We reviewed, retrospectively, 65 patients who had undergone arthroscopic treatment for osteochondral lesions of the talus. The 46 men and 19 women with a mean age at operation of 34.25 years, were followed up for a mean of 3.5 years. The medial aspect was affected in 45 patients and the lateral aspect in 20. All the lateral lesions and 35 (75%) of the medial lesions were traumatic in origin. Medial lesions presented later than lateral lesions (3 v 1.5 years) and had a much greater incidence of cystic change (46% v 8%). At follow-up, 34 patients had achieved a good result, and 17 and 14 fair and poor results, respectively. Of the 14 poor results, 13 involved medial lesions. Cystic lesions had a poor outcome in 53% of patients. Excision and curettage led to better results than excision and drilling of the base. Further arthroscopic surgery for patients with a poor result was disappointing. There was no association between outcome and the patient’s age

Surgical exposure of the ankle is usually obtained by an anterior approach, especially for replacement arthroplasty. The transfibular approach has been popular for arthrodesis. We describe a new posterior approach to the ankle and posterior subtalar joint based on an extra-articular vertical calcaneal osteotomy behind the subtalar joint. The posterior flap so formed is hinged medially and offers wide exposure of the back of the ankle and posterior subtalar joint. This hinge allows safe and stable reduction of the osteotomised calcaneum, and the plane of dissection follows an ‘internervous plane’ behind the fibula. We have had good results after using this incision in 12 patients with osteoarthritis or rheumatoid arthritis and there have been no difficulties with wound healing