Objectives: Talar cysts, a common manifestation of osteochondral lesions of the talus (OLT), often result from trauma and cause significant pain and dysfunction. Cysts > 10 mm require grafting, and autologous iliac bone is an ideal graft source. However, accessing posteromedial lesions remains challenging: oblique osteotomies are associated with high osteoarthritis rates (up to 50%) and delayed union, while bi plane chevron osteotomies have reported malunion rates as high as 30%. To address these limitations, this study investigated the effectiveness of medial malleolus triple plane osteotomy combined with autologous iliac bone grafting for large talar cysts.
Methods: This retrospective case series included patients with talar cysts larger than 10 mm in diameter who were treated in our Hospital between February 2021 and March 2023. Patients underwent medial malleolus triple-plane osteotomy with autologous iliac bone grafting. Postoperative outcomes were assessed, including neurological complications, skin healing, radiological assessment of fracture healing, graft fusion, joint space evaluation, American Orthopedic Foot and Ankle Society Ankle-Hindfoot Score (AOFAS-AHS), Kaikkonen functional scores, and Visual Analogue Scale (VAS) scores. Statistical analyses were performed using paired t-tests to compare preoperative and final follow-up scores.
Results: A total of nine patients (mean age 34.20 ± 9.23 years; seven males) were included, which had a follow-up period of 23.00 ± 7.80 months. Primary wound healing was achieved in all cases, with no neurovascular injuries reported. Postoperative X-rays demonstrated that the osteotomy lines became indistinct at 3 months, disappeared progressively by 6 months, and were fully healed by 12 months, at which point the internal fixation was removed. The grafted talar region exhibited sclerosis at 3 months, progressive assimilation with surrounding bone density at 6 months, and subtle visibility of the graft site at 12 months. At final follow-up, compared to preoperative values, patients had significantly improved VAS scores (p < 0.05), AOFAS-AHS scores (92.37 ± 2.09 vs. 59.39 ± 6.31, p < 0.05), and Kaikkonen functional scores (89.11 ± 3.11 vs. 60.23 ± 2.79, p < 0.05).
Conclusions: Medial malleolus triple-plane osteotomy and autologous iliac bone grafting might be effective in treating talar cysts in this series of patients. Patients experienced less pain and improved functional scores at the final follow-up with no neurovascular injuries.
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