title: Is retrograde drilling really useful for osteochondral lesion of talus with subchondral cyst?: A case report.
abstract: BACKGROUND
  Retrograde drilling is a well accepted procedure for osteochondral lesion of the talus and subchondral cyst with intact overlying cartilage. It has good results in most reports. Compared to anterograde drilling, retrograde drilling can protect the integrity of the articular cartilage. The purpose of this study was to evaluate the suitability of using retrograde drilling for osteochondral lesion with subchondral cyst and discuss the mechanism involved in the development of subchondral cyst.
  
  
  METHODS
  We report a 53-year-old man who had complained left ankle pain that lasted over 6 months which was exacerbated by walking.
  
  
  METHODS
  We diagnosed it as osteochondral lesion of the talus with subchondral cyst.
  
  
  METHODS
  Plain X-ray, computed tomography, and magnetic resonance imaging (MRI) of the ankle.
  
  
  RESULTS
  He undertook retrograde drilling without debridement of cartilage. After the surgery, the pain had been subsided for 1 year, although arthritic change had progressed. However, after 5 years of retrograde drilling, he revisited our hospital due to severe ankle pain. Plain X-ray and MRI showed arthritic change of the ankle and multiple cystic formation of talus.
  
  
  CONCLUSIONS
  Retrograde drilling has some problem because this procedure is not theoretically correct when the development of a subchondral cyst in osteochondral lesion of the talus is considered. In addition, retrograde drilling may impair uninjured bone marrow of the talus, resulting in the development of multiple cystic formations.
authors.affiliation: Department of Orthopedic Surgery, Chonbuk National University Medical School, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju-shi, Chonbuk, South Korea.
authors.forename: Seong-Yup
authors.initials: SY
authors.lastname: Jeong
authors.forename: Jong-Kil
authors.initials: JK
authors.lastname: Kim
authors.forename: Kwang-Bok
authors.initials: KB
authors.lastname: Lee
mesh_terms: D000818:Animals; D000843:Ankle Joint / Q000503:physiopathology; D001182:Arthroscopy / Q000009:adverse effects* / Q000379:methods; D001845:Bone Cysts / Q000503:physiopathology / Q000601:surgery*; D002358:Cartilage, Articular / Q000503:physiopathology / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000379:methods; D010147:Pain Measurement; D018570:Risk Assessment; D013628:Talus / Q000601:surgery*; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome