![david seil bleib david seil bleib](https://i.pinimg.com/474x/17/b4/6e/17b46ed900b5286eda3555c711d3467f.jpg)
It is possible to access a greater talar dome area in a non-perpendicular fashion, especially from the posterior soft tissue approach. Gaining perpendicular access to the central portion of the talar dome, measured in the sagittal plane, has clear limitations via soft tissue approaches either medially or laterally from the anterior or posterior aspects of the ankle. The methodological quality of all included studies was determined to be satisfactory. The greatest exposure of the talar dome can be achieved perpendicularly by performing an additional malleolar osteotomy (90.9% for lateral, and 100% for medial). The most commonly used methods quantified talar access in the sagittal plane (6/9 studies, 66.7%). Five surgical approaches (anteromedial AM, anterolateral AL, posteromedial PM, posterolateral PL, and direct posterior via an Achilles tendon splitting DP), four types of osteotomy (anterolateral tibial, medial malleolar, distal fibular, and plafondplasty), and two methods of distraction (Hintermann retractor and external fixator) were used among the included studies. Most of these (7/9 studies) investigated talar dome access in the context of treating osteochondral lesions of the talus (OLTs) requiring perpendicular visualization of the involved region. Of 3108 reviewed articles, nine cadaveric studies (113 limbs from 83 cadavers) evaluating the accessibility of the talar dome were included in the final analysis. The Quality Appraisal for Cadaveric Studies (QUACS) scale was used to assess the methodological quality of each included study. Realizing the limits of access from soft tissue exposures and osteotomies, with and without external distraction, will help surgeons to select the appropriate approach for each individual clinical situation.Ī literature search was performed using three major medical databases: PubMed (MEDLINE), Scopus, and Embase.
![david seil bleib david seil bleib](https://i.pinimg.com/474x/61/cc/a7/61cca71dfbf1c17e7af41dde352dab5f.jpg)
The aim of this study is to systematically review the current, relevant literature and provide a thorough understanding of the various open surgical approaches utilized to gain access to the talar dome for treatment of osteochondral lesions.