Retrograde Drilling for Osteochondral Lesion of the Talus in Juvenile Patients

Abstract

Background: Retrograde drilling (RD) is generally used for treating osteochondral lesion of the talus (OLT) with a stable osteochondral fragment and nearly normal articular cartilage surface. Previous studies that included participants of various ages have reported good clinical results. This study aimed to clarify the clinical outcomes of RD for OLT in juvenile patients whose bone-forming ability and physical activity might affect the healing process. Methods: This retrospective study included 8 juvenile patients who underwent RD for OLT (5 boys and 3 girls, mean age 14.9 years, mean follow-up 2 years, 7 medial and 1 central lesion). American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score and ankle activity score were evaluated, and arthroscopic findings were graded according to the International Cartilage Research Society (ICRS) classification system. The condition of the underlying bone was assessed on preoperative computed tomographic images. The stability, incorporation, and subsidence of the osteochondral fragment, articular surface congruity, and the area of the bone marrow lesion (BML) were evaluated using magnetic resonance imaging (MRI). Results: AOFAS ankle-hindfoot score and ankle activity score significantly improved postoperatively. Arthroscopically, the lesions were classified as ICRS grade 0 or 1. Bone sclerosis or multiple small cysts of the underlying bone were observed in all patients. MRI demonstrated no signs of osteochondral fragment instability or subsidence, good or fair fragment incorporation, good articular surface congruity, or slight irregularity. The postoperative BML was reduced; however, these BMLs were still detectable at 1 year after surgery. Conclusion: Our data suggested that RD is an option for treating juvenile patients with OLT refractory to nonoperative treatment at short-term follow-up. Although bone sclerosis or multiple small cysts were identified in the underlying bone preoperatively and the BML under the osteochondral fragment remained postoperatively, clinical status such as pain and physical activity level were improved by RD. Level of Evidence: Level IV, retrospective case series.

Treatment of Osteochondral Lesions of the Talus in the Skeletally Immature Population: A Systematic Review

“…A simplified pooling method was performed for 3 studies reporting clinical outcomes after treatment with RD. 9 , 24 This yielded a pooled success rate of 95% (95% CI: 78%-99%) for a total of 22 patients. Two studies reported separate results for lesions with and without a history of trauma, 9 , 24 yielding a success rate of 86% (95% CI: 47%-97%) for traumatic lesions and 100% (95% CI: 65%-100%) for lesions without a history of trauma, for a total of 7 and 7 lesions, respectively.…”

Re-operation rate after surgical treatment of osteochondral lesions of the talus in paediatric and adolescent patients

“…They performed retrograde drilling only in the case of intact overlaying cartilage identified in arthroscopy. Another series of eight patients (mean age 14.9 years) who were treated with retrograde drilling were also reported to have significant clinical improvements (according to the American Orthopaedic Foot and Ankle Society ankle hind-foot score and ankle activity score) [ 24 ]. The OCLTs treated in the above study had a cartilage status of ICRS stage 0 or 1.…”

Matrix-associated autologous chondrocyte implantation with autologous bone grafting of osteochondral lesions of the talus in adolescents: patient-reported outcomes with a median follow-up of 6 years

“…There are several reports of good clinical outcomes following ankle arthroscopy and retrograde drilling [ 4 , 7 , 8 ]. However, this technique is reserved for OCLTs with intact overlaying cartilage [ 24 ].…”

“…Operative therapy options of OCLTs in the paediatric and adolescent population vary; there is a lack of internationally accepted treatment guidelines. For low-stage OCLTs, good clinical results have been reported after arthroscopic treatment with bone marrow stimulation (BMS) techniques, fragment fixation, and retrograde drilling [ 3 – 8 ]. However, relatively high re-operation rates due to treatment failure have also been reported [ 9 ].…”