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Fluoro-Free navigated retrograde drilling of osteochondral lesions

  • Sports Traumatology
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Retrograde drilling of osteochondral lesions (OCLs) is a recommended, but demanding operative approach for revascularization of lesions in stage 1–3 according to Berndt and Harty after failed conservative treatment. The gold standard of intraoperative driller guidance is fluoroscopic control. Limitations are a 2D visualization of a 3D procedure and sometimes limited view of the OCL in fluoroscopy, leading to increased radiation exposure. A new image-free navigation procedure was evaluated for practicability and precision in first clinical applications.

Methods

In a period of 7 months, retrograde drillings were performed in eight patients (3x femoral condyle, 5x talus) using the new Fluoro-Free navigation procedure without rigidly fixed reference bases.

Results

In total, 29 retrograde drillings were performed without any technical problem. The overall mean operating time was 82.1 ± 29.3 min (34.6 ± 6.4 min for the standard arthroscopy and 11.2 ± 1.2 min per drill). Twenty-seven of 29 drillings hit the target with a 100% first-pass accuracy. Two complications during drilling (one navigation specific and one navigation independent) were observed.

Conclusion

The paper describes the promising first clinical applications of a new Fluoro-Free navigation procedure for the retrograde drilling of OCLs determined by arthroscopy. The benefit of that navigated drillings with a high rate of first-pass accuracy and no need for radiation exposure in contrast to standard techniques is highlighted.

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Conflict of interest

The Friedrich Schiller University of Jena has received patent-related reimbursement from BrainLAB AG. The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Trauma Surgery, Hand Surgery and Reconstructive Surgery, Friedrich Schiller University, Jena, Erlanger Allee 101, 07740, Jena, Germany

    Florian Gras, Ivan Marintschev, Kajetan Klos, Thomas Mückley & Gunther O. Hofmann

  2. Department of Orthopaedic Surgery, University of Virginia Health System, P.O. Box 801016, Charlottesville, VA, 22908, USA

    David M. Kahler

  3. Berufsgenossenschaftliche Kliniken Halle, Merseburger Straße 165, 06112, Halle, Germany

    Gunther O. Hofmann

Authors
  1. Florian Gras
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  2. Ivan Marintschev
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  3. David M. Kahler
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  4. Kajetan Klos
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  5. Thomas Mückley
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  6. Gunther O. Hofmann
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Correspondence to Florian Gras.

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Gras, F., Marintschev, I., Kahler, D.M. et al. Fluoro-Free navigated retrograde drilling of osteochondral lesions. Knee Surg Sports Traumatol Arthrosc 19, 55–59 (2011). https://doi.org/10.1007/s00167-010-1260-8

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  • DOI: https://doi.org/10.1007/s00167-010-1260-8

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