Percutaneous Drilling for Early-Stage Osteonecrosis About the Ankle.

INTRODUCTION

The mid-term clinical, patient-reported, and radiographic outcomes of percutaneous drilling to treat early-stage osteonecrosis (without joint collapse) of the distal part of the tibia or of the talus are promising.

STEP 1 PREOPERATIVE PLANNING FOR A LATERAL TALAR LESION: Obtain anteroposterior and lateral ankle radiographs as well as magnetic resonance imaging (MRI) studies of the ankle to evaluate the stage of the osteonecrotic disease.

STEP 2 PERCUTANEOUS PIN INSERTION LATERAL TALAR LESION: Insert a 1.8-mm Steinmann pin or Ilizarov wire percutaneously under biplanar fluoroscopic visualization.

STEP 3 PERCUTANEOUS DRILLING: Make one, two, or three passes with a 3.2-mm cannulated drill bit over the pin into the lesion(s).

STEP 4 BACKFILLING THE BONE TUNNEL OPTIONAL: Infiltrate the defect with demineralized bone matrix to backfill the drill track and the deep necrotic bone defect.

STEP 5 POSTOPERATIVE MANAGEMENT: The patient bears weight as tolerated in a removable short leg rigid boot for the first four weeks and avoids high-impact activities for at least ten months.

RESULTS

In our study, there were significant improvements in the mean American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score (p = 0.001), University of California Los Angeles (UCLA) activity score (p = 0.025), and visual analog scale (VAS) pain score (p = 0.001) at a mean of five years (range, two to nine years) postoperatively.IndicationsContraindicationsPitfalls & Challenges.