Arthroscopic treatment of osteochondral lesions of the talus

Abstract

Objective: To assess pain and function of the ankle in patients with injuries up to 1.5 cm diameter by the American Orthopaedic Foot and Ankle Society (AOFAS) score after arthroscopic treatment. Methods: The AOFAS scale was applied before and after arthroscopy, as well as the degree of subjective satisfaction of ambulatory patients. Patients with type I osteochondral injuries, acute trauma, using plaster, presenting lesions in other joints of the lower limbs and cognitive impairment that would prevent the application of the satisfaction questionnaire were excluded from the study.

Treatment of osteochondral defects of the talus

“…394 We had hypothesized that the size of the OCD would be a significant predictor of outcome, as has been reported in some of the previous studies that investigated predictors of outcome of arthroscopic treatment of OCDs (Table 4). 44,76,77,82,128,156,165,190,235,244,334 However, none of the predictive factors investigated in the present study was found to be significantly associated with the clinical or radiographic outcome. The fact that no prognostic factors were identified may have been due to insufficient study power.…”

“…Th e use of either a drill or a K-wire also allows a transmalleolar or retrograde approach to the lesion. 334,381 A drawback of the transmalleolar approach is the iatrogenic damage of the opposing tibial articular cartilage. Moreover, it has been associated with persistent pain and oedema, and even a stress fracture may occur.…”

“…In addition, several continuous factors were dichotomized on the basis of information in the literature. 44,235,334,457 Specifically, defect size was dichotomized as ≤11 and >11 mm; age, as ≤32 years and >32 years; duration of symptoms, as ≤12 months and >12 A B C Figure 2. Examples of grades 0, I, and II of the ankle osteoarthritis classification system.…”

“…82,147 Diff erent methods are used to approach the lesion during arthroscopy, e.g., full plantar fl exion, distraction, and transmalleolar or retrograde drilling. 125,334,346,381 Depending on the location of the defect, the arthroscopic approach can be performed from either anterior or posterior. 432 Furthermore, diff erent tools for bone marrow stimulation can be used, i.e., a K-wire, drill or microfracture awl.…”

Potential pitfall in the microfracturing technique during the arthroscopic treatment of an osteochondral lesion

“…A drawback of the transmalleolar approach is the iatrogenic damage of the opposing tibial articular cartilage. Moreover, it has been associated with persistent pain and oedema, and even a stress fracture may occur [7].…”