Is Antegrade Transmalleolar Drilling Method for Osteochondral Lesion of Talus Necessary? Iatrogenic Cystic Formation at the Tibia: A Report of Five Cases (original) (raw)

A modified retrograde drilling technique of osteochondral lesions of the talus: A technical note

Indian Journal of Orthopaedics Surgery

Osteochondral lesions of the talus typically present as cartilage denudation after trauma or as cystic lesions in the bone with intact cartilage. Osteochondral fractures require an anterograde approach for treatment. Retrograde drilling and packing with a bone graft can treat lesions with intact cartilage. Because subchondral lesions involve the posterior aspect of the talar dome, these lesions can be difficult to localize with an image intensifier.We describe a method in which ankle arthroscopy is used to visualize a subchondral lesion, along with an ACL jig to target the lesion precisely.: We performed retrograde drilling in two patients: a 29-year-old man and a 34-year-old man. Each patient presented with a subchondral cystic lesion in the posteromedial aspect of the talus. We treated both patients by modifying the standard technique for retrograde drilling. Patients were evaluated before and after surgery using the AOFAS score and X-rays of the ankle joint. The X-rays taken at t...

Arthroscopic management of small osteochondral lesions of the talus

Current Orthopaedic Practice, 2017

Background: The aim of the study was to evaluate the short-term clinical outcomes of arthroscopic drilling in the management of small osteochondral lesions of the talus (OLT). Methods: Thirty-two patients with small OLT (area <150 mm 2 and cyst depth <7 mm as measured on CT and MRI) were treated by arthroscopic debridement and drilling. Four patients underwent simultaneous modified Broström procedures. Five patients required retrograde drilling, three because the overlying cartilage was intact and two because the lesion was posterior. Outcomes were measured using the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale and subjective patient satisfaction. Results: The mean age at surgery was 32 ± 8 yr (range, 18-50 yr). There were 22 men (68.75%) and 10 women (31.25%). Four patients (12.5%) were playing sports regularly, one professionally and three recreationally. After a mean follow-up duration of 26 mo (range 12-48 mo), the mean AOFAS score improved from 71.78 ± 11 (range 51-87) preoperatively to 91 ± 7 (range 80-100). The results were excellent in 15 patients (46.9%), good in 12 (37.5%), fair in five(15.6%). According to the Saxena criteria 16 patients (50%) were very satisfied, nine patients (28.1%) were satisfied, six patients (18.8%) were satisfied with reservations and one patient (3.1%) was unsatisfied. Conclusions: Arthroscopic drilling for small OLT is safe and easy with results comparable to microfracture but with the advantages of deeper penetration and the ability to drill retrograde into posterior lesions or lesions with intact cartilage.

Osteochondral Lesions of the Talus: Predictors of Clinical Outcome

Foot & Ankle International, 2011

Background: Osteochondral lesions of the talus (OLT) are a common and challenging condition treated by the orthopedic foot and ankle surgeon. Multiple operative treatment modalities have been recommended, and there are several factors that need to be considered when devising a treatment plan. In this study, we retrospectively reviewed a group of patients treated operatively for osteochondral lesions of the talus to determine factors that may have affected outcome. Methods: A retrospective chart review of clinical, radiographic and operative records was performed for all patients treated for OLTs via marrow stimulation technique. All had a minimum followup of 6 months or until return to full activity, preoperative magnetic resonance imaging (MRI) of the OLT to determine size, and failure of nonoperative treatment. Results: A total of 130 patients were included in the study. This included 64 males and 66 females. The average patient age at the time of surgery was 35.1 ± 13.7 (range, 12 to 73) years. The average followup was 37.2 ± 40.2 (range, 7.43 to 247) weeks. The average size of the lesion was 0.84 ± 0.67 cm 2. There were 20 lesions larger than 1.5 cm 2 and 110 lesions smaller than 1.5 cm 2. There were 113 contained lesions and 17 uncontained lesions. OLTs larger than 1.5 cm 2 and uncontained lesions were associated with a poor clinical outcome. Conclusions: The treatment of osteochondral lesions of the talus remains a challenge to the foot and ankle surgeon. Arthroscopic debridement and drilling will often provide satisfactory results. However, larger lesions and uncontained lesions

One-Stage Treatment for Osteochondral Lesion of the Talus

Sports Injuries of the Foot and Ankle, 2019

Chondral lesions of the talus are usually caused by acute ankle sprain or a chronic ankle instability due to insufficiency of the passive lateral ankle stabilizers. In most of the patients, the lesion remains asymptomatic for a long period of time. Pain, the first clinical symptom of the lesions, usually starts when subchondral bone is affected by the repetitive microtrauma and the chondral lesion becomes an on osteochondral lesion. That is why the patient who qualifies to be treated operatively usually has an osteochondral lesion that needs a bilayer reconstruction. In those cases a technique that is a combination of both bone and cartilage reconstruction is recommended. The biological osteochondral reconstruction (BIOR) technique allows the surgeon to not only treat the cartilage but also the underlying bone. In severe cases of osteochondral lesion, a sophisticated reconstruction of the talar dome shape is needed in order to regain the ankle joint congruency.

Management of Osteochondral Lesions of the Talar Dome

The Open Orthopaedics Journal, 2017

Osteochondral lesion of the talus (OLT) is a common condition associated with ankle injury that brings challenges in the diagnosis and treatment. Symptoms related to this condition are nonspecific including pain, swelling, stiffness, and mechanical symptoms of locking and catching. While the natural history of the OLTs is not well understood, surgical treatment is often required especially in chronic cases and acute cases with displaced articular fragments. Arthroscopic treatment of the OLTs aims to restore ankle joint function and pain relief by the removal of the chondral or osteochondral fragment, debridement and stabilization of cartilage rim and subchondral bone, and stimulate healing of the bone and damaged cartilage. In patients with a large lesion or after a failure of previous bone marrow stimulation, biologic restoration techniques including the use of particulate juvenile cartilage techniques, autogenous chondrocyte implantation, and osteochondral autograft or allograft t...

Osteochondral lesions of the talus

Journal of Pediatric Surgery, 1980

Osteochondral lesions of the talus can present as a late complication of ankle injuries. As the talus is largely covered by articular cartilage, it has a limited ability for repair. Early and accurate diagnosis is important as talar integrity is required for optimal function of the ankle. The common presentation is chronic ankle pain with a history of ankle trauma. Conservative treatment involving a period of casting and non-weight-bearing is recommended for acute, non-displaced osteochondral lesions. Surgical management is recommended for unstable lesions or failed conservative management.

Current management of talar osteochondral lesions

World journal of orthopedics, 2017

Osteochondral lesions of the talus (OLT) occur in up to 70% of acute ankle sprains and fractures. OLT have become increasingly recognized with the advancements in cartilage-sensitive diagnostic imaging modalities. Although OLT may be treated nonoperatively, a number of surgical techniques have been described for patients whom surgery is indicated. Traditionally, treatment of symptomatic OLT have included either reparative procedures, such as bone marrow stimulation (BMS), or replacement procedures, such as autologous osteochondral transplantation (AOT). Reparative procedures are generally indicated for OLT < 150 mm(2) in area. Replacement strategies are used for large lesions or after failed primary repair procedures. Although short- and medium-term results have been reported, long-term studies on OLT treatment strategies are lacking. Biological augmentation including platelet-rich plasma and concentrated bone marrow aspirate is becoming increasingly popular for the treatment of ...

Natural History of Nonoperatively Treated Osteochondral Lesions of the Talus

Foot & Ankle International, 2014

Background: We hypothesized that patients undergoing nonoperative treatment for asymptomatic or minimally symptomatic osteochondral lesions of the talus (OLTs) would not deteriorate clinically or radiologically over time. Methods: Forty-eight patients (mean age = 48 years; range, 13-78 years) with an OLT confirmed by magnetic resonance imaging (MRI) who had not undergone ankle joint surgery were retrospectively reviewed. All patients were evaluated after a minimum follow-up of 2 years (mean = 52 months; range, 27-124 months). All patients filled out an individual questionnaire and underwent a physical and radiographic assessment (radiograph and hindfoot MRI). Results: At final follow-up, 43 ankles (86%) in 41 patients were pain-free (visual analogue scale [VAS] 0, n = 12) or less painful (VAS 1-3, n = 31). Radiographically, osteoarthritis was absent in 47%, and grade 1 and 2 osteoarthritis each were found in 27% (van Dijk classification). Magnetic resonance imaging revealed no subst...