Operative Technique and Clinical Outcome in Endoscopic Core Decompression of Osteochondral Lesions of the Talus: A Pilot Study

Abstract

BackgroundRevitalizing the necrotic subchondral bone and preserving the intact cartilage layer by retrograde drilling is the preferred option for treatment of undetached osteochondral lesions of the talus (OLT). We assessed the effectiveness of Endoscopic Core Decompression (ECD) in treatment of OLT.Material/MethodsSeven patients with an undetached OLT of the medial talar dome underwent surgical treatment using an arthroscopically-guided transtalar drill meatus for core decompression of the lesion. Under endoscopic visualization the OLT was completely debrided while preserving the cartilage layer covering the defect. The drill tunnel and debrided OLT were filled using an injectable bone graft substitute. Various clinical scores, radiographic imaging, and MRI were evaluated after a mean follow-up of 24.1 months.ResultsThe American Orthopedic Foot and Ankle Society Score significantly improved from 71.0±2.4 to 90.3±5.9, and the Foot and Ankle Disability Index improved from 71.8±11.1 to 91.7±4.8. Radiographically, we observed good bone remodelling of the medial talar dome contour within 3 months. In MRI, an alteration of the bony signal of the drill tunnel and the excised OLT remained for more than 12 months.ConclusionsFirst follow-up results for the surgical technique described in this study are highly promising for treatment of undetached stable OLT grade II or transitional stage II–III according to the Pritsch classification. Even lesions larger than 150 mm2 showed good clinical scores, with full restoration of the medial talar dome contour in radiographic imaging.

Subchondral Pathology: Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle

“…13 To our knowledge, there are only small case series or case reports reporting outcomes of RD with calcium phosphate substitutes. 2,20 Beck et al reported good clinical results in only 7 patients who underwent RD with calcium phosphate substitutes at 2 years of follow-up. 2 Although bone void substitutes may be a good option for subchondral bone marrow lesions with associated cyst(s), there is a paucity of clinical evidence to support their use.…”

“…2,20 Beck et al reported good clinical results in only 7 patients who underwent RD with calcium phosphate substitutes at 2 years of follow-up. 2 Although bone void substitutes may be a good option for subchondral bone marrow lesions with associated cyst(s), there is a paucity of clinical evidence to support their use. Furthermore, there are no studies comparing cancellous bone grafting and bone void substitutes.…”

The Frequency and Severity of Complications in Surgical Treatment of Osteochondral Lesions of the Talus: A Systematic Review and Meta-Analysis of 6,962 Lesions

“…Scoring the methodological quality of the 134 non-comparative studies resulted in an average score of 10.1 (range: 5-13) out of 16 points. 11,14,15,17,27 -29,36 …”

“…43,52,59,61 -63,66,81,92,93,109,113,117,121,123,125,131,135,141,143,146,149,150,153,158,164,165,167,168,171,173,176,177,179 -183,187,190,192,195 -200,202,204 -206 b Significantly different from metal implants ( Q = 3.86, P = 0.0493). 11,42,53,56,59,116,118,137,170,177,194,196 c…”

Outcomes from Osteochondral Autograft Transplant or Mosaicplasty in 26 Patients with Type V Osteochondral Lesions of the Talus

“…Although the incidence rate is relatively low, in most cases, it is necessary to heal the cartilage and osteochondral talus injury because it has a great influence on daily life, particularly in young people and those who wish to actively participate in sports [ 3 ]. Indeed, nondisplaced cartilage lesions were often treated with a nonoperative approach, and symptomatic injuries were surgically treated [ 4 – 6 ]. The success rate of surgical treatment is higher after a period of non-surgical treatment [ 7 ].…”