Extended Abstract (for invited Faculty only) Cartilage /Cell Transplantation

3.1.2 - Arthroscopic Approach to Cartilage Defects – Ankle (Pre-Recorded)

Presentation Topic
Cartilage /Cell Transplantation
Lecture Time
14:45 - 15:00
Potsdam 1
Session Type
Special Session
  • C. Becher (Heidelberg, DE)
  • C. Becher (Heidelberg, DE)



A number of operative treatment options have been reported to treat osteochondral lesions of the talus (OLT). The choice of operative treatment methods are dependent on the grade, size and site of the lesion. Recently, several new techniques have been introduced for the management of such lesions. However, there is a lack randomized or comparative studies to determine whether one technique is superior to the others. Bone marrow stimulation with microfracture arthroplasty is the most common procedure for the management of OLT. It induces repair of localized articular cartilage defects of the talus. The use of additional scaffolds has become increasingly popular with several case series reporting promising results in the treatment of OLT´s in athletes and with the combination of an autologous bone graft in the mid-term.


The treatment with a scaffold has been designed to be performed by an open technique that often involves a medial or lateral malleolar osteotomy. Arthroscopic treatment is believed being advantageous because it is associated with significantly less surgical trauma than the open technique, and it avoids the need for a malleolar osteotomy. Furthermore, arthroscopic evaluation allows the status of the cartilage to be accurately assessed in all parts of the joint. Possible complications of malleolus osteotomy that include direct morbidity by injury to adjacent structures, mid-term morbidity by malunion or non-union of the osteotomy, and long-term morbidity by the development of local cartilage degeneration and the need for hardware removal, which may become symptomatic in an area with a limited soft tissue envelope, can be avoided.

The procedure is performed with the patient under either spinal or general anesthesia in the supine position using standard anteromedial and anterolateral portal approaches for the ankle. The application of a thigh tourniquet at a pressure of 250-300 mmHg is recommended. For distraction, a Hintermann-Spreader or an ankle arthroscopy distraction strap or bandage can be used. Debridement of the lesion is performed in common fashion by creating healthy and stable cartilage borders and vital bleeding subchondral bone by bone marrow stimulation. If a bone graft is needed (recommended in lesions with a depth of >3mm bone defect), enlargement of the portal, by which the lesion is treated, is recommended to a length of about 2cm. The intraarticular fluid needs to be removed after debridement and the OLT dried using cotton sponges. The application of a cannula might facilitate the application of the bone graft and an acellular matrix. Fixation of the matrix might be necessary using a commercially available fibrin glue. The stability of the matrix should be checked within a normal ankle range of motion under direct arthroscopic vision.

Reported complication rates for the arthroscopic approach in the treatment of OLT of the talus are low. Arthroscopic bone marrow stimulation with microfracture alone and with the addition of an acellular matrix with or without a bone graft are effective for the treatment of patients suffering from osteochondral talar lesions. Further research is requested to determine possible differences with respect to possible influencing parameters such as lesion size and its depth.