Initial Outcomes of 3-Dimensional Imaging-Based Computer-Assisted Retrograde Drilling of Talar Osteochondral Lesions

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.