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This Article Full Text Full Text (PDF) All Versions of this Article: 34/9/1450    most recent 0363546506287300v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Request Reprints Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (1) Citing Articles via Google Scholar Google Scholar Articles by Kono, M. Articles by Ochi, M. Search for Related Content PubMed PubMed Citation Articles by Kono, M. Articles by Ochi, M. Related Collections Ankle Chondral/cartilage Arthroscopy

Retrograde Drilling for Osteochondral Lesions of the Talar Dome

Michihaya Kono, MD^*, Masato Takao, MD, PhD^,, Kohei Naito, MD, PhD^*, Yuji Uchio, MD, PhD^* and Mitsuo Ochi, MD, PhD

From the ^* Department of Orthopaedic Surgery, Shimane University School of Medicine, Shimane, Japan, the Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan, and the Department of Orthopaedic Surgery, Graduate School of Biomedical Science, Hiroshima University, Hiroshima, Japan

Address correspondence to Masato Takao, MD, PhD, Department of Orthopaedic Surgery, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi, Tokyo, 173-8606, Japan (e-mail: masatotakao{at}aa.cyberhome.ne.jp).

Background: For the treatment of osteochondral lesions of the talar dome without detachment of the cartilage, there is little information on whether transmalleolar drilling or retrograde drilling is more effective in terms of clinical and morphologic evaluations.

Hypothesis: Retrograde drilling may be more effective than transmalleolar drilling for lesions without cartilage detachment.

Study Design: Case control study; Level of evidence, 3.

Methods: Subjects were 30 patients with lesions on 1 foot of grade 0 or I, determined according to a modified Pritsch classification system. Nineteen patients underwent transmalleolar drilling (TMD group), and 11 patients underwent retrograde drilling (RD group). Ankle arthroscopy was performed 1 year postoperatively to evaluate cartilage conditions.

Results: Arthroscopic findings revealed that in the TMD group, 11 lesions (57.9%) were unchanged (grade I), and 8 lesions (42.1%) had deteriorated from grade 0 to I; in the RD group, 3 lesions (27.2%) had improved from grade I to 0, and 8 (72.8%) were unchanged (2 grade 0 lesions and 6 grade I lesions). There was a significant difference between the 2 groups in the distribution of cases that had improved, were unchanged, or had deteriorated (P < .0001).

Conclusions: This study showed that compared with transmalleolar drilling, retrograde drilling for osteochondral lesions of the talar dome can improve the arthroscopic assessment of the lesions.

Key Words: ankle • osteochondral lesions • talar dome • arthroscopy • retrograde drilling

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