Retrograde drilling for ankle joint osteochondral lesions: a systematic review.

BACKGROUND: Extensive literature exists about the treatment of ankle osteochondral lesions, but there is no specific review of retrograde drilling, despite its common application. Indications for retrograde drilling are still few and are far from clear, and some evolutions of the technique have recently occurred. The aim of this review is to provide an update on actual applications and techniques of retrograde drilling for ankle osteochondral lesions. METHODS: A systematic review was carried out according to the 2020 PRISMA guidelines. The PubMed and Embase databases were searched in June 2023. The search string focused on studies related to retrograde drilling in the treatment of ankle osteochondral lesions. RESULTS: Twenty-one articles for a total of 271 ankles were included in this review. The mean length of the treated lesions was 11.4 mm. Different navigation systems were used, with fluoroscopy the most commonly used. Various adjuvants were employed after drilling, with bone graft the most commonly applied. In most cases, postoperative patient satisfaction and symptom relief were reported, and no complications occurred. Retrograde drilling was found to be suitable for the treatment of subchondral cysts with intact cartilage or small lesions. Some modifications to the original technique may allow surgical indications to be extended to more complex cases. CONCLUSIONS: Middle-term results of retrograde drilling showed postoperative satisfaction and symptom relief with both original and modified techniques. Additional research is required to investigate the long-term results. LEVEL OF EVIDENCE: IV. TRIAL REGISTRATION: This systematic review was registered on PROSPERO (id number: CRD42022371128).

Surgical management of osteochondral lesions of the first metatarsal head: A systematic review.

BACKGROUND: Treating osteochondral lesions of the first metatarsal head can help reducing pain and preventing end-stage arthritic cartilage degeneration and hallux rigidus. Several surgical techniques have been described, but no clear indications are reported. This systematic review aims to offer an overview of the current surgical treatments for focal osteochondral lesions of the first metatarsal head. METHODS: The selected articles were examined to extract data about population, surgical technique, and clinical outcomes. RESULTS: Eleven articles were included. Mean age at surgery was 38,2 years. Osteochondral autograft was the most used technique. After surgery, an improvement was achieved in AOFAS, VAS, and hallux dorsiflexion but not in plantarflexion. CONCLUSION: There is limited evidence and knowledge regarding the surgical management of the first metatarsal head osteochondral lesions. Various surgical techniques have been proposed, drawn from other districts. Good clinical results have been reported. Further high-level comparative studies are necessary to design an evidence-based treatment algorithm.

Subtalar arthroereisis post-operative management in children: A literature review.

PURPOSE: Subtalar arthroereisis is a minimally-invasive technique for the treatment of flexible flatfoot. Some issues regarding the procedure are still debated, such as post-operative management. The aim of this study is to offer a review of the pertaining literature to identify current post-operative protocols and describe possible differences among them. METHODS: We searched the PubMed database for all papers related to subtalar arthroereisis in children specifying the post-operative protocols. After reviewing all studies according to excluding criteria, 50 articles were selected for analysis. RESULTS: Based on the literature review, different post-operative protocols emerged in the treatment of patients undergoing subtalar arthroereisis, in particular regarding length of hospital stay, type and duration of immobilization, weight-bearing management, adopted rehabilitation scheme, sport resumption and implant removal. CONCLUSIONS: The most important finding was the existence of a wide variety in post-operative management after subtalar arthroereisis in children, thus confirming that no clear consensus still exists in this field.