This prospective case series followed 105 consecutive patients treated with ankle arthroscopy plus microfracture for osteochondral lesions. It asks a practical question: which patients actually benefit, and what predicts success or failure? Outcomes were tracked with VAS pain scores, the Roles and Maudsley score, and AOFAS over a mean 31.6 months.
20 mm: 0/24 successful
When you see a talar osteochondral lesion on MRI, measure it. This paper hands you a usable decision rule: microfracture reliably works below 15 mm and reliably fails above it. For a lesion over 15 mm in a young active patient, counsel toward osteochondral transplantation or autologous chondrocyte implantation rather than expecting microfracture alone to succeed.
A key teaching point: ankle pain is often multifactorial. When instability or anterolateral scar coexists with a small lesion, addressing those mechanical problems concurrently improves results, which is why those patients did better here.
Weight the appraisal appropriately. This is Level IV evidence with no randomization and mean follow-up of only 31 months, so long-term degeneration is unknown. Patients with large lesions self-selected microfracture by refusing more invasive surgery, which limits conclusions about that subgroup.
This prospective case series followed 105 consecutive patients treated with ankle arthroscopy plus microfracture for osteochondral lesions. It asks a practical question: which patients actually benefit, and what predicts success or failure? Outcomes were tracked with VAS pain scores, the Roles and Maudsley score, and AOFAS over a mean 31.6 months.
20 mm: 0/24 successful
When you see a talar osteochondral lesion on MRI, measure it. This paper hands you a usable decision rule: microfracture reliably works below 15 mm and reliably fails above it. For a lesion over 15 mm in a young active patient, counsel toward osteochondral transplantation or autologous chondrocyte implantation rather than expecting microfracture alone to succeed.
A key teaching point: ankle pain is often multifactorial. When instability or anterolateral scar coexists with a small lesion, addressing those mechanical problems concurrently improves results, which is why those patients did better here.
Weight the appraisal appropriately. This is Level IV evidence with no randomization and mean follow-up of only 31 months, so long-term degeneration is unknown. Patients with large lesions self-selected microfracture by refusing more invasive surgery, which limits conclusions about that subgroup.