SLR - August 2023 - Sarah Mansager, DPM
Title: Talar OsteoPeriostic Grafting from the Iliac Crest (TOPIC): Two-Year Prospective Results of a Novel Press-Fit Surgical Technique for Large, Complex Osteochondral Lesions of the Medial TalusReference: Dahmen J, Rikken Q, Stufkens SAS, Kerkhoffs GMMJ. Talar OsteoPeriostic Grafting from the Iliac Crest (TOPIC): Two-Year Prospective Results of a Novel Press-Fit Surgical Technique for Large, Complex Osteochondral Lesions of the Medial Talus. J Bone Joint Surg Am. 2023 Jun 26.
Level of Evidence: Therapeutic Level IV
Scientific Literature Review
Reviewed By: Sarah Mansager, DPM
Residency Program: MedStar Washington Hospital Center/MedStar Georgetown University Hospital
Podiatric Relevance: Techniques for single stage surgical treatment of large osteochondral lesions of the talus do not have a clear consensus for which is considered to be the best treatment modality. Autologous osteochondral transplantation has been utilized for talar defects >10mm in size, however, this procedure is not without its own complications and disadvantages. This study aims to illustrate the TOPIC procedure as a clinically effective and safe technique for treatment of large medial osteochondral defects of the talus, specifically in regard to donor-site morbidity, and graft nonunion or failure.
Methods: This is a prospective, single-center, non-randomized, clinical cohort study with a 2-year follow up, including 43 patients with a large (>10mm in anteroposterior and/or mediolateral and/or depth) symptomatic medial osteochondral lesion of the talus who were managed with the TOPIC procedure. Clinical outcomes were evaluated via comparison of preoperative and postoperative patient-reported measures from the NRS, FAOS, MCS, PCS, and AOFAS scoring systems. In addition, computed tomography was utilized to determine graft consolidation and cyst development postoperatively.
Results: The primary outcome was the comparison between the NRS score for pain during walking preoperatively versus postoperatively. The improvements documented were considered to be highly effective. Additionally, all other NRS scores for pain were noted to have significant improvements. These results were reflected within all FAOS subscales scores. Outside of the patient reported measures, there was a 100% rate of union at the distal tibial osteotomy site and consolidation of the graft assessed through CT. The additional measure of cyst formation was documented to be 48% at 1 year postoperatively and 67% at 2 years postoperatively. There were 4 complications noted within the study: Two cases of hypoesthesia, one case of CRPS, and one graft fracture at 23 months postoperatively.
Conclusions: The TOPIC procedure attempts to offer an additional approach in treatment of large OCD lesions, and serves as an alternative to autologous osteochondral transplantation, bulk allograft, arthrodesis, and ankle replacement. The technique analyzed demonstrates clinically significant differences in pain scores through a short-term assessment. Further studies are needed to evaluate long term outcomes associated with the proposed procedure. In addition to long-term outcome studies, it would be imperative to test the study hypothesis with varying locations of osteochondral lesions within the talus. Addressing central and lateral lesions may present new or more prevalent complications, possible needs for additional surgical procedures, and/or notable increases in donor-site morbidity.