Percutaneous Drilling for the Treatment of Atraumatic Osteonecrosis of the Ankle

Abstract 

Atraumatic osteonecrosis of the ankle can be severely debilitating and can lead to joint collapse. A relatively new technique of percutaneous drilling has previously been used to relieve the symptoms of osteonecrotic hips and knees. The purpose of the present study was to examine the results of this technique when used to treat osteonecrosis of the ankle. Between September 2002 and June 2005, the senior author (M.A.M.) treated and prospectively followed 44 symptomatic osteonecrotic ankles (31 patients) using this drilling technique. The series included 23 (74.2%) women and 8 (25.8%) men with a mean age of 43 ± 11 years. Arthrodesis had been recommended for 14 (45.2%) of these patients (20 [45.5%] ankles). At a mean follow-up duration of 45 ± 12 months, 40 (91%) ankles had achieved a successful clinical outcome. The mean American Orthopaedic Society of Foot and Ankle Society Ankle and Hindfoot score increased from 42 ± 5 points preoperatively to 88 ± 10 points postoperatively, and this difference was statistically significant (P < .0001). There were no perioperative complications, although 3 ankles subsequently collapsed and required arthrodesis. The percutaneous drilling technique appears to be a useful method for the relief of symptomatic ankle osteonecrosis.

Level of Clinical Evidence: 2

Keywords: avascular, bone graft, core decompression, Steinmann pin, surgery, talus