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European Radiology

, Volume 24, Issue 7, pp 1572–1576 | Cite as

MRI-guided percutaneous retrograde drilling of osteochondritis dissecans of the talus: a feasibility study

  • Pekka KerimaaEmail author
  • Risto Ojala
  • Juha-Jaakko Sinikumpu
  • Pekka Hyvönen
  • Jussi Korhonen
  • Paula Markkanen
  • Osmo Tervonen
  • Roberto Blanco Sequeiros
Interventional

Abstract

Objectives

The purpose of this study was to evaluate the feasibility of MRI guidance for percutaneous retrograde drilling in the treatment of osteochondritis dissecans of the talus (OCDT).

Methods

Four patients, one juvenile and three adults, with one OCDT lesion each and persisting ankle pain after conservative treatment, were treated with MRI-guided retrograde drilling. All lesions were stable and located in the middle or posterior medial third of the talar dome. Pain relief and the ability to return to normal activities were assessed during clinical follow-up. MRI and plain film radiographs were used for imaging follow-up.

Results

Technical success was 100 % with no complications and with no damage to the overlying cartilage. All patients experienced some clinical benefit, although only one had complete resolution of pain and one had a relapse leading to surgical treatment. Changes in the pathological imaging findings were mostly very slight during the follow-up period.

Conclusions

MRI guidance seems accurate, safe and technically feasible for retrograde drilling of OCDT. Larger series are needed to reliably assess its clinical value.

Key Points

MRI serves as a useful guidance method for numerous mini-invasive applications.

Retrograde drilling is a cartilage-sparing alternative in the treatment of osteochondritis dissecans.

MRI guidance seems feasible for treatment of osteochondritis dissecans of the talus.

Keywords

Osteochondritis dissecans Interventional MRI Ankle Retrograde drilling Musculoskeletal 

Abbreviations

OCDT

osteochondritis dissecans of the talus

Notes

Acknowledgements

The scientific guarantor of this publication is Dr. Pekka Kerimaa, a specialist in radiology and interventional radiology, and a member of the permanent staff. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional Review Board approval was not required because the procedure used replaced a more invasive procedure in the clinical setting. Approval from the clinics involved was obtained, as was approval from the patients to use their data retrospectively. Oral informed consent was obtained from all subjects (patients) in this study. Methodology: retrospective, experimental clinical, performed at one institution.

References

  1. 1.
    Murawski CD, Kennedy JG (2013) Operative treatment of osteochondral lesions of the talus. J Bone Joint Surg Am 95:1045–1054Google Scholar
  2. 2.
    Navid DO, Myerson MS (2002) Approach alternatives for treatment of osteochondral lesions of the talus. Foot Ankle Clin 7:635–649PubMedCrossRefGoogle Scholar
  3. 3.
    Lam KY, Siow HM (2012) Conservative treatment for juvenile osteochondritis dissecans of the talus. J Orthop Surg 20:176–180Google Scholar
  4. 4.
    Perumal V, Wall E, Babekir N (2007) Juvenile osteochondritis dissecans of the talus. J Pediatr Orthop 27:821–825PubMedCrossRefGoogle Scholar
  5. 5.
    Zwingmann J, Sudkamp NP, Schmal H, Niemeyer P (2012) Surgical treatment of osteochondritis dissecans of the talus: A systematic review. Arch Orthop Trauma Surg 132:1241–1250Google Scholar
  6. 6.
    van Bergen CJ, de Leeuw PA, van Dijk CN (2008) Treatment of osteochondral defects of the talus. Rev Chir Orthop Reparatrice Appar Mot 94:398–408Google Scholar
  7. 7.
    Elias I, Zoga AC, Morrison WB, Besser MP, Schweitzer ME, Raikin SM (2007) Osteochondral lesions of the talus: localization and morphologic data from 424 patients using a novel anatomical grid scheme. Foot Ankle Int 28:154–161PubMedCrossRefGoogle Scholar
  8. 8.
    Hembree WC, Wittstein JR, Vinson EN et al (2012) Magnetic resonance imaging features of osteochondral lesions of the talus. Foot Ankle Int 33:591–597Google Scholar
  9. 9.
    Taranow WS, Bisignani GA, Towers JD, Conti SF (1999) Retrograde drilling of osteochondral lesions of the medial talar dome. Foot Ankle Int 20:474–480PubMedCrossRefGoogle Scholar
  10. 10.
    Kono M, Takao M, Naito K, Uchio Y, Ochi M (2006) Retrograde drilling for osteochondral lesions of the talar dome. Am J Sports Med 34:1450–1456PubMedCrossRefGoogle Scholar
  11. 11.
    Heywood CS, Benke MT, Brindle K, Fine KM (2011) Correlation of magnetic resonance imaging to arthroscopic findings of stability in juvenile osteochondritis dissecans. Arthroscopy 27:194–199Google Scholar
  12. 12.
    Hoffmann M, Petersen JP, Schroder M et al (2012) Retrograde drilling of talar osteochondritis dissecans lesions: a feasibility and accuracy analysis of a novel electromagnetic navigation method versus a standard fluoroscopic method. Arthroscopy 28:1547–1554Google Scholar
  13. 13.
    Rosenberger RE, Fink C, Bale RJ, El Attal R, Muhlbacher R, Hoser C (2006) Computer-assisted minimally invasive treatment of osteochondrosis dissecans of the talus. Oper Orthop Traumatol 18:300–316PubMedCrossRefGoogle Scholar
  14. 14.
    Bale RJ, Hoser C, Rosenberger R, Rieger M, Benedetto KP, Fink C (2001) Osteochondral lesions of the talus: Computer-assisted retrograde drilling—feasibility and accuracy in initial experiences. Radiology 218:278–282PubMedCrossRefGoogle Scholar
  15. 15.
    Geerling J, Zech S, Kendoff D et al (2009) Initial outcomes of 3-dimensional imaging-based computer-assisted retrograde drilling of talar osteochondral lesions. Am J Sports Med 37:1351–1357Google Scholar
  16. 16.
    Gras F, Marintschev I, Muller M et al (2010) Arthroscopic-controlled navigation for retrograde drilling of osteochondral lesions of the talus. Foot Ankle Int 31:897–904Google Scholar
  17. 17.
    Seebauer CJ, Bail HJ, Rump JC, Walter T, Teichgraber UK (2010) Advancements in orthopedic intervention: retrograde drilling and bone grafting of osteochondral lesions of the knee using magnetic resonance imaging guidance. Cardiovasc Intervent Radiol 33:1230–1234Google Scholar
  18. 18.
    Ojala R, Kerimaa P, Lakovaara M et al (2011) MRI-guided percutaneous retrograde drilling of osteochondritis dissecans of the knee. Skeletal Radiol 40:765–770PubMedCrossRefGoogle Scholar
  19. 19.
    Blanco Sequeiros R, Vahasarja V, Ojala R (2008) Magnetic resonance-guided growth plate bone bridge resection at 0.23 tesla: report of a novel technique. Acta Radiol 49:668–672Google Scholar
  20. 20.
    Kerimaa P, Marttila A, Hyvönen P et al (2013) MRI-guided biopsy and fine needle aspiration biopsy (FNAB) in the diagnosis of musculoskeletal lesions. Eur J Radiol 82:2328–2333PubMedCrossRefGoogle Scholar
  21. 21.
    Blanco Sequeiros R, Klemola R, Ojala R, Jyrkinen L, Vaara T, Tervonen O (2003) Percutaneous MR-guided discography in a low-field system using optical instrument tracking: A feasibility study. J Magn Reson Imaging 17:214–219CrossRefGoogle Scholar
  22. 22.
    Seebauer CJ, Bail HJ, Wichlas F et al (2009) Osteochondral lesions of the talus: Retrograde drilling with high-field-strength MR guidance. Radiology 252:857–864Google Scholar
  23. 23.
    Berndt AL, Harty M (2004) Transchondral fractures (osteochondritis dissecans) of the talus. J Bone Joint Surg Am 86-A:1336PubMedGoogle Scholar

Copyright information

© European Society of Radiology 2014

Authors and Affiliations

  • Pekka Kerimaa
    • 1
    Email author
  • Risto Ojala
    • 1
  • Juha-Jaakko Sinikumpu
    • 2
  • Pekka Hyvönen
    • 3
  • Jussi Korhonen
    • 2
  • Paula Markkanen
    • 1
  • Osmo Tervonen
    • 1
  • Roberto Blanco Sequeiros
    • 1
  1. 1.Department of RadiologyOulu University HospitalOuluFinland
  2. 2.Department of Paediatric SurgeryOulu University HospitalOuluFinland
  3. 3.Department of SurgeryOulu University HospitalOuluFinland

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