alignment view (C).

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  Figure 2 On T2-weighted coronal (A) and sagittal (B) magnetic resonance imaging, subchondral cyst formations were found with a suspicious cartilage defect on medial talar dome.

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  Figure 3 Redo arthroscopic microfracture was performed (A) followed by medial opening wedge supramalleolar osteotomy with 6 mm wedge (B: anteroposterior view, C: lateral view).

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  Figure 4 At postoperative 41 months, patient’s symptom was subsided with a stable maintenance of osteotomy site without a further deterioration of prior osteochondral lesion of talus (A: anteroposterior view, B: lateral view, C: hindfoot alignment view).

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