Arthroscopic debridement and bone marrow stimulation (i.e., drilling or microfracturing) is considered the primary surgical treatment of osteochondral defects of the talus.
Step 1: Position the Patient
For anterior ankle arthroscopy, position the patient supine; for posterior arthroscopy, position the patient prone.
Step 2: Arthroscopic Approach
For anterior ankle arthroscopy, place the portals medial to the tibialis anterior tendon and lateral to the peroneus tertius tendon at the level of the ankle joint; for posterior arthroscopy, place the portals lateral and medial to the Achilles tendon just above the level of the tip of the lateral malleolus.
Step 3: Debridement and Bone Marrow Stimulation
Fully debride the osteochondral defect and create multiple microfractures in the bottom of the defect.
Step 4: Closure and Postoperative Care
Prescribe partial weight-bearing for six weeks.
A systematic review of the literature identified eighteen studies on bone marrow stimulation that included a total of 388 patients3. The study weighted success rate was 85% (range, 46% to 100%).
What to Watch For
Pitfalls & Challenges