Single-Stage All-Arthroscopic Autologous Cancellous Bone Transplantation in Treatment of Cystic Osteochondral Lesion of the Talus

Abstract

Osteochondral lesions of the talus (OLTs) are common sports-associated ankle injuries and are being increasingly recognized as a source of persistent ankle pain and disability. Although a vast array of surgical techniques have been reported, there are no rigid indications of decision-making for specific procedures. For symptomatic large or cystic lesions, multiple implants are introduced to reconstruct subchondral defects of the talus, which normally require malleolar osteotomy. However, this invasive procedure possibly arouses concerns of delayed union or nonunion, intraoperative chondral damage, and need for secondary surgery to remove internal fixations. This Technical Note introduces a technique of single-stage all-arthroscopic autologous cancellous bone transplantation in the treatment of cystic OLTs. With the creation of an accessory anteromedial portal, ideal perpendicular visualization of the osteochondral defects is provided, which facilitates thorough inspection and debridement under arthroscopy. After sufficient curettage and debridement, multiple subchondral channels are created by microfracture. Cancellous autograft is then harvested from the ipsilateral Gerdy tubercle and implanted into the defects with a specifically designed delivery guide apparatus, which suits the tight and narrow ankle cavity. This technique provides a promising alternative to address cystic OLTs with minimal invasion and no need for malleolar osteotomy.