Osteochondral Lesions of the Talus: Retrograde Drilling with High-Field-Strength MR Guidance

Seebauer, Christian; Bail, Hermann Josef; Wichlas, Florian; Jung, Tobias; Papanikolaou, Ioannis S.; Voort, I. van der; Rump, Jens; Schilling, René L.; Winkelmann, Andreas; Walther, T; Chopra, Sasha S.; Teichgräber, Ulf

doi:10.1148/radiol.2523081981

Cited by 18 publications

(11 citation statements)

References 22 publications

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“…Computer-assisted surgery for retrograde drilling procedures in OCD lesions has increased the precision of drilling; furthermore, this method reduces radiation exposure [18,19]. Navigation systems offer higher precision compared with uoroscopy-guided techniques; thus, different navigation techniques have been established, such as opto-electronic guidance systems, 3-dimensional uoroscopy-based, MRI-based, or computed tomography-based methods [26].…”

Section: Discussionmentioning

confidence: 99%

“…Retrograde drilling avoids articular surface violation in most cases, but control of the drill depth and drill placement can be challenging and require radiographic guidance [14]. As a result of the complexity of these surgeries, numerous approaches have been reported: freehand uoroscopy-guided drilling with or without guiding techniques [15] such as computed tomography [16,17], MRI [18,19] and ultrasoundguided [20] options, as well as opto-electronically [21] and x-ray [22] guidance.…”

Section: Introductionmentioning

confidence: 99%

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Electromagnetic Navigation Reduces Radiation Exposure and Provides Excellent Accuracy for Retrograde Drilling in Osteochondrosis Dissecans of the Talus

Berger-Groch

Jungesblut

Hoffmann

et al. 2020

Preprint

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Background: Retrograde drilling in osteochondrosis dissecans (OCD) is a widely used surgical intervention. A radiation-free electromagnetic navigation system (ENS)-based method was compared with the standard freehand fluoroscopic (SFF) method regarding clinical applicability.Methods: We performed a clinical cohort study at a department of Orthopaedics in a Level 1 children’s hospital with 40 patients (20 SFF and 20 ENS). Retrograde drilling of the talar dome was used in patients with unstable medial OCD (MRI stage 2 according to Hepple’s revised classification; stage 2 according to the International Cartilage Repair Society). The outcome measurements were: a) Intraoperative fluoroscopy exposure and length of surgery and b) Postoperative serial follow-up MRIs every 6 months.Results: 22 female and 18 male patients aged 13.8 ± 1.6 years (range: 11-17 years) were included. Using the ENS technique, length of surgery was significantly reduced to 20.2 ± 6.4 min compared to 36.1 ± 11.8 min (p<0.01) for the SFF technique. The average x-ray radiation time for the SFF technique was 23.5 ± 13.5 sec and 1.9 ± 1.7 sec for the ENS technique (p<0.01). Radiation exposure was significantly reduced from 44.6 ± 19.7 mSv (SFF technique) to 5.6± 2.8 mSv (ENS technique) (p<0.01). Intraoperative perforation of cartilage occurred once in the SFF group. Correct placement of the drilling channel was verified in all patients on follow-up MRI after six months and a timely healing was seen after two years. No differences were detected on follow-up MRI between the two methods.Conclusions: The ENS method provides for a significant reduction in length of surgery and radiation exposure. ENS was without intraoperative cartilage perforation. The clinical and radiological follow-up parameters are comparable for SFF- and ENS-guided retrograde drilling.Trial registration: WF – 085/20, 05/2020 “retrospectively registered”

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Electromagnetic Navigation Reduces Radiation Exposure and Provides Excellent Accuracy for Retrograde Drilling in Osteochondrosis Dissecans of the Talus

Berger-Groch

Jungesblut

Hoffmann

et al. 2020

Preprint

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“…Studies showed that retrograde drilling can manage subchondral necrotic sclerotic lesions for bone marrow stimulation without damaging the cartilage surface in the treatment of undisplaced OCLs of the talus 2, 8–10 . These lesions can be excised accurately under the guidance of fluoroscopy 10 , MRI 22 or computer-assisted navigation 23–25 . Arthroscopic-controlled or computer-assisted navigation could allow a more exact localization.…”

Section: Discussionmentioning

confidence: 99%

Combined Therapy with Shock Wave and Retrograde Bone Marrow-Derived Cell Transplantation for Osteochondral Lesions of the Talus

Gao

Chen

Sun

et al. 2017

Sci Rep

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Multiple treatment strategies have been developed for osteochondral lesions (OCLs) of the talus. The purpose of this retrospective study was to assess retrograde autologous bone marrow cell (BMC) transplantation via core drilling (CD) combined with focused extracorporeal shock wave treatment (ESWT) in undisplaced OCL of the talus. A total of 69 patients with unilateral osteochondral lesions of the talus (Hepple grade I–III) were divided into two groups: 41 patients received combined therapy of ESWT and BMC transplantation (group A), while 28 were administered BMC transplantation alone (group B). The patients were followed up clinically and radiographically for a minimum of 2 years. Mean follow-up was 4.1 ± 2.8 years. AOFAS scores increased more significantly while pain intensity levels decreased in group A after treatment, compared with group B values (P < 0.001). In MRI follow-up, a more remarkable improvement of OCLs of the talus was observed in group A compared with group B (P = 0.040). Therefore, the combined technique reported here is a highly effective therapeutic option in OCLs of the talus with intact cartilage. It promotes patient recovery with pain control, and improves clinical outcome for more than 2 years after surgery.

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“…In the reports of OCD lesions of the talus, open MRI scanners and navigation systems tend to be used for the retrograde drilling. 14 , 15 , 18 , 22 , 29 However, for drilling the OCD lesion of the femoral condyle, an image intensifier is often used even now. 20 , 30 – 32 The reason for this is that it is thought that a clear lateral view of the femoral condyle is more easily obtained compared to the talus, because the femoral condyle is not surrounded by other bones, unlike the talus.…”

Section: Discussionmentioning

confidence: 99%

Osteochondritis Dissecans Involving the Trochlear Groove Treated With Retrograde Drilling

et al. 2015

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Osteochondritis dissecans (OCD) occurs frequently in the humeral capitellum of the upper extremity, whereas OCD involving the trochlear groove (trochlear groove OCD) is rarely reported. A standard treatment for trochlear groove OCD has therefore not been determined, although several methods have been tried.The case of a 14-year-old male gymnast with bilateral trochlear groove OCD is presented. Retrograde drilling from the lateral condyle of the humerus was applied for the OCD lesion of the left elbow, since it was larger in size than that in the right elbow and was symptomatic. Conversely, since the right lesion was small and asymptomatic, it was managed conservatively.After treatment, consolidation of the OCD lesions was observed in both elbows. However, the time to healing was shorter in the left elbow treated surgically than in the right elbow managed conservatively.In conclusion, retrograde drilling is a very simple and minimally invasive treatment. This case suggests that retrograde drilling for trochlear groove OCD may be a useful procedure that may accelerate the healing process for OCD lesions.

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Osteochondral Lesions of the Talus: Retrograde Drilling with High-Field-Strength MR Guidance

Cited by 18 publications

References 22 publications

Electromagnetic Navigation Reduces Radiation Exposure and Provides Excellent Accuracy for Retrograde Drilling in Osteochondrosis Dissecans of the Talus

Electromagnetic Navigation Reduces Radiation Exposure and Provides Excellent Accuracy for Retrograde Drilling in Osteochondrosis Dissecans of the Talus

Combined Therapy with Shock Wave and Retrograde Bone Marrow-Derived Cell Transplantation for Osteochondral Lesions of the Talus

Osteochondritis Dissecans Involving the Trochlear Groove Treated With Retrograde Drilling

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