Abstract
PurposeArthroscopic bone marrow stimulation (BMS) has been considered the primary surgical treatment for osteochondral defects (OCDs) of the talus. However, fixation has been considered as a good alternative. Recently, a new arthroscopic fixation technique was described: the lift, drill, fill and fix procedure (LDFF). The purpose of this study was to evaluate the clinical and radiological results between arthroscopic LDFF and arthroscopic BMS in primary fixable talar OCDs at 1-year follow-up.MethodsIn a prospective comparative study, 14 patients were treated with arthroscopic BMS and 14 patients with arthroscopic LDFF. Pre- and postoperative clinical assessment included the American Orthopaedic Foot and Ankle Society (AOFAS) score and the numeric rating scales (NRSs) of pain at rest and running. Additionally, the level of the subchondral plate (flush or depressed) was analysed on the 1 year postoperative computed tomography scans.ResultsNo significant differences in the AOFAS and NRS pain at rest and running were found between both groups at 1-year follow-up. After LDFF the level of the subchondral bone plate was flush in 10 patients and after BMS in three patients (p = 0.02).ConclusionNo clinical differences were found between arthroscopic LDFF and arthroscopic BMS in the treatment of talar OCDs at 1-year follow-up. However, the subchondral bone plate restores significantly superior after arthroscopic LDFF compared to arthroscopic BMS. It may therefore give less progression of ankle osteoarthritis in the future with a thus potential better long-term outcome.Level of evidenceIII.
Highlights
Osteochondral defects (OCDs) of the talus often have a severe impact on the quality of life of patients [25]
The subchondral bone plate restores significantly superior after arthroscopic LDFF compared to arthroscopic bone marrow stimulation (BMS)
Out of our previous cohort [20], 14 patients were included who were treated with arthroscopic BMS in case of the presence of a fixable talar OCD
Summary
Osteochondral defects (OCDs) of the talus often have a severe impact on the quality of life of patients [25]. Arthroscopic bone marrow stimulation (BMS) has been considered the primary surgical treatment for chronic OCDs up to 15 mm. This preference is based on the ease of execution of the technique, the low complication rate and high success rates reported in the literature [30, 31]. After debridement and bone marrow stimulation the subchondral bone plate is often irregular and depressed [19]. These factors might be the reason why progression of ankle osteoarthritis is seen in 33–34% of the patients at long-term follow-up [4, 16, 24]
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