-

Öz

Amaç: Bu çalışmanın amacı talusun medialindeki osteokondral lezyonlarının mozaikplasti ile tedavisi sırasında tercih ettiğimiz Chevron osteotomisinin orta dönem sonuçlarını değerlendirerek cerrahiye katkısını ve osteotomi alanında oluşabilecek komplikasyonları azaltıp azaltmadığını radyolojik olarak değerlendirmektir.Çalışma planı: Mozaikplasti sırasında Chevron tipi medial malleol osteotomisi yapılan ve takip süresi iki yıldan uzun olan 42 hasta (31 erkek, 11 kadın) çalışmaya alındı. Ortalama yaş 34 (dağılım 18–54) yıldı. Preoperatif dönemde MRI üzerinden lezyonun boyutları koronal ve sagital planda milimetre (mm) cinsinden ölçüldü. Postoperatif grafiler üzerinden osteotominin koronal planda tibia uzun aksı ile yaptığı açı, sagital planda kollar arasındaki açı ve vidaların osteotomi hattına gönderilme açısı ölçüldü. Son kontrol sırasında çekilen grafilerde kaynamama, yanlış kaynama ve vidalara bağlı komplikasyonlar değerlendirildi.Bulgular: Hastaların ortalama takip süresi 31,4 aydı. Son kontrol grafilerinde distraksiyon, distal parçada migrasyon veya rotasyon gözlenmedi. Sadece bir hastada radyolojik kaynamama vardı. Ortalama kaynama süresi 5,8 haftaydı. 8 hastanın vidaları ortalama 7.4 ayda çıkarıldı. Osteotomi hattının tibianın uzun ekseni ile olan ortalama açısı 29,0°±6,5°, koronal planda osteotomi kolları arasındaki açı 74,7°±8,3° ve vidaların koronal planda gönderilme açısı 85,7°±5,9° olarak bulundu.Çıkarımlar: Chevron osteotomisi, talus medialinde bulunan osteokondral lezyonların tedavisi için kullanılan güvenli bir yardımcı cerrahi yöntem olmakla birlikte ve geometrisi sayesinde etkin bir tespite izin verdiği için hızlı ve anatomik iyileşmeyi sağlayan bir yöntemdir

Anahtar Kelimeler

• Malleol; osteotomi; osteokondral lezyon; talus; ters Chevron

Chevron osteotomy in patients with scheduled osteotomy of the medial malleolus

Abstract

Objective: The aim of the present study was to evaluate intermediate-term outcomes of Chevron osteotomy for treatment of osteochondral lesions of the talus with mosaicplasty and to assess its effect on surgery and whether it reduces complications that might occur intraoperatively.
Methods: The present study included a total of 42 patients (31 men and 11 women) who underwent Chevron osteotomy of the medial malleolus and who had been followed for more than 2 years. Mean age of the patients was 34 years (range: 18–54 years). Preoperatively, size of the lesions was measured in millimeters in the coronal and sagittal planes using magnetic resonance imaging (MRI). The angle between the osteotomy with the long axis of the tibia was measured on the coronal plane, the angle between the arms and the angle for the screws to be directed to the osteotomy line were measured on the sagittal plane on the postoperative images. Nonunion, malunion, and complications from the screws were evaluated from X-ray images taken at the final follow-up.
Results: Mean duration for follow-up was 31.4 years (range: 24–46). On the X-ray images taken at the final follow-up, no distraction, migration of the distal part, or rotation was observed. Only 1 patient experienced radiological non-union. Mean duration to union was 5.8 weeks (range: 4–14 weeks). Screws of 8 patients were removed at an average of 7.4 months (range: 5–11 months). The angle between the osteotomy line and long axis of the tibia was 29.0°±6.5°, the angel between the osteotomy arms on the sagittal plane was 74.7°±8.3°, and the direction angle of the screws on the coronal plane was 85.7°±5.9°.
Conclusion: Chevron osteotomy is an assistive surgical method used for treatment of osteochondral lesions located in the medial talar joint surface (TOL) which provides fast anatomical healing because it allows efficient fixation due to its geometry.

Keywords

• Inverted Chevron
• malleolus
• osteochondral lesions of talus
• osteotomy
• talus

References

1. Navid DO, Myerson MS. Approach alternatives for treat- ment of osteochondral lesions of the talus. Foot Ankle Clin 2002;7:635–49.
2. Seil R, Rupp S, Pape D, Dienst M, Kohn D. Approach to open treatment of osteochondral lesions of the talus. [Ar- ticle in German] Orthopade 2001;30:47–52. [Abstract]
3. Thordarson DB, Kaku SK. Results of step-cut medial mal- leolar osteotomy. Foot Ankle Int 2006;27:1020–3.
4. Thordarson DB. Talar body fractures. Orthop Clin North Am 2001;32:65–77.
5. Ziran BH, Abidi NA, Scheel MJ. Medial malleolar osteot- omy for exposure of complex talar body fractures. J Orthop Trauma 2001;15:513–8.
6. Ray Rb, Coughlın Ej Jr. Osteochondritis dissecans of the talus. J Bone Joint Surg Am 1947;29:697–706.
7. O’Farrell TA, Costello BG. Osteochondritis dissecans of the talus. The late results of surgical treatment. J Bone Joint Surg Br 1982;64:494–7.
8. Spatt JF, Frank NG, Fox IM. Transchondral fractures of the dome of the talus. J Foot Surg 1986;25:68–72.

9. Wallen EA, Fallat LM. Crescentic transmalleolar osteoto- my for optimal exposure of the medial talar dome. J Foot Surg 1989;28:389–94.
10. Alexander IJ, Watson JT. Step-cut osteotomy of the medial malleolus for exposure of the medial ankle joint space. Foot Ankle 1991;11:242–3.
11. Oznur A. Medial malleolar window approach for osteochon- dral lesions of the talus. Foot Ankle Int 2001;22:841–2.
12. Lamb J, Murawski CD, Deyer TW, Kennedy JG. Chevron- type medial malleolar osteotomy: a functional, radiograph- ic and quantitative T2-mapping MRI analysis. Knee Surg Sports Traumatol Arthrosc 2013;21:1283–8.
13. van Bergen CJ, Tuijthof GJ, Sierevelt IN, van Dijk CN. Direction of the oblique medial malleolar osteotomy for exposure of the talus. Arch Orthop Trauma Surg 2011;131:893,901.
14. Cohen BE, Anderson RB. Chevron-type transmalleolar osteotomy: an approach to medial talar dome lesions. Tech Foot Ankle Surg 2002;1:158–62.
15. Siegel SJ, Mount AC. Step-cut medial malleolar osteoto- my: literature review and case reports. J Foot Ankle Surg 2012;51:226–33.
16. Young KW, Deland JT, Lee KT, Lee YK. Medial approach- es to osteochondral lesion of the talus without medial mal- leolar osteotomy. Knee Surg Sports Traumatol Arthrosc 2010;18:634–7.
17. Davidson AM, Steele HD, MacKenzie DA, Penny JA. A review of twenty-one cases of transchondral fracture of the talus. J Trauma 1967;7:378–415.
18. Kelikian H, Kelikian AS. Disorders of the Ankle. In: Or- thopedic Physical Assessment. 2nd ed. Saunders, Philadel- phia 1985.
19. Yablon IG, Segal D, Leach RE, editors. Ankle Injuries, New York: Churchill Livingston; 1988.
20. Lee KB, Yang HK, Moon ES, Song EK. Modified step-cut medial malleolar osteotomy for osteochondral grafting of the talus. Foot Ankle Int 2008;29:1107–10.
21. Mendicino RW, Lee MS, Grossman JP, Shromoff PJ. Oblique medial malleolar osteotomy for the management of talar dome lesions. J Foot Ankle Surg 1998;37:516–23.
22. O’Loughlin PF, Heyworth BE, Kennedy JG. Current con- cepts in the diagnosis and treatment of osteochondral le- sions of the ankle. Am J Sports Med 2010;38:392–404.