The Retrograde Drilling for Osteochondral Talar Lesion in Children

CATEGORY: Ankle, Arthroscopy INTRODUCTION/PURPOSE: Osteochondral talar lesions (OCL) are infrequent in children, and little is known about the treatment and clinical outcome of these defects. Clinicians normally first attempt nonoperative treatment of these lesions, but if such treatment fails, surgical many treatments including retrograde drilling (RD), are attempted. RD is usually reserved for large OCLs with intact overlying cartilage. Good clinical outcomes have been reported in RD. However, the clinical outcomes of RD for OCL in children remains unclear. The purpose of this study was to evaluate the clinical and radiographic outcomes of RD in skeletally immature children. METHODS: From January 2015 to April 2018, RD was performed on eight feet with OCL in six consecutive patients in skeletally immature children. Arthroscopic lateral ankle ligament repair was also performed in one of the eight feet, and one foot was excluded; therefore, we studied seven feet in five patients. The patients comprised three boys and two girls with a mean age at surgery of 11 (range, 9–12) years. All patients were followed for a minimum of 6 months postoperatively, the average follow-up was 19.1 (range, 8–39) months. All patients were grade 0, determined according to a modified Pritsch classification system. All patients were evaluated for Japanese Society for Surgery of the Foot (JSSF) scale and radiographic outcomes at preoperatively and postoperatively final follow up. RESULTS: The average JSSF scale improved from 79.4 points (range, 69–90 points) to 100 points in all feet at final follow-up (p<0.01). The postoperative size of OCL using CT findings was improved than preoperative size. According to the postoperative computed tomography (CT) findings, four feet were good, three foot were fair. There were no incidences of postoperative complications. CONCLUSION: In our study, we suggest that RD for OCL in skeletally immature children is effective surgical treatment.