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Arthroscopic Drilling With Debridement of Remaining Cartilage for Osteochondral Lesions of the Talar Dome in Unstable Ankles

Masato Takao, MD, PhD^*,, Yuji Uchio, MD, PhD, Hiroyuki Kakimaru, MD, Nobuyuki Kumahashi, MD and Mitsuo Ochi, MD, PhD

From the Department of Orthopaedic Surgery, Shimane University School of Medicine, Shimane, Japan, and the Department of Orthopaedic Surgery, Hiroshima University School of Medicine, Hiroshima, Japan

^* Address correspondence to Masato Takao, Assistant Professor, Department of Orthopaedic Surgery, Shimane University School of Medicine, 89-1, Enya, Izumo, Shimane, 693-8501, Japan (e-mail: mtakao{at}med.shimane-u.ac.jp).

Background: Arthroscopic examination has shown that the regenerative cartilage that appears after arthroscopic drilling for the treatment of osteochondral lesions of the talar dome does not always cover the cartilage defect sufficiently.

Hypothesis: The remaining degenerative cartilage at the lesions may obstruct the healing of the articular cartilage.

Study Design: Prospective cohort study.

Methods: Thirty-nine patients underwent arthroscopic drilling that kept the remaining cartilage at the lesion (group A), and 30 patients underwent arthroscopic drilling that removed the remaining cartilage at the lesion (group B). At 1 year after the operation, we performed ankle arthroscopy to evaluate the cartilage condition.

Results: The arthroscopic findings revealed that in group A, 11 cases (28.2%) were improved, 12 cases (30.8%) were unchanged, and 16 cases (41.0%) had deteriorated; in group B, 27 cases (93.1%) were improved and 2 cases were unchanged. There were significant differences between group A and group B in the rate of cases whose cartilage condition was seen to improve under arthroscopic examination (P < 0.0001).

Conclusions: The study shows that in the treatment of osteochondral lesions of the talar dome, the removing of the remaining degenerative cartilage may be of some benefit in the treatment of these lesions.

Key Words: ankle • osteochondral lesions • talar dome • arthroscopy • drilling

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