[Arthroscopic cartilage surgery of the ankle : Chondroplasty, retrograde drilling, nano-/microfracture].

OBJECTIVE

Repair of the cartilage surface to prevent progression of cartilage pathologies that are associated with pain and limited mobility.

INDICATIONS

Talar cartilage lesions up to 1 cm.

CONTRAINDICATIONS

Joint infection, generalized arthritis, poor compliance.

SURGICAL TECHNIQUE

If the cartilage layer is arthroscopically intact: retrograde drilling to increase blood flow and decompress a bone marrow edema or cyst. Superficial cartilage damage: chondroplasty and surface smoothing to limit loose bodies or damage progression. Deep cartilage damage down to the subchondral plate: nano- or microfracture with surface growth cell protrusion to gain replacement cartilage.

POSTOPERATIVE MANAGEMENT

For primary smoothing of the cartilage surface, immobilization with partial loading is recommended until proper wound healing. However, if there is cartilage damage that requires replacement cartilage to form, prolonged partial loading for up to 6 weeks, followed by increased loading is required.

RESULTS

Chondroplasty is usually used in combination with other treatment steps, so few results are available for this treatment alone. Retrograde drilling shows good results in young patients with still open growth plates. Furthermore, a recurrence rate of up to 50% can occur. Nano- or microfracture shows good to excellent results for lesions up to 1 cm. For larger lesions this procedure alone appears to be insufficient.