Initial outcomes of 3-dimensional imaging-based computer-assisted retrograde drilling of talar osteochondral lesions.
BACKGROUND
In operative treatment of Berndt and Harty stage 1 and stage 2 osteochondral lesions of the talus, the goal is revascularization. The use of computer-assisted guided retrograde drilling of osteochondral lesions has been described as a new technique with promising results.


OBJECTIVE
This study reports the follow-up assessment of patients treated with Iso-C-3D-navigated retrograde drilling. Its aim was to establish whether the greater precision of computer-assisted drilling results in satisfactory clinical outcomes.


METHODS
Case series; Level of evidence, 4.


METHODS
Patients who underwent navigated Iso-C-3D-based retrograde drilling between June 1, 2003, and July 31, 2005, were included in the follow-up study. Clinical outcomes were measured using (1) the Ankle-Hindfoot Scale of the American Orthopaedic Foot and Ankle Society and (2) the Visual Analogue Scale-Foot and Ankle. Radiological outcomes were assessed via radiographs and magnetic resonance imaging. Surgeon satisfaction was assessed using a simple 0 to 10 rating scheme for feasibility, accuracy, and clinical benefit.


RESULTS
Average follow-up time was 25 months (range, 20-34). Twenty patients satisfied the inclusion criteria: 12 men and 8 women; mean age, 35 years (range, 19-58). One patient was excluded because he required a cartilage restoration procedure. All scores improved at the time of follow-up-Ankle-Hindfoot Scale, from 76 to 90 (P < .001); Visual Analogue Scale-Foot and Ankle, from 79 to 92 (P < .001). The average ratings of the operating surgeons (n = 3) were as follows: feasibility 9.0 (range, 7.3-10.0); accuracy, 8.5 (range, 5.8-10.0); and clinical benefit, 8.5 (5.7-10.0). At follow-up, magnetic resonance imaging revealed an improvement of the Hepple score in 80% of patients.


CONCLUSIONS
Arthroscopic treatment of osteochondral lesions of the talus is well established. A retrograde approach does not breach the overlying intact talar cartilage. The results of this follow-up study of 3-dimensional computer navigated drilling are promising.
Department for Trauma and Reconstructive Surgery, Diakoniekrankenhaus Friederikenstift, Hannover, Germany. jens.geerling@gmx.de
Jens
J
Geerling
Stefan
S
Zech
Daniel
D
Kendoff
Musa
M
Citak
Padhraig F
PF
O'Loughlin
Tobias
T
Hüfner
Christian
C
Krettek
Martinus
M
Richter
D000328:Adult; D016512:Ankle Injuries / Q000601:surgery*; D001182:Arthroscopy / Q000379:methods*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D055034:Osteochondrosis / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D020127:Recovery of Function; D025321:Surgery, Computer-Assisted; D013628:Talus / Q000503:physiopathology* / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult