SLR - March 2010 - David Shofler
Reference:
Lee K., Bai L., Yoon T., Jung S., Seon J. (2009). Second-Look Arthroscopic Findings and Clinical Outcomes After Microfracture for Osteochondral Lesions of the Talus. American Journal of Sports Medicine, 37 (Supplement 1), 63S-70S.
Scientific Literature Reviews
Reviewed by: David Shofler, DPM
Residency Program: Cedars-Sinai Medical Center, Los Angeles, CA
Podiatric Relevance:
Osteochondral lesions of the talus often present as localized ankle pain. This is the first study to evaluate the success of arthroscopic microfracture utilizing second-look arthroscopy.
Methods:
Nineteen patients (20 ankles) who underwent arthroscopic microfracture for osteochondral lesions of the talus underwent second-look arthroscopy 12months postoperatively. The lesions were posteromedial in 16 ankles, and anterolateral in four. The mean osteochondral lesion size was 0.9 cm². MR imaging was performed pre-operatively for all 20 ankles. Microfracture holes were created in a spiral pattern of subchondral penetration using arthroscopic awls. Recorded second-look arthroscopy was performed at 12 months post-operatively and assessed by 2 independent observers.
Results:
Mean AOFAS scores improved from 60.8 points to 86.2 postoperatively, with no patients showing deterioration. At second-look arthroscopy, seven of the 20 lesions (35%) had healed incompletely, each classified as Ferkel and Cheng stage D lesions. Ferkel and Cheng lesions staged A through C had an average AOFAS score of 88.5, and the AOFAS score of lesions staged D through F was 82.0. Based on International Cartilage Repair System (ICRS) grading, 12 of the 20 lesions were grades I or II, and 8 were grade III (abnormal).
Conclusions:
While the majority of patients achieved good clinical outcomes, second-look arthroscopy revealed incomplete osteochondral lesion healing. There was a good correlation between quality of the repair and AOFAS score. Lesion peripheries were not as well repaired as lesion centers, suggesting increased attention be directed to the periphery. Long-term studies are suggested to evaluate the durability of repair by microfracture.