Arthroscopic Collagenous Matrix Therapy for Osteochondral Lesions of the Talus

Abstract

Osteochondral lesions of the talus frequently are seen in injuries, typically caused by trauma or repetitive stress, which affect both the cartilage and the underlying bone of the ankle joint. If left untreated, these lesions can result in chronic pain, joint instability, and impaired function. Treatment options traditionally range from conservative approaches to surgical procedures, such as microfracture, osteochondral autografts, and allografts. In this Technical Note, we discuss our experience with anterior ankle arthroscopy, specifically focusing on debridement, microfracture, and the application of cell-free collagenous matrix in osteochondral lesions of the talus.

Fig 1

Magnetic resonance imaging of the left ankle joint depicting the osteochondral lesion of the talus (OLT) in (A) coronal T1-weighted image with the medial malleolus (MM) and lateral malleolus (LM) with subchondral cyst in the anteromedial aspect, (B) sagittal image showing the OLT in the superior aspect of talar dome, and (C) axial image where in the OLT is located anteromedial aspect of the talus in between the MM and LM.

Fig 2

Superficial peroneal nerve depicted by fourth toe flexion sign (Stephen sign) of the left ankle in supine position as the foot dangles free of the table.

Fig 3

Arthroscopic view of the left tibiotalar joint in supine position visualized from the anterolateral portal as the arthroscopic shaver enters through the anteromedial portal were in the notable osteochondral lesion of the talus (OLT) is identified and debrided.

Fig 4

Dry arthroscopic view of the left tibiotalar joint in supine position from the anterolateral portal held in traction depicting the 18-gauge spinal needle from the anteromedial portal pointing toward the refined osteochondral lesion of the talus with raw bleeding spot. Note the trocar inlet is off to make the visualization field dry.

Fig 5

Dry arthroscopic view of the left tibiotalar joint from the anterolateral portal with the patient in the supine position held for 8 to 12 minutes of manual traction depicting the crystallization of the collagenous matrix injected followed by the gradual further release of traction.