Anterior Chevron-type Tibial Osteotomy for Treatment of Osteochondral Lesion of the Talus Using Osteochondral Autograft Transfer System: A Case Report and Technical Description

In the osteochondral autograft transfer system (OATS) procedure, a wide accessible area is required to introduce the femoral plug at varying angles. This may not always be achievable with a simple arthrotomy using anteromedial, posteromedial, or anterolateral approaches. The aim of this case presentation was to describe the use of an anterior chevron-type tibial osteotomy as a technical approach for treating a centrolateral osteochondral lesion of the talus (OLT) with the OATS technique. We present a case of a 48-year-old female patient with a history of chronic right ankle pain following an ankle sprain 32 years ago. The anterior osteotomy was performed with dimensions of ∼3 cm in width, 2 cm in depth, and 4 cm in height. After removing the anterior tibial bone block, we identified and debrided the OLT. The lesion site was prepared using a trephine, and a bone plug obtained from the lateral femoral trochlea was inserted, congruent with the surrounding articular cartilage. Finally, the temporarily removed anterior tibial bone block was reattached and secured with 3 cannulated screws. At the 44-month follow-up, the patient was asymptomatic and fully active. Level of Evidence: Diagnostic Level 5. See Instructions for Authors for a complete description of levels of evidence.