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.
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Article info
Publication history
Published online: August 19, 2019
Accepted:
May 9,
2019
Received:
January 3,
2019
Footnotes
The authors report funding from Clinical Medicine Plus X-Young Scholars Project of Peking University (PKU2018LCXQ009), National Natural Science Foundation of China (31670982), and Beijing Natural Science Foundation (5184033). Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Identification
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© 2019 by the Arthroscopy Association of North America
