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

Abstract

Large bone cyst of the talar body is frequently associated with an osteochondral lesion. The talar bone cyst can be an incidental radiologic finding. However, when the talus is extensively destroyed, there is a risk of pathologic fracture and damage to the articular cartilage, leading to persistent swelling and pain of the subtalar joint and ankle joint. Open debridement and bone grafting frequently requires extensive soft-tissue dissection or even different types of malleolar osteotomy for proper access to the lesion. The purpose of this Technical Note is to describes the technique of endoscopic curettage, nanofracture, and filling the cyst with injectable bone graft substitute. This minimally invasive approach has minimal disruption of the normal cartilage surface.

Arthroscopic Revision of Attenuated Anterior Cruciate Ligament Graft With Enlarged Bone Tunnels Using Injectable Bone Graft Substitute

“…This might enhance vascular infiltration and replacement of the graft by new bone, while providing osteoconductive and mechanical support. 13 , 14 Moreover, its initial stability after setting can avoid dropping of the graft from the femoral bone tunnel into the knee joint by the effect of gravity. 4 …”

Arthroscopic Treatment of Bone Cyst of Anterior Half of the Talar Body

“…Injectable regenerative graft instead of autograft is used to eliminate donor morbidity, shorten the operation, and eliminate the risk of dropping of bone graft into the ankle joint. 5 The injectable regenerative graft is based on combinations of the fast-dissolving calcium sulfate and the stronger and more slowly remodeling calcium phosphate compounds. This might enhance vascular infiltration and replacement of the graft by new bone, whilst providing osteoconductive and mechanical support.…”

“…The procedure starts with ankle arthroscopy via the anteromedial and anterolateral portals, which are at the lateral side of tibialis anterior tendon and the medial side of peroneus tertius tendon respectively ( Fig 3 ). 5 Three- to four-millimeter skin incisions are made at the portal sites and the subcutaneous tissue is bluntly dissected down to the ankle joint capsule with a hemostat. The capsule is perforated by the tip of the hemostat.…”

“…Many surgical approaches have been advocated to treat symptomatic bone cysts. 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 Because the majority of the talar surface is covered with articular cartilage, open surgical approaches to the talar bone cysts frequently require extensive soft-tissue dissection, malleolar osteotomy, and damage to the talar articular cartilage. 1 , 2 Arthroscopic treatment of talar bone cyst is a feasible alternative minimally invasive approach to reduce the surgical trauma and eliminate the need of osteotomy.…”

“… 1 , 2 Arthroscopic treatment of talar bone cyst is a feasible alternative minimally invasive approach to reduce the surgical trauma and eliminate the need of osteotomy. 1 , 2 , 3 , 4 , 5 , 12 Bone cyst of the anterior part of the talar body can be debrided via a bone window of the talar neck which is normally void of cartilage. 3 This Technical Note describes the technique of endoscopic debridement and filling the cyst with injectable bone graft substitute.…”