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
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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.

距骨穹窿后内侧骨软骨病变的治疗方法:关节镜录像回顾。
背景:距骨软骨病变(OLTs)最常见于距骨后内侧穹窿;然而,关于微骨折的合适方法尚无一致的指导方针;即仅通过前关节镜是否可以获得足够的可视化,以及在何种情况下需要后关节镜。目的:确定(1)关节镜下后内侧OLT微骨折是否可以仅通过踝关节前镜完成;(2)是否有特殊情况可能需要后侧踝关节镜。研究设计:横断面研究;证据水平,3。方法:我们回顾性回顾了2010年1月至2021年6月期间在距骨后内侧穹窿进行原发性关节镜下微骨折OLT的患者的视频。根据关节镜检查方向(前、后)将入组患者分为两组。然后,我们重点关注通过前踝关节镜组的前内侧或前外侧门静脉是否足够显示后内侧OLT(后踝关节镜组的后内侧或后外侧门静脉)。同样,我们评估了手术中是否有足够的微骨折技术。结果:本研究共纳入79例患者,其中前、后关节镜组分别为62例和17例。79.0%的病例通过前内侧门静脉完全观察到后内侧门静脉olt,通过前外侧门静脉观察到后内侧门静脉olt效果更好(93.5%)。在接受前踝关节镜检查的患者中,只有4例(6.5%)观察受限,导致微骨折手术不充分。在这4例患者中,我们观察到2例患者由于关节间隙狭窄,即使有足够的牵张,也难以推进关节镜和其他设备,而其余2例患者在术前磁共振成像中由于位置向后延伸到胫骨平台以外,因此不可行。相比之下,所有患者均成功通过后踝关节镜进行后内侧OLT微骨折。结论:当手术治疗后内侧OLT患者时,在大多数情况下,前踝关节镜允许成功执行微骨折手术,除非有联合病理需要对后踝关节进行手术干预。后路踝关节镜只能选择性地用于远后内侧OLT或关节间隙狭窄的患者,即使有足够的牵拉。
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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).
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