title: Retrograde drilling for osteochondral lesions of the talar dome.
abstract: BACKGROUND
  For the treatment of osteochondral lesions of the talar dome without detachment of the cartilage, there is little information on whether transmalleolar drilling or retrograde drilling is more effective in terms of clinical and morphologic evaluations.
  
  
  OBJECTIVE
  Retrograde drilling may be more effective than transmalleolar drilling for lesions without cartilage detachment.
  
  
  METHODS
  Case control study; Level of evidence, 3.
  
  
  METHODS
  Subjects were 30 patients with lesions on 1 foot of grade 0 or I, determined according to a modified Pritsch classification system. Nineteen patients underwent transmalleolar drilling (TMD group), and 11 patients underwent retrograde drilling (RD group). Ankle arthroscopy was performed 1 year postoperatively to evaluate cartilage conditions.
  
  
  RESULTS
  Arthroscopic findings revealed that in the TMD group, 11 lesions (57.9%) were unchanged (grade I), and 8 lesions (42.1%) had deteriorated from grade 0 to I; in the RD group, 3 lesions (27.2%) had improved from grade I to 0, and 8 (72.8%) were unchanged (2 grade 0 lesions and 6 grade I lesions). There was a significant difference between the 2 groups in the distribution of cases that had improved, were unchanged, or had deteriorated (P < .0001).
  
  
  CONCLUSIONS
  This study showed that compared with transmalleolar drilling, retrograde drilling for osteochondral lesions of the talar dome can improve the arthroscopic assessment of the lesions.
authors.affiliation: Department of Orthopaedic Surgery, Shimane University School of Medicine, Shimane, Japan.
authors.forename: Michihaya
authors.initials: M
authors.lastname: Kono
authors.forename: Masato
authors.initials: M
authors.lastname: Takao
authors.forename: Kohei
authors.initials: K
authors.lastname: Naito
authors.forename: Yuji
authors.initials: Y
authors.lastname: Uchio
authors.forename: Mitsuo
authors.initials: M
authors.lastname: Ochi
mesh_terms: D000293:Adolescent; D000328:Adult; D016512:Ankle Injuries / Q000145:classification / Q000000981:diagnostic imaging / Q000601:surgery*; D001182:Arthroscopy / Q000379:methods*; D002358:Cartilage, Articular / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery*; D016022:Case-Control Studies; D002648:Child; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011859:Radiography; D013628:Talus / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery*; D016896:Treatment Outcome