Technical note: Resterilizable noninvasive ankle distraction device

Treatment of osteochondral defects of the talus

“…210 The maximum joint distraction has been reported to average 1.3 to 4.5 mm. 108,428 Continuous distraction, however, could possibly lead to more neurovascular complications. 96,108 We prefer an anterior arthroscopy technique without continuous distraction, applying dorsiflexion and plantar flexion as indicated and, if necessary, temporary noninvasive distraction.…”

“…During this part of the procedure a soft tissue distractor may be applied ( Figure 5A). 424,428 It should now be possible to visualise the lesion in the forced plantarfl exed position ( Figure 5B) and to identify the defect by palpating the cartilage with a probe or hook ( Figure 5C). Debridement is performed with use of the bonecutter shaver or a small closed-cup curette ( Figure 5D).…”

“…A soft-tissue distraction device can be used when indicated. 428 For irrigation, normal saline with gravity flow is suitable. A 4.0-mm, 30° arthroscope is routinely used for posterior ankle arthroscopy.…”

“…The surgeon, blinded to the plantarflexion CT scan, measured the anteroposterior distance between the anterior border of the OCD and the anterior distal tibial rim with the patient's ankle in full plantar flexion, using a specially developed arthroscopic ruler ( Figure 3B). After the measurement, in some difficult cases, a small bony rim or osteophyte of the anterior distal tibia was removed with a bonecutter shaver, or noninvasive distraction with a strap around the ankle 428 was used to improve exposure. The OCD was treated by debridement from anteriorly to posteriorly and additional microfracturing with a curved microfracture awl.…”

“…With noninvasive distraction, the force of distraction was not actually measured in this group, but it was 110 N in OCD patients in a previous study. 428 Th e optimal surgical approach depends on the characteristics of the OCD and the patient, the type of treatment, and the experience of the surgeon. 296,408 Anterior arthroscopic ankle surgery is the primary treatment of choice and has the advantages of enhanced visualization, outpatients' treatment, less postoperative morbidity than open surgery, and early functional rehabilitation.…”