Arthroscopic-Controlled Navigation for Retrograde Drilling of Osteochondral Lesions of the Talus

Abstract

Background: Retrograde drilling of symptomatic osteochondral lesions (OCL) is usually controlled by fluoroscopy. Due to the limited visualization of the OCLs in the acquired images and the narrow access to the talar dome, this approach can be demanding. Several navigation procedures have been reported (2D- or 3D- fluoroscopy or intraoperative CT-based) to increase the accuracy and reduce the radiation exposure. We developed a new arthroscopic-controlled navigation procedure which is free of radiation exposure and free of a reference base rigidly fixed to the bone. 17 We hypothesized that this procedure (Fluoro-Free) is at least as precise as the standard 2D-Fluoro navigation (2D-Fluoro). Furthermore, our first clinical experiences are described and discussed. Material and Methods: Sixteen drillings per group (standard 2D-Fluoro vs. Fluoro-Free) were performed in artificial sawbones. Times for the different steps of each drilling procedure were recorded and the precision evaluated by measuring the deviation and depth of drilling. Results: The accuracy of the Fluoro-Free navigation was as precise as the standard 2D-Fluoro based navigation (axis deviation of drill tip to the target point: 1.07 ± 0.11 versus 1.14 ± 0.15 mm). Due to the simplified workflow without radiation exposure and fixation of a reference base, the Fluoro-Free procedure was significantly faster (mean procedure time per drilling: 23.7 ± 11.6 versus 165 ± 9 seconds) and easy to use. Its clinical usefulness was demonstrated during three retrograde drillings of a talar OCL in a 16-year-old patient. Conclusion: The Fluoro-Free navigation procedure is a simplified approach for retrograde drilling of OCL in the talus under arthroscopic control without radiation exposure and without the need for fixation of a dynamic reference base to the bone. Level of Evidence: V, Expert Opinion