Approach to Osteochondral Lesions of the Posteromedial Talar Dome: A Review of Arthroscopic Videos.

IF 2.4 3区 医学 Q2 ORTHOPEDICS
Orthopaedic Journal of Sports Medicine Pub Date : 2025-03-28 eCollection Date: 2025-03-01 DOI:10.1177/23259671251324176
Jun Young Choi, Jae-Hoo Lee, Kyeong Woo Park, Jin Soo Suh
{"title":"Approach to Osteochondral Lesions of the Posteromedial Talar Dome: A Review of Arthroscopic Videos.","authors":"Jun Young Choi, Jae-Hoo Lee, Kyeong Woo Park, Jin Soo Suh","doi":"10.1177/23259671251324176","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Osteochondral lesions of the talus (OLTs) most commonly occur in the posteromedial talar dome; however, there are no consensus guidelines on the appropriate approach to performing microfracture; that is, whether adequate visualization can be achieved solely through anterior ankle arthroscopy as well as the circumstances under which posterior ankle arthroscopy is required.</p><p><strong>Purpose: </strong>To ascertain whether (1) arthroscopic microfracture of posteromedial OLT can be accomplished solely through anterior ankle arthroscopy and (2) if there are specific conditions that may require posterior ankle arthroscopy.</p><p><strong>Study design: </strong>Cross-sectional study; Level of evidence, 3.</p><p><strong>Methods: </strong>We retrospectively reviewed videos of patients who underwent primary arthroscopic microfractures for OLT on the posteromedial talar dome between January 2010 and June 2021. The enrolled patients were divided into 2 groups according to the direction of arthroscopy (anterior or posterior). Then, we focused on whether visualization of the posteromedial OLT was adequate through the anteromedial or anterolateral portal in the anterior ankle arthroscopy group (posteromedial or posterolateral portal in the posterior ankle arthroscopy group). Similarly, we assessed whether a sufficient microfracture technique was feasible during surgery.</p><p><strong>Results: </strong>A total of 79 patients were included in this study, among which 62 and 17 were assigned to the anterior and posterior ankle arthroscopy groups, respectively. Posteromedial OLTs were fully observed through the anteromedial portal in 79.0% of cases and better observed through the anterolateral portal (93.5%). Among the patients who underwent anterior ankle arthroscopy, only 4 (6.5%) experienced limited visualization, leading to an insufficient microfracture procedure. In 2 of these 4 patients, we observed challenges in advancing the arthroscopy and other devices owing to the narrow joint space, even with sufficient distraction, whereas the remaining 2 showed infeasibilities derived from the location extending posteriorly beyond the tibial plafond on preoperative magnetic resonance imaging. In contrast, microfracture of posteromedial OLT via posterior ankle arthroscopy was successfully performed in all patients.</p><p><strong>Conclusion: </strong>When surgically treating patients with posteromedial OLT, anterior ankle arthroscopy allowed for the successful performance of the microfracture procedure in most cases, unless there was a combined pathology necessitating surgical intervention on the posterior ankle. Posterior ankle arthroscopy can be selectively utilized only for far posteromedial OLT or in patients with narrow joint space, even with sufficient distraction.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"13 3","pages":"23259671251324176"},"PeriodicalIF":2.4000,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11954570/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Orthopaedic Journal of Sports Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/23259671251324176","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/3/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0

Abstract

Background: Osteochondral lesions of the talus (OLTs) most commonly occur in the posteromedial talar dome; however, there are no consensus guidelines on the appropriate approach to performing microfracture; that is, whether adequate visualization can be achieved solely through anterior ankle arthroscopy as well as the circumstances under which posterior ankle arthroscopy is required.

Purpose: To ascertain whether (1) arthroscopic microfracture of posteromedial OLT can be accomplished solely through anterior ankle arthroscopy and (2) if there are specific conditions that may require posterior ankle arthroscopy.

Study design: Cross-sectional study; Level of evidence, 3.

Methods: We retrospectively reviewed videos of patients who underwent primary arthroscopic microfractures for OLT on the posteromedial talar dome between January 2010 and June 2021. The enrolled patients were divided into 2 groups according to the direction of arthroscopy (anterior or posterior). Then, we focused on whether visualization of the posteromedial OLT was adequate through the anteromedial or anterolateral portal in the anterior ankle arthroscopy group (posteromedial or posterolateral portal in the posterior ankle arthroscopy group). Similarly, we assessed whether a sufficient microfracture technique was feasible during surgery.

Results: A total of 79 patients were included in this study, among which 62 and 17 were assigned to the anterior and posterior ankle arthroscopy groups, respectively. Posteromedial OLTs were fully observed through the anteromedial portal in 79.0% of cases and better observed through the anterolateral portal (93.5%). Among the patients who underwent anterior ankle arthroscopy, only 4 (6.5%) experienced limited visualization, leading to an insufficient microfracture procedure. In 2 of these 4 patients, we observed challenges in advancing the arthroscopy and other devices owing to the narrow joint space, even with sufficient distraction, whereas the remaining 2 showed infeasibilities derived from the location extending posteriorly beyond the tibial plafond on preoperative magnetic resonance imaging. In contrast, microfracture of posteromedial OLT via posterior ankle arthroscopy was successfully performed in all patients.

Conclusion: When surgically treating patients with posteromedial OLT, anterior ankle arthroscopy allowed for the successful performance of the microfracture procedure in most cases, unless there was a combined pathology necessitating surgical intervention on the posterior ankle. Posterior ankle arthroscopy can be selectively utilized only for far posteromedial OLT or in patients with narrow joint space, even with sufficient distraction.

求助全文
约1分钟内获得全文 求助全文
来源期刊
Orthopaedic Journal of Sports Medicine
Orthopaedic Journal of Sports Medicine Medicine-Orthopedics and Sports Medicine
CiteScore
4.30
自引率
7.70%
发文量
876
审稿时长
12 weeks
期刊介绍: The Orthopaedic Journal of Sports Medicine (OJSM), developed by the American Orthopaedic Society for Sports Medicine (AOSSM), is a global, peer-reviewed, open access journal that combines the interests of researchers and clinical practitioners across orthopaedic sports medicine, arthroscopy, and knee arthroplasty. Topics include original research in the areas of: -Orthopaedic Sports Medicine, including surgical and nonsurgical treatment of orthopaedic sports injuries -Arthroscopic Surgery (Shoulder/Elbow/Wrist/Hip/Knee/Ankle/Foot) -Relevant translational research -Sports traumatology/epidemiology -Knee and shoulder arthroplasty The OJSM also publishes relevant systematic reviews and meta-analyses. This journal is a member of the Committee on Publication Ethics (COPE).
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信