SLR - November 2012 - Nicholas R. Schmerbach
Reference: Donnenwerth, Michael P., Roukis, Thomas S. (2012). Outcome of Arthroscopic Debridement and Microfracture as the Primary Treatment for Osteochondral Lesions of the Talar Dome. Arthroscopy: The Journal of Arthroscopic and Related Surgery.
Scientific Literature Review
Reviewed by: Nicholas R. Schmerbach, DPM
Residency Program: Columbia St. Mary’s Hospital, Milwaukee, WI
Podiatric Relevance:
This article looks at a widely used treatment option for the treatment of osteochondral lesions of the talus. The fact that the article is a systematic review gives one a wide variety and number of studies looking at this treatment option as a whole in this one article. Many podiatric surgeons use arthroscopic treatment of foot and ankle pathologies in one way or another and believe in microfracture as a viable treatment option for osteochondral lesions throughout the foot and ankle and most notably the talar dome. The article helps to confirm the use of debridement and microfracture as a treatment option of osteochondral lesion of the talar dome.
Methods:
This article is a systematic review of systematic review of Level II, III, and IV studies looking at patient outcomes with the use of arthroscopic debridement and microfracture as a treatment option for osteochondral lesions of the talar dome. The noted authors undertook a search of both electric and paper journals for articles that pertained to the arthroscopic debridement and microfracture of osteochondral lesions of the talar dome. Of the articles identified, only articles published in peer-reviewed journals that used the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot scoring system for outcome measurement, and use of arthroscopic debridement and microfracture for treatment of osteochondral lesions of the talar dome were considered for inclusion. The identified articles were then analyzed, with results being complied and compared to form conclusions on the viability of arthroscopic debridement and microfracture as a treatment option.
Results:
Through the article search there were 29 potential articles identified for possible inclusion with a total of seven articles meeting the final inclusion criteria. The noted articles included a total of 299 ankles on 295 patients. Mean follow-up of the included studies was approximately 54 months with a range of 11 to 120 months. Of the noted patients, the average AOFAS hindfoot score prior to treatment was 61.7 points and following arthroscopic debridement and microfracture was 86.8 points. This improvement of AOFAS hindfoot score correlated with 80.2 percent of patients reviewed reporting good to excellent results.
Conclusions:
Through systematic review it has been shown that arthroscopic debridement and microfracture of osteochondral lesions is a viable treatment option with greater than 80 percent of individuals included in the studies reviewed describing a good to excellent result following this treatment modality. The article does point out that further investigation in terms of a prospective study would help to validate the noted results and conclusion.