Arthroscopic management of osteochondral lesions of the talus: Results of drilling and usefulness of magnetic resonance imaging before and after treatment

Since the advent of operative ankle arthroscopy and magnetic resonance imag ing (MRI) specific treatment of osteochondritis dissecans of the talus has progressed rapidly. Drilling is still the treatment of choice in early stag es of osteochondritis dissecans of the talus. Rear-entry guides and preoper ative planning with MRI have led to better results with this kind of treatm ent. Within 5 years, 42 patients (26 male and 16 female) underwent arthrosc opic treatment of osteochondritis dissecans of the talus, 22 underwent perc utaneous drilling, 13 cancellous bone grafting, 4 refixation, and 3 curetta ge. The average age of the patients was 28 years (range, 11 to 53 years). A clinical score system was used in a clinical and MRI follow-up of 19 of th e patients with K-wire drilling. Up to 100 points are given in the categori es pain, stability/insecurity, efficiency/pain-free walking distance, gait, differences in circumference, range of motion, and power. There was a hist ory of trauma in 31 of the 42 patients. The majority of lesions (24 cases) were localized at the lateral talus, and these patients all had trauma. In 11 of the 18 lesions at the medial talus, there was no evidence of trauma. The 19 patients in the follow-up achieved an average of 87 points. K-wire d rilling represents the chief component of early stages with intact or parti ally fractured cartilage surface, whereas arthroscopically controlled cance llous bone grafts after curettage are used in grade Il stages only. Results of K-wire drilling are not worse than those of cancellous bone grafts; thi s is attributable to a generous perforation of the sclerosis. This has cont ributed to an improved preoperative diagnosis with MRI.