Outcomes Following Ankle Microfracture Surgery

Abstract

Articular cartilage defects of the ankle can lead to persistent pain and disability and are often the result of trauma. Non-operative management is generally associated with poor outcomes and microfracture surgery has become the first-line treatment for many articular cartilage defects. The purpose of this study is to determine outcomes scores and patient satisfaction following microfracture surgery of the ankle joint. This study was approved by an institutional review board. All patients 18 years or older who underwent ankle microfracture surgery by a single surgeon were included in this study. All data were collected prospectively and stored in a data registry. Intraoperative data and detailed surgical findings were documented at time of surgery. Patients completed a subjective questionnaire at a minimum of one year following ankle surgery. Outcome measures that were collected included Foot and Ankle Disability Index (FADI): Activities of Daily Living (ADL) subscale, Sport subscale, and FADI total score. Lysholm score, Tegner activity scale and patient satisfaction with outcome, which is based on a 10 point scale, with 10 equal to very satisfied, and 1 equal to very unsatisfied, were also collected. There were 41 patients (21 males, 20 females) with a mean age of 42 years (range, 23 – 65 years) who fit inclusion criteria and were included in this study. There were 26 patients (70%) available for follow-up, with a mean follow-up time of 24 mos (range, 12 – 41 months). Mean Lysholm score was 73 (range, 31 – 95). For FADI, mean FADI ADL was 81 (range, 33 – 99), FADI Sport was 60 (range, 13 – 97) and FADI total score was 76 (range, 28 – 98). Median Tegner activity scale was 4 (range, 0 – 8). Median patient satisfaction with outcome was 8 (5 – 10). Four patients (13%) required subsequent surgery following index microfracture surgery. Mean time to second surgery was 17 months (range, 4 – 32). Of these four patients, one had post-traumatic arthritis that required an ankle fusion, one had a persistent articular cartilage defect that required osteochondral bone grafting, one had a recurrent articular cartilage defect that required repeat microfracture and one underwent revision surgery due to persistent pain. Patients reported high levels of satisfaction with outcome following ankle microfracture surgery. Microfracture may be a suitable option for patients who have articular cartilage damage of the ankle. In this study, short-term outcomes indicated that patients were able to regain function and recreational activity levels following ankle microfracture.