Retrograde drilling for osteochondral lesions of the talar dome

Background: For the treatment of osteochondral lesions of the talar dome without detachment of the cartilage, there is little information on whether transmalleolar drilling or retrograde drilling is more effective in terms of clinical and morphologic evaluations. Hypothesis: Retrograde drilling may be more effective than transmalleolar drilling for lesions without cartilage detachment. Study Design: Case control study; Level of evidence, 3. Methods: Subjects were 30 patients with lesions on 1 foot of grade 0 or 1, determined according to a modified Fritsch classification system. Nineteen patients underwent transmalleolar drilling (TMD group), and 11 patients underwent retrograde drilling (RD group). Ankle arthroscopy was performed 1 year postoperatively to evaluate cartilage conditions. Results: Arthroscopic findings revealed that in the TMD group, 11 lesions (57.9%) were unchanged (grade I), and 8 lesions (42.1%) had deteriorated from grade 0 to I; in the RD group, 3 lesions (27.2%) had improved from grade I to 0, and 8 (72.8%) were unchanged (2 grade 0 lesions and 6 grade I lesions). There was a significant difference between the 2 groups in the distribution of cases that had improved, were unchanged, or had deteriorated (P <.0001). Conclusions: This study showed that compared with transmalleolar drilling, retrograde drilling for osteochondral lesions of the talar dome can improve the arthroscopic assessment of the lesions.