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Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy 4/2016

01.02.2016 | Ankle

Long-term results of microfracture in the treatment of talus osteochondral lesions

verfasst von: Gökhan Polat, Ali Erşen, Mehmet Emin Erdil, Taha Kızılkurt, Önder Kılıçoğlu, Mehmet Aşık

Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy | Ausgabe 4/2016

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Abstract

Purpose

Osteochondral lesions of the talus are common injuries, and many clinicians consider arthroscopic debridement and microfracture as the first-stage treatment. This study assessed the long-term clinical and radiographic outcomes of arthroscopic debridement and microfracture for osteochondral lesions of the talus.

Methods

A total of 82 patients (48 males, 34 females) who were treated with arthroscopic debridement and microfracture for osteochondral lesions of the talus between 1996 and 2009 with a minimum 5-year follow-up were included in our study group. Functional scores (AOFAS, VAS) and ankle range of motion were determined, and an arthrosis evaluation was performed. Subgroup evaluations based on age, lesion localization, and defect size were performed using functional outcome correlations.

Results

The mean age of the patients was 35.9 ± 13.4 years (14–69 years), and the mean follow-up period was 121.3 months (61–217 months). The mean defect size was 1.7 ± 0.7 cm2 (0.25–5). The mean pre-operative AOFAS score was 58.7 ± 5.2 (49–75), and the mean post-operative AOFAS score was 85.5 ± 9.9 (56–100). At the last follow-up, 35 patients (42.6 %) had no symptoms and 19 patients (23.1 %) had pain after walking more than 2 h or after competitive sports activities. Radiological assessments of arthrosis revealed that no patient had grade 4 arthritis but that 27 patients (32.9 %) had a one-stage increase in their arthrosis level. Subgroup analyses of the lesion location demonstrated that lateral lesions had significantly better functional results (p = 0.02).

Conclusions

Arthroscopic debridement and microfracture provide a good option for the treatment of osteochondral lesions of the talus over the long term in select patients. Functional outcomes do not correlate with defect size or patient age. Orthopaedic surgeons should adopt the microfracture technique, which is minimally invasive and effective for treating osteochondral lesions of the talus.

Level of evidence

IV.
Literatur
1.
Zurück zum Zitat Anders S, Lechler P, Rackl W, Grifka J, Schaumburger J (2012) Fluoroscopy-guided retrograde core drilling and cancellous bone grafting in osteochondral defects of the talus. Int Orthop 36(8):1635–1640CrossRefPubMedPubMedCentral Anders S, Lechler P, Rackl W, Grifka J, Schaumburger J (2012) Fluoroscopy-guided retrograde core drilling and cancellous bone grafting in osteochondral defects of the talus. Int Orthop 36(8):1635–1640CrossRefPubMedPubMedCentral
3.
Zurück zum Zitat Becher C, Thermann H (2005) Results of microfracture in the treatment of articular cartilage defects of the talus. Foot Ankle Int 26(8):583–589PubMed Becher C, Thermann H (2005) Results of microfracture in the treatment of articular cartilage defects of the talus. Foot Ankle Int 26(8):583–589PubMed
4.
Zurück zum Zitat Choi WJ, Kim BS, Lee JW (2012) Osteochondral lesion of the talus: could age be an indication for arthroscopic treatment? Am J Sports Med 40(2):419–424CrossRefPubMed Choi WJ, Kim BS, Lee JW (2012) Osteochondral lesion of the talus: could age be an indication for arthroscopic treatment? Am J Sports Med 40(2):419–424CrossRefPubMed
5.
Zurück zum Zitat Chuckpaiwong B, Berkson EM, Theodore GH (2008) Microfracture for osteochondral lesions of the ankle: outcome analysis and outcome predictors of 105 cases. Arthroscopy 24(1):106–112CrossRefPubMed Chuckpaiwong B, Berkson EM, Theodore GH (2008) Microfracture for osteochondral lesions of the ankle: outcome analysis and outcome predictors of 105 cases. Arthroscopy 24(1):106–112CrossRefPubMed
6.
Zurück zum Zitat Correia SI, Pereira H, Silva-Correia J, Van Dijk CN, Espregueira-Mendes J, Oliveira JM, Reis RL (2014) Current concepts: tissue engineering and regenerative medicine applications in the ankle joint. J R Soc Interface 11(92):20130784CrossRefPubMedPubMedCentral Correia SI, Pereira H, Silva-Correia J, Van Dijk CN, Espregueira-Mendes J, Oliveira JM, Reis RL (2014) Current concepts: tissue engineering and regenerative medicine applications in the ankle joint. J R Soc Interface 11(92):20130784CrossRefPubMedPubMedCentral
7.
Zurück zum Zitat Donnenwerth MP, Roukis TS (2012) Outcome of arthroscopic debridement and microfracture as the primary treatment for osteochondral lesions of the talar dome. Arthroscopy 28(12):1902–1907CrossRefPubMed Donnenwerth MP, Roukis TS (2012) Outcome of arthroscopic debridement and microfracture as the primary treatment for osteochondral lesions of the talar dome. Arthroscopy 28(12):1902–1907CrossRefPubMed
8.
Zurück zum Zitat El-Rashidy H, Villacis D, Omar I, Kelikian AS (2011) Fresh osteochondral allograft for the treatment of cartilage defects of the talus: a retrospective review. J Bone Joint Surg Am 93(17):1634–1640CrossRefPubMed El-Rashidy H, Villacis D, Omar I, Kelikian AS (2011) Fresh osteochondral allograft for the treatment of cartilage defects of the talus: a retrospective review. J Bone Joint Surg Am 93(17):1634–1640CrossRefPubMed
9.
Zurück zum Zitat Ferkel RD, Zanotti RM, Komenda GA, Sgaglione NA, Cheng MS, Applegate GR, Dopirak RM (2008) Arthroscopic treatment of chronic osteochondral lesions of the talus: long-term results. Am J Sports Med 36(9):1750–1762CrossRefPubMed Ferkel RD, Zanotti RM, Komenda GA, Sgaglione NA, Cheng MS, Applegate GR, Dopirak RM (2008) Arthroscopic treatment of chronic osteochondral lesions of the talus: long-term results. Am J Sports Med 36(9):1750–1762CrossRefPubMed
10.
Zurück zum Zitat Giannini S, Buda R, Vannini F, Di Caprio F, Grigolo B (2008) Arthroscopic autologous chondrocyte implantation in osteochondral lesions of the talus: surgical technique and results. Am J Sports Med 36(5):873–880CrossRefPubMed Giannini S, Buda R, Vannini F, Di Caprio F, Grigolo B (2008) Arthroscopic autologous chondrocyte implantation in osteochondral lesions of the talus: surgical technique and results. Am J Sports Med 36(5):873–880CrossRefPubMed
11.
Zurück zum Zitat Hangody L (2003) The mosaicplasty technique for osteochondral lesions of the talus. Foot Ankle Clin 8(2):259–273CrossRefPubMed Hangody L (2003) The mosaicplasty technique for osteochondral lesions of the talus. Foot Ankle Clin 8(2):259–273CrossRefPubMed
12.
Zurück zum Zitat Hannon CP, Smyth NA, Murawski CD, Savage-Elliott I, Deyer TW, Calder JD, Kennedy JG (2014) Osteochondral lesions of the talus: aspects of current management. Bone Joint J 96(2):164–171CrossRefPubMed Hannon CP, Smyth NA, Murawski CD, Savage-Elliott I, Deyer TW, Calder JD, Kennedy JG (2014) Osteochondral lesions of the talus: aspects of current management. Bone Joint J 96(2):164–171CrossRefPubMed
13.
Zurück zum Zitat Kreuz PC, Steinwachs M, Erggelet C, Lahm A, Henle P, Niemeyer P (2006) Mosaicplasty with autogenous talar autograft for osteochondral lesions of the talus after failed primary arthroscopic management: a prospective study with a 4-year follow-up. Am J Sports Med 34(1):55–63CrossRefPubMed Kreuz PC, Steinwachs M, Erggelet C, Lahm A, Henle P, Niemeyer P (2006) Mosaicplasty with autogenous talar autograft for osteochondral lesions of the talus after failed primary arthroscopic management: a prospective study with a 4-year follow-up. Am J Sports Med 34(1):55–63CrossRefPubMed
14.
Zurück zum Zitat Lee KB, Bai LB, Chung JY, Seon JK (2010) Arthroscopic microfracture for osteochondral lesions of the talus. Knee Surg Sports Traumatol Arthrosc 18(2):247–253CrossRefPubMed Lee KB, Bai LB, Chung JY, Seon JK (2010) Arthroscopic microfracture for osteochondral lesions of the talus. Knee Surg Sports Traumatol Arthrosc 18(2):247–253CrossRefPubMed
15.
Zurück zum Zitat Magnan B, Samaila E, Bondi M, Vecchini E, Micheloni GM, Bartolozzi P (2012) Three-dimensional matrix-induced autologous chondrocytes implantation for osteochondral lesions of the talus: midterm results. Adv Orthop 2012:942174PubMedPubMedCentral Magnan B, Samaila E, Bondi M, Vecchini E, Micheloni GM, Bartolozzi P (2012) Three-dimensional matrix-induced autologous chondrocytes implantation for osteochondral lesions of the talus: midterm results. Adv Orthop 2012:942174PubMedPubMedCentral
16.
Zurück zum Zitat Murawski CD, Foo LF, Kennedy JG (2010) A review of arthroscopic bone marrow stimulation techniques of the talus: the good, the bad, and the causes for concern. Cartilage 1(2):137–144CrossRefPubMedPubMedCentral Murawski CD, Foo LF, Kennedy JG (2010) A review of arthroscopic bone marrow stimulation techniques of the talus: the good, the bad, and the causes for concern. Cartilage 1(2):137–144CrossRefPubMedPubMedCentral
17.
Zurück zum Zitat Murawski CD, Kennedy JG (2013) Operative treatment of osteochondral lesions of the talus. J Bone Joint Surg Am 95(11):1045–1054CrossRefPubMed Murawski CD, Kennedy JG (2013) Operative treatment of osteochondral lesions of the talus. J Bone Joint Surg Am 95(11):1045–1054CrossRefPubMed
18.
Zurück zum Zitat Niemeyer P, Salzmann G, Schmal H, Mayr H, Südkamp NP (2012) Autologous chondrocyte implantation for the treatment of chondral and osteochondral defects of the talus: a meta-analysis of available evidence. Knee Surg Sports Traumatol Arthrosc 20(9):1696–1703CrossRefPubMed Niemeyer P, Salzmann G, Schmal H, Mayr H, Südkamp NP (2012) Autologous chondrocyte implantation for the treatment of chondral and osteochondral defects of the talus: a meta-analysis of available evidence. Knee Surg Sports Traumatol Arthrosc 20(9):1696–1703CrossRefPubMed
19.
Zurück zum Zitat O’Loughlin PF, Heyworth BE, Kennedy JG (2010) Current concepts in the diagnosis and treatment of osteochondral lesions of the ankle. Am J Sports Med 38(2):392–404CrossRefPubMed O’Loughlin PF, Heyworth BE, Kennedy JG (2010) Current concepts in the diagnosis and treatment of osteochondral lesions of the ankle. Am J Sports Med 38(2):392–404CrossRefPubMed
20.
Zurück zum Zitat Paul J, Sagstetter M, Lämmle L, Spang J, El-Azab H, Imhoff AB, Hinterwimmer S (2012) Sports activity after osteochondral transplantation of the talus. Am J Sports Med 40(4):870–874CrossRefPubMed Paul J, Sagstetter M, Lämmle L, Spang J, El-Azab H, Imhoff AB, Hinterwimmer S (2012) Sports activity after osteochondral transplantation of the talus. Am J Sports Med 40(4):870–874CrossRefPubMed
21.
Zurück zum Zitat Robinson DE, Winson IG, Harries WJ, Kelly AJ (2003) Arthroscopic treatment of osteochondral lesions of the talus. J Bone Joint Surg Br 85(7):989–993CrossRefPubMed Robinson DE, Winson IG, Harries WJ, Kelly AJ (2003) Arthroscopic treatment of osteochondral lesions of the talus. J Bone Joint Surg Br 85(7):989–993CrossRefPubMed
22.
Zurück zum Zitat Savage-Elliott I, Ross KA, Smyth NA, Murawski CD, Kennedy JG (2014) Osteochondral lesions of the talus: a current concepts review and evidence-based treatment paradigm. Foot Ankle Spec 7(5):414–422CrossRefPubMed Savage-Elliott I, Ross KA, Smyth NA, Murawski CD, Kennedy JG (2014) Osteochondral lesions of the talus: a current concepts review and evidence-based treatment paradigm. Foot Ankle Spec 7(5):414–422CrossRefPubMed
23.
Zurück zum Zitat Takao M, Ochi M, Naito K, Uchio Y, Kono T, Oae K (2003) Arthroscopic drilling for chondral, subchondral, and combined chondral-subchondral lesions of the talar dome. Arthroscopy 19(5):524–530CrossRefPubMed Takao M, Ochi M, Naito K, Uchio Y, Kono T, Oae K (2003) Arthroscopic drilling for chondral, subchondral, and combined chondral-subchondral lesions of the talar dome. Arthroscopy 19(5):524–530CrossRefPubMed
24.
Zurück zum Zitat Takakura Y, Tanaka Y, Kumai T, Tamai S (1995) Low tibial osteotomy for osteoarthritis of the ankle. Results of a new operation in 18 patients. J Bone Joint Surg Br 77(1):50–54PubMed Takakura Y, Tanaka Y, Kumai T, Tamai S (1995) Low tibial osteotomy for osteoarthritis of the ankle. Results of a new operation in 18 patients. J Bone Joint Surg Br 77(1):50–54PubMed
25.
Zurück zum Zitat Ulstein S, Årøen A, Røtterud JH (2014) Microfracture technique versus osteochondral autologous transplantation mosaicplasty in patients with articular chondral lesions of the knee: a prospective randomized trial with long-term follow-up. Knee Surg Sports Traumatol Arthrosc 22(6):1207–1215CrossRefPubMedPubMedCentral Ulstein S, Årøen A, Røtterud JH (2014) Microfracture technique versus osteochondral autologous transplantation mosaicplasty in patients with articular chondral lesions of the knee: a prospective randomized trial with long-term follow-up. Knee Surg Sports Traumatol Arthrosc 22(6):1207–1215CrossRefPubMedPubMedCentral
26.
Zurück zum Zitat Valderrabano V, Leumann A, Rasch H, Egelhof T, Hintermann B, Pagenstert G (2009) Knee-to-ankle mosaicplasty for the treatment of osteochondral lesions of the ankle joint. Am J Sports Med 37(Suppl 1):105S–111SCrossRefPubMed Valderrabano V, Leumann A, Rasch H, Egelhof T, Hintermann B, Pagenstert G (2009) Knee-to-ankle mosaicplasty for the treatment of osteochondral lesions of the ankle joint. Am J Sports Med 37(Suppl 1):105S–111SCrossRefPubMed
27.
Zurück zum Zitat van Bergen CJ, de Leeuw PA, van Dijk CN (2008) Treatment of osteochondral defects of the talus. Rev Chir Orthop Rep Appar Mot 94(8 Suppl):398–408CrossRef van Bergen CJ, de Leeuw PA, van Dijk CN (2008) Treatment of osteochondral defects of the talus. Rev Chir Orthop Rep Appar Mot 94(8 Suppl):398–408CrossRef
28.
Zurück zum Zitat Van Bergen CJ, Kox LS, Maas M, Sierevelt IN, Kerkhoffs GM, van Dijk CN (2013) Arthroscopic treatment of osteochondral defects of the talus: outcomes at eight to 20 years of follow-up. J Bone Joint Surg Am 95(6):519–525CrossRefPubMed Van Bergen CJ, Kox LS, Maas M, Sierevelt IN, Kerkhoffs GM, van Dijk CN (2013) Arthroscopic treatment of osteochondral defects of the talus: outcomes at eight to 20 years of follow-up. J Bone Joint Surg Am 95(6):519–525CrossRefPubMed
29.
Zurück zum Zitat Yoshimura I, Kanazawa K, Takeyama A, Angthong C, Ida T, Hagio T, Hanada H, Naito M (2013) Arthroscopic bone marrow stimulation techniques for osteochondral lesions of the talus: prognostic factors for small lesions. Am J Sports Med 41(3):528–534CrossRefPubMed Yoshimura I, Kanazawa K, Takeyama A, Angthong C, Ida T, Hagio T, Hanada H, Naito M (2013) Arthroscopic bone marrow stimulation techniques for osteochondral lesions of the talus: prognostic factors for small lesions. Am J Sports Med 41(3):528–534CrossRefPubMed
30.
Zurück zum Zitat Zengerink M, Struijs PA, Tol JL, van Dijk CN (2010) Treatment of osteochondral lesions of the talus: a systematic review. Knee Surg Sports Traumatol Arthrosc 18(2):238–246CrossRefPubMedPubMedCentral Zengerink M, Struijs PA, Tol JL, van Dijk CN (2010) Treatment of osteochondral lesions of the talus: a systematic review. Knee Surg Sports Traumatol Arthrosc 18(2):238–246CrossRefPubMedPubMedCentral
Metadaten
Titel
Long-term results of microfracture in the treatment of talus osteochondral lesions
verfasst von
Gökhan Polat
Ali Erşen
Mehmet Emin Erdil
Taha Kızılkurt
Önder Kılıçoğlu
Mehmet Aşık
Publikationsdatum
01.02.2016
Verlag
Springer Berlin Heidelberg
Erschienen in
Knee Surgery, Sports Traumatology, Arthroscopy / Ausgabe 4/2016
Print ISSN: 0942-2056
Elektronische ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-016-3990-8

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