Triplanar osteotomy versus medial malleolar osteotomy for the treatment of talar osteochondral lesions: a comparative clinical and radiological study

Abstract

Objective: This study aimed to compare the clinical and radiographic outcomes of triplanar osteotomy (TPO), a technique introduced to provide more direct and perpendicular access with potentially greater osteotomy stability, with those of conventional medial malleolar osteotomy (MMO) for the treatment of osteochondral lesions of the talus. Methods: A retrospective comparative cohort study involving 61 patients diagnosed with Hepple stage IV-V OLT who were treated with mosaicplasty was performed. Among these patients, 31 patients received TPO, while 30 underwent MMO. The groups were similar at baseline in terms of demographics and lesion characteristics. The primary outcomes assessed included the American Orthopedic Foot and Ankle Society (AOFAS) score, the visual analog scale (VAS) score for pain, and the time to achieve full weight bearing (FWB). The secondary outcomes included the Tegner activity scale score and complication rates. Results: At a mean follow-up period of 36.7 Å} 15.8 months (TPO: 38.6 Å} 15.4; MMO: 34.6 Å} 16.3), both techniques significantly improved from baseline. The TPO group was associated with lower final VAS scores and greater VAS improvement compared with the MMO group. Additionally, patients in the TPO group reached FWB significantly sooner (5.0 Å} 1.8 weeks vs. 6.8 Å} 2.6 weeks, P = .002). The final AOFAS and Tegner scores were excellent and comparable across both groups. The time to union was similar, and no significant differences were observed in major complication rates. Conclusion: Although both osteotomy techniques were effective, TPO was associated with lower postoperative pain scores and earlier return to full weight-bearing in this retrospective cohort. Triplanar osteotomy appears to be a feasible alternative to conventional MMO for the surgical treatment of talar osteochondral lesions; however, larger prospective studies with longer follow-up are needed to determine whether these findings represent true superiority.   Cite this article as: Başal Ö, Dinçer R, Karapınar SE, G.k H, Doral MN. Triplanar osteotomy versus medial malleolar osteotomy for the treatment of talar osteochondral lesions: a comparative clinical and radiological study. Acta Orthop Traumatol Turc., 2026; 60(5), 0888, doi: 10.5152/j.aott.2026.26888.