Background
Treatment of osteochondral lesions of the talus (OLTs) in children presents a difficult clinical challenge, with few large series reported.
Purpose
To evaluate functional and radiographic outcomes for children and adolescents undergoing arthroscopic treatment of symptomatic OLT with a minimum follow-up of 2 years.
Methods
Study Design: Case series; Level of evidence, 4.
- Patients were identified who had symptomatic OLT treated arthroscopically with marrow stimulation techniques.
- Inclusion criteria were age ≤18 years, symptomatic chronic OLT as the surgical indication, failure of nonoperative treatment, and minimum follow-up of 24 months.
- Outcome measures included Foot Function Index, American Orthopaedic Foot and Ankle Society Hindfoot Score, Tegner Activity Scale, 36-Item Short Form Health Survey (Short Form-36, v 2), visual analog scale, ankle range of motion, and patient satisfaction survey.
- Weightbearing radiographs were compared with preoperative radiographs via an ankle arthritis classification system.
- Magnetic resonance imaging (MRI) was used to evaluate postoperative lesion characteristics per the MOCART scale (magnetic resonance observation of cartilage repair tissue).
- The size, location, lesion stability, traumatic etiology, skeletal maturity, and length of follow-up were recorded and analyzed through univariate logistic regression.
Results
- The study group consisted of 22 patients (11 male, 11 female) with a mean age of 14.4 years (range, 8-18 years) and a mean follow-up of 8.3 years (range, 2-27 years).
- Of 22 patients, 20 were satisfied with the results from surgery and would recommend it to others.
- Mean follow-up visual analog scale for pain was reported as 2.2 on a 10-point scale, and mean American Orthopaedic Foot and Ankle Society score at follow-up was 86.6.
- Mean postoperative Foot Function Index scores for the study group were as follows: pain, 17.1; disability, 16.5; activity, 4.7; and overall, 38.7.
- Mean Short Form-36 physical component score was 50.7.
- Postoperative radiographs indicated a van Dijk osteoarthritis grade of 0 in 56%, I in 38%, II in 6%, and III in 0%.
- Postoperative MRI MOCART scores showed complete filling of the cartilage in 27% of cases, complete graft integration in 22%, and intact repair surface in 22%, with a mean MOCART score of 48.0.
- No correlation was found between radiographic and MRI findings and clinical outcomes.
- None of the prognostic factors were significantly associated with patient satisfaction, progression of arthritis, or MOCART scores.
Conclusions
Arthroscopic treatment of symptomatic OLT in adolescent patients (≤18 years) demonstrated high functional outcomes, high clinical satisfaction rates, and minimal radiographic osteoarthritic progression despite low MOCART scores.
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