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. 2012 Aug;36(8):1635-40.
doi: 10.1007/s00264-012-1530-9. Epub 2012 Apr 11.

Fluoroscopy-guided retrograde core drilling and cancellous bone grafting in osteochondral defects of the talus

Sven Anders  1 , Philipp Lechler, Walter Rackl, Joachim Grifka, Jens Schaumburger
Affiliations

Fluoroscopy-guided retrograde core drilling and cancellous bone grafting in osteochondral defects of the talus

Sven Anders et al. Int Orthop. 2012 Aug.

Abstract

Purpose: In undetached osteochondral lesions (OCL) of the talus both revitalisation of the subchondral necrosis and cartilage preservation are essential. For these cases, we assess the results of minimally invasive retrograde core drilling and cancellous bone grafting.

Methods: Forty-one osteochondral lesions of the talus (12x grade I, 22x grade II and 7x grade III according to the Pritsch classification, defect sizes 7-14 mm) in 38 patients (mean age 33.2 years) treated by fluoroscopy-guided retrograde core drilling and autologous cancellous bone grafting were evaluated by clinical scores and MRI. The mean follow-up was 29.0 (±13) months.

Results: The AOFAS score increased significantly from 47.3 (±15.3) to 80.8 (±18.6) points. Lesions with intact cartilage (grades I and II) had a tendency to superior results than grade III lesions (83.1 ± 17.3 vs. 69.4 ± 22.2 points, p = 0.07). First-line treatments and open distal tibial growth plates led to significantly better outcomes (each p < 0.05). Age, gender, BMI, time to follow-up, defect localisation or a traumatic origin did not influence the score results. On a visual analogue scale pain intensity reduced from 7.5 (±1.5) to 3.7 (±2.6) while subjective function increased from 4.6 (±2.0) to 8.2 (±2.3) (each p < 0.001). In MRI follow-ups, five of the 41 patients showed a complete bone remodelling. In two cases demarcation was detectable.

Conclusions: The technique reported is a highly effective therapeutic option in OCL of the talus with intact cartilage grades I and II. However, second-line treatments and grade III lesions with cracked cartilage surface can not be generally recommended for this procedure.

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Figures

Fig. 1
Fig. 1
Fluoroscopy-guided positioning of the pilot Kirschner wire into the centre of the medial osteochondral lesion (OCL) in the AP and lateral plain view radiographs
Fig. 2
Fig. 2
Guided by the Kirschner wire the cannulated drill is gently passed through the sclerotic zone of the osteochondral lesion (OCL) controlled by fluoroscopy in the AP and lateral plain view radiographs
Fig. 3
Fig. 3
Debridement of the osteochondral lesion (OCL) through the drill hole by a sharp spoon
Fig. 4
Fig. 4
The viable part of the drilling core is plugged underneath the intact cartilage
Fig. 5
Fig. 5
American Orthopaedic Foot and Ankle Society (AOFAS) score results by arthroscopic stage according to Pritsch [9] (*p < 0.05)
See this image and copyright information in PMC

References

    1. Zengerink M, Szerb I, Hangody L, Dopirak RM, Ferkel RD, Dijk CN. Current concepts: treatment of osteochondral ankle defects. Foot Ankle Clin. 2006;11:331–359. doi: 10.1016/j.fcl.2006.03.008. - DOI - PubMed
    1. Takao M, Ochi M, Naito K, Uchio Y, Kono T, Oae K. Arthroscopic drilling for chondral, subchondral, and combined chondral-subchondral lesions of the talar dome. Arthroscopy. 2003;19:524–530. doi: 10.1053/jars.2003.50111. - DOI - PubMed
    1. Draper SD, Fallat LM. Autogenous bone grafting for the treatment of talar dome lesions. J Foot Ankle Surg. 2000;39:15–23. doi: 10.1016/S1067-2516(00)80059-9. - DOI - PubMed
    1. Hangody L, Kish G, Modis L, Szerb I, Gaspar L, Dioszegi Z, Kendik Z. Mosaicplasty for the treatment of osteochondritis dissecans of the talus: two to seven year results in 36 patients. Foot Ankle Int. 2001;22:552–558. - PubMed
    1. Becher C, Thermann H. Results of microfracture in the treatment of articular cartilage defects of the talus. Foot Ankle Int. 2005;26:583–589. - PubMed

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