Jimeno Torres Eugenio, Ibañez Maximiliano, Campillo Recio David, Alberti Fito Gloria, Mendez Gil Ana, Jimeno Torres Jose Maria
Department of Orthopedic Surgery and Traumatology, ICATME, Hospital Universitari Dexeus, UAB, Barcelona, Spain.
Arthrosc Tech. 2020 Jul 23;9(8):e1155-e1161. doi: 10.1016/j.eats.2020.04.015. eCollection 2020 Aug.
Osteochondral lesions that compromise the ankle are rare, with an incidence between 0.02% and 1.5% according to different series. This location is the third in frequency, after knee and elbow. The location of the osteochondral lesion allows one to infer the producing mechanism. Lateral defects are produced by inversion and dorsiflexion of the ankle (usually anterior, affecting 3 and 6 talar zones), whereas medial defects are produced by plantar flexion, inversion, and internal rotation (most commonly posterior, affecting 4 and 7 talar zones). The injury causes pain associated with weight load, impaired function, limited range of motion, stiffness, blockage, and edema. Early diagnosis of an osteochondral lesion is particularly important because the lack of diagnosis can lead to the evolution of a small and stable lesion in a larger lesion or an unstable fragment, which can result in chronic pain, instability of the joint, and premature osteoarthritis. Multiple therapeutic strategies have been described, including conservative and surgical treatment. The purpose of this Technical Note is to describe arthroscopic-assisted retrograde drilling with tibial autograft procedure for osteochondral lesions of the talar dome.
累及踝关节的骨软骨损伤较为罕见，根据不同系列报道，其发病率在0.02%至1.5%之间。该部位的发病率在各部位中排第三，仅次于膝关节和肘关节。骨软骨损伤的部位有助于推断其产生机制。外侧缺损由踝关节内翻和背屈引起（通常在前侧，累及距骨的3区和6区），而内侧缺损由跖屈、内翻和内旋引起（最常见于后侧，累及距骨的4区和7区）。该损伤会导致与负重相关的疼痛、功能受损、活动范围受限、僵硬、卡顿和水肿。骨软骨损伤的早期诊断尤为重要，因为诊断不及时会导致小而稳定的损伤发展为更大的损伤或不稳定碎片，进而可能导致慢性疼痛、关节不稳定和过早出现骨关节炎。已经描述了多种治疗策略，包括保守治疗和手术治疗。本技术说明的目的是描述关节镜辅助下带胫骨自体骨移植的逆行钻孔术治疗距骨穹窿部骨软骨损伤。
