Treatment of osteochondral lesions of the talus with microfracture technique and postoperative hyaluronan injection (original) (raw)
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Outcomes of arthroscopic debridement and microfracture for osteochondral lesions of the talus
Journal of Turgut Ozal Medical Center, 2017
Aim: Osteochondral Lesions of the Talus (OLT) is a common pathology in orthopedic injuries. Recently arthroscopic microfracture treatment is widely used as a simple technique with clinically satisfactory outcomes. The present study aimed to reveal the outcomes of arthroscopic OLT treatment and determine the appropriate patient group. Material and Methods: 21 patients who underwent arthroscopic debridement and microfracture for OLT were evaluated retrospectively between March 2015 and May 2016. The clinical assessment was performed by using The American Orthopaedic Foot & Ankle Society (AOFAS) and Visual Analog Scale (VAS) prior to the surgery and at the final follow up. Results: The mean diameter of lesions were measured as 1.1 cm² (0.7-1.7) arthroscopically. The mean age of the patients was 35 (18-55) years. Lesions were located at the medial side in 17 patients and lateral side in 4 patients. The mean value of preop AOFAS score was 65.4±7.3 (55-78) and it was 86.6 ± 8.3 (68-100) at the final follow up. VAS scores of the patients were 6.7±1.2 (5-9) prior to the surgery and 2.2±1.3 (0-5) at the final follow up. Conclusion: Arthroscopic treatment of OLTs is a beneficial technique with low complication rate in broad range of patients. Patient's age and lesion size are guideway in patients requiring arthroscopic treatment. As the age and lesion size increase, surgical treatment becomes less beneficial.
The American journal of sports medicine, 2018
Subchondral bone marrow edema (BME) has been associated with articular cartilage loss, with the potential to be a negative prognostic indicator for clinical outcomes after microfracture. However, no single study has investigated the association between BME and clinical outcomes after microfracture for osteochondral lesions of the talus (OLTs) at midterm follow-up. To clarify the association between postoperative subchondral BME and clinical outcomes in patients treated with microfracture for OLTs at both short-term and midterm follow-up using a grading system that classified the extent of BME of the talus. Cohort study; Level of evidence, 3. Patients who underwent microfracture between 2008 and 2013 were assessed at 2- and 4-year postoperative follow-up. BME was evaluated using magnetic resonance imaging, and the presence of subchondral BME was determined with fat-suppressed T2-weighted sequences. Clinical outcomes were evaluated using the Foot and Ankle Outcome Score (FAOS). P <...
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2006
The purpose of this study was to compare outcomes of chondroplasty versus microfracture versus osteochondral autologous transplantation (OAT) in patients with osteochondral lesions of the talus (OLT). Methods: After prospective sample size analysis, patients with symptomatic, recalcitrant Ferkel class 2b, 3, and 4 OLT were randomized to chondroplasty, microfracture, or OAT treatment groups. Outcomes were measured with use of the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale (AHS), the Subjective Assessment Numeric Evaluation (SANE) rating, Numeric Pain Intensity (NPI), and magnetic resonance imaging (MRI). Results: Eleven patients had chondroplasty, 10 ankles (9 patients) had microfracture, and 12 patients had OAT. Mean time to follow-up was 53 months (range, 24 to 119 months). AHS scores showed no differences at 12 and 24 months, and SANE ratings showed no differences at final follow-up. NPI was significantly lower (P Ͻ .001) in chondroplasty and microfracture cases as compared with OAT at 24 hours postoperatively. Pearson's correlation analysis demonstrated an inverse relation between microfracture and OAT groups in that better outcome was associated with smaller lesions, compared with the chondroplasty group, which revealed mixed results with no particular trend. MRI revealed incomplete fill and edema after chondroplasty or microfracture and chondral gaps after OAT. Conclusion: Our results demonstrate no difference between chondroplasty, microfracture, and OAT with regard to AHS and SANE ratings in patients with OLT. However, NPI at 24 hours postoperatively was significantly lower in patients who had chondroplasty and microfracture. Level of Evidence: Level I, Therapeutic study, high-quality randomized controlled trial with no statistically significant differences but narrow confidence interval.
Foot & Ankle Orthopaedics, 2019
Background: Osteochondral lesions of the talus (OLTs) are common injuries in young, active patients. Microfracture is an effective treatment for lesions less than 150 mm 2 in size. Most commonly employed postoperative protocols involve delaying weightbearing for 6 to 8 weeks (DWB), though one study suggests that early weightbearing (EWB) may not be detrimental to patient outcomes. The goal of this research is to compare outcomes following EWB and DWB protocols after microfracture for OLTs. Methods: We performed a prospective, randomized, multicenter clinical trial of subjects with unilateral, primary, unifocal OLTs treated with microfracture. Thirty-eight subjects were randomized into EWB (18 subjects) and DWB (20 subjects) at their first postsurgical visit. The EWB group began unrestricted WB at that time, whereas the DWB group were instructed to remain strictly nonweightbearing for an additional 4 weeks. Primary outcome measures were the American Academy of Orthopaedic Surgery (AAOS) Foot and Ankle score and numeric rating scale (NRS) pain score. Results: The EWB group demonstrated significant improvement in AAOS Foot and Ankle Questionnaire scores at the 6week follow-up appointment as compared to the DWB group (83.1 + 13.5 vs 68.7 + 15.8, P ¼ .017). Following this point, there were no significant differences in AAOS scores between groups. At no point were NRS pain scores significantly different between the groups. Conclusions: EWB after microfracture for OLTs was associated with improved AAOS scores in the short term. Thereafter and through 2 years' follow-up, no statistically significant differences were seen between EWB and DWB groups. Level of Evidence: Level II, prospective randomized trial.
Orthopaedic Journal of Sports Medicine
Background: Little is known about the long-term prognosis of osteochondral lesions of the talus (OLTs) after nonoperative treatment. Purpose: To evaluate the clinical and radiological long-term results of initially successfully treated OLTs after a minimum follow-up of 10 years. Study Design: Case series; Level of evidence, 4. Methods: Between 1998 and 2006, 48 patients (50 ankles) with OLTs were successfully treated nonoperatively. These patients were enrolled in a retrospective long-term follow-up, for which 24 patients could not be reached or were available only by telephone. A further 2 OLTs (6%) that had been treated surgically were excluded from the analysis and documented as failures of nonoperative treatment. The final study group of 22 patients (mean age at injury, 42 years; range, 10-69 years) with 24 OLTs (mean size, 1.4 cm2; range, 0.2-3.8 cm2) underwent clinical and radiological evaluation after a mean follow-up of 14 years (range, 11-20 years). Ankle pain was evaluated...
Operative Treatment for Osteochondral Lesions of the Talus: Biologics and Scaffold-Based Therapy
Cartilage, 2017
Numerous basic science articles have published evidence supporting the use of biologic augmentation in the treatment of osteochondral lesions of the talus (OLT). However, a comprehensive evaluation of the clinical outcomes of those treatment modalities in OLT has yet to be published. The purpose of this review is to provide an evidence-based overview of clinical outcomes following biologic augmentation to surgical treatments for OLT. A comprehensive literature review was performed. Two commonly used surgical techniques for the treatment of OLT-bone marrow stimulation and osteochondral autograft transfer-are first introduced. The review describes the operative indications, step-by- step operative procedure, clinical outcomes, and concerns associated with each treatment. A review of the currently published basic science and clinical evidence on biologic augmentation in the surgical treatments for OLT, including platelet-rich plasma, concentrated bone marrow aspirate, and scaffold-base...
Osteochondral Lesions of the Talus: Predictors of Clinical Outcome
Foot & Ankle International, 2011
Background: Osteochondral lesions of the talus (OLT) are a common and challenging condition treated by the orthopedic foot and ankle surgeon. Multiple operative treatment modalities have been recommended, and there are several factors that need to be considered when devising a treatment plan. In this study, we retrospectively reviewed a group of patients treated operatively for osteochondral lesions of the talus to determine factors that may have affected outcome. Methods: A retrospective chart review of clinical, radiographic and operative records was performed for all patients treated for OLTs via marrow stimulation technique. All had a minimum followup of 6 months or until return to full activity, preoperative magnetic resonance imaging (MRI) of the OLT to determine size, and failure of nonoperative treatment. Results: A total of 130 patients were included in the study. This included 64 males and 66 females. The average patient age at the time of surgery was 35.1 ± 13.7 (range, 12 to 73) years. The average followup was 37.2 ± 40.2 (range, 7.43 to 247) weeks. The average size of the lesion was 0.84 ± 0.67 cm 2. There were 20 lesions larger than 1.5 cm 2 and 110 lesions smaller than 1.5 cm 2. There were 113 contained lesions and 17 uncontained lesions. OLTs larger than 1.5 cm 2 and uncontained lesions were associated with a poor clinical outcome. Conclusions: The treatment of osteochondral lesions of the talus remains a challenge to the foot and ankle surgeon. Arthroscopic debridement and drilling will often provide satisfactory results. However, larger lesions and uncontained lesions
Arthroscopic management of small osteochondral lesions of the talus
Current Orthopaedic Practice, 2017
Background: The aim of the study was to evaluate the short-term clinical outcomes of arthroscopic drilling in the management of small osteochondral lesions of the talus (OLT). Methods: Thirty-two patients with small OLT (area <150 mm 2 and cyst depth <7 mm as measured on CT and MRI) were treated by arthroscopic debridement and drilling. Four patients underwent simultaneous modified Broström procedures. Five patients required retrograde drilling, three because the overlying cartilage was intact and two because the lesion was posterior. Outcomes were measured using the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale and subjective patient satisfaction. Results: The mean age at surgery was 32 ± 8 yr (range, 18-50 yr). There were 22 men (68.75%) and 10 women (31.25%). Four patients (12.5%) were playing sports regularly, one professionally and three recreationally. After a mean follow-up duration of 26 mo (range 12-48 mo), the mean AOFAS score improved from 71.78 ± 11 (range 51-87) preoperatively to 91 ± 7 (range 80-100). The results were excellent in 15 patients (46.9%), good in 12 (37.5%), fair in five(15.6%). According to the Saxena criteria 16 patients (50%) were very satisfied, nine patients (28.1%) were satisfied, six patients (18.8%) were satisfied with reservations and one patient (3.1%) was unsatisfied. Conclusions: Arthroscopic drilling for small OLT is safe and easy with results comparable to microfracture but with the advantages of deeper penetration and the ability to drill retrograde into posterior lesions or lesions with intact cartilage.