Percutaneous Drilling for Early-Stage Osteonecrosis About the Ankle.

Abstract

The mid-term clinical, patient-reported, and radiographic outcomes of percutaneous drilling to treat early-stage osteonecrosis (without joint collapse) of the distal part of the tibia or of the talus are promising. Obtain anteroposterior and lateral ankle radiographs as well as magnetic resonance imaging (MRI) studies of the ankle to evaluate the stage of the osteonecrotic disease. Insert a 1.8-mm Steinmann pin or Ilizarov wire percutaneously under biplanar fluoroscopic visualization. Make one, two, or three passes with a 3.2-mm cannulated drill bit over the pin into the lesion(s). Infiltrate the defect with demineralized bone matrix to backfill the drill track and the deep necrotic bone defect. The patient bears weight as tolerated in a removable short leg rigid boot for the first four weeks and avoids high-impact activities for at least ten months. In our study, there were significant improvements in the mean American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score (p = 0.001), University of California Los Angeles (UCLA) activity score (p = 0.025), and visual analog scale (VAS) pain score (p = 0.001) at a mean of five years (range, two to nine years) postoperatively.IndicationsContraindicationsPitfalls & Challenges.