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Outcomes Are Favorable After Arthroscopic Treatment of Osteochondritis Dissecans of the Talus

Published:November 04, 2014DOI:https://doi.org/10.1053/j.jfas.2014.09.025

      Abstract

      Arthroscopic treatment of osteochondritis dissecans (OCD) of the talus has resulted in outcomes as good as, or better than, those after arthrotomy. We noted a lack of prospective studies investigating the outcomes of arthroscopic treatment. As such, we conducted a prospective study investigating the functional outcomes, pain scores, patient satisfaction, and expectation scores of patients undergoing arthroscopic treatment of OCD of the talus, hypothesizing that these patients would have good outcomes and satisfaction. A total of 61 patients underwent arthroscopic chondroplasty, removal of loose bodies, and microfracture for OCD of the talus and completed ≥1 year of follow-up. We evaluated patients pre- and postoperatively at 6 and 12 months using the Ankle-Hindfoot score, visual analog scale for pain, and Medical Outcomes Study short-form 36 questionnaires. We also evaluated the patients’ expectations and satisfaction. The mean Ankle-Hindfoot score improved significantly from 53.0 ± 14.3 points preoperatively to 77.8 ± 19.1 at 6 months and 83.1 ± 18.3 at 12 months after arthroscopic treatment (p < .001). The overall scores at the final follow-up visit were excellent for 30 (49%), good for 6 (10%), fair for 18 (30%), and poor for 7 (11%). The patients also experienced significant improvement in the visual analog scale score and physical component score of the short-form 36 questionnaire (p < .001). Of the 61 patients, 67% had their expectations fulfilled and 74% were satisfied with their surgery at 12 months of follow-up. Arthroscopic treatment of OCD of the talus continues to be a successful procedure to alleviate pain and loss of function. It is also associated with improvements to quality of life and good patient satisfaction.

      Level of Clinical Evidence

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      References

        • König F.
        Ueber freie Korper in den Gelenken.
        Deutesche Zeitschr Chir. 1888; 27: 90-109
        • Berndt A.L.
        • Harty M.
        Transchondral fractures (osteochondritis dissecans) of the talus.
        J Bone Joint Surg Am. 1959; 41: 988-1020
        • Hembree W.C.
        • Wittstein J.R.
        • Vinson E.N.
        • Queen R.M.
        • Larose C.R.
        • Singh K.
        • Easley M.E.
        Magnetic resonance imaging features of osteochondral lesions of the talus.
        Foot Ankle Int. 2012; 33: 591-597
        • Tol J.L.
        • Struijs P.A.
        • Bossuyt P.M.
        • Verhagen R.A.
        • van Dijk C.N.
        Treatment strategies in osteochondral defects of the talar dome: a systematic review.
        Foot Ankle Int. 2000; 21: 119-126
        • Gaulrapp H.
        • Hagena F.W.
        • Wasmer G.
        Postoperative evaluation of osteochondrosis dissecans of the talus with special reference to medial malleolar osteotomy.
        Z Orthp Ihre Grenzgeb. 1996; 134: 346-353
        • Ogilvie-Harris D.J.
        • Sarrosa E.A.
        Arthroscopic treatment of osteochondritis dissecans of the talus.
        Arthroscopy. 1999; 15: 805-808
        • Steadman J.R.
        • Briggs K.K.
        • Rodrigo J.J.
        • Kocher M.S.
        • Gill T.J.
        • Rodkey W.G.
        Outcomes of microfracture for traumatic chondral defects of the knee: average 11-year followup.
        Arthroscopy. 2003; 5: 477-484
        • Gautier E.
        • Kolker D.
        • Jakob R.P.
        Treatment of cartilage defects of the talus by autologous osteochondral grafts.
        J Bone Joint Surg Br. 2001; 84: 237-244
        • Woelfle J.V.
        • Reichel H.
        • Javaheripour-Otto K.
        • Nelitz M.
        Clinical outcome and magnetic resonance imaging after osteochondral autologous transplantation in osteochondritis dissecans of the talus.
        Foot Ankle Int. 2013; 34: 173-179
        • Emre T.Y.
        • Ege T.
        • Cift H.T.
        • Demircioğlu D.T.
        • Seyhan B.
        • Uzun M.
        Open mosaicplasty in osteochondral lesions of the talus: a prospective study.
        Foot Ankle Surg. 2012; 51: 556-560
        • Giannini S.
        • Battaglia M.
        • Buda R.
        • Cavallo M.
        • Ruffilli A.
        • Vannini F.
        Surgical treatment of osteochondral lesions of the talus by open-field autologous chondrocyte implantation: a 10-year followup clinical and magnetic resonance imaging T2-mapping evaluation.
        Am J Sports Med. 2009; 37: 112S-118S
        • Schneider T.E.
        • Karaikudi S.
        Matrix-induced autologous chondrocyte implantation (MACI) grafting for osteochondral lesions of the talus.
        Foot Ankle Int. 2009; 30: 810-814
        • Becher C.
        • Thermann H.
        Results of microfracture in the treatment of articular cartilage defects of the talus.
        Foot Ankle Int. 2005; 26: 583-589
        • Siow H.M.
        • Tay D.K.
        • Mitra A.K.
        Arthroscopic treatment of osteochondritis dissecans of the talus.
        Foot Ankle Surg. 2004; 10: 181-186
        • Schuman L.
        • Struijs P.A.
        • van Dijk C.N.
        Arthroscopic treatment for osteochondral defects of the talus: results at followup at 2 to 11 years.
        J Bone Joint Surg Br. 2002; 84: 364-368
        • Kumai T.
        • Takakura Y.
        • Higashiyama I.
        • Tamai S.
        Arthroscopic drilling for the treatment of osteochondral lesions of the talus.
        J Bone Joint Surg Am. 1999; 81: 1229-1235
        • Pritsch M.
        • Horoshovski H.
        • Farine I.
        Arthroscopic treatment of osteochondral lesions of the talus.
        J Bone Joint Surg Am. 1986; 68: 862-865
        • Baker C.L.
        • Andrews J.R.
        • Ryan J.B.
        Arthroscopic treatment of transchondral talar dome fractures.
        Arthroscopy. 1986; 2: 82-87
        • Kitaoka H.B.
        • Patzer G.L.
        Analysis of clinical grading scales for the foot and ankle.
        Foot Ankle Int. 1997; 18: 443-446
        • Ibrahim T.
        • Beiri A.
        • Azzabi M.
        • Best A.J.
        • Taylor G.J.
        • Menon D.K.
        Reliability and validity of the subjective component of the American Orthopaedic Foot and Ankle Society clinical rating scales.
        J Foot Ankle Surg. 2007; 46: 65-74
        • Ware J.E.
        • Sherbourne C.D.
        The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection.
        Med Care. 1992; 30: 473-483
        • Ware Jr., J.E.
        • Kosinski M.
        • Bayliss M.S.
        • McHorney C.A.
        • Rogers W.H.
        • Raczek A.
        Comparison of methods for the scoring and statistical analysis of SF-36 health profile and summary measures: summary of results from the Medical Outcomes Study.
        Med Care. 1995; 33: AS264-AS479
        • Savva N.
        • Jabur M.
        • Davies M.
        • Saxby T.
        Osteochondral lesions of the talus: results of repeat arthroscopic debridement.
        Foot Ankle Int. 2007; 28: 669-673
        • Janse A.J.
        • Gemke R.J.
        • Uiterwaal C.S.
        • van der Tweel I.
        • Kimpen J.L.
        • Sinnema G.
        Quality of life: patients and doctors don't always agree: a meta-analysis.
        J Clin Epidemiol. 2004; 57: 653-661
        • Pettine K.A.
        • Morrey B.F.
        Osteochondral fractures of the talus: a long-term followup.
        J Bone Joint Surg Br. 1987; 69-B: 89-92