Arthroscopic Retrograde Drilling in Juvenile Osteochondritis Dissecans of the Talus

Masquijo, Julio Javier; Ferreyra, Andrés; Baroni, Eduardo

doi:10.1097/bpo.0000000000000498

Cited by 22 publications

(46 citation statements)

References 22 publications

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“…Comparative literature for the talus is lacking. In a case series of six patients, Mosquijo et al observed a relief of symptoms in all patients, but only three patients (50%) showed complete healing on radiographs on a mean follow-up of 37 months [31].…”

Section: Discussionmentioning

confidence: 95%

“…Frail bone structure after repetitive attempts to reach the OCD lesion can result in iatrogenic fractures [29,30]. Precise retrograde drilling without damaging the articular cartilage surface is thus very important [18,31]. It is not always possible to use mechanical targeting devices, similar to those used for tunnel positioning in anterior cruciate ligament reconstruction [18], because their pre-shaped design does not always allow for accurate placement [10,17].…”

Section: Discussionmentioning

confidence: 99%

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Electromagnetic Navigation Reduces Radiation Exposure and Provides Excellent Accuracy for Retrograde Drilling in Osteochondrosis Dissecans of the Talus

Berger-Groch

Jungesblut

Hoffmann

et al. 2020

Preprint

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Background: Retrograde drilling in osteochondrosis dissecans (OCD) is a widely used surgical intervention. A radiation-free electromagnetic navigation system (ENS)-based method was compared with the standard freehand fluoroscopic (SFF) method regarding clinical applicability.Methods: We performed a clinical cohort study at a department of Orthopaedics in a Level 1 children’s hospital with 40 patients (20 SFF and 20 ENS). Retrograde drilling of the talar dome was used in patients with unstable medial OCD (MRI stage 2 according to Hepple’s revised classification; stage 2 according to the International Cartilage Repair Society). The outcome measurements were: a) Intraoperative fluoroscopy exposure and length of surgery and b) Postoperative serial follow-up MRIs every 6 months.Results: 22 female and 18 male patients aged 13.8 ± 1.6 years (range: 11-17 years) were included. Using the ENS technique, length of surgery was significantly reduced to 20.2 ± 6.4 min compared to 36.1 ± 11.8 min (p<0.01) for the SFF technique. The average x-ray radiation time for the SFF technique was 23.5 ± 13.5 sec and 1.9 ± 1.7 sec for the ENS technique (p<0.01). Radiation exposure was significantly reduced from 44.6 ± 19.7 mSv (SFF technique) to 5.6± 2.8 mSv (ENS technique) (p<0.01). Intraoperative perforation of cartilage occurred once in the SFF group. Correct placement of the drilling channel was verified in all patients on follow-up MRI after six months and a timely healing was seen after two years. No differences were detected on follow-up MRI between the two methods.Conclusions: The ENS method provides for a significant reduction in length of surgery and radiation exposure. ENS was without intraoperative cartilage perforation. The clinical and radiological follow-up parameters are comparable for SFF- and ENS-guided retrograde drilling.Trial registration: WF – 085/20, 05/2020 “retrospectively registered”

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Electromagnetic Navigation Reduces Radiation Exposure and Provides Excellent Accuracy for Retrograde Drilling in Osteochondrosis Dissecans of the Talus

Berger-Groch

Jungesblut

Hoffmann

et al. 2020

Preprint

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show abstract

“…In our institution, regardless of lesion size, RD is performed for OLTs in skeletally immature children when the talar articular cartilage is intact, because skeletally immature children have a good ability for induction of subchondral bone revascularization and stimulation of new bone formation. 2,7,10 Masquijo et al 8 reported that arthroscopic RD was effective for symptom relief in skeletally immature children, although 50% of cases had persistent lesions on radiographs. In the present study, primary OLT treatment with RD resulted in a good Berndt and Harty clinical outcome in 7 ankles (87.5%).…”

Section: Discussionmentioning

confidence: 99%

“…Masquijo et al 8 showed that arthroscopic RD can be effective for symptom relief in skeletally immature children. However, no studies have evaluated the preoperative and postoperative computed tomography (CT) findings of RD in skeletally immature children.…”

Section: Introductionmentioning

confidence: 99%

“…At our institution, regardless of lesion size, RD is performed for OLTs in skeletally immature children when the talar articular cartilage is intact, because skeletally immature children have a strong ability for new bone formation. 2,7,10 Masquijo et al 8 showed that arthroscopic RD can be effective for symptom relief in skeletally immature children. However, no studies have evaluated the preoperative and postoperative computed tomography (CT) findings of RD in skeletally immature children.…”

Section: Introductionmentioning

confidence: 99%

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Retrograde Drilling for Osteochondral Lesions of the Talus in Skeletally Immature Children

Minokawa

Yoshimura

Kanazawa³

et al. 2020

Foot Ankle Int.

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Background: Osteochondral lesions of the talus (OLTs) involve damage to the cartilage and subchondral bone and are infrequent in children. Clinicians usually attempt nonsurgical treatment of OLTs first, and subsequently progress to surgical treatments, including retrograde drilling (RD), if the initial outcomes are insufficient. Good clinical outcomes of RD have been reported. However, the clinical outcomes of RD in skeletally immature children remain unclear, and the associated preoperative and postoperative computed tomography (CT) findings have not been reported. The purpose of this study was to evaluate the clinical outcomes and CT findings and clarify the efficacy of RD for OLTs. Methods: From January 2015 to April 2018, RD was performed on 8 ankles in 6 skeletally immature children. The patients comprised 4 boys and 2 girls with a mean age at surgery of 11.1 years. The mean follow-up was 22.8 months. The clinical outcomes were evaluated according to the Japanese Society for Surgery of the Foot (JSSF) scale. Preoperative and final follow-up CT findings were used to determine the degree of healing. Results: The mean JSSF scale in all ankles improved from 79.4 (range, 69-90) points preoperatively to 98.4 (range, 87-100) points at final follow-up ( P < .05). In the preoperative CT findings, 3 ankles had no bone fragmentation, 4 had partial bone fragmentation, and 1 had whole fragmentation. In the final follow-up CT findings, 4 ankles demonstrated good healing, 3 were fair, and 1 was poor. Conclusion: The present findings suggest that RD is an effective surgical treatment for OLTs in skeletally immature children. Level of Evidence: Level IV, retrospective case series.

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Osteochondral Lesion of the Talus

Hämel

2021

Foot and Ankle Surgery in Children and Adolescents

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Arthroscopic Retrograde Drilling in Juvenile Osteochondritis Dissecans of the Talus

Abstract: Level IV-therapeutic.

Cited by 22 publications

References 22 publications

Electromagnetic Navigation Reduces Radiation Exposure and Provides Excellent Accuracy for Retrograde Drilling in Osteochondrosis Dissecans of the Talus

Electromagnetic Navigation Reduces Radiation Exposure and Provides Excellent Accuracy for Retrograde Drilling in Osteochondrosis Dissecans of the Talus

Retrograde Drilling for Osteochondral Lesions of the Talus in Skeletally Immature Children

Osteochondral Lesion of the Talus

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