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Background:

In operative treatment of Berndt and Harty stage 1 and stage 2 osteochondral lesions of the talus, the goal is revascularization. The use of computer-assisted guided retrograde drilling of osteochondral lesions has been described as a new technique with promising results.

Purpose:

This study reports the follow-up assessment of patients treated with Iso-C-3D-navigated retrograde drilling. Its aim was to establish whether the greater precision of computer-assisted drilling results in satisfactory clinical outcomes.

Study Design:

Case series; Level of evidence, 4.

Methods:

Patients who underwent navigated Iso-C-3D-based retrograde drilling between June 1, 2003, and July 31, 2005, were included in the follow-up study. Clinical outcomes were measured using (1) the Ankle-Hindfoot Scale of the American Orthopaedic Foot and Ankle Society and (2) the Visual Analogue Scale–Foot and Ankle. Radiological outcomes were assessed via radiographs and magnetic resonance imaging. Surgeon satisfaction was assessed using a simple 0 to 10 rating scheme for feasibility, accuracy, and clinical benefit.

Results:

Average follow-up time was 25 months (range, 20–34). Twenty patients satisfied the inclusion criteria: 12 men and 8 women; mean age, 35 years (range, 19–58). One patient was excluded because he required a cartilage restoration procedure. All scores improved at the time of follow-up—Ankle-Hindfoot Scale, from 76 to 90 (P < .001); Visual Analogue Scale–Foot and Ankle, from 79 to 92 (P < .001). The average ratings of the operating surgeons (n = 3) were as follows: feasibility 9.0 (range, 7.3–10.0); accuracy, 8.5 (range, 5.8–10.0); and clinical benefit, 8.5 (5.7–10.0). At follow-up, magnetic resonance imaging revealed an improvement of the Hepple score in 80% of patients.

Conclusion:

Arthroscopic treatment of osteochondral lesions of the talus is well established. A retrograde approach does not breach the overlying intact talar cartilage. The results of this follow-up study of 3-dimensional computer navigated drilling are promising.

Background: Autologous chondrocyte implantation (ACI) in the ankle was considered up to now an extremely technically demanding surgery with considerable morbidity for the patients.

Hypothesis: Hyalograft C scaffold allows arthroscopic ACI, thanks to a specifically designed instrumentation.

Study Design: Case series; Level of evidence, 4.

Methods: Forty-six patients with a mean age of 31.4 years (range, 20–47) underwent operation from 2001 to 2004. They had posttraumatic talar dome lesions, type II or IIA. In the first step of surgery, an ankle arthroscopy was performed, with cartilage harvest from the detached osteochondral fragment or from the margins of the lesion. Chondrocytes were cultured on a Hyalograft C scaffold. In the second step of surgery, the Hyalograft C patch was arthroscopically implanted into the lesion, with a specifically designed instrumentation. Lesions >5 mm deep were first filled with autologous cancellous bone. Patients were evaluated clinically with the American Orthopaedic Foot and Ankle Society (AOFAS) score preoperatively and at 12 and 36 months after surgery. At a mean time interval of 18 months, the first 3 patients underwent a second-look arthroscopy with cartilage harvest from the implant and histological examination.

Results: The mean preoperative AOFAS score was 57.2 ± 14.3. At the 12-month follow-up, the mean AOFAS score was 86.8 ± 13.4 (P < .0005), while at 36 months after surgery, the mean score was 89.5 ± 13.4 (P < .0005). Clinical results were significantly related to the age of patients and to previous operations for cartilage repair. The results of the histological examinations revealed hyaline-like cartilage regeneration.

Conclusions: The Hyalograft C scaffold and the specifically designed instrumentation allowed arthroscopic implantation of chondrocytes, with excellent clinical and histological results.