Abstract
PurposeThe purpose of this study was to describe the mid-term clinical and radiological results of a novel arthroscopic fixation technique for primary osteochondral defects (OCD) of the talus, named the lift, drill, fill and fix (LDFF) technique.MethodsTwenty-seven ankles (25 patients) underwent an arthroscopic LDFF procedure for primary fixable talar OCDs. The mean follow-up was 27 months (SD 5). Pre- and post-operative clinical assessments were prospectively performed by measuring the Numeric Rating Scale (NRS) of pain in/at rest, walking and when running. Additionally, the Foot and Ankle Outcome Score (FAOS) and the Short Form-36 (SF-36) were used to assess clinical outcome. The patients were radiologically assessed by means of computed tomography (CT) scans pre-operatively and 1 year post-operatively.ResultsThe mean NRS during running significantly improved from 7.8 pre-operatively to 2.9 post-operatively (p = 0.006), the NRS during walking from 5.7 to 2.0 (p < 0.001) and the NRS in rest from 2.3 to 1.2 (p = 0.015). The median FAOS at final follow-up was 86 for pain, 63 for other symptoms, 95 for activities of daily living, 70 for sport and 53 for quality of life. A pre- and post-operative score comparison was available for 16 patients, and improved significantly in most subscores. The SF-36 physical component scale significantly improved from 42.9 to 50.1. Of the CT scans at 1 year after surgery, 81% showed a flush subchondral bone plate and 92% of OCDs showed union.ConclusionArthroscopic LDFF of a fixable primary talar OCD results in excellent improvement of clinical outcomes. The radiological follow-up confirms that fusion of the fragment is feasible in 92%. This technique could be regarded as the new gold standard for the orthopedic surgeon comfortable with arthroscopic procedures.Level of evidenceProspective case series, therapeutic level IV.
Highlights
Management of talar osteochondral defects (OCD) is still a challenge
Previous studies have shown that the quality of fibrocartilage decreases over time, that it shows inferior wear characteristics, and it has been proven that the subchondral bone plate shows irregularities
The contraindications were ankle osteoarthritis grade II or grade III [39], type IV OCDs according to the modified Berndt and Harty classification scale [3, 19], rheumatoid arthritis, chondral lesions, a concomitant defect in the tibia, an ankle fracture < 6 months old, tendinopathy, advanced osteoporosis, concomitant painful or disabling disease of the lower limb and infectious pathology or any kind of malignancy
Summary
Multiple factors are to be taken into account when determining the best available treatment. There are numerous surgical treatment strategies available, with a substantial increase in the number of procedures over the past decades. For primary talar OCDs, bone marrow stimulation is the most frequently performed treatment [5]. This technique has shown good clinical results at short-term and mid-term follow-up [5, 11, 17]. It aims at focusing on the intrinsic capacity of the ankle to heal the cartilage due to the formation of fibrocartilage [24]. Previous studies have shown that the quality of fibrocartilage decreases over time, that it shows inferior wear characteristics, and it has been proven that the subchondral bone plate shows irregularities
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