Triplanar Osteotomy vs. Medial Malleolar Osteotomy in Talus Osteochondritis Dissecans: Which Technique Provides Better Outcomes?

Background Medial malleolar osteotomy (MMO) is the conventional procedure for accessing talar dome lesions during mosaicplasty; however, it is linked to considerable complication rates. The triplanar osteotomy (TPO) technique was introduced to offer more direct and perpendicular access and enhanced biomechanical stability. This study aimed to compare the clinical and radiographic outcomes of TPO with those of traditional MMO. Methods A retrospective comparative cohort study was performed involving 61 patients diagnosed with Hepple stage IV-V osteochondral lesions of the talus who were treated with mosaicplasty. Of these, thirty-one patients received TPO, while thirty underwent MMO. The groups were similar at baseline regarding demographics and lesion characteristics. The primary outcomes assessed included the American Orthopaedic Foot & Ankle Society (AOFAS) score, the visual analog scale (VAS) for pain, and time to achieve full weight bearing. Secondary outcomes encompassed the Tegner Activity Scale, the time to achieve full weight-bearing, and the rates of complications. Results With a mean follow-up period exceeding 36 months, both techniques showed significant improvements from baseline. The TPO group exhibited statistically superior results in pain relief, evidenced by a notably lower final VAS score (1.45 ± 0.74 compared to 2.70 ± 1.02, p < 0.001) and a greater degree of improvement (ΔVAS 4.84 compared to 3.33, p < 0.001). Additionally, patients in the TPO group reached full weight-bearing significantly sooner (5.0 ± 1.8 weeks versus 6.8 ± 2.6 weeks, p = 0.002). 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 are effective for accessing talar osteochondral lesions and result in excellent functional outcomes, the triplanar osteotomy offers significant benefits in terms of enhanced postoperative pain relief and a quicker return to weight-bearing. TPO is a biomechanically robust and potentially superior alternative to conventional MMO for the surgical treatment of talar osteochondral lesions. Level of Evidence Level III, Retrospective Comparative Study.