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Comparison of the medial midline and the anterolateral portal in ankle arthroscopy for the treatment of osteochondral lesions of the medial talus

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Abstract

Purpose

To compare the clinical efficacy and complication rates between the medial midline and anterolateral portals in ankle arthroscopy for treating medial osteochondral lesions of the talus (OLTs).

Methods

We retrospectively analyzed patients with medial OLTs who underwent either a dual medial approach (via the medial midline and anteromedial portal) or a traditional approach (via the anterolateral and anteromedial portal) between June 2017 and January 2023. The degree of injury was evaluated by radiographs, computed tomography, and magnetic resonance imaging. Clinical outcomes were assessed using the visual analog scale (VAS), the American Orthopaedic Foot and Ankle Society (AOFAS) score, and the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) scoring system. The incidence of postoperative complications, including superficial peroneal nerve (SPN) injury, was evaluated in all patients.

Results

There were 39 patients in total; 16 patients underwent the dual medial approach, and 23 patients underwent the traditional approach. The mean age was 39.4 ± 9.0 years, and the mean follow-up duration was 18.7 ± 6.4 months. The clinical outcomes improved significantly in both groups (*P < 0.05), but there was no significant difference between the two groups (P > 0.05). Postoperative complications were mainly SPN injury. The incidence of SPN injury was 13.0% in the traditional approach group and 0% in the dual medial approach group, with no significant difference between the two groups (P > 0.05), but a trend of reduction in SPN injury was observed in the dual medial approach group.

Conclusion

The dual medial approach can also treat medial OLTs well, providing clear visualization and more convenient operation and reducing the possibility of injury to the SPN compared with the traditional approach. Therefore, we consider that the MM portal would be a good alternative to the anterolateral portal in treating medial OLTs.

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Data availability

Data is available upon request from the authors.

References

  1. Corr D, Raikin J, O’Neil J, Raikin S (2021) Long-term Outcomes of microfracture for treatment of osteochondral lesions of the talus. Foot Ankle Int 42:833–840. https://doi.org/10.1177/1071100721995427

    Article  PubMed  Google Scholar 

  2. O’Loughlin PF, Heyworth BE, Kennedy JG (2010) Current concepts in the diagnosis and treatment of osteochondral lesions of the ankle. Am J Sports Med 38:392–404. https://doi.org/10.1177/0363546509336336

    Article  PubMed  Google Scholar 

  3. Rungprai C, Tennant JN, Gentry RD, Phisitkul P (2017) Management of osteochondral lesions of the talar dome. Open Orthop J 11:743–761. https://doi.org/10.2174/1874325001711010743

    Article  PubMed  PubMed Central  Google Scholar 

  4. Savage-Elliott I, Ross KA, Smyth NA, Murawski CD, Kennedy JG (2014) Osteochondral lesions of the talus: a current concepts review and evidence-based treatment paradigm. Foot Ankle Spec 7:414–422. https://doi.org/10.1177/1938640014543362

    Article  PubMed  Google Scholar 

  5. van Osch GJ, Brittberg M, Dennis JE, Bastiaansen-Jenniskens YM, Erben RG, Konttinen YT, Luyten FP (2009) Cartilage repair: past and future–lessons for regenerative medicine. J Cell Mol Med 13:792–810. https://doi.org/10.1111/j.1582-4934.2009.00789.x

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Heinegård D, Saxne T (2011) The role of the cartilage matrix in osteoarthritis. Nat Rev Rheumatol 7:50–56. https://doi.org/10.1038/nrrheum.2010.198

    Article  CAS  PubMed  Google Scholar 

  7. Weigelt L, Laux CJ, Urbanschitz L, Espinosa N, Klammer G, Götschi T, Wirth SH (2020) Long-term prognosis after successful nonoperative treatment of osteochondral lesions of the talus: an observational 14-year follow-up study. Orthop J Sports Med 8:2325967120924183. https://doi.org/10.1177/2325967120924183

    Article  PubMed  PubMed Central  Google Scholar 

  8. McGahan PJ, Pinney SJ (2010) Current concept review: osteochondral lesions of the talus. Foot Ankle Int 31:90–101. https://doi.org/10.3113/fai.2010.0090

    Article  PubMed  Google Scholar 

  9. Qulaghassi M, Cho YS, Khwaja M, Dhinsa B (2021) Treatment strategies for osteochondral lesions of the talus: a review of the recent evidence. Foot (Edinb) 47:101805. https://doi.org/10.1016/j.foot.2021.101805

    Article  PubMed  Google Scholar 

  10. Giannini S, Vannini F (2004) Operative treatment of osteochondral lesions of the talar dome: current concepts review. Foot Ankle Int 25:168–175. https://doi.org/10.1177/107110070402500311

    Article  PubMed  Google Scholar 

  11. Glazebrook MA, Ganapathy V, Bridge MA, Stone JW, Allard JP (2009) Evidence-based indications for ankle arthroscopy. Arthroscopy 25:1478–1490. https://doi.org/10.1016/j.arthro.2009.05.001

    Article  PubMed  Google Scholar 

  12. Polat G, Erşen A, Erdil ME, Kızılkurt T, Kılıçoğlu Ö, Aşık M (2016) Long-term results of microfracture in the treatment of talus osteochondral lesions. Knee Surg Sports Traumatol Arthrosc 24:1299–1303. https://doi.org/10.1007/s00167-016-3990-8

    Article  PubMed  Google Scholar 

  13. van Bergen CJ, Kox LS, Maas M, Sierevelt IN, Kerkhoffs GM, van Dijk CN (2013) Arthroscopic treatment of osteochondral defects of the talus: outcomes at eight to twenty years of follow-up. J Bone Joint Surg Am 95:519–525. https://doi.org/10.2106/jbjs.L.00675

    Article  PubMed  Google Scholar 

  14. Zengerink M, Struijs PA, Tol JL, van Dijk CN (2010) Treatment of osteochondral lesions of the talus: a systematic review. Knee Surg Sports Traumatol Arthrosc 18:238–246. https://doi.org/10.1007/s00167-009-0942-6

    Article  PubMed  Google Scholar 

  15. Zhang B, Li Y, Yang X, Gong X, Sun N, Lai L, Li W, Wu Y (2024) Arthroscopic surgery for ankle gouty arthritis: a retrospective analysis of clinical outcomes at six month follow-up based on a novel classification system. Int Orthop 48:1031–1037. https://doi.org/10.1007/s00264-023-06057-5

    Article  PubMed  Google Scholar 

  16. Chen Z, Xue X, Li Q, Song Y, Xu H, Wang W, Hua Y (2023) Outcomes of a novel all-inside arthroscopic anterior talofibular ligament repair for chronic ankle instability. Int Orthop 47:995–1003. https://doi.org/10.1007/s00264-023-05721-0

    Article  PubMed  Google Scholar 

  17. Xu M, Li R, Chen G, Zhou X, Wei D, Cao G, Shi R (2024) Arthroscopy-assisted reduction and simultaneous robotic-assisted screw placement in the treatment of fractures of the posterior talar process. Int Orthop 48:573–580. https://doi.org/10.1007/s00264-023-06006-2

    Article  PubMed  Google Scholar 

  18. Zekry M, Shahban SA, El Gamal T, Platt S (2019) A literature review of the complications following anterior and posterior ankle arthroscopy. Foot Ankle Surg 25:553–558. https://doi.org/10.1016/j.fas.2018.06.007

    Article  PubMed  Google Scholar 

  19. Muir D, Saltzman CL, Tochigi Y, Amendola N (2006) Talar dome access for osteochondral lesions. Am J Sports Med 34:1457–1463. https://doi.org/10.1177/0363546506287296

    Article  PubMed  Google Scholar 

  20. van Dijk CN, Scholten PE, Krips R (2000) A 2-portal endoscopic approach for diagnosis and treatment of posterior ankle pathology. Arthroscopy 16:871–876. https://doi.org/10.1053/jars.2000.19430

    Article  PubMed  Google Scholar 

  21. Carlson MJ, Ferkel RD (2013) Complications in ankle and foot arthroscopy. Sports Med Arthrosc Rev 21:135–139. https://doi.org/10.1097/JSA.0b013e31828e5c6c

    Article  PubMed  Google Scholar 

  22. Ferkel RD, Small HN, Gittins JE (2001) Complications in foot and ankle arthroscopy. Clin Orthop Relat Res:89–104. https://doi.org/10.1097/00003086-200110000-00010

  23. Hepple S, Guha A (2013) The role of ankle arthroscopy in acute ankle injuries of the athlete. Foot Ankle Clin 18:185–194. https://doi.org/10.1016/j.fcl.2013.02.001

    Article  PubMed  Google Scholar 

  24. Bregman PJ, Schuenke MJ (2016) A commentary on the diagnosis and treatment of superficial peroneal (fibular) nerve injury and entrapment. J Foot Ankle Surg 55:668–674. https://doi.org/10.1053/j.jfas.2015.11.005

    Article  PubMed  Google Scholar 

  25. Ribak S, Fonseca JR, Tietzmann A, Gama SA, Hirata HH (2016) The anatomy and morphology of the superficial peroneal nerve. J Reconstr Microsurg 32:271–275. https://doi.org/10.1055/s-0035-1568881

    Article  PubMed  Google Scholar 

  26. Zhang K, Khan AA, Dai H, Li Y, Tao T, Jiang Y, Gui J (2020) A modified all-inside arthroscopic remnant-preserving technique of lateral ankle ligament reconstruction: medium-term clinical and radiologic results comparable with open reconstruction. Int Orthop 44:2155–2165. https://doi.org/10.1007/s00264-020-04773-w

    Article  PubMed  Google Scholar 

  27. Yang HY, Lee KB (2020) Arthroscopic microfracture for osteochondral lesions of the talus: second-look arthroscopic and magnetic resonance analysis of cartilage repair tissue outcomes. J Bone Joint Surg Am 102:10–20. https://doi.org/10.2106/jbjs.19.00208

    Article  PubMed  Google Scholar 

  28. Takagi K (1982) The classic. Arthroscope. Kenji Takagi. J. Jap. Orthop. Assoc., 1939. Clin Orthop Relat Res 6–8

  29. Drez D Jr, Guhl JF, Gollehon DL (1981) Ankle arthroscopy: technique and indications. Foot Ankle 2:138–143. https://doi.org/10.1177/107110078100200303

    Article  PubMed  Google Scholar 

  30. Buckingham RA, Winson IG, Kelly AJ (1997) An anatomical study of a new portal for ankle arthroscopy. J Bone Joint Surg Br 79:650–652. https://doi.org/10.1302/0301-620x.79b4.7428

    Article  CAS  PubMed  Google Scholar 

  31. Ferkel RD, Heath DD, Guhl JF (1996) Neurological complications of ankle arthroscopy. Arthroscopy 12:200–208. https://doi.org/10.1016/s0749-8063(96)90011-0

    Article  CAS  PubMed  Google Scholar 

  32. Ferkel RD, Fischer SP (1989) Progress in ankle arthroscopy. Clin Orthop Relat Res 210–220. https://journals.lww.com/clinorthop/abstract/1989/03000/progress_in_ankle_arthroscopy.27.aspx

  33. Saito A, Kikuchi S (1998) Anatomic relations between ankle arthroscopic portal sites and the superficial peroneal and saphenous nerves. Foot Ankle Int 19:748–752. https://doi.org/10.1177/107110079801901107

    Article  CAS  PubMed  Google Scholar 

  34. Solomon LB, Ferris L, Henneberg M (2006) Anatomical study of the ankle with view to the anterior arthroscopic portals. ANZ J Surg 76:932–936. https://doi.org/10.1111/j.1445-2197.2006.03909.x

    Article  PubMed  Google Scholar 

  35. Bardas CA, Benea HRC, Apostu D, Oltean-Dan D, Tomoaia G, Bauer T (2021) Clinical outcomes after arthroscopically assisted talus fracture fixation. Int Orthop 45:1025–1031. https://doi.org/10.1007/s00264-020-04859-5

    Article  PubMed  Google Scholar 

  36. Yang L, Wang Q, Wang Y, Ding X, Liang H (2024) Comparative clinical study of the modified Broström procedure for the treatment of the anterior talofibular ligament injury-outcomes of the open technique compared to the arthroscopic procedure. Int Orthop 48:409–417. https://doi.org/10.1007/s00264-023-05963-y

    Article  PubMed  Google Scholar 

  37. Feiwell LA, Frey C (1994) Anatomic study of arthroscopic debridement of the ankle. Foot Ankle Int 15:614–621. https://doi.org/10.1177/107110079401501107

    Article  CAS  PubMed  Google Scholar 

  38. Inoue J, Yasui Y, Sasahara J, Takenaga T, Wakabayashi K, Nozaki M, Kobayashi M, Ha M, Fukushima H, Kato J, Miyamoto W, Kawano H, Murakami H, Yoshida M (2023) Comparison of visibility and risk of neurovascular tissue injury between portals in needle arthroscopy of the anterior ankle joint: a cadaveric study. Orthop J Sports Med 11:23259671231174476. https://doi.org/10.1177/23259671231174477

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China

    Piqian Zhao, Junhui Xing, Mingyang Gao, Changbao Wang, Yingjie Xu, Hongtao Zhang & Yu Cheng

  2. Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China

    Zijie Pei

  3. Department of Orthopedics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China

    Zijie Pei

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  1. Piqian Zhao
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Contributions

All authors contributed to the study’s conception and design. Material preparation, data collection, and analysis were performed by Yu Cheng, Zijie Pei, and Piqian Zhao. The first draft of the manuscript was written by Piqian Zhao and Yu Cheng, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Hongtao Zhang or Yu Cheng.

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The Medical Ethics Committee of the First Affiliated Hospital of Soochow University approved the study.

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Informed consent was obtained from all individual participants included in the study.

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Piqian Zhao and Zijie Pei contributed equally to this study.

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Zhao, P., Pei, Z., Xing, J. et al. Comparison of the medial midline and the anterolateral portal in ankle arthroscopy for the treatment of osteochondral lesions of the medial talus. International Orthopaedics (SICOT) (2024). https://doi.org/10.1007/s00264-024-06159-8

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