Articles   |    
Arthroscopic Drilling for the Treatment of Osteochondral Lesions of the Talus*
View Disclosures and Other Information
Investigation performed at Nara Medical University, Nara
J Bone Joint Surg Am, 1999 Sep 01;81(9):1229-35
5 Recommendations (Recommend) | 3 Comments | Saved by 3 Users Save Case


Background: An osteochondral lesion of the talus is a relatively rare disorder of the ankle. While a number of treatment options have been reported, it appears to be difficult to manage all lesions with a single approach. We evaluated the indications for and the results of arthroscopic drilling for the treatment of an osteochondral lesion of the talus.Methods: Eighteen ankles (seventeen patients) with a symptomatic osteochondral lesion of the talus were examined. The ages of the patients ranged from ten to seventy-eight years (mean, 28.0 years) at the time of the operation, and the patients were followed postoperatively for two to 9.5 years (mean, 4.6 years). After the continuity of the cartilage overlying the lesion and the stability of the lesion had been confirmed, arthroscopic drilling was performed with use of a Kirschner wire that was 1.0 to 1.2 millimeters in diameter. A cast was not applied postoperatively, and full weight-bearing was allowed six weeks after the procedure.Results: The clinical result was good for thirteen ankles and fair for five; all ankles had improvement. Twelve of the thirteen ankles that were in patients who were less than thirty years old had a good result. In contrast, only one of the five ankles in patients who were fifty years old or more had a good result. Thus, the clinical results tended to be better for younger patients. Improvement was seen radiographically in fifteen ankles. However, the three ankles in patients who were more than sixty years old were found to have no improvement on radiographic examination. Analysis of the group of patients who had a history of trauma revealed that the mean interval between the injury and the operation was 6.3 months for the three ankles that had a good radiographic result and 11.3 months for the six that had a fair result. Thus, the radiographic results tended to be better when the interval between the injury and the operation was shorter.Conclusions: Arthroscopic drilling for the treatment of medial osteochondral lesions of the talus does not require osteotomy of the medial malleolus or postoperative immobilization; thus, the procedure is less invasive than other types of operative treatment for the condition and it allows early resumption of daily activities and sports. On the basis of the results in this study, we believe that the procedure is effective and useful in young patients, especially those who have not yet had closure of the epiphyseal plate. A specific indication for the procedure is an early lesion with only mild osteosclerosis of the surrounding talar bone, continuity of the cartilaginous surface, and stability of the osteochondral fragment.

Figures in this Article
    Sign In to Your Personal ProfileSign In To Access Full Content
    Not a Subscriber?
    Get online access for 30 days for $35
    New to JBJS?
    Sign up for a full subscription to both the print and online editions
    Register for a FREE limited account to get full access to all CME activities, to comment on public articles, or to sign up for alerts.
    Register for a FREE limited account to get full access to all CME activities
    Have a subscription to the print edition?
    Current subscribers to The Journal of Bone & Joint Surgery in either the print or quarterly DVD formats receive free online access to JBJS.org.
    Forgot your password?
    Enter your username and email address. We'll send you a reminder to the email address on record.

    Forgot your username or need assistance? Please contact customer service at subs@jbjs.org. If your access is provided
    by your institution, please contact you librarian or administrator for username and password information. Institutional
    administrators, to reset your institution's master username or password, please contact subs@jbjs.org


    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
    CME Activities Associated with This Article
    Submit a Comment
    Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
    Comments are moderated and will appear on the site at the discretion of JBJS editorial staff.

    * = Required Field
    (if multiple authors, separate names by comma)
    Example: John Doe

    Related Content
    The Journal of Bone & Joint Surgery
    JBJS Case Connector
    Topic Collections
    Related Audio and Videos
    Results provided by:
    Clinical Trials
    Readers of This Also Read...
    JBJS Jobs
    Connecticut - Yale University School of Medicine
    S. Carolina - Department of Orthopaedic Surgery Medical Univerity of South Carlonina
    W. Virginia - Charleston Area Medical Center