{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T09:20:15Z","timestamp":1793092815377,"version":"4.5.0"},"reference-count":22,"publisher":"Springer Science and Business Media LLC","issue":"2","license":[{"start":{"date-parts":[[2023,10,12]],"date-time":"2023-10-12T00:00:00Z","timestamp":1697068800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,10,12]],"date-time":"2023-10-12T00:00:00Z","timestamp":1697068800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Oper Orthop Traumatol"],"published-print":{"date-parts":[[2024,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Objective<\/jats:title>\n                <jats:p>Osteochondral lesions of the talus (OLT) with a\u00a0fragment on the talar dome that fail conservative treatment and need surgical treatment can benefit from in situ fixation of the OLT. Advantages of fixation include the preservation of native cartilage, a high quality subchondral bone repair, and the restoration of the joint congruency by immediate fragment stabilization. To improve the chance of successful stabilization, adequate lesion exposure is critical, especially in difficult to reach lesions located on the posteromedial talar dome. In this study we describe the open Lift, Drill, Fill, Fix (LDFF) technique for medial osteochondral lesions of the talus with an osteochondral fragment. As such, the lesion can be seen as an intra-articular non-union that requires debridement, bone-grafting, stabilization, and compression. The LDFF procedure combines these needs with access through a\u00a0medial distal tibial osteotomy.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Indications<\/jats:title>\n                <jats:p>Symptomatic osteochondral lesion of the talus with a\u00a0fragment (\u2265\u202f10\u202fmm diameter and \u2265\u202f3\u202fmm thick as per computed tomography [CT] scan) situated on the medial talar dome which failed 3\u20136\u00a0months conservative treatment.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Contraindications<\/jats:title>\n                <jats:p>Systemic disease, including active bacterial arthritis, hemophilic or other diffuse arthropathies, rheumatoid arthritis of the ankle joint, and malignancies. Neuropathic disease. End-stage ankle osteoarthritis or Kellgren and Lawrence score\u00a03 or\u00a04 [3]. Ipsilateral medial malleolus fracture less than 6\u00a0months prior. Relative contra-indication: posttraumatic stiffness with range of motion (ROM) &lt;\u202f5\u00b0. Children with open physis: do not perform an osteotomy as stabilization of the osteotomy may lead to early closure of the physis, potentially resulting in symptomatic varus angulation of the distal tibia. In these cases only arthrotomy can be considered.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Surgical technique<\/jats:title>\n                <jats:p>The OLT is approached through a\u00a0medial distal tibial osteotomy, for which the screws are predrilled and the osteotomy is made with an oscillating saw and finished with a\u00a0chisel in order to avoid thermal damage. Hereafter, the joint is inspected and the osteochondral fragment is identified. The cartilage is partially incised at the borders and the fragment is then lifted as a\u00a0hood of a\u00a0motor vehicle (lift). The subchondral bone is debrided and thereafter drilled to allow thorough bone marrow stimulation (drill) and filled with autologous cancellous bone graft from either the iliac crest or the distal tibia (fill). The fragment is then fixated (fix) in anatomical position, preferably with two screws to allow additional rotational stability. Finally, the osteotomy is reduced and fixated with two screws.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Postoperative management<\/jats:title>\n                <jats:p>Casting includes 5\u00a0weeks of short leg cast non-weightbearing and 5\u00a0weeks of short leg cast with weightbearing as tolerated. At 10-week follow-up, a\u00a0CT scan is made to confirm fragment and osteotomy healing, and patients start personalized rehabilitation under the guidance of a\u00a0physical therapist.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00064-023-00833-7","type":"journal-article","created":{"date-parts":[[2023,10,12]],"date-time":"2023-10-12T16:02:45Z","timestamp":1697126565000},"page":"132-144","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Open lift\u2013drill\u2013fill\u2013fix for medial osteochondral lesions of the talus: surgical technique","Offene Lift-drill-fill-fix-Methode bei medialen osteochondralen L\u00e4sionen des Talus: Operationstechnik"],"prefix":"10.1007","volume":"36","author":[{"given":"Quinten G. H.","family":"Rikken","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara J. C.","family":"Favier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jari","family":"Dahmen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sjoerd A. S.","family":"Stufkens","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gino M. M. J.","family":"Kerkhoffs","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,10,12]]},"reference":[{"key":"833_CR1","doi-asserted-by":"publisher","DOI":"10.1177\/19476035221102569","author":"J Dahmen","year":"2022","unstructured":"Dahmen\u00a0J, Jaddi\u00a0S, Hagemeijer\u00a0NC et al (2022) Incidence of (Osteo)chondral lesions of the ankle in isolated syndesmotic injuries: a\u00a0systematic review and meta-analysis. Cartilage. https:\/\/doi.org\/10.1177\/19476035221102569","journal-title":"Cartilage"},{"key":"833_CR2","doi-asserted-by":"publisher","DOI":"10.1177\/1947603520954510","author":"PR van Diepen","year":"2020","unstructured":"van Diepen\u00a0PR, Dahmen\u00a0J, Altink\u00a0JN et\u00a0al (2020) Location distribution of 2,087 osteochondral lesions of the talus. Cartilage. https:\/\/doi.org\/10.1177\/1947603520954510","journal-title":"Cartilage"},{"key":"833_CR3","doi-asserted-by":"publisher","first-page":"494","DOI":"10.1136\/ard.16.4.494","volume":"16","author":"JH Kellgren","year":"1957","unstructured":"Kellgren\u00a0JH, Lawrence\u00a0JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16:494\u2013502. https:\/\/doi.org\/10.1136\/ard.16.4.494","journal-title":"Ann Rheum Dis"},{"key":"833_CR4","doi-asserted-by":"publisher","DOI":"10.1007\/s00064-020-00673-9","author":"GMMJ Kerkhoffs","year":"2020","unstructured":"Kerkhoffs\u00a0GMMJ, Altink\u00a0JN, Stufkens\u00a0SAS, Dahmen\u00a0J (2020) Talar OsteoPeriostic grafting from the Iliac Crest (TOPIC) for large medial talar osteochondral defects. Oper Orthop Traumatol. https:\/\/doi.org\/10.1007\/s00064-020-00673-9","journal-title":"Oper Orthop Traumatol"},{"key":"833_CR5","doi-asserted-by":"publisher","first-page":"1265","DOI":"10.1007\/s00167-014-3057-7","volume":"24","author":"GMMJ Kerkhoffs","year":"2016","unstructured":"Kerkhoffs\u00a0GMMJ, Reilingh\u00a0ML, Gerards\u00a0RM, de Leeuw\u00a0PAJ (2016) Lift, drill, fill and fix (LDFF): a\u00a0new arthroscopic treatment for talar osteochondral defects. Knee Surg Sports Traumatol Arthrosc 24:1265\u20131271. https:\/\/doi.org\/10.1007\/s00167-014-3057-7","journal-title":"Knee Surg. Sports Traumatol. Arthrosc."},{"key":"833_CR6","doi-asserted-by":"publisher","first-page":"3339","DOI":"10.1007\/s00167-020-05954-1","volume":"28","author":"D K\u00f6rner","year":"2020","unstructured":"K\u00f6rner\u00a0D, Ateschrang\u00a0A, Schr\u00f6ter\u00a0S et\u00a0al (2020) Concomitant ankle instability has a\u00a0negative impact on the quality of life in patients with osteochondral lesions of the talus: data from the German Cartilage Registry (KnorpelRegister DGOU). Knee Surg Sports Traumatol Arthrosc 28:3339\u20133346. https:\/\/doi.org\/10.1007\/s00167-020-05954-1","journal-title":"Knee Surg. Sports Traumatol. Arthrosc."},{"key":"833_CR7","doi-asserted-by":"publisher","first-page":"369","DOI":"10.1302\/0301-620X.84B3.12373","volume":"84","author":"T Kumai","year":"2002","unstructured":"Kumai\u00a0T, Takakura\u00a0Y, Kitada\u00a0C et\u00a0al (2002) Fixation of osteochondral lesions of the talus using cortical bone pegs. J\u00a0Bone Joint Surg Br 84:369\u2013374. https:\/\/doi.org\/10.1302\/0301-620X.84B3.12373","journal-title":"J Bone Joint Surg Br"},{"key":"833_CR8","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1007\/s00167-019-05687-w","volume":"28","author":"KTA Lambers","year":"2020","unstructured":"Lambers\u00a0KTA, Dahmen\u00a0J, Reilingh\u00a0ML et\u00a0al (2020) Arthroscopic lift, drill, fill and fix (LDFF) is an effective treatment option for primary talar osteochondral defects. Knee Surg Sport Traumatol Arthrosc 28:141\u2013147. https:\/\/doi.org\/10.1007\/s00167-019-05687-w","journal-title":"Knee Surg Sport Traumatol Arthrosc"},{"key":"833_CR9","doi-asserted-by":"publisher","first-page":"1025","DOI":"10.3113\/FAI.2010.1025","volume":"31","author":"S Nakagawa","year":"2010","unstructured":"Nakagawa\u00a0S, Hara\u00a0K, Minami\u00a0G et\u00a0al (2010) Arthroscopic fixation technique for osteochondral lesions of the talus. Foot Ankle Int 31:1025\u20131027. https:\/\/doi.org\/10.3113\/FAI.2010.1025","journal-title":"Foot Ankle Int"},{"key":"833_CR10","doi-asserted-by":"publisher","first-page":"1388","DOI":"10.1177\/1071100719868726","volume":"40","author":"T Nakasa","year":"2019","unstructured":"Nakasa\u00a0T, Ikuta\u00a0Y, Ota\u00a0Y et\u00a0al (2019) Clinical results of bioabsorbable pin fixation relative to the bone condition for osteochondral lesion of the talus. Foot Ankle Int 40:1388\u20131396. https:\/\/doi.org\/10.1177\/1071100719868726","journal-title":"Foot Ankle Int"},{"key":"833_CR11","doi-asserted-by":"publisher","first-page":"323","DOI":"10.1177\/1071100718809351","volume":"40","author":"T Nakasa","year":"2019","unstructured":"Nakasa\u00a0T, Ikuta\u00a0Y, Tsuyuguchi\u00a0Y et\u00a0al (2019) MRI tracking of the effect of bioabsorbable pins on bone marrow edema after fixation of the osteochondral fragment in the talus. Foot Ankle Int 40:323\u2013329. https:\/\/doi.org\/10.1177\/1071100718809351","journal-title":"Foot Ankle Int"},{"key":"833_CR12","doi-asserted-by":"publisher","first-page":"103070","DOI":"10.1016\/J.OTSR.2021.103070","volume":"107","author":"G Padiolleau","year":"2021","unstructured":"Padiolleau\u00a0G, Amouyel\u00a0T, Barbier\u00a0O et\u00a0al (2021) Safety of malleolar osteotomies in surgery for osteochondral lesions of the talus. Orthop Traumatol Surg Res 107:103070. https:\/\/doi.org\/10.1016\/J.OTSR.2021.103070","journal-title":"Orthop Traumatol Surg Res"},{"key":"833_CR13","doi-asserted-by":"publisher","first-page":"3393","DOI":"10.1016\/J.ARTHRO.2021.10.002\/ATTACHMENT\/C36BA43F-492E-483B-ADFF-6CB094CFA608\/MMC1.PDF","volume":"37","author":"RT Powers","year":"2021","unstructured":"Powers\u00a0RT, Dowd\u00a0TC, Giza\u00a0E (2021) Surgical treatment for osteochondral lesions of the talus. Arthroscopy 37:3393\u20133396. https:\/\/doi.org\/10.1016\/J.ARTHRO.2021.10.002\/ATTACHMENT\/C36BA43F-492E-483B-ADFF-6CB094CFA608\/MMC1.PDF","journal-title":"Arthroscopy"},{"key":"833_CR14","doi-asserted-by":"publisher","first-page":"1031","DOI":"10.1177\/0363546520988739","volume":"49","author":"Y Rak Choi","year":"2021","unstructured":"Rak Choi\u00a0Y, Soo Kim\u00a0B, Kim\u00a0YM et\u00a0al (2021) Internal fixation of osteochondral lesion of the talus involving a\u00a0large bone fragment. Am J Sports Med 49:1031\u20131039. https:\/\/doi.org\/10.1177\/0363546520988739","journal-title":"Am J Sports Med"},{"key":"833_CR15","doi-asserted-by":"publisher","first-page":"1698","DOI":"10.1177\/0363546516668292","volume":"45","author":"L Ramponi","year":"2017","unstructured":"Ramponi\u00a0L, Yasui\u00a0Y, Murawski\u00a0CD et\u00a0al (2017) Lesion size is a\u00a0predictor of clinical outcomes after bone marrow stimulation for osteochondral lesions of the talus: a\u00a0systematic review. Am J Sports Med 45:1698\u20131705. https:\/\/doi.org\/10.1177\/0363546516668292","journal-title":"Am J Sports Med"},{"key":"833_CR16","doi-asserted-by":"publisher","first-page":"2177","DOI":"10.1007\/s00167-017-4654-z","volume":"26","author":"ML Reilingh","year":"2018","unstructured":"Reilingh\u00a0ML, Lambers\u00a0KTA, Dahmen\u00a0J et\u00a0al (2018) The subchondral bone healing after fixation of an osteochondral talar defect is superior in comparison with microfracture. Knee Surg Sports Traumatol Arthrosc 26:2177\u20132182. https:\/\/doi.org\/10.1007\/s00167-017-4654-z","journal-title":"Knee Surg. Sports Traumatol. Arthrosc."},{"key":"833_CR17","doi-asserted-by":"publisher","first-page":"23S","DOI":"10.1177\/1071100718781096","volume":"39","author":"ML Reilingh","year":"2018","unstructured":"Reilingh\u00a0ML, Murawski\u00a0CD, DiGiovanni\u00a0CW et\u00a0al (2018) Fixation techniques: proceedings of the international consensus meeting on cartilage repair of the ankle. Foot Ankle Int 39:23S\u201327S. https:\/\/doi.org\/10.1177\/1071100718781096","journal-title":"Foot Ankle Int"},{"key":"833_CR18","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1016\/j.fcl.2020.10.002","volume":"26","author":"QG Rikken","year":"2021","unstructured":"Rikken\u00a0QG, Kerkhoffs\u00a0GM (2021) Osteochondral lesions of the talus: an individualized treatment paradigm from the Amsterdam perspective. Foot Ankle Clin 26:121\u2013136. https:\/\/doi.org\/10.1016\/j.fcl.2020.10.002","journal-title":"Foot Ankle Clin"},{"key":"833_CR19","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-022-07243-5","author":"QGH Rikken","year":"2022","unstructured":"Rikken\u00a0QGH, Altink\u00a0JN, Dahmen\u00a0J et al (2022) Sustained long-term clinical outcomes after arthroscopic lift-drill-fill and fixation (LDFF) of primary talar osteochondral lesions. Knee Surg Sports Traumatol Arthrosc. https:\/\/doi.org\/10.1007\/s00167-022-07243-5","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"833_CR20","doi-asserted-by":"publisher","first-page":"470","DOI":"10.1055\/s-2004-832393","volume":"129","author":"A Schuh","year":"2004","unstructured":"Schuh\u00a0A, Salminen\u00a0S, Zeiler\u00a0G, Schraml\u00a0A (2004) Ergebnisse der refixation der osteochondrosis dissecans des talus mit kirschnerdr\u00e4hten. Zentralbl Chir 129:470\u2013475. https:\/\/doi.org\/10.1055\/s-2004-832393","journal-title":"Zentralbl Chir"},{"key":"833_CR21","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1007\/S001320050572","volume":"30","author":"R Seil","year":"2001","unstructured":"Seil\u00a0R, Rupp\u00a0S, Pape\u00a0D et\u00a0al (2001) Approach to open treatment of osteochondral lesions of the talus. Orthopade 30:47\u201352. https:\/\/doi.org\/10.1007\/S001320050572","journal-title":"Orthopade"},{"key":"833_CR22","doi-asserted-by":"publisher","DOI":"10.1177\/03635465221084365","author":"EJ Wijnhoud","year":"2022","unstructured":"Wijnhoud\u00a0EJ, Rikken\u00a0QGH, Dahmen\u00a0J et\u00a0al (2022) One in three patients with chronic lateral ankle instability has a\u00a0cartilage lesion. Am J Sports Med. https:\/\/doi.org\/10.1177\/03635465221084365","journal-title":"Am J Sports Med"}],"container-title":["Operative Orthop\u00e4die und Traumatologie"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00064-023-00833-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00064-023-00833-7\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00064-023-00833-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,4,12]],"date-time":"2024-04-12T16:02:39Z","timestamp":1712937759000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00064-023-00833-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,12]]},"references-count":22,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2024,4]]}},"alternative-id":["833"],"URL":"https:\/\/doi.org\/10.1007\/s00064-023-00833-7","relation":{},"ISSN":["0934-6694","1439-0981"],"issn-type":[{"value":"0934-6694","type":"print"},{"value":"1439-0981","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,10,12]]},"assertion":[{"value":"1 December 2022","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 May 2023","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 June 2023","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 October 2023","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Q.\u00a0Rikken, B.J.C.\u00a0Favier, J.\u00a0Dahmen, S.A.S.\u00a0Stufkens and G.M.M.J.\u00a0Kerkhoffs declare that they have no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"IRB was obtained before the start of the study. All studies mentioned were in accordance with the ethical standards.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}