Introduction: Symptomatic osteochondral lesions of the talus have been managed with a variety of operative techniques involving open or arthroscopic approaches to the ankle joint. The purpose of this study is to report our technique of drilling stable osteochondral lesions of the talus via a percutaneous retrograde approach using computed tomography for guidance.

Materials and Methods: Seven adult patients with Berndt and Harty Stage 2 or 2A/5 (subchondral cyst positive) talar osteochondral lesions, confirmed by magnetic resonance imaging, had retrograde drilling with CT guidance performed under local anaesthesia. Follow-up MR imaging was performed to investigate radiological evidence of healing.

Results: All retrograde drillings performed were technically successful.

Discussion: The concept of retrograde drilling is to preserve intact articular cartilage while encouraging revascularisation of the osteochondral fragment. The use of CT allowed drilling without conventional direct visualisation of the articular surface via arthrotomy or arthroscopy. The procedure can therefore potentially be performed in an outpatient setting. Suggestions are made from review of the literature as to improve further the technique for future studies.