Arthroscopically Assisted Bone Pegs Fixation Without Malleolar Osteotomy for Osteochondral Lesion of Talus

CATEGORY: Ankle, Arthroscopy INTRODUCTION/PURPOSE: Several surgical treatments have been suggested for osteochondral lesions of talus (OLT). Fixation of osteochondral fragment using bone pegs is physiologic and does not require removal of implants and has no risk of foreign body reaction. However, this procedure commonly requires osteotomy of malleolus to obtain sufficient surgical field. Therefore, it has longer rehabilitation and a risk of malunion of osteotomy site. We have performed bone pegs fixation without malleolar osteotomy through arthroscopic assistant. The purpose of this study was to introduce our technique and to evaluate clinical and radiographic outcomes of bone pegs fixation for OLT. METHODS: Ten patients (10 ankles) with osteochondral lesions of talus were treated by arthroscopically assisted autogenous bone pegs fixation without malleolar osteotomy. Intraoperative assessments were evaluated site of lesion, size of fragment, and number of pegs. Clinical assessments were evaluated using VAS and AOFAS score preoperatively and at last follow-up. And SF-36 and ROM of ankle (comparing with uninvolved ankle (%)) was evaluated at last follow-up. Radiographic assessments were evaluated according to criteria as described by Kumai et al. RESULTS: The lesion was on posteromedial side in 8 patients and anterolateral side in 2 patients. Mean fragment size was 9.6*13.5 mm. And mean number of used pegs were 2.6. VAS and AOFAS score significantly improved from 6.1 and 74.8 preoperatively to 1 and 93.7 at last follow-up. SF-36 was 80.5 at last follow-up. ROM of ankle joints revealed 97% of uninvolved ankle joints at the last follow-up. Radiographic results were good in 4 patients, fair in 5 patients, and poor in 1 patient. CONCLUSION: Arthroscopically assisted bone pegs fixation without malleolar osteotomy could be a treatment option for OTL with large fragment.