Retrograde drilling of osteochondral lesions of the medial talar dome.

Sixteen patients (16 ankles) with symptomatic osteochondral lesions of the medial talar dome were treated arthroscopically with percutaneous retrograde drilling through the sinus tarsi. The surgical technique allows preservation of intact articular cartilage, in contrast to traditional methods. All patients treated with this technique during a 24-month period were included in the study. Patient age ranged from 16 to 44 years (mean, 33 years). Follow-up ranged from 19 to 38 months (mean, 24 months). A staging system based on magnetic resonance imaging examination was used to grade the lesions preoperatively. Outcome was evaluated using the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale. Preoperative scores ranged from 35 to 75 points, with a mean of 53.9 points. Postoperative American Orthopaedic Foot and Ankle Society scores ranged from 48 to 100 points, with a mean of 82.6 points. Mean improvement was 25 points. There were no surgical complications. Short-term results were comparable to results reported with other available techniques.

A metallic hemiarthroplasty resurfacing prosthesis for the hallux metatarsophalangeal joint.

Two-hundred seventy-nine arthritic hallux metatarsophalangeal joints treated surgically with a metallic resurfacing hemiarthroplasty over a 40-year period were reviewed. The implant, which is made available in three evenly graded sizes, is designed to replace only the articular surface of the proximal phalanx, with minimal resection of bone stock. The pathologic indications for surgery included classical hallux rigidus, rheumatoid arthritis, and degenerative changes associated with hallux valgus and bunion deformity. Follow-up at 8 months to 33 years after surgery revealed good or excellent clinical results in 95%. The time to follow-up was in excess of 5 years in 101 (36%) of the procedures, beyond 10 years in 62 (22%), and longer than 20 years in 23 (8%). Unlike other available surgical options for this debilitating condition, biomechanics of the hallux metatarsophalangeal joint remained unaffected and problems associated with prosthetic wear or mechanical failure were not encountered.