Arthroscopic Treatment of Osteochondral Talar Defects.

Introduction: Arthroscopic debridement and bone marrow stimulation (i.e., drilling or microfracturing) is considered the primary surgical treatment of osteochondral defects of the talus.

Step 1 Position The Patient: For anterior ankle arthroscopy, position the patient supine; for posterior arthroscopy, position the patient prone.

Step 2 Arthroscopic Approach: For anterior ankle arthroscopy, place the portals medial to the tibialis anterior tendon and lateral to the peroneus tertius tendon at the level of the ankle joint; for posterior arthroscopy, place the portals lateral and medial to the Achilles tendon just above the level of the tip of the lateral malleolus.

Step 3 Debridement And Bone Marrow Stimulation: Fully debride the osteochondral defect and create multiple microfractures in the bottom of the defect.

Step 4 Closure And Postoperative Care: Prescribe partial weight-bearing for six weeks.

Results: A systematic review of the literature identified eighteen studies on bone marrow stimulation that included a total of 388 patients. The study weighted success rate was 85% (range, 46% to 100%).

What To Watch For: IndicationsContraindicationsPitfalls & Challenges.