Transtalar Drilling of Osteochondral Lesions of the Talus in Children and Adolescents

This is the authors' abstract. We don't add key points for this paper.

Osteochondral lesions of the talus are relatively uncommon but should always be kept in the differential diagnosis of patients presenting with ankle pain. These lesions most commonly affect patients in the first 2 to 3 decades of life and usually, but not always, have a traumatic origin. At presentation, these lesions should be worked up thoroughly with plain radiographs and a magnetic resonance imaging or computed tomography scan because of the potential for mechanical wear of the adjacent cartilage. If a loose body is identified, surgical intervention is indicated. If a lesion is identified but the articular surface is largely intact, a period of nonoperative treatment should be attempted. In the pediatric and adolescent population, the majority of patients will respond well to a period of immobilization and non-weight bearing. If unsuccessful, a number of surgical treatment options have been described. Arthroscopic surgery with transtalar (retrograde) drilling of the lesion is particularly attractive because it offers the benefit of penetrating the sclerotic rim of the lesion, which theoretically allows revascularization while avoiding damage to the articular surface, which is an inherent disadvantage of antegrade drilling of the lesion through areas of intact cartilage.