Arthroscopic management of small osteochondral lesions of the talus: drilling revisited

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Abstract

Background:

The aim of the study was to evaluate the short-term clinical outcomes of arthroscopic drilling in the management of small osteochondral lesions of the talus (OLT).

Methods:

Thirty-two patients with small OLT (area <150 mm2 and cyst depth <7 mm as measured on CT and MRI) were treated by arthroscopic debridement and drilling. Four patients underwent simultaneous modified Broström procedures. Five patients required retrograde drilling, three because the overlying cartilage was intact and two because the lesion was posterior. Outcomes were measured using the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale and subjective patient satisfaction.

Results:

The mean age at surgery was 32±8 yr (range, 18-50 yr). There were 22 men (68.75%) and 10 women (31.25%). Four patients (12.5%) were playing sports regularly, one professionally and three recreationally. After a mean follow-up duration of 26 mo (range 12-48 mo), the mean AOFAS score improved from 71.78±11 (range 51-87) preoperatively to 91±7 (range 80-100). The results were excellent in 15 patients (46.9%), good in 12 (37.5%), fair in five(15.6%). According to the Saxena criteria 16 patients (50%) were very satisfied, nine patients (28.1%) were satisfied, six patients (18.8%) were satisfied with reservations and one patient (3.1%) was unsatisfied.

Conclusions:

Arthroscopic drilling for small OLT is safe and easy with results comparable to microfracture but with the advantages of deeper penetration and the ability to drill retrograde into posterior lesions or lesions with intact cartilage.

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