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Arthroscopic Treatment of Osteochondral Talar Defects
Christiaan J.A. van Bergen, MD; Ruben Zwiers, MSc; C. Niek van Dijk, MD, PhD

Overview

Introduction 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.

Results 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 Indications

Contraindications

Pitfalls & Challenges

Introduction

Arthroscopic debridement and bone marrow stimulation (i.e., drilling or microfracturing) is considered the primary surgical treatment of osteochondral defects of the talus1-4. Advantages of this procedure are the relative simplicity of the technique, outpatient treatment, low costs, and early rehabilitation1,2. Depending on its location, the osteochondral defect can be accessed through an anterior or posterior arthroscopic approach.

The procedure is done in four stages:

Step 1: Position the Patient

For anterior ankle arthroscopy, position the patient supine; for posterior arthroscopy, position the patient prone.

  • For anterior ankle arthroscopy (Fig. 1):

    • ○ Use either general or spinal anesthesia.

    • ○ Place a tourniquet around the thigh.

    • ○ Place the patient in the supine position.

    • ○ The heel of the affected foot rests on …