Talar Osteochondral Allograft Transplant With Medial Malleolar Osteotomy

Symptomatic, large osteochondral lesions of the talus (OLT) represent challenging clinical scenarios. Access to OLT lesions may require an open approach if prior treatments have failed or if the lesion is too large to sufficiently address arthroscopically. Medial malleolar osteotomies can allow for improved visualization of lesions along the medial shoulder of the talus, but with notable morbidity. Here, we present a comprehensive technique for the treatment of large OLT along the medial talus with a medial malleolar osteotomy and fresh-frozen osteochondral allograft talus reconstruction. We describe the preoperative considerations, intraoperative technique, and postoperative management for this complex surgery. Level of Evidence Level V—expert opinion.