SLR - July 2019 - Kevin J. Huntsman
Reference: Duramaz A, Baca E. Microfracture Provides Better Clinical Results Than Debridement in the Treatment of Acute Talar Osteochondral Lesions Using Arthroscopic Assisted Fixation of Acute Ankle Fractures. Knee Surgery, Sports Traumatology, Arthroscopy. 2018 April.Scientific Literature Review
Reviewed By: Kevin J. Huntsman, DPM
Residency Program: Hunt Regional Medical Center – Greenville, TX
Podiatric Relevance: Ankle arthroscopy has been considered a useful method for detection and treatment of accompanying intraarticular pathologies in acute ankle fractures. Osteochondral lesions of the talus (OCL) are commonly associated with acute ankle fractures, but are at times not identified until months after the initial injury. Ankle arthroscopy helps identify OCLs and provides opportunity for early treatment of lesions on the talus. The purpose of this study was to compare the treatment results of osteochondral lesions of talus (OLT) with debridement versus microfracture in arthroscopy-assisted surgery of acute ankle fractures.
Methods: A retrospective analysis was performed at a single institution by two separate surgeons. Only closed unilateral bimalleolar ankle fractures were included in the study. The time period for these fractures was from 2011 and 2013. Treatment of the ankle fracture consisted of arthroscopic assisted repair and evaluation of intra-articular pathology associated with the bimalleolar ankle fracture. Patients were divided into two groups regarding OLT treatment; acute debridement or microfracture was performed on the talus. Of the closed bimalleolar ankle fractures, 11 consecutive patients were treated with arthroscopic acute debridement of the talus and 14 patients were treated with arthroscopic acute microfracture of the talus. All patients were followed clinically and radiographically in the postoperative period for a total of two years. Ankle pain was evaluated with the visual analog score (VAS), ankle functions were assessed with American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS), and osteoarthritic changes were analyzed with Van Dijk score.
Results: In this study regarding the two separate treatments for OCL of the talus, there was no significant difference between the groups in terms of age, gender, side of injury and mechanism of injury. When comparing mean time to surgery, time to fracture healing, time to initial weight-bearing and full weight-bearing, follow-up period and Van Dijk score were all similar in both groups. In comparison of microfracture and debridement, the AOFAS score and VAS score were considered statistically significantly better in the microfracture group (p = 0.044 and p = 0.001).
Conclusions: Overall, this study demonstrates the value of arthroscopic evaluation of ankle fractures and associated intra-articular pathology treatment that can be performed at the same time. This is designed to improve postoperative functional outcomes and to help prevent post-traumatic osteoarthritis. It’s reported that both debridement and microfracture of OCLs produce good functional outcomes two years postoperatively. Microfracture was found to be significantly more successful, clinically, when compared to debridement. This will be able to help those surgeons who suspect concomitant OCLs with ankle fractures provide better results after surgery and prevent possible osteoarthritis of the ankle joint.