How do doctors get the word out when they've made a new discovery or tried something different that worked? They use technical notes. This is a short article in a medical journal telling what they did, how they did it, and the results.

Doctors from the Hirosaki University School of Medicine in Japan wrote a technical note on an ankle problem involving the talar dome. The talar dome is a curved surface on top of the ankle bone, the talus. Sometimes a small area of bone with its covering of cartilage tears in this area. It can be a small tear, a partially detached piece, or a piece torn off completely. Complete tears create osteochondral lesions (OCL). The OCL fragment may stay connected to the dome, or it may move into another part of the joint.

Surgery is one treatment for OCL. How the operation is done depends on the size and location of the tear. A tear in the front of the joint is easier to reach. Only a small incision is needed. A tear in the back is more difficult to treat. Usually, the doctor has to remove the ankle bone on the inside of the leg to get to a back tear. This part of the ankle is called the medial malleolus.

In this study, doctors report a new way to reach an OCL in the back. Instead or removing the medial malleolus, the surgeon drills a tunnel through the bone. Then an arthroscope is passed through the tunnel to the talar dome. An arthroscope is a slender tool with a tiny TV camera on the end. It allows the doctor to see inside the joint and repair the damage.

There is a danger of breaking the malleolus when drilling through it. These doctors haven't had this problem. They were even able to return the core of bone taken out when the tunnel was made. Patients are able to move the foot right away, and they can put partial weight on the ankle two weeks after the operation.

The authors say that OCL of the talus is hard to treat. They report using this new method to go through the malleolus works well if done right.

Kazuhiro Sasaki, MD, et al. Arthroscopically Assisted Osteochondral Autogenous Transplantation for Osteochondral Lesion of the Talus Using a Transmalleolar Approach. In Arthroscopy. October 2003. Vol. 19. No. 8. Pp. 922-927.