Arthroscopic drilling for chondral, subchondral, and combined chondral-subchondral lesions of the talar dome.
OBJECTIVE
We investigated the efficacy of drilling as a treatment for chondral (C), subchondral (S), and combined chondral-subchondral (CS) lesions of the talar dome associated with trauma, using magnetic resonance imaging (MRI), ankle arthroscopy, and the ankle-hindfoot scale of the American Orthopaedic Foot and Ankle Society (AOFAS score).


METHODS
Case series study.


METHODS
Arthroscopic drilling was performed on 72 patients whose lesions were less than 7 mm in diameter. The patients included 45 men and boys and 27 women and girls whose age at the time of surgery was between 14 and 57 years (mean age, 30.7 +/- 9.5 years). They were followed up for 24 to 71 months (mean follow-up, 39 +/- 6.4 months).


RESULTS
There were 13 cases of chondral lesions, 10 cases of S lesions, and 49 cases of CS lesions. The MRI findings revealed that in the chondral lesion group, 13 cases were unchanged and 0 deteriorated; in the S lesion group, 2 improved, 8 were unchanged, and 0 deteriorated; and in the CS lesion group, 13 improved, 36 were unchanged, and 0 deteriorated. The arthroscopic findings showed that in the chondral lesion group, 2 improved, 9 were unchanged, and 1 deteriorated; in the S lesion group, all 8 cases deteriorated; and in the CS lesion group, 28 improved, 22 were unchanged, and 0 deteriorated. Drilling did not always improve the MRI and arthroscopic findings of the 3 respective types of lesions. However, the mean AOFAS score at the most recent follow-up was excellent; 91.7 +/- 2.4 points in the chondral lesion group, 93.1 +/- 2.1 points in the S lesion group, and 98.8 +/- 1.2 points in the CS lesion group.


CONCLUSIONS
Our study shows that drilling did not always improve the MRI and arthroscopic findings. However, the clinical results obtained as measured by the AOFAS score were excellent.
Takao
Masato
M
Department of Orthopaedics, Shimane Medical University, Izumo, Shimane, Japan. mtakao@shimane-med.ac.jp
Ochi
Mitsuo
M
Naito
Kohei
K
Uchio
Yuji
Y
Kono
Taisuke
T
Oae
Kazunori
K
D000293:Adolescent; D000328:Adult; D016512:Ankle Injuries / Q000601:surgery*; D001182:Arthroscopy; D001863:Bone Screws; D002358:Cartilage, Articular / Q000293:injuries / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017844:Lateral Ligament, Ankle / Q000293:injuries; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D013180:Sprains and Strains / Q000628:therapy; D013628:Talus / Q000293:injuries; D013710:Tendons / Q000637:transplantation; D013978:Tibial Fractures / Q000601:surgery; D016896:Treatment Outcome