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Arthroscopic Treatment of Osteochondral Talar Defects
Christiaan J.A. van Bergen, MD1; Ruben Zwiers, MSc1; C. Niek van Dijk, MD, PhD1
1 Department of Orthopaedic Surgery, Orthopaedic Research Center Amsterdam, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. E-mail address for C.J.A. van Bergen: c.j.vanbergen@amc.nl. E-mail address for R. Zwiers: r.zwiers@amc.nl. E-mail address for C.N. van Dijk: c.n.vandijk@amc.nl
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Based on an original article: J Bone Joint Surg Am. 2013 Mar 20;95(6):519-25.

Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
JBJS Essential Surgical Techniques, 2013 May 22;3(2):e10 1-7. doi: 10.2106/JBJS.ST.M.00028
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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%).

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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