Clinical Outcomes and Pin Insertion Angles After Osteochondral Fragment Fixation for Medial Osteochondral Lesions of the Talus With and Without Medial Malleolus Osteotomy.

Abstract

To compare the postoperative outcomes and pin insertion characteristics of osteochondral fragment fixation for medial osteochondral lesions of the talus (OLT) performed with and without medial malleolus osteotomy (MMO). A total of 45 ankles from 41 patients with medial OLT who underwent osteochondral fragment fixation and were followed up for at least 1 year were retrospectively reviewed. The cohort included 17 men and 24 women, with a mean age of 20.4 ± 10.1 years. Twenty-four ankles treated with medial malleolus osteotomy (MMO) were classified into the MMO group, and 21 ankles treated without osteotomy (WMMO) were classified into the WMMO group. Clinical outcomes were assessed using the Japanese Society for Surgery of the Foot (JSSF) scale, and pin insertion angles and bone union were evaluated using postoperative imaging. The follow-up period was statistically significantly longer in the MMO group (31.3 ± 20.6 vs 18.4 ± 9.8 months, p < 0.001). No statistically significant differences were observed between the groups in terms of lesion location or final postoperative clinical outcomes. The JSSF scores improved statistically significantly in both groups (both p < 0.0001), with no difference at the final follow-up (MMO: 97.1 ± 5.5; WMMO: 95.3 ± 5.8). No statistically significant between-group differences were observed in bone union status or bone marrow edema. The pin insertion angles differed statistically significantly between the groups; in the coronal plane, pins in the WMMO group were inserted more perpendicularly to the articular surface, whereas in the sagittal plane, pins in the MMO group were directed more posteriorly (both p < 0.0001). Osteochondral fragment fixation for medial OLT can be performed without MMO. In this cohort, no statistically significant differences were detected in the evaluated short- to mid-term clinical or radiological outcomes compared with the conventional osteotomy approach. This osteotomy-sparing technique allows more perpendicular pin insertion and may be considered a treatment option for medial OLT. Level of evidence Level 3.