Minimally Invasive Management of Posterolateral Osteochondral Lesions of the Talus Using Posterior Ankle Arthroscopy and Autologous Iliac Osteochondral Grafts

Chronic osteochondral lesions of the talus often require bone grafts to support healing. When located posterolaterally, these lesions require an open lateral malleolar osteotomy for adequate exposure. However, this approach can complicate healing and affect post-osteotomy congruency, potentially affecting long-term outcomes. We describe a posterior ankle arthroscopy technique with ankle positioning in dorsiflexion, which enhances visualization and enables talar posterolateral lesion debridement, subchondral drilling, and precise fitting of cylindrical iliac osteochondral autograft. This technique contributes to the effective management of challenging posterolateral osteochondral lesions of the talus.