Retroarticular drilling for osteochondritis dissecans of the talus: A systematic review

Rémi Pelletier-Roy; Ylan Tran; Géraldine Merle; Marie-Lyne Nault

doi:10.1016/j.otsr.2024.103834

Retroarticular drilling for osteochondritis dissecans of the talus: A systematic review

Orthop Traumatol Surg Res. 2024 Feb 8:103834. doi: 10.1016/j.otsr.2024.103834. Online ahead of print.

Authors

Rémi Pelletier-Roy¹, Ylan Tran¹, Géraldine Merle², Marie-Lyne Nault³

Affiliations

¹ Université de Montréal, 2900, boulevard Édouard-Montpetit, Montréal, QC H3T 1J4, Canada.
² Polytechnique Montréal, 2500, chemin de Polytechnique, Montréal, QC H3T 1J4, Canada; CHU Sainte-Justine, 3175, chemin de la Côte Ste-Catherine, Montréal, QC H3T 1C5, Canada.
³ Université de Montréal, 2900, boulevard Édouard-Montpetit, Montréal, QC H3T 1J4, Canada; CHU Sainte-Justine, 3175, chemin de la Côte Ste-Catherine, Montréal, QC H3T 1C5, Canada; Hôpital du Sacré-Cœur de Montréal (HSCM), Department of Orthopedic surgery, 5400, boulevard Gouin Ouest, Montreal, QC H4J 1C5, Canada. Electronic address: timinet@hotmail.com.

PMID: 38340961
DOI: 10.1016/j.otsr.2024.103834

Abstract

Background: Opinions differ on the optimal treatment for stable talar osteochondritis dissecans (OCD) with intact cartilage. Some recommend conservative management, while others prefer surgical care, which includes debridement and micro-fractures, transarticular drilling through a direct or medial malleolus approach and retroarticular drilling. The rationale behind retroarticular drilling is to induce bone marrow healing without touching the intact cartilage. The goal of this systematic review is to summarize the clinical outcomes of retroarticular drilling as a standalone procedure for stable talar OCD with intact cartilage.

Patients and methods: A systematic review of the literature prospectively registered in the PROSPERO register was performed along the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Medline, EMBASE and Evidence-Based Medicine databases were searched from inception to December 2021 for retroarticular drilling for stable talar OCD with an intact cartilage. Two independent evaluators screened the search results, selected the articles to be included in the analysis and assessed the methodological quality of all included articles with the Newcastle-Ottawa Scale (NOS).

Results: Twelve studies, on 99 patients were included in the final analysis. Methodological quality was poor for all the included studies. High heterogeneity prevented any pooling or meta-analysis, but favorable clinical results were reported according to excellent post-intervention scores on the American Orthopedic Foot and Anke Score (AOFAS), ranging from 88.9 to 100. There was also significant improvement in pain as measured by the Visual Analog Scale (VAS), ranging between 2.3 and 5.9.

Discussion: Favorable results seem to be achieved with retroarticular drilling without grafting for stable talar OCD with intact cartilage, but more powered comparative studies between surgical options and conservative management are needed to establish the gold standard treatment.

Level of evidence: IV.

Keywords: Ankle; Drilling; Osteochondritis Dissecans; Retroarticular; Retrograde; Talus.

Publication types

Review