Arthroscopically Assisted Anterior Treatment of Symptomatic Large Talar Bone Cyst

Abstract

Symptomatic cystic lesions of the talus are rare. The traditional operations usually do not provide visualization to reveal the deep structure of the lesion and could cause cartilage damage or other severe traumatic injury. We report an operative technique to reach the cystic lesion without talar cartilage damage, remove the lesion, and fill defect with a bone graft assisted by anterior arthroscopy and evaluate its safety and reliability for future study. Seven cases of talar bone cyst were included. The patients were placed in the supine position after anesthesia induction and noninvasive ankle traction was applied. Standard anteromedial and anterolateral portals were established to observe the ankle; the distal end of the medial approach was moderately enlarged to 2 to 3 cm. The biopsy specimen of the cyst was obtained under arthroscopic guidance; the cyst wall was abraded and the sclerotic rim drilled. Arthrocare radiofrequency ablation was performed to prevent recurrence. The defect was tightly impacted with autologous or allograft cancellous bone. All cysts in these cases were located in the medial talus; anteroposterior radiographs and computed tomographic coronary scan showed a cyst diameter of >1 cm. Intraoperative inspection showed a tiny chondral gap on the talar dome in 1 case and on the medial wall of talus in 1 case; no cartilage injury was found in the remainder. Two cases were impacted with grafted autogenous iliac bone into the talar defect and 5 cases with allograft cancellous bone. Computed tomography confirmed that the cysts had healed, with no signs of recurrence found in any patient at 1 year postoperatively. The mean American Orthopaedic Foot and Ankle Society ankle-hindfoot scale score increased from 65 preoperatively to 91 points postoperatively, a statistically significant difference (p < .01). No complications developed and no reoperations were required postoperatively. Arthroscopically assisted anterior treatment with autologous or allograft bone graft is an effective method for symptomatic large talar bone cysts.

Endoscopic Treatment of Symptomatic Foot and Ankle Bone Cyst with 3D Printing Application

“…This technique is especially suitable for bone cysts combined with other structural abnormalities at the posterior malleolus, such as tenosynovitis of flexor pollicis longus, symptomatic triquetral bone, and villonodular synovitis. Zhu et al reported an anterior arthroscopic treatment for 7 cases of talar bone cysts, which also achieved satisfactory results in the short term [5]. In this study, the number of cases has been increased to 21; as for the location of cysts, in addition to the talus, distal tibia and calcaneus were also included.…”

“…For example, the incidence of talar bone cysts accounts for 0.003% of the bone tumor, and they are commonly diagnosed as simple bone cysts, aneurysmal bone cysts, intraosseous ganglion, etc. [1][2][3][4][5][6][7][8]. The etiology and mechanism of bone cysts have not been fully elucidated.…”

Management of Bone Cyst of Talar Body by Endoscopic Curettage, Nanofracture, and Bone Graft Substitute

“…However, when the talus is extensively destroyed, there is risk of pathologic fracture and damage to the articular cartilage, leading to persistent swelling and pain of the subtalar joint and ankle joint. 3 For symptomatic cyst recalcitrant to conservative treatment, surgery is indicated. Because most of the area of the talus is covered with articular cartilage, it is rather difficult to conduct surgical procedures without damaging the cartilage of the talus.…”

“…Because most of the area of the talus is covered with articular cartilage, it is rather difficult to conduct surgical procedures without damaging the cartilage of the talus. 3 Open debridement and bone grafting frequently requires extensive soft-tissue dissection or even different types of malleolar osteotomy for proper access to the lesion. 3 , 4 Arthroscopic treatment is a possible solution to reduce the surgical trauma and eliminate the need of osteotomy.…”

“… 3 Open debridement and bone grafting frequently requires extensive soft-tissue dissection or even different types of malleolar osteotomy for proper access to the lesion. 3 , 4 Arthroscopic treatment is a possible solution to reduce the surgical trauma and eliminate the need of osteotomy. 3 , 4 As compared with fluoroscopic-guided curettage and bone grafting of the talar cyst, 5 the arthroscopic approach can have better assessment of completeness of debridement and can manage the associated OCL.…”