SLR - March 2020 - Spruha Magodia
Reference: Yang HY, Lee KB. Arthroscopic Microfracture for Osteochondral Lesions of the Talus: Second-Look Arthroscopic and Magnetic Resonance Analysis of Cartilage Repair Tissue Outcomes. J Bone Joint Surg Am. 2020 Jan 2; 102 (1): 10-20.Scientific Literature Review
Reviewed By: Spruha Magodia, DPM
Residency Program: Temple University Hospital – Philadelphia, PA
Podiatric Relevance: Arthroscopy has become a staple of podiatric surgical practice. Osteochondral lesions secondary to traumatic injury are not an uncommon pathology encountered in our field. Since microfracture is considered a primary technique for osteochondral lesions of the talus, it benefits practitioners to ascertain why it is still useful and how successful it really is. The authors of the article evaluate the outcomes related to cartilage repair after microfracture with use of second-look arthroscopy and MRI. The authors hypothesize that second-look arthroscopy and MRI after microfracture for the treatment of osteochondral lesions would not reveal deterioration and that clinically, there would be good functional outcomes over time.
Methods: One hundred thirty-seven patients were identified who had undergone arthroscopic microfracture for the treatment of symptomatic osteochondral lesions of the talus between January 2008 and December 2015. All patients had been managed by a single surgeon. Inclusion criteria were a lesion < 2.0mm2 and the patient had to have failed non-operative treatment. Patients were then evaluated at a minimum of two years after surgery with second-look arthroscopy and MRI for evaluation of the cartilage repair tissue. Twenty-five patients of the 137 underwent second-look arthroscopy and MRI at a mean of 3.6 years.
Results: Significant improvement was noted in all functional outcome categories between preoperative and follow-up evaluations. Via second-look arthroscopy, it was revealed that 36 percent of the patients (nine ankles), still had abnormalities such as synovitis, including synovial hypertrophy, in 32 percent, osteophytes in 12 percent and loose, displaced fragments of articular cartilage in 8 percent.
Conclusions: The authors of this study conclude that second-look arthroscopy demonstrated that 36 percent of the lesions were incompletely healed, with inferior quality of the repair tissue in comparison to the original native cartilage at a mean average of 3.6 years after arthroscopic microfracture. They discuss that while microfracture is useful, it alone as a treatment option still results in production of fibrocartilage, which is inferior to native cartilage. However, from a functional clinical standpoint, many patients did demonstrate good to excellent outcomes. This study is important in that it assesses a common treatment option but also demonstrates that further improvements are required and that new modalities, especially biologic options such as bone marrow aspirate or platelet-rich plasma, should be studied.