Advertisement

Vascular Compromising Effect of Drilling for Osteochondral Lesions of the Talus: A Three-Dimensional Micro–Computed Tomography Study

      Purpose

      To explore an optimal drilling depth and direction for osteochondral lesions of the talus based on a 3-dimensional vascular microarchitecture model constructed with micro–computed tomography (microCT).

      Methods

      Twelve tali were perfused with the contrast agent and then scanned with microCT. The talar dome was divided into 9 zones, and the vessel densities were measured at the subchondral depths of 0 to 5 mm, 5 to 10 mm and 10 to 15 mm in each zone. The anterolateral (AL) and posterolateral (PL) approaches of retrograde drilling were simulated and the vascular compromising effect was evaluated.

      Results

      The vessel density of the 0- to 5-mm depth was lower than that of the 5- to 10-mm (P = .001) and 10- to 15-mm (P = .007) depths, but no significant difference was found between the 5- to 10-mm and 10- to 15-mm depths (P > .9999). The vessel density in the 5- to 10-mm depth of medial talar dome was similar to that of the adjacent zones (P = .05). Vessel density in the 5- to 10-mm depth around the lateral talar dome was higher in the anterior and medial side. The anterolateral approach disturbed the main intraosseous vessels from the tarsal canal–tarsal sinus, causing extensive vascular compromise in the talus neck and body, whereas the posterolateral approach disturbed only the vessels near the tunnel.

      Conclusions

      The vessel density changed greatly from the subchondral 0- to 5-mm to the 5- to 10-mm depth. The vessel densities of the 5- to 10-mm depth around the medial talar dome were similar, whereas the anterior and medial side of the lateral talar dome was better vascularized. The posterolateral approach caused less vascular damage than the anterolateral approach.

      Clinical Relevance

      The anterograde drilling depth was preferable to the subchondral 5- to 10-mm depth. There was no preferred drilling direction for the osteochondral lesion in the medial talar dome, whereas it is preferable to drill anteriorly or medially in the lateral dome. The posterolateral approach might be a safer alternative for retrograde drilling.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Arthroscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Wodicka R.
        • Ferkel E.
        • Ferkel R.
        Osteochondral lesions of the ankle.
        Foot Ankle Int. 2016; 37: 1023-1034
        • van Dijk C.N.
        • Reilingh M.L.
        • Zengerink M.
        • van Bergen C.J.
        Osteochondral defects in the ankle: Why painful?.
        Knee Surg Sports Traumatol Arthrosc. 2010; 18: 570-580
        • Looze C.A.
        • Capo J.
        • Ryan M.K.
        • et al.
        Evaluation and management of osteochondral lesions of the talus.
        Cartilage. 2017; 8: 19-30
        • Hannon C.P.
        • Smyth N.A.
        • Murawski C.D.
        • et al.
        Osteochondral lesions of the talus: aspects of current management.
        J Bone Joint Surg Br. 2014; 96: 164-171
        • Dahmen J.
        • Lambers K.
        • Reilingh M.L.
        • et al.
        No superior treatment for primary osteochondral defects of the talus.
        Knee Surg Sports Traumatol Arthrosc. 2018; 26: 2142-2157
        • O'Loughlin P.F.
        • Heyworth B.E.
        • Kennedy J.G.
        Current concepts in the diagnosis and treatment of osteochondral lesions of the ankle.
        Am J Sports Med. 2010; 38: 392-404
        • Medda S.
        • Al'Khafaji I.M.
        • Scott A.T.
        Ankle arthroscopy with microfracture for osteochondral defects of the talus.
        Arthrosc Tech. 2017; 6: e167-e174
        • Kerimaa P.
        • Ojala R.
        • Sinikumpu J.J.
        • et al.
        MRI-guided percutaneous retrograde drilling of osteochondritis dissecans of the talus: A feasibility study.
        Eur Radiol. 2014; 24: 1572-1576
        • Kono M.
        • Takao M.
        • Naito K.
        • Uchio Y.
        • Ochi M.
        Retrograde drilling for osteochondral lesions of the talar dome.
        Am J Sports Med. 2006; 34: 1450-1456
        • Gelberman R.H.
        • Mortensen W.W.
        The arterial anatomy of the talus.
        Foot Ankle. 1983; 4: 64-72
        • Jeong S.Y.
        • Kim J.K.
        • Lee K.B.
        Is retrograde drilling really useful for osteochondral lesion of talus with subchondral cyst? A case report.
        Medicine (Baltimore). 2016; 95: e5418
        • Wang D.Y.
        • Li X.
        • Shen Z.C.
        • et al.
        [Three-dimensional architecture of intraosseous vascular anatomy of the hamate: a micro-computed tomography study].
        Beijing Da Xue Xue Bao Yi Xue Ban. 2018; 50: 245-248
        • Elias I.
        • Zoga A.C.
        • Morrison W.B.
        • et al.
        Osteochondral lesions of the talus: Localization and morphologic data from 424 patients using a novel anatomical grid scheme.
        Foot Ankle Int. 2007; 28: 154-161
        • Choi J.I.
        • Lee K.B.
        Comparison of clinical outcomes between arthroscopic subchondral drilling and microfracture for osteochondral lesions of the talus.
        Knee Surg Sports Traumatol Arthrosc. 2016; 24: 2140-2147
        • Chen H.
        • Hoemann C.D.
        • Sun J.
        • et al.
        Depth of subchondral perforation influences the outcome of bone marrow stimulation cartilage repair.
        J Orthop Res. 2011; 29: 1178-1184
        • Chen H.
        • Sun J.
        • Hoemann C.D.
        • et al.
        Drilling and microfracture lead to different bone structure and necrosis during bone-marrow stimulation for cartilage repair.
        J Orthop Res. 2009; 27: 1432-1438
        • Chen H.
        • Chevrier A.
        • Hoemann C.D.
        • et al.
        Characterization of subchondral bone repair for marrow-stimulated chondral defects and its relationship to articular cartilage resurfacing.
        Am J Sports Med. 2011; 39: 1731-1740
        • Feiwell L.A.
        • Frey C.
        Anatomic study of arthroscopic portal sites of the ankle.
        Foot Ankle. 1993; 14: 142-147
        • Haytmanek C.T.
        • Williams B.T.
        • James E.W.
        • et al.
        Radiographic identification of the primary lateral ankle structures.
        Am J Sports Med. 2015; 43: 79-87
        • Akiyama K.
        • Takakura Y.
        • Tomita Y.
        • et al.
        Neurohistology of the sinus tarsi and sinus tarsi syndrome.
        J Orthop Sci. 1999; 4: 299-303
        • Michels F.
        • Guillo S.
        • Vanrietvelde F.
        • Brugman E.
        • Stockmans F.
        How to drill the talar tunnel in ATFL reconstruction.
        Knee Surg Sports Traumatol Arthrosc. 2016; 24: 991-997