Skip to main content
Log in

An anterior ankle arthroscopic technique for retrograde osteochondral autograft transplantation of posteromedial and central talar dome cartilage defects

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

Abstract

Purpose

The purpose of this study was to present an arthroscopic technique for the treatment for posteromedial and central cartilage defects of the talus using anterior arthroscopic portals and without performing a medial malleolar osteotomy.

Methods

Nine fresh cadavers were dissected. Autografts were implanted under arthroscopy using a retrograde osteochondral transplantation system, and their position was estimated using specific angular calibrators and later confirmed by software analysis of two photographs of the disarticulated ankle joint.

Results

In eight cases, the congruence between the surrounding articular cartilage and the cartilage of the graft was high, with differences measuring <1 mm. There were no iatrogenic cartilage lesions of the tibial plafond and no fractures of the talus. All the autografts remained stable during full range of motion cycles of the ankle joint. One failure was reported.

Conclusion

This cadaveric study showed that the retrograde osteochondral autograft transplantation technique in the talus is feasible. It can be used to restore the posteromedial and central talar articular surfaces using conventional ankle arthroscopic instrumentation and anterior arthroscopic portals without resorting to a medial malleolar osteotomy. Further clinical and biomechanical studies are required to prove the efficacy of this technique and its reproducibility in routine clinical practice.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Alexander IJ, Watson JT (1991) Step-cut osteotomy of the medial malleolus for exposure of the medial ankle joint space. Foot Ankle 11:242–243

    Article  CAS  PubMed  Google Scholar 

  2. Al-Shaikh RA, Chou LB, Mann JA et al (2002) Autologous osteochondral grafting for talar cartilage defects. Foot Ankle Int 23:381–389

    PubMed  Google Scholar 

  3. Baker CL Jr, Morales RW (1999) Arthroscopic treatment of transchondral talar dome fractures: a long-term follow-up study. Arthroscopy 15:197–202

    Article  PubMed  Google Scholar 

  4. Baltzer AW, Arnold JP (2005) Bone-cartilage transplantation from the ipsilateral knee for chondral lesions of the talus. Arthroscopy 21:159–166

    Article  PubMed  Google Scholar 

  5. Bodó G, Hangody L, Szabó Z et al (2000) Arthroscopic autologous osteochondral mosaicplasty for the treatment of subchondral cystic lesion in the medial femoral condyle in a horse. Acta Vet Hung 48:343–354

    Article  PubMed  Google Scholar 

  6. Canale ST, Belding RH (1980) Osteochondral lesions of the talus. J Bone Joint Surg Am 62:97–102

    CAS  PubMed  Google Scholar 

  7. Chin TW, Mitra AK, Lim GH et al (1996) Arthroscopic treatment of osteochondral lesion of the talus. Ann Acad Med Singapore 25:236–240

    CAS  PubMed  Google Scholar 

  8. Gaulrapp H, Hagena FW, Wasmer G (1996) Postoperative evaluation of osteochondrosis dissecans of the talus with special reference to medial malleolar osteotomy. Z Orthop Ihre Grenzgeb 134:346–353

    Article  CAS  PubMed  Google Scholar 

  9. Gautier E, Kolker D, Jakob RP (2002) Treatment of cartilage defects of the talus by autologous osteochondral grafts. J Bone Joint Surg Br 84:237–244

    Article  CAS  PubMed  Google Scholar 

  10. Gobbi A, Francisco RA, Lubowitz JH et al (2006) Osteochondral lesions of the talus: randomized controlled trial comparing chondroplasty, microfracture, and osteochondral autograft transplantation. Arthroscopy 22:1085–1092

    Article  PubMed  Google Scholar 

  11. Hangody L, Fules P (2003) Autologous osteochondral mosaicplasty for the treatment of fullthickness defects of weight-bearing joints: ten years of experimental and clinical experience. J Bone Joint Surg Am 85(A suppl 2):25–32

    PubMed  Google Scholar 

  12. Hangody L, Kish G, Kárpáti Z et al (1997) Arthroscopic autogenous osteochondral mosaicplasty for the treatment of femoral condylar articular defects. A preliminary report. Knee Surg Sports Traumatol Arthrosc 5:262–267

    Article  CAS  PubMed  Google Scholar 

  13. Harris JD, Siston RA, Pan X, Flanigan DC (2010) Autologous chondrocyte implantation: a systematic review. J Bone Joint Surg Am 92:2220–2233

    PubMed  Google Scholar 

  14. Hoffmann M, Petersen JP, Schröder 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 28:1547–1554

    Article  PubMed  Google Scholar 

  15. Horas U, Pelinkovic D, Herr G et al (2003) Autologous chondrocyte implantation and osteochondral cylinder transplantation in cartilage repair of the knee joint. A prospective, comparative trial. J Bone Joint Surg Am 85-A:185–192

    CAS  PubMed  Google Scholar 

  16. Hoser C, Bichier O, Bale R et al (2004) A computer assisted surgical technique for retrograde autologous osteochondral grafting in talar osteochondritis dissecans (OCD): a cadaveric study. Knee Surg Traumatol Arthrosc 12:65–71

    Article  Google Scholar 

  17. Hunt SA, Sherman O (2003) Arthroscopic treatment of osteochondral lesions of the talus with correlation of outcome scoring systems. Arthroscopy 19:360–367

    Article  PubMed  Google Scholar 

  18. Kelberine F, Frank A (1999) Arthroscopic treatment of osteochondral lesions of the talar dome: a retrospective study of 48 cases. Arthroscopy 15:77–84

    Article  CAS  PubMed  Google Scholar 

  19. Kiliçoğlu O, Taşer O (2005) Retrograde osteochondral grafting for osteochondral lesion of the talus: a new technique eliminating malleolar osteotomy. Acta Orthop Traumatol Turc 39:274–9

    PubMed  Google Scholar 

  20. Kono M, Takao M, Naito K (2006) Retrograde drilling for osteochondral lesions of the talar dome. Am J Sports Med 34:1450–1456

    Article  PubMed  Google Scholar 

  21. Kreuz PC, Steinwachs M, Erggelet C et al (2006) Mosaicplasty with autogenous talar autograft for osteochondral lesions of the talus after failed primary arthroscopic management: a prospective study with a 4-year follow-up. Am J Sports Med 34:55–63

    Article  PubMed  Google Scholar 

  22. Lee CH, Chao KH, Huang GS et al (2003) Osteochondral autografts for osteochondritis dissecans of the talus. Foot Ankle Int 24:815–822

    PubMed  Google Scholar 

  23. Lee KB, Yang HK, Moon ES, Song EK (2008) Modified step-cut medial malleolar osteotomy for osteochondral grafting of the talus. Foot Ankle Int 29:1107–1110

    Article  PubMed  Google Scholar 

  24. Lohrer H (2009) New technique for medial malleolar osteotomy for treatment of osteochondral talar lesions. Foot Ankle Int 30:285–286

    PubMed  Google Scholar 

  25. Matsusue Y, Kotake T, Nakagawa Y, Nakamura T (2001) Arthroscopic osteochondral autograft transplantation for chondral lesion of the tibial plateau of the knee. Arthroscopy 17:653–659

    Article  CAS  PubMed  Google Scholar 

  26. Mendicino RW, Lee MS, Grossman JP et al (1998) Oblique medial malleolar osteotomy for the management of talar dome lesions. J Foot Ankle Surg 37:516–523

    Article  CAS  PubMed  Google Scholar 

  27. Muir D, Saltzman CL, Tochigi Y, Amendola N (2006) Talar dome access for osteochondral lesions. Am J Sports Med 34:1457–1463

    Article  PubMed  Google Scholar 

  28. Navid DO, Myerson MS (2002) Approach alternatives for treatment of osteochondral lesions of the talus. Foot Ankle Clin 7:635–649

    Article  PubMed  Google Scholar 

  29. Nickisch F, Barg A, Saltzman CL et al (2012) Postoperative complications of posterior ankle and hindfoot arthroscopy. J Bone Joint Surg Am 94:439–446

    Article  PubMed  Google Scholar 

  30. Ogut T, Ayhan E, Irgit K, Sarikaya AI (2011) Endoscopic treatment of posterior ankle pain. Knee Surg Sports Traumatol Arthrosc 19:1355–1361

    Article  PubMed  Google Scholar 

  31. Robinson DE, Winson IG, Harries WJ, Kelly AJ (2003) Arthroscopic treatment of osteochondral lesions of the talus. J Bone Joint Surg Br 85:989–993

    Article  CAS  PubMed  Google Scholar 

  32. Sammarco GJ, Makwana NK (2002) Treatment of talar osteochondral lesions using local osteochondral graft. Foot Ankle Int 23:693–698

    PubMed  Google Scholar 

  33. Scranton PE Jr, Frey CC, Feder KS (2006) Outcome of osteochondral autograft transplantation for type-V cystic osteochondral lesions of the talus. J Bone Joint Surg Br 88:614–619

    Article  PubMed  Google Scholar 

  34. Ueblacker P, Burkart A, Imhoff AB (2004) Retrograde cartilage transplantation on the proximal and distal tibia. Arthroscopy 20:73–78

    Article  PubMed  Google Scholar 

  35. van Bergen CJ, Tuijthof GJ, Maas M, Sierevelt IN, van Dijk CN (2012) Arthroscopic accessibility of the talus quantified by computed tomography simulation. Am J Sports Med 40:2318–2324

    Article  PubMed  Google Scholar 

  36. van Bergen CJ, Tuijthof GJ, Sierevelt IN, van Dijk CN (2011) Direction of the oblique medial malleolar osteotomy for exposure of the talus. Arch Orthop Trauma Surg 131:893–901

    Article  PubMed Central  PubMed  Google Scholar 

  37. Wallen EA, Fallat LM (1989) Crescentic transmalleolar osteotomy for optimal exposure of the medial talar dome. J Foot Surg 28:389–394

    CAS  PubMed  Google Scholar 

  38. 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

    Article  PubMed Central  PubMed  Google Scholar 

  39. Zengerink M, Szerb I, Hangody L et al (2006) Current concepts: treatment of osteochondral ankle defects. Foot Ankle Clin 11:331–359

    Article  PubMed  Google Scholar 

  40. Ziran BH, Abidi NA, Scheel MJ (2001) Medial malleolar osteotomy for exposure of complex talar body fractures. J Orthop Trauma 15:513–518

    Article  CAS  PubMed  Google Scholar 

Download references

Conflict of interest

PB is an occasional consultant of Smith and Nephew. No other conflict of interest relevant to this article was reported.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Konstantinos G. Makridis.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wajsfisz, A., Makridis, K.G., Naji, O. et al. An anterior ankle arthroscopic technique for retrograde osteochondral autograft transplantation of posteromedial and central talar dome cartilage defects. Knee Surg Sports Traumatol Arthrosc 22, 1298–1303 (2014). https://doi.org/10.1007/s00167-013-2502-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-013-2502-3

Keywords

Navigation