SLR - June 2011 - Brandon D. Wilde
Reference: Lee, K.B., Bai, L.B., Yoon, T.R., Jung, S.T., Seon, J.K. Second-look arthroscopic findings and clinical outcomes after microfracture for osteochondral lesions of the talus. The American Journal of Sports Medicine, 37(supplement 1), (2009) 63S-70S.
Scientific Literature Review
Reviewed by: Brandon D. Wilde, DPM
Residency Program: DVA New Mexico, Albuquerque, NM
Podiatric Relevance:
The management of osteochondral lesions of the talus is a challenging task. Microfracture drilling of the talus is a common technique for management of these lesions. This study addresses the cartilage repair after microfracture surgery with second-look arthroscopic evaluation.
Methods:
Twenty-two patients with twenty-three osteochondral lesions were treated with arthroscopic microfracture surgery. To be included in the study, the patient had to have a chronic symptomatic osteochondral lesion of the talus, no previous ankle surgery, a lesion less than 1.5 cm², and age 50 or younger. The mean size of osteochondral lesions was 0.9 cm², the average patient age was 38 years, and mean symptom duration was 22 months. Nineteen patients (20 ankles) agreed to follow up with arthroscopic examination of the talar dome 12 months post-operatively. American Orthopedic Foot and Ankle Society Ankle-Hindfoot (AOFAS) scores were reported prior to the first operation as well as prior to the second-look arthroscopy to assess pain, function and patient satisfaction.
Results:
Second-look arthoscopic findings at 12 months postoperatively showed that 60% of lesions achieved a normal or near-normal state. 40% of lesions remained abnormal. Overall, only 30% of lesions achieved complete integration with the adjacent cartilage. The average AOFAS scores improved from 60.8 to 86.2, and 90% of ankles achieved an excellent or good AOFAS score of over 80 points.
Conclusions:
Microfracture drilling of the talus continues to be a viable option for osteochondral lesions of the talus. The authors of the study conclude that although in most cases the cartilage isn’t completely integrated with the adjacent cartilage after 12 months, the patients are satisfied and AOFAS scores are greatly improved. Long-term follow up with histologic examination of the cartilage would provide more insight, but would also pose ethical dilemmas.