Description
Introduction
Osteochondral defects (OCD) of the talus proceed to be a challenging entity. Especially for larger subcondral bone fragments located posteromedially.
The lift, drill, fill and fix (LDFF) technique has already been discribed as surgical treatment if bone marrow stimulation (BMS) fails [1]. However, for posterior lesions a distal tibial osteotomy (DTO) is used to gain adequate acces [2].
We present three cases where an additional medial transmalleolar portal was used to perform the LDFF technique arthroscopically.
Case reports
Three patients (between 20 -28 years old), one female and two males, were planned for arthroscopic LDFF after initial conservative threatment failed.
They all had OCD lesions in zone 7 (as described by Elias et al.) wich ranged from 10 to 12 mm mediolateral and 10 to 15 mm anteroposterior in size.
Surgical technique
Patients were installed in supine position, classical anteromedial en anterolateral ankle arthroscopy portals were made. The lesion was debrided, lifted and filled with autologous bonegrafts (from the ipsilateral proximal tibia). Using a meniscal root guide (Arthrex), placed in the anteromedial portal, the ideal position of our additional transmalleolar portal was determined. Through this 2,4 mm transmalleolar portal we fixed the OCD fragment with two 1,3 mm chondral darts (Arthrex).
Discussion
The transmalleolar portal is not a novel technique. However, the use of a transmalleolar portal for an arthroscopic LDFF procedure has not yet been described [3]. Using a transmalleolar portal eliminates the risk of non-union and hardware irritation, and additionally it gives the possibility of early mobilization of the ankle joint, which are the main disadvantages of a DTO.
Compared to previously described portals, we use a 2,4 mm portal, minimizing the risk of complications when making an extra defect in the cartilage.
This technique showed good results, with VAS scores between 0 and 2 postoperatively, compared to 6 and 8 preoperative.
