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Fluoroscopy-guided retrograde core drilling and cancellous bone grafting in osteochondral defects of the talus

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Abstract

Purpose

In undetached osteochondral lesions (OCL) of the talus both revitalisation of the subchondral necrosis and cartilage preservation are essential. For these cases, we assess the results of minimally invasive retrograde core drilling and cancellous bone grafting.

Methods

Forty-one osteochondral lesions of the talus (12x grade I, 22x grade II and 7x grade III according to the Pritsch classification, defect sizes 7–14 mm) in 38 patients (mean age 33.2 years) treated by fluoroscopy-guided retrograde core drilling and autologous cancellous bone grafting were evaluated by clinical scores and MRI. The mean follow-up was 29.0 (±13) months.

Results

The AOFAS score increased significantly from 47.3 (±15.3) to 80.8 (±18.6) points. Lesions with intact cartilage (grades I and II) had a tendency to superior results than grade III lesions (83.1 ± 17.3 vs. 69.4 ± 22.2 points, p = 0.07). First-line treatments and open distal tibial growth plates led to significantly better outcomes (each p < 0.05). Age, gender, BMI, time to follow-up, defect localisation or a traumatic origin did not influence the score results. On a visual analogue scale pain intensity reduced from 7.5 (±1.5) to 3.7 (±2.6) while subjective function increased from 4.6 (±2.0) to 8.2 (±2.3) (each p < 0.001). In MRI follow-ups, five of the 41 patients showed a complete bone remodelling. In two cases demarcation was detectable.

Conclusions

The technique reported is a highly effective therapeutic option in OCL of the talus with intact cartilage grades I and II. However, second-line treatments and grade III lesions with cracked cartilage surface can not be generally recommended for this procedure.

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Orthopedics, University of Regensburg, Regensburg, Germany

    Sven Anders, Philipp Lechler, Walter Rackl, Joachim Grifka & Jens Schaumburger

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  1. Sven Anders
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  2. Philipp Lechler
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  3. Walter Rackl
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  4. Joachim Grifka
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  5. Jens Schaumburger
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Correspondence to Sven Anders.

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Anders, S., Lechler, P., Rackl, W. et al. Fluoroscopy-guided retrograde core drilling and cancellous bone grafting in osteochondral defects of the talus. International Orthopaedics (SICOT) 36, 1635–1640 (2012). https://doi.org/10.1007/s00264-012-1530-9

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  • DOI: https://doi.org/10.1007/s00264-012-1530-9

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