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

Abstract

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 the 3-month follow-up showed a well-maintained contour of the talar dome with complete incorporation of the bone graft. The AOFAS scores for both patients were greater than 90, excellent per the Saxena and Eakin criteria. This method decreases radiation exposure, invasiveness, and surgical time of the procedure.