Ferkel, Am J Sports Med 2008 - Arthroscopic Treatment of Chronic Osteochondral Lesions of the Talus: Long-Term Results - Article Summary

Arthroscopic Treatment of Chronic Osteochondral Lesions of the Talus: Long-Term Results

Ferkel, Dopirak, et al.·Am J Sports Med·2008·418 citations·Case series

Background

Osteochondral lesions of the talus are relatively uncommon but may be a cause of significant pain and disability in symptomatic patients.

Purpose

Hypothesis: Arthroscopic treatment of osteochondral lesions of the talus will result in good long-term clinical outcomes in the majority of patients.

Methods

Study Design: Case series; Level of evidence, 4.

50 patients with chronic osteochondral lesions of the talus underwent arthroscopic treatment.
Average age was 32 years (range, 12-72 years).
Average follow-up was 71 months (range, 24-152 months).
Treatment consisted of either drilling of the osteochondral lesions of the talus in situ (n = 4), excision of the osteochondral lesions of the talus and abrasion arthroplasty (n = 6), or excision of the osteochondral lesions of the talus and drilling (n = 40).
Preoperative and intraoperative staging of the osteochondral lesions of the talus was performed.
Follow-up evaluation included 3 clinical rating systems: Alexander, modified Weber, and American Orthopaedic Foot and Ankle Society Ankle/Hindfoot scores.

Results

There were 72% excellent/good, 20% fair, and 8% poor results on the Alexander scale.
According to the modified Weber scale, there were 64% excellent/good, 30% fair, and 6% poor results.
The average American Orthopaedic Foot and Ankle Society Ankle/Hindfoot score was 84 (range, 34-100).
We found no correlation between plain radiographs, computed tomography, or magnetic resonance imaging staging and clinical results.
However, there was significant correlation between arthroscopic stage and clinical outcome.
17 patients had been seen 5 years previously and evaluated using the same criteria; 35% demonstrated a deterioration in their result over time.

Conclusions

Arthroscopic treatment of chronic symptomatic osteochondral lesions of the talus results in good clinical outcomes in the majority of patients. However, pain and functional limitation may persist in some patients, especially those noted to have unstable osteochondral defects at the time of arthroscopy.

Supplemental

Arthroscopic Treatment of Chronic Osteochondral Lesions of the Talus: Long-Term Results.

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Arthroscopic Treatment of Chronic Osteochondral Lesions of the Talus: Long-Term Results

Ferkel, Dopirak, et al.·Am J Sports Med·2008·418 citations·Case series

DOI·PubMed

Background

Osteochondral lesions of the talus are relatively uncommon but may be a cause of significant pain and disability in symptomatic patients.

Purpose

Hypothesis: Arthroscopic treatment of osteochondral lesions of the talus will result in good long-term clinical outcomes in the majority of patients.

Methods

Study Design: Case series; Level of evidence, 4.

50 patients with chronic osteochondral lesions of the talus underwent arthroscopic treatment.
Average age was 32 years (range, 12-72 years).
Average follow-up was 71 months (range, 24-152 months).
Treatment consisted of either drilling of the osteochondral lesions of the talus in situ (n = 4), excision of the osteochondral lesions of the talus and abrasion arthroplasty (n = 6), or excision of the osteochondral lesions of the talus and drilling (n = 40).
Preoperative and intraoperative staging of the osteochondral lesions of the talus was performed.
Follow-up evaluation included 3 clinical rating systems: Alexander, modified Weber, and American Orthopaedic Foot and Ankle Society Ankle/Hindfoot scores.

Results

There were 72% excellent/good, 20% fair, and 8% poor results on the Alexander scale.
According to the modified Weber scale, there were 64% excellent/good, 30% fair, and 6% poor results.
The average American Orthopaedic Foot and Ankle Society Ankle/Hindfoot score was 84 (range, 34-100).
We found no correlation between plain radiographs, computed tomography, or magnetic resonance imaging staging and clinical results.
However, there was significant correlation between arthroscopic stage and clinical outcome.
17 patients had been seen 5 years previously and evaluated using the same criteria; 35% demonstrated a deterioration in their result over time.

Conclusions

Background

Osteochondral lesions of the talus are relatively uncommon but may be a cause of significant pain and disability in symptomatic patients.

Purpose

Hypothesis: Arthroscopic treatment of osteochondral lesions of the talus will result in good long-term clinical outcomes in the majority of patients.

Methods

Study Design: Case series; Level of evidence, 4.

50 patients with chronic osteochondral lesions of the talus underwent arthroscopic treatment.
Average age was 32 years (range, 12-72 years).
Average follow-up was 71 months (range, 24-152 months).
Treatment consisted of either drilling of the osteochondral lesions of the talus in situ (n = 4), excision of the osteochondral lesions of the talus and abrasion arthroplasty (n = 6), or excision of the osteochondral lesions of the talus and drilling (n = 40).
Preoperative and intraoperative staging of the osteochondral lesions of the talus was performed.
Follow-up evaluation included 3 clinical rating systems: Alexander, modified Weber, and American Orthopaedic Foot and Ankle Society Ankle/Hindfoot scores.

Results

There were 72% excellent/good, 20% fair, and 8% poor results on the Alexander scale.
According to the modified Weber scale, there were 64% excellent/good, 30% fair, and 6% poor results.
The average American Orthopaedic Foot and Ankle Society Ankle/Hindfoot score was 84 (range, 34-100).
We found no correlation between plain radiographs, computed tomography, or magnetic resonance imaging staging and clinical results.
However, there was significant correlation between arthroscopic stage and clinical outcome.
17 patients had been seen 5 years previously and evaluated using the same criteria; 35% demonstrated a deterioration in their result over time.

Conclusions

Background

Osteochondral lesions of the talus are relatively uncommon but may be a cause of significant pain and disability in symptomatic patients.

Purpose

Hypothesis: Arthroscopic treatment of osteochondral lesions of the talus will result in good long-term clinical outcomes in the majority of patients.

Methods

Study Design: Case series; Level of evidence, 4.

50 patients with chronic osteochondral lesions of the talus underwent arthroscopic treatment.
Average age was 32 years (range, 12-72 years).
Average follow-up was 71 months (range, 24-152 months).
Treatment consisted of either drilling of the osteochondral lesions of the talus in situ (n = 4), excision of the osteochondral lesions of the talus and abrasion arthroplasty (n = 6), or excision of the osteochondral lesions of the talus and drilling (n = 40).
Preoperative and intraoperative staging of the osteochondral lesions of the talus was performed.
Follow-up evaluation included 3 clinical rating systems: Alexander, modified Weber, and American Orthopaedic Foot and Ankle Society Ankle/Hindfoot scores.

Results

There were 72% excellent/good, 20% fair, and 8% poor results on the Alexander scale.
According to the modified Weber scale, there were 64% excellent/good, 30% fair, and 6% poor results.
The average American Orthopaedic Foot and Ankle Society Ankle/Hindfoot score was 84 (range, 34-100).
We found no correlation between plain radiographs, computed tomography, or magnetic resonance imaging staging and clinical results.
However, there was significant correlation between arthroscopic stage and clinical outcome.
17 patients had been seen 5 years previously and evaluated using the same criteria; 35% demonstrated a deterioration in their result over time.