Retrograde drilling of osteochondral lesions of the talus (SS-107)

Abstract

Osteochondral lesions of the talus that maintain an intact articular surface may be successfully treated with retrograde decompression of the cystic lesions utilizing a novel cannulated system. The surgical management of symptomatic osteochondral defects of the medial talar dome is difficult. When the articular surface is intact retrograde drilling through the body of the talus is accepted as one alternative to stimulate bone healing for stabilization of the OCD fragment. Between 1999 and 2001, eight consecutive patients underwent surgical treatment for symptomatic posterior medial OCD lesion of their talar dome. All patients underwent arthroscopy of the ankle followed by retrograde drilling of the talar lesion. A novel cannulated system was used to target the lesion, remove the necrotic segment and then backfill using Grafton. The average age of the patients was 36 years old (range 12–49 years). Follow-up ranged from 8 months to 44 months (mean 24 months). One patient was lost to follow-up. Of the remaining seven, outcomes were assessed with a modified American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale and the SF-12 general health survey. Four patients have repeat MRI scans at one year follow-up. The preoperative AOFAS scores from the modified hindfoot scale ranged from 0 to 41 (mean 22). Postoperative scores ranged from 52 to 68 (mean 56). Mean improvement of 34 points. The SF-12 has two components: the Physical Component Score (PCS) and the Mental Component Score (MCS). Mean preoperative and latest follow-up SF-12 PCS were 35.8 and 44.0, respectively. Mean preoperative and latest follow-up SF-12 MCS were 40.7 and 52.8, respectively. In this limited series, this technique appears to give comparable short-term results to previously described techniques. The new cannulated system simplifies the surgical procedure allowing the expansion of the technique to the general orthopedic surgeon and potentially greater safety. Overall, this procedure offers decreased operative time and maximizes safety and accuracy with retrograde talar drilling. Osteochondral lesions of the talus that maintain an intact articular surface may be successfully treated with retrograde decompression of the cystic lesions utilizing a novel cannulated system. The surgical management of symptomatic osteochondral defects of the medial talar dome is difficult. When the articular surface is intact retrograde drilling through the body of the talus is accepted as one alternative to stimulate bone healing for stabilization of the OCD fragment. Between 1999 and 2001, eight consecutive patients underwent surgical treatment for symptomatic posterior medial OCD lesion of their talar dome. All patients underwent arthroscopy of the ankle followed by retrograde drilling of the talar lesion. A novel cannulated system was used to target the lesion, remove the necrotic segment and then backfill using Grafton. The average age of the patients was 36 years old (range 12–49 years). Follow-up ranged from 8 months to 44 months (mean 24 months). One patient was lost to follow-up. Of the remaining seven, outcomes were assessed with a modified American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale and the SF-12 general health survey. Four patients have repeat MRI scans at one year follow-up. The preoperative AOFAS scores from the modified hindfoot scale ranged from 0 to 41 (mean 22). Postoperative scores ranged from 52 to 68 (mean 56). Mean improvement of 34 points. The SF-12 has two components: the Physical Component Score (PCS) and the Mental Component Score (MCS). Mean preoperative and latest follow-up SF-12 PCS were 35.8 and 44.0, respectively. Mean preoperative and latest follow-up SF-12 MCS were 40.7 and 52.8, respectively. In this limited series, this technique appears to give comparable short-term results to previously described techniques. The new cannulated system simplifies the surgical procedure allowing the expansion of the technique to the general orthopedic surgeon and potentially greater safety. Overall, this procedure offers decreased operative time and maximizes safety and accuracy with retrograde talar drilling.