[Computer-assisted retrograde drilling of osteochondritic lesions of the talus with the help of fluoroscopic navigation].
OBJECTIVE
Due to the narrow access to the talar dome and the proximity of osteochondritic lesions to the joint surface, the therapeutic retrograde drilling often requires multiple attempts and repeated intraoperative X-ray-control. The advantages of a fluoroscopy-based computer-assisted navigation system regarding efficient planning and easy performance of the ideal drill path are evaluated in respect to accuracy and radiation exposure, as well as to time requirements.


METHODS
A 5 mm spherical target was subcortically implanted in the medial aspect of the talar dome of 16 human cadaver specimens. Free-hand drilling was performed using the FluoroNav TM system in one group and conventional repetitive C-arm control in the other. The computed evaluation of the operative results was realized in a CT-generated 3D-model with the help of the DISOS planning and calculation program. The distance of the tip of the drill to the center of the lesion was measured, as well as X-ray exposure and total operating time.


RESULTS
The CAS procedure missed the lesion only once. The mean deviation of the computer-guided drill path was measured to be 2 mm, whereas the conventional method led to a mean distance of 5 mm from the target. Conventional drilling failed to reach the target in 5 cases, violating the articular cartilage twice. Navigation reduced the traditionally required multiple attempts of the intervention to just one drill canal and reduced radiation time to 25 %. Despite the increased technical preparation required, the navigated procedure only exceeded the conventional operating time by 2 minutes.


CONCLUSIONS
Thanks to the significantly increased accuracy, fluoroscopic navigation offers a high degree of safety and efficacy for this minimally invasive procedure. The operation can easily be performed successfully causing only minimal collateral damage to the bone, preserving the joint surface. The inherent risks of the retrograde drilling of osteochondritic lesions are lower with navigation, while the radiation exposure of the patient and the staff is significantly reduced.
Ohnsorge
J A K
JA
Orthopädische Universitätsklinik, UK Aachen, Germany. johnsorge@orthopaedie-aachen.de
Portheine
F
F
Mahnken
A H
AH
Prescher
A
A
Wirtz
D C
DC
Siebert
C H
CH
D002102:Cadaver; D005471:Fluoroscopy / Q000379:methods; D005534:Foot Diseases / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000295:instrumentation / Q000379:methods*; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D010008:Osteochondritis Dissecans / Q000000981:diagnostic imaging* / Q000601:surgery*; D011829:Radiation Dosage; D011835:Radiation Protection; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods; D025321:Surgery, Computer-Assisted / Q000379:methods*; D013628:Talus / Q000000981:diagnostic imaging / Q000601:surgery