Clin Orthop Surg.  2016 Mar;8(1):119-122. 10.4055/cios.2016.8.1.119.

Is Antegrade Transmalleolar Drilling Method for Osteochondral Lesion of Talus Necessary? Iatrogenic Cystic Formation at the Tibia: A Report of Five Cases

• Kim JY
• Reyes FJ
• Yi Y
• Lee WC

• KMID: 2363956
• DOI: http://doi.org/10.4055/cios.2016.8.1.119

Abstract

Antegrade transmalleolar drilling method is one of the options for the treatment of osteochondral lesion of talus (OLT). We present five patients who underwent tibial drilling for treatment of OLT and later developed distal tibial cystic formation induced by cartilage opening or heat necrosis during drilling. Antegrade transmalleolar drilling can be a possible option for the treatment of OLT if the lesion is not easily reachable; however, other viable treatment should be considered due to its possibility of distal tibial pathologic change.

Keyword

Tibia; Talus; Cartilage; Osteochondritis dissecans; Cysts

MeSH Terms

Adult
Ankle Joint/surgery
Cartilage, Articular/*surgery
Female
Humans
*Iatrogenic Disease
Male
*Musculoskeletal Diseases/etiology/surgery
*Orthopedic Procedures/adverse effects/methods
Talus/*surgery
*Tibia/injuries/surgery
Young Adult

Figure

• 

  Fig. 1 Magnetic resonance imaging (MRI) findings of patient no. 1. (A) Preoperative MRI showing osteochondral lesion on medial talar dome. (B, C) Eight-month postoperative MRI revealing tract traversed by bone drilling and evidence of bone edema on medial malleolus. (D) Three-year postoperative MRI revealing presence of cystic lesion (arrow) on medial malleolar axilla.

• 

  Fig. 2 Postoperative magnetic resonance imaging (MRI) of patient no. 2 and patient no. 4. (A) Postoperative MRI of patient no. 2 revealing presence of a floating necrotic bone fragment within a cystic lesion over the medial malleolar axilla. (B) Ten-month postoperative MRI of patient no. 4 showing bone drill pathway remnant (arrow heads) and evidence of cystic lesion (arrow) over the medial malleolus.

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