J Korean Orthop Assoc.  2007 Dec;42(6):750-755. 10.4055/jkoa.2007.42.6.750.

Clinical Results of the Multiple Drilling for Osteochondral Lesion of the Medial Talar Dome

Affiliations
  • 1Department of Orthopedic Surgery, School of Medicine, Kyung Hee University, Seoul, Korea. dukech@khmc.or.kr

Abstract

PURPOSE: To evaluate the treatment outcomes of transmalleolar multiple drilling with a K-wire for an osteochondral lesion of the medial talar dome after an mean follow-up period of 77 months.
MATERIALS AND METHODS
Among patients treated surgically for a symptomatic osteochondral lesion of the talus between March 1997 and December 2002, sixteen ankles (fifteen patients) with a medial talar dome lesion were treated by transmalleolar multiple drilling and followed-up for at least 3 years. The average age at the time of surgery was 34.4 years (range, 19-58 years). The mean follow-up period was 77 months (range, 41-107 months).
RESULTS
At the latest follow-up, the average VAS at motion decreased from 6.8 to 2.1 (p=0.004). The AOFAS score improved from 64 points to 86.2 points (p=0.001). The 8 ankles in those less than thirty years of age at that time of surgery showed a VAS at motion of 1.8 and an AOFAS score of 91.1 points. In contrast, 8 ankles in those who older than thirty one years of age had a VAS at motion of 2.4 and an AOFAS score of 81.2 points. The younger group showed a significantly better AOFAS score than the older group (p=0.001). However, there was no significant difference in the VAS score (p=0.22).
CONCLUSION
Multiple drilling has a good effect in pain control and ankle function for patients with an osteochondral lesion of the medial talar dome 10 mm. The procedure is particularly effective and useful in younger patients.

Keyword

Talus; Medial talar dome; Osteochondral lesion; Multiple drilling

MeSH Terms

Ankle
Follow-Up Studies
Humans
Talus

Cited by  1 articles

Autologous Osteochondral Transplantation as a Secondary Procedure after Failed Microfracture for Osteochondral Lesion of Talus
Su-Young Bae
J Korean Foot Ankle Soc. 2015;19(2):47-50.    doi: 10.14193/jkfas.2015.19.2.47.


Reference

1. Agung M, Ochi M, Adachi N, Uchio Y, Takao M, Kawasaki K. Osteochondritis dissecans of the talus treated by the transplantation of tissue-engineered cartilage. Arthroscopy. 2004. 20:1075–1080.
Article
2. Alexander AH, Lichtman DM. Surgical treatment of transchondral talar-dome fractures (osteochondritis dissecans): long-term follow-up. J Bone Joint Surg Am. 1980. 62:646–652.
Article
3. Anderson IF, Crichton KJ, Grattan-Smith T, Cooper RA, Brazier D. Osteochondral fractures of the dome of the talus. J Bone Joint Surg Am. 1989. 71:1143–1152.
Article
4. Baker CL, Andrews JR, Ryan JB. Arthroscopic treatment of transchondral talar dome fractures. Arthroscopy. 1986. 2:82–87.
Article
5. Baltzer AW, Arnold JP. Bone-cartilage transplantation from the ipsilateral knee for chondral lesions of the talus. Arthroscopy. 2005. 21:159–166.
Article
6. Bauer M, Jonsson K, Linden B. Osteochondritis dissecans of the ankle. A 20-year follow-up study. J Bone Joint Surg Br. 1987. 69:93–96.
Article
7. Becher C, Thermann H. Results of microfracture in the treatment of articular cartilage defects of the talus. Foot Ankle Int. 2005. 26:583–589.
Article
8. Berndt AL, Harty M. Transchondral fractures (osteochondritis dissecans) of the talus. J Bone Joint Surg Am. 1959. 41:988–1020.
Article
9. Canale ST, Belding RH. Osteochondral lesions of the talus. J Bone Joint Surg Am. 1980. 62:97–102.
Article
10. Choi CH, Cheon YM. Arthroscopic treatment of osteochondritis dissecans of the talus. J Korean Arthrosc Soc. 2002. 6:161–170.
11. Flick AB, Gould N. Osteochondritis dissecans of the talus (transchondral fractures of the talus): review of the literature and new surgical approach for medial dome lesions. Foot Ankle. 1985. 5:165–185.
Article
12. Hangody L, Kish G, Modis L, et al. Mosaicplasty for the treatment of osteochondritis dissecans of the talus: two to seven year results in 36 patients. Foot Ankle Int. 2001. 22:552–558.
Article
13. Hepple S, Winson IG, Glew D. Osteochondral lesions of the talus: a revised classification. Foot Ankle Int. 1999. 20:789–793.
Article
14. Hudelmaier M, Glaser C, Hohe J, et al. Age-related changes in the morphology and deformational behavior of knee joint cartilage. Arthritis Rheum. 2001. 44:2556–2561.
Article
15. Kappis M. Weitere Beitrage zur traunatischmechanischen Entstehung der "Spontaten" Knorpela- blosungen (sogen, osteochondritis dissecans). Dische Z Chir. 1922. 171:13.
16. Kreuz PC, Erggelet C, Steinwachs MR, et al. Is microfracture of chondral defects in the knee associated with different results in patients aged 40 years or younger? Arthroscopy. 2006. 22:1180–1186.
Article
17. Kumai T, Takakura Y, Higashiyama I, Tamai S. Arthroscopic drilling for the treatment of osteochondral lesions of the talus. J Bone Joint Surg Am. 1999. 81:1229–1235.
Article
18. Lee JW, Park KK, Hahn SB, Kang ES. Clinical and Radiologic results of arthroscopic treatment for osteochondral lesion with subchondral cyst on talus. J Korean Foot Ankle Soc. 2003. 7:21–29.
19. Lee MC, Seong SC, Kang SB. Arthroscopic treatment of osteochondral lesion of ankle. J Korean Knee Soc. 1993. 5:88–97.
20. ManeiroL E, Martin MA, de Andres MC, et al. Mitochondrial respiratory activity is altered in osteoarthritic human articular chondrocytes. Arthritis Rheum. 2003. 48:700–708.
21. Parisien JS. Arthroscopic treatment of osteochondral lesions of the talus. Am J Sports Med. 1986. 14:211–217.
Article
22. Park SS, Lee HS, Lee JS, Choi ES, Park KJ. Comparative study of the clinical results between arthroscopic multiple drilling and autologous osteochondral grafting for osteochondral lesions of the talus. J Korean Orthop Assoc. 2006. 41:504–511.
Article
23. Pettine KA, Morrey BF. Osteochondral fractures of the talus. A long-term follow-up. J Bone Joint Surg Br. 1987. 69:89–92.
Article
24. Schuman L, Struijis PA, Van Dijk CN. Arthroscopic treatment for osteochondral defects of the talus. Results at follow-up at 2 to 11 years. J Bone Joint Surg Br. 2002. 84:364–368.
25. Shearer C, Loomer R, Clement D. Nonoperatively managed stage 5 osteochondral talar lesions. Foot Ankle Int. 2002. 23:651–654.
Article
26. Steadman JR, Briggs KK, Rodrigo JJ, Kocher MS, Gill TJ, Rodkey WG. Outcomes of microfracture for traumatic chondral defects of the knee: average 11-year follow-up. Arthroscopy. 2003. 19:477–484.
Article
27. Tol JL, Struijs PA, Bossuyt PM, Verhagen RA, van Dijk CN. Treatment strategies in osteochondral defects of the talar dome: a systematic review. Foot Ankle Int. 2000. 21:119–126.
Article
28. Trickey WR, Lee GM, Guilak F. Viscoelastic properties of chondrocytes from normal and osteoarthritic human cartilage. J Orthop Res. 2000. 18:891–898.
Article
29. Van Buecken K, Barrack RL, Alexander AH, Ertl JP. Arthroscopic treatment of transchondral talar dome fractures. Am J Sports Med. 1989. 17:350–356.
Article
30. van Dijk CN, Verhagen RA, Tol JL. Arthroscopy for problems after ankle fracture. J Bone Joint Surg Br. 1997. 79:280–284.
Article
31. Verbruggen G, Cornelissen M, Almqvist KF, et al. Influence of aging on the synthesis and morphology of the aggrecans synthesized by differentiated human articular chondrocytes. Osteoarthritis Cartilage. 2000. 8:170–179.
Article
32. Verhagen RA, Struijs PA, Bossuyt PM, van Dijk CN. Systematic review of treatment strategies for osteochondral defects of the talar dome. Foot Ankle Clin. 2003. 8:233–242.
Article
33. Wester JU, Jensen IE, Rasmussen F, Lindequist S, Schantz K. Osteochondral lesions of the talar dome in children. A 24(7-36) year follow-up of 13cases. Acta Orthop Scand. 1994. 65:110–112.
Full Text Links
  • JKOA
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr