Osteochondral Autograft Transfer System Procedure for Posterior Osteochondral Lesions of the Talus Through Prone Position Midline Achilles Tendon-Splitting Approach

Posteriorly based osteochondral lesions of the talus (OCLTs) are relatively rare, and when they are symptomatic and not amenable to traditional arthroscopic treatment techniques, they may require osteochondral graft transfer procedures, such as the osteochondral autograft transfer system (OATS) procedure. Historically described osteotomies to gain perpendicular access to these OCLTs, while excellent techniques, present many possible postoperative morbidities. This technical tip describes the use of a prone position midline Achilles tendon-splitting approach, a well-described approach to the posterior ankle and hindfoot, to perform osteochondral autograft transfer without need for any malleolar osteotomies. At 12 months postoperatively, the patient reported a pain visual analog score of 1.0 (75% improvement) and demonstrated an American Orthopaedic Foot and Ankle Society ankle and hindfoot score of 90 (38% improvement). At 24 months postoperatively, the patient had near complete resolution of ankle pain and had returned to normal recreational physical activities. (Journal of Surgical Orthopaedic Advances 26(1):58–64, 2017) Key words: Achilles tendon, approach, osteochondral lesion, posterior, split, talus