2025 ISAKOS Biennial Congress Paper
Clinical and Radiological Outcomes of Retrograde Drilling for Osteochondral Lesions of the Talus in Skeletally Mature and Immature Patients
Hideyuki Sawada, MD, Nishinomiya, Hyogo JAPAN
Shota Morimoto, MD, PhD, Nishinomiya, Hyogo JAPAN
Masashi Nakamura, MD, Nishinomiya, Hyogo JAPAN
Yuta Matsumae, MD JAPAN
Mitsuki Shimizu, MD, Nishinomiya, hyogo JAPAN
Tomoya Iseki, MD, PhD, Nishinomiya, Hyogo JAPAN
Toshiya Tachibana, MD, PhD, Nishinomiya, Hyogo JAPAN
Hyogo medical university, Nishinomiya, Hyogo, JAPAN
FDA Status Not Applicable
Summary
This study suggests that retrograde drilling for osteochondral lesions of the talus provides good clinical and radiological outcomes in skeletally mature and immature patients, and more effective in skeletally immature patients.
Abstract
Background
Osteochondral lesions of the talus (OLTs) are lesions of the articular cartilage of the talus and underlying the subchondral bone. Retrograde drilling (RD) is generally indicated for treatment of OLTs with a stable osteochondral fragment and nearly normal cartilage surface. Previous literatures have reported that RD for OLTs provided good clinical outcomes in patients of various ages. In addition, several studies have described that RD can be more effective in skeletally immature patients than in skeletally mature patients because they have a strong ability for new bone formation. However, there are no studies comparing the surgical results of RD for OLTs between skeletally mature and immature patients. The purpose of this study is to clarify the clinical and radiological outcomes of RD for OLTs and to compare these outcomes between skeletally mature and immature patients.
Methods
The authors analyzed patients who underwent RD for OLT between April 2017 and August 2022. The minimum follow-up period of the patients was 2 years. The clinical outcomes were evaluated using the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS) score at pre-operation and 2 years postoperatively. As the radiological outcomes, computed tomography (CT) findings at pre-operation and 2 years postoperatively were used to evaluate the degree of healing. Good healing was defined as complete osseous union or ossification, fair healing as partial osseous union or ossification, and poor healing as no change from the preoperative CT findings. Additionally, the clinical and radiological outcomes were statistically compared between the skeletally mature (group M) and immature (group I) groups.
Results
A total of 31 patients (13 men, 18 women, mean age 20.3±9.2 years) were included in this study. The OLTs were located on the medial aspect in 27 patients and lateral aspect in 4 patients, the mean length, width and height of the lesions were 8.9±2.3 mm, 6.9±2.3 mm, and 4.2±1.1 mm, respectively. According to the Anderson classification, 17 and 14 lesions were graded 2 and 3, respectively. The mean AOFAS score significantly increased from 65.7±8.7 at pre-operation to 94.9±7.6 at 2 years postoperatively. CT findings at 2 years postoperatively showed good healing in 17 patients, fair in 12 patients and poor in 2 patients, compared to preoperative CT findings. Additionally, 19 patients were assigned to the group M, while 12 patients were assigned to the group I. There were no significant differences in the demographic characteristics of the patients between the two groups. In comparing of the clinical and radiological outcomes, there were no significant differences in the clinical outcomes, but the rate of good healing in the radiological outcomes was significantly higher in group I (9 of 12 patients, 75.0 %) than group M (8 of 19 patients, 42.1 %).
Conclusions
RD for OLT provided good clinical and radiological outcomes at short-term follow-up, and more effective for OLT in skeletally immature patients.