Arthroscopic treatment of osteochondral lesions of the talus

Abstract

A retrospective study of the arthroscopic treatment of transchondral fractures of the talar dome in 18 patients was conducted. Followup ranged from 3 months to 3 years; 10 patients had an average followup of 2 years (Group A) and 8 of 6.5 months (Group B). The 10 male and 8 female patients ranged in age from 14 to 40 years. Thirteen lesions were posteromedial while five were anterolateral. Fourteen of the 18 patients reported an inversion type injury to the ankle from playing various sports on weekends. One patient had a bimalleolar fracture of the ankle sustained in a car accident 18 months prior to referral, while the last patient in the series had a bilateral fracture of the os calcis from a work-related falling incident. All patients underwent conservative care for at least 4 months prior to referral. Arthroscopic treatment consisted of partial synovec tomy, debridement of osteochondral lesions with re moval of loose fragments, curettage, abrasion, and, in one case, drilling. For analysis of postoperative management, patients were divided into two groups, 10 with the 2 year followup comprising Group A and the 8 with the 6.5 month followup in Group B. Group A was nonweight bearing for 6 weeks while Group B was ambulatory 2 weeks postoperatively. Group A was fully ambulatory when the 6 week nonweightbearing period expired. All patients had a full range of motion at the time of suture removal (1 week to 10 days). Both groups were evalu ated objectively and subjectively. Excellent or good results were obtained in 88% of the patients. One patient whose bimalleolar fracture of 18 months prior to referral was treated with plaster, but without achiev ing anatomical reduction, had a poor result. Complica tions were minimal: a broken ring curette was easily retrieved during one procedure, and a suture abscess cleared up with removal of the suture. This study suggested that even in chronic lesions, arthroscopic surgery can yield a high percentage of excellent or good results with minimal morbidity, brief hospitalization, and a rapid recovery time for the patient by avoiding long skin incisions and deep soft tissue dissections, grooving of the distal tibia, or osteotomy of the medial malleolus.