Hu Fengyi, Yang Shuai, Shi Weili, Liu Ziming, Guo Qinwei
Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China.
Arthrosc Tech. 2024 Sep 5;14(2):103208. doi: 10.1016/j.eats.2024.103208. eCollection 2025 Feb.
Osteochondral lesions of the talus (OLTs) are common sports-associated ankle injuries and are being increasingly recognized as a source of persistent ankle pain and disability. Although a vast array of surgical techniques have been reported, there are no rigid indications of decision-making for specific procedures. For symptomatic large or cystic lesions, multiple implants are introduced to reconstruct subchondral defects of the talus, which normally require malleolar osteotomy. However, this invasive procedure possibly arouses concerns of delayed union or nonunion, intraoperative chondral damage, and need for secondary surgery to remove internal fixations. This Technical Note introduces a technique of single-stage all-arthroscopic autologous cancellous bone transplantation in the treatment of cystic OLTs. With the creation of an accessory anteromedial portal, ideal perpendicular visualization of the osteochondral defects is provided, which facilitates thorough inspection and debridement under arthroscopy. After sufficient curettage and debridement, multiple subchondral channels are created by microfracture. Cancellous autograft is then harvested from the ipsilateral Gerdy tubercle and implanted into the defects with a specifically designed delivery guide apparatus, which suits the tight and narrow ankle cavity. This technique provides a promising alternative to address cystic OLTs with minimal invasion and no need for malleolar osteotomy.
距骨骨软骨损伤（OLTs）是常见的与运动相关的踝关节损伤，并且越来越被认为是持续性踝关节疼痛和功能障碍的一个原因。尽管已经报道了大量的手术技术，但对于特定手术并没有严格的决策指征。对于有症状的大型或囊性损伤，通常需要进行踝关节截骨术，采用多种植入物来重建距骨的软骨下缺损。然而，这种侵入性手术可能会引发对延迟愈合或不愈合、术中软骨损伤以及需要二次手术取出内固定物的担忧。本技术说明介绍了一种单阶段全关节镜下自体松质骨移植治疗囊性OLTs的技术。通过建立一个辅助前内侧入路，可以对骨软骨缺损进行理想的垂直可视化，这有助于在关节镜下进行彻底的检查和清创。在充分刮除和清创后，通过微骨折创建多个软骨下通道。然后从同侧的Gerdy结节获取松质骨自体移植物，并使用专门设计的输送引导装置将其植入缺损处，该装置适合狭窄的踝关节腔。这项技术为治疗囊性OLTs提供了一种有前景的替代方法，具有微创且无需踝关节截骨的优点。
