M Richter1, S Zech. 1. Klinik für Fuß- und Sprunggelenkchirurgie, Krankenhaus Rummelsberg, Schwarzenbruck. martinus.richter@klinikum-coburg.de
Abstract
OBJECTIVE: Subchondral decompression and revascularization in Osteochondrosis dissecans (OCD) of the talus with cartilage preservation. INDICATIONS: Symptomatic talar OCD stage I and II, i.e., cartilage intact or almost intact. CONTRAINDICATIONS: Talar OCD stage III and IV, i.e., cartilage not intact. SURGICAL TECHNIQUE: Diagnostic ankle arthroscopy. Insertion of dynamic reference base (DRB) in the talar neck through a stab incision. After 3D image acquisition and planning of the drilling, navigated drilling with a 5 mm drill. Insertion of a 1 mm titanium wire into the canal and 3D image acquisition for evaluation of the canal. Autologous cancellous bone transplantation into the canal. Arthroscopic evaluation. POSTOPERATIVE MANAGEMENT: For 6 weeks, 15 kg partial weight bearing without immobilization. After 6 weeks full weight bearing. RESULTS: A total of 52 patients with symptomatic talar OCD stage I and II were included in a clinical follow-up study. Time needed for preparation, including the placement of the DRB, scanning time, and preparation of the trajectories was 7 min 32 s (4-30 min). In 50 cases (96%), the drilling was judged with 3D imaging to be correct. In the remaining 2 cases (4%), the drilling ended in the caudal portion of the lesion. A perforation of the cartilage was not registered arthroscopically. Follow-up after 12 months (range 6-36 months) was possible in 48 patients (92%). Three patients (6%) had been converted to bone cartilage transplantation (OATS) due to recurrent symptoms. These patients were excluded from follow-up. The follow-up scores were Visual Analogue Scale Foot and Ankle (mean 93 points [range 86-100 points]) and the SF 36 (standardized to 100 point maximum, 90 points [range 79-100 points]).
OBJECTIVE: Subchondral decompression and revascularization in Osteochondrosis dissecans (OCD) of the talus with cartilage preservation. INDICATIONS: Symptomatic talar OCD stage I and II, i.e., cartilage intact or almost intact. CONTRAINDICATIONS: Talar OCD stage III and IV, i.e., cartilage not intact. SURGICAL TECHNIQUE: Diagnostic ankle arthroscopy. Insertion of dynamic reference base (DRB) in the talar neck through a stab incision. After 3D image acquisition and planning of the drilling, navigated drilling with a 5 mm drill. Insertion of a 1 mm titanium wire into the canal and 3D image acquisition for evaluation of the canal. Autologous cancellous bone transplantation into the canal. Arthroscopic evaluation. POSTOPERATIVE MANAGEMENT: For 6 weeks, 15 kg partial weight bearing without immobilization. After 6 weeks full weight bearing. RESULTS: A total of 52 patients with symptomatic talar OCD stage I and II were included in a clinical follow-up study. Time needed for preparation, including the placement of the DRB, scanning time, and preparation of the trajectories was 7 min 32 s (4-30 min). In 50 cases (96%), the drilling was judged with 3D imaging to be correct. In the remaining 2 cases (4%), the drilling ended in the caudal portion of the lesion. A perforation of the cartilage was not registered arthroscopically. Follow-up after 12 months (range 6-36 months) was possible in 48 patients (92%). Three patients (6%) had been converted to bone cartilage transplantation (OATS) due to recurrent symptoms. These patients were excluded from follow-up. The follow-up scores were Visual Analogue Scale Foot and Ankle (mean 93 points [range 86-100 points]) and the SF 36 (standardized to 100 point maximum, 90 points [range 79-100 points]).
Authors: Richard D Ferkel; Robert M Zanotti; Gregory A Komenda; Nicholas A Sgaglione; Margaret S Cheng; Gregory R Applegate; Ryan M Dopirak Journal: Am J Sports Med Date: 2008-09 Impact factor: 6.202
Authors: Oliver D Jungesblut; Josephine Berger-Groch; Michael Hoffmann; Malte Schroeder; Kara L Krajewski; Ralf Stuecker; Martin Rupprecht Journal: BMC Musculoskelet Disord Date: 2021-02-03 Impact factor: 2.362