Skip to main content

Arthroscopic Debridement of Osteochondral Lesions of the Talus

  • Chapter
Cartilage Lesions of the Ankle

Abstract

Osteochondral ankle defects are mostly caused by a traumatic event but can occur even spontaneously. Conservative treatment is the first choice of management, but in case of persistence of symptoms, surgical treatment is required.

Over the last decades, several techniques have been developed, but currently no clear guidelines exist yet, and the best choice of surgical treatment is still debated.

This chapter focuses on a particular set of procedures, such as arthroscopic debridement, microfracturing and/or microdrilling. The main goals are cleaning the ankle joint from every osteochondral fragment and modelling and promoting the development of a new articular surface over the defect area in order to restore the previous functional qualities. All these results must be reached as less invasively as possible, avoiding risks of thermal damage during the procedure, limiting postoperative complications and permitting a reasonable fast recovery.

In the presence of specific indications, such as a small- to medium-sized lesion, primary surgery, young patients, a traumatic etiology and lateral lesions, excellent results can be reached with an effective, minimally invasive and not expensive strategy.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 39.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Zengerink M, Struijs PA, Tol JL et al (2010) Treatment of osteochondral lesions of the talus: a systematic review. Knee Surg Sports Traumatol Arthrosc 18(2):238–246

    Article  PubMed Central  PubMed  Google Scholar 

  2. Robinson DE, Winson IG, Harries WJ et al (2003) Arthroscopic treatment of osteochondral lesions of the talus. J Bone Joint Surg Br 85(13):989–993

    Article  CAS  PubMed  Google Scholar 

  3. Chew KTL, Tay E, Wong ES (2008) Osteochondral lesions of the talus. Ann Acad Med Singapore 37(1):63–68

    PubMed  Google Scholar 

  4. Glazebrook M, Tak-Choy Lau J, Allard J-P (2010) Osteochondral lesions of the talar dome: cartilage replacement using osteochondral autogenous transplantation and mosaicplasty. In: AANA advanced arthroscopy: the foot and ankle, 1st edn. Saunders/Elsevier, Philadelphia, pp 117–124

    Google Scholar 

  5. Easley ME, Orr J, Nunley JA II (2013) Autologous transfer procedure for repairing articular cartilage defects in the talus: OATS procedure. In: Master techniques in orthopaedic surgery: the foot and ankle, 3rd edn. Lippincott Williams & Wilkins, Philadelphia, pp 685–712

    Google Scholar 

  6. Scranton PR Jr, McDermott JE (2001) Treatment of type V osteochondral lesions of the talus with ipsilateral knee osteochondral autografts. Foot Ankle Int 22(5):380–384

    PubMed  Google Scholar 

  7. Ferkel R, Zanotti RM, Komenda GA et al (2008) Arthroscopic treatment of chronic osteochondral lesions of the talus – long-term results. Am J Sports Med 36(9):1750–1762

    Article  PubMed  Google Scholar 

  8. Schmid MR, Pfirrmann CWA, Hodler J et al (2003) Cartilage lesions in the ankle joint: comparison of MR arthrography and CT arthrography. Skeletal Radiol 32(5):259–265

    Article  CAS  PubMed  Google Scholar 

  9. Tol JL, Struijs PA, Bossuyt PM et al (2000) Treatment strategies in osteochondral defects of the talar dome: a systematic review. Foot Ankle Int 21(2):119–126

    CAS  PubMed  Google Scholar 

  10. Kumai T, Takakura Y, Kitada C et al (2002) Fixation of osteochondral lesions of the talus using cortical bone pegs. J Bone Joint Surg Br 84(3):369–374

    Article  CAS  PubMed  Google Scholar 

  11. Kumai T, Takakura Y, Higashiyama I et al (1999) Arthroscopic drilling for the treatment of osteochondral lesions of the talus. J Bone Joint Surg Am 81(9):1229–1235

    CAS  PubMed  Google Scholar 

  12. Taranow WS, Bisignani GA, Towers JD et al (1999) Retrograde drilling of osteochondral lesions of the medial talar dome. Foot Ankle Int 20(8):474.480

    Article  PubMed  Google Scholar 

  13. Schuman L, Struijs PA, van Dijk CN (2002) Arthroscopic treatment for osteochondral defects of the talus. J Bone Joint Surg Br 84(3):364–368

    Article  CAS  PubMed  Google Scholar 

  14. Baums MH, Schultz W, Kostuj T et al (2014) Cartilage repair techniques of the talus: an update. World J Orthop 5(3):171–179

    Article  PubMed Central  PubMed  Google Scholar 

  15. Becher C, Thermann H (2005) Results of microfracture in the treatment of articular cartilage defects of the talus. Foot Ankle Int 26(8):583–589

    PubMed  Google Scholar 

  16. Chen H, Sun J, Hoemann CD et al (2009) Drilling and microfracture lead to different bone structure and necrosis during bone-marrow stimulation for cartilage repair. J Orthop Res 27(11):1432–1438

    Article  PubMed  Google Scholar 

  17. Takao M, Ochi M, Naito K et al (2003) Arthroscopic drilling for chondral, subchondral, and combined chondral-subchondral lesions of the talar dome. Arthroscopy 19(5):524–530

    Article  PubMed  Google Scholar 

  18. Takao M, Uchio Y, Kakimaru H et al (2004) Arthroscopic drilling with debridement of remaining cartilage for osteochondral lesions of the talar dome in unstable ankles. Am J Sports Med 32(2):332–336

    Article  PubMed  Google Scholar 

  19. Giannini S, Vannini F (2004) Operative treatment of osteochondral lesions of the talar dome: current concepts review. Arthroscopy 25(3):168–175

    Google Scholar 

  20. Kono M, Takao M, Naito K et al (2006) Retrograde drilling of osteochondral lesions of the talar dome. Am J Sports Med 34(9):1450–1456

    Article  PubMed  Google Scholar 

  21. Kok AC, den Dunnen S, Tuijthof GJM et al (2012) Is technique performance a prognostic factor in bone marrow stimulation of the talus? J Foot Ankle Surg 51(6):777–782

    Article  PubMed  Google Scholar 

  22. Ogilvie-Harris DJ, Sarrosa EA (1999) Arthroscopic treatment after previous failed open surgery for osteochondral dissecans of the talus. Arthroscopy 15(8):809–812

    Article  CAS  PubMed  Google Scholar 

  23. Mirzayan R (2006) Microfracture technique. In: Cartilage injury in the athlete, 1st edn. Thieme Medical Publishers, Inc, New York, p 119

    Google Scholar 

  24. Doral MN, Bilge O, Batmaz G et al (2012) Treatment of osteochondral lesions of the talus with microfracture technique and postoperative hyaluronan injection. Knee Surg Sports Traumatol Arthrosc 20(7):1398–1403

    Article  CAS  PubMed  Google Scholar 

  25. Donnenwerth MP, Roukis TS (2012) Outcome of arthroscopic debridement and microfracture as the primary treatment for osteochondral lesions of the talar dome. Arthroscopy 28(12):1902–1907

    Article  PubMed  Google Scholar 

  26. Klammer G, Maquieira GJ, Spahn S et al (2015) Natural History of Nonoperatively Treated Osteochondral Lesions of the Talus. Foot Ankle 36(1):24-31

    Article  PubMed  Google Scholar 

  27. Savva N, Jabur M, Davies M, Saxby T (2007) Osteochondral lesions of the talus: results of repeat arthroscopic debridement. Foot Ankle Int 28(6):669–673

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Gian Luigi Canata MD .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2015 ISAKOS

About this chapter

Cite this chapter

Canata, G.L., Casale, V. (2015). Arthroscopic Debridement of Osteochondral Lesions of the Talus. In: Canata, G., van Dijk, C. (eds) Cartilage Lesions of the Ankle. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-46332-1_4

Download citation

  • DOI: https://doi.org/10.1007/978-3-662-46332-1_4

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-46331-4

  • Online ISBN: 978-3-662-46332-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics