Osteochondral Grafting of the Distal Tibia Without a Malleolar Osteotomy: An All-Arthroscopic Antegrade Approach

Osteochondral (OCD) lesions of the tibia are rare and can be treated with microfracture and debridement in the first instance. However, a major issue arises if bulk-grafting is required as access to the joint surface for perpendicular packing/insertion is not possible. Tibial osteotomy for access to the talus has morbidity associated with it, but moreover it does not significantly improve access to the tibia for standard retrograde (ie, from the joint surface into the bone) drilling and insertion of a graft into an OCD lesion. In order to obviate the need for malleolar osteotomy an antegrade approach through the bone rather than the joint can be used avoiding any disruption of the joint. We have developed this technique for use in the tibia and the talus and present a case of OCD autografting of the tibia to demonstrate this method of insertion without osteotomy. A jig is used to locate the surface of the lesion and then the tunnel is prepared by drilling onto this marker from the opposite side of the bone. This produces an oblique tunnel that requires harvesting of a matched graft. Insertion can then be performed from outside-in. Level of Evidence: Diagnostic Level 5. See Instructions for Authors for a complete description of levels of evidence.