SLR - June 2023 - Mary Brandt, DPM
Title: Analysis of factors affecting the prognosis of osteochondral lesions of the talusReference: Bai, L., Zhang, Y., Chen, S., Bai, Y., Lu, J., & Xu, J. (2023). Analysis of factors affecting the prognosis of osteochondral lesions of the talus. International orthopaedics, 47(3), 861–871.
Scientific Literature Review
Level of Evidence: III
Reviewed by: Mary Brandt, DPM
Residency Program: West Penn Hospital, Allegheny Health Network, Pittsburgh, PA
Podiatric Relevance: Osteochondral lesions of the talus can be a challenging pathology for foot and ankle physicians. There are a number of factors to analyze including location and size of the lesion, age, and overall goals of the patient. Due to variable long-term outcomes with different surgical interventions, a clear treatment consensus has not been identified. This article details an effective treatment option for this debilitating injury.
Methods: This study is a retrospective analysis of 44 patients who underwent osteochondral transplantation between January 2017 and December of 2020 at the Foot and Ankle Surgery Department of Xi’An Honghui Hospital. The authors utilized a nine-division method that split the talar dome into a 3x3 grid to determine the location of the osteochondral lesion of the talus. Mimics software was then used to measure the area, depth, and volume of the lesion. The Visual Analog Scale (VAS), the American Orthopaedic Foot and Ankle Society (AOFAS) score, and the SF-36 score were each collected both before the operative and at the final follow-up appointment. Exclusion criteria for the study included incomplete closure of the patient’s growth plate, ankle and knee osteoarthritis, ankle deformity, infection, bone tumors, diabetic foot, rheumatoid arthritis, and gout.
Results: 18 men and 12 women were included in the study, with an average of 44.20 ± 13.77 years. The average follow-up time was 24.33± 12.19 months. The average disease duration was 28.30 ± 21.25 months. The average injury surface area 147.51 ± 44.01 mm2, with the average injury depth of 9.21 ± 0.73 mm, and the average injury volume 939.20 ± 217.33 mm3. The medial femoral condyle was used in 13 cases to obtain the osteochondral transplantation, and the non-weight-bearing area of the talus was used in the remaining 17 cases. They found that the VAS, AOFAS, and SF-36 all significantly improved compared to prior to the surgery (P<0.05). Improvement was seen in both the activity level of the patients, as well as, overall joint pain. The VAS, AOFAS, and SF-36 scores were not significantly correlated with age, duration of illness, gender, size of lesion, or zone of injury (all P<0.05).
Conclusions: This article concluded that good clinical results can be reached for treatment of talar osteochondral lesions with use of talar osteochondral transplantation. They also found that age, sex, duration of illness, location, surface area, depth, and volume of the lesion all had no effect on the prognosis of the osteochondral transplantation. The use of talar osteochondral transplantation should be considered a viable option with treating OCD’s of the talus, regardless of the patient demographics or lesion size.