Topic 18 · Everything else
Surgical Approaches: Malleolar Osteotomy
Cutting the malleolus to reach a medial lesion adds recovery time and risk — and MASCOT excludes lesions that would need one.
→ To access OLT, surgeons sometimes need to temporarily cut the ankle bone (malleolus) and move it aside. Like opening a hatch to reach inside. It heals after, but adds recovery time and potential complications.
When Is Osteotomy Needed?
Posteromedial lesions are often difficult to access with arthroscopy alone and may require a medial malleolar osteotomy (MMO). The 2024 DGOU recommendations note that MMO has a minor effect on clinical outcome compared to other factors [128].
2024 German Cartilage Registry Data
A large registry study examined MMO prevalence and consequences [129]:
- MMO improves visibility and accessibility of the talus
- But poses risk of periprocedural morbidity
- Osteotomy consolidation: 98.5% success rate
- Malreduction rate: 23.9% (lower with 3 screws vs 2 screws: 16.7% vs 32%)
MMO vs Anterior Malleolar Osteotomy (2025)
A 2025 comparison study found [130]:
- No significant difference in surgical complication rates between MMO and AMO
- Functional outcomes significantly better at 1 year with MMO
- No significant difference at 2-year follow-up
Hardware Removal
A 2025 study on adolescent athletes found 75% had osteotomy fixation screws removed due to hardware irritation [131]. Osseous union typically occurs at 6.2 weeks average.