Clinical Outcomes of Osteochondral Lesions of the Tibial Plafond Following Arthroscopic Microfracture

Abstract

Category: Ankle, Arthroscopy Introduction/Purpose: There is little data regarding osteochondral lesions of the tibial plafond with only a few studies reporting clinical outcomes after arthroscopic treatment. The purpose of this study is to evaluate the clinical outcomes and the level of sports activities following arthroscopic microfracture for osteochondral lesions of the tibial plafond. Methods: A retrospective review was conducted for all patients who underwent arthroscopic microfracture surgery for ankle osteochondral lesions from January 2014 to June 2017. For functional evaluation, the Visual Analog Scale (VAS) pain score, Foot and Ankle Ability Measure (FAAM) score, and Short Form-12 (SF-12) general health questionnaire were used. We also investigated the level of sports activity before and after the surgery. Results: 16 patients were included in the study, and the mean follow-up period was 29.8 months. The mean FAAM score was significantly improved from 57.6 (range, 6.0-88.9) for the activities of daily living subscale and 34.5 (range, 3.1-92.6) for the sports subscale to 84.3 (range, 46.4-100.0) and 65.2 (range, 23.3-55.1) for each subscale respectively at the final follow-up. There were also significant improvements in SF-12 score, from 36.3 (range, 23.3- 55.1) to 46.0 (range, 18.9-56.6) for SF-12 PCS, and from 41.3 (range, 14.2-65.0) to 52.6 (range, 32.8-60.8) for SF-12 MCS at the final follow-up. Although 16 of 16 (100%) were able to return to their sports activity, the level of sports activity was lower than their level before the surgery. Conclusion: Arthroscopic microfracture provided satisfactory clinical outcomes for osteochondral lesions of the tibial plafond. Though one hundred percentage of patients were able to return to sports activity after the surgery, the level of sports activity was lower than their level before the surgery.

Osteochondral Lesions of the Distal Tibial Plafond: A Systematic Review of Lesion Locations and Treatment Outcomes

“…Ten articles were included in the review (Figure 1, Table 1). 2,3,5,10,13,18,20,24,29,36 All studies were published in 2000 or later and were deemed level 4 evidence, except for Elias et al 15 The mean Methodological Index for Non-randomized Studies score of the 5 surgical treatment studies 3,12,23,27,33 was 8.6 (range, 8-10); each of these was a noncomparative case series.…”

“…12,23,33 Cuttica et al 12 noted a return to unrestricted activity 20.9 ± 9.7 weeks after microfracture, with those with isolated lesions returning 4.1 weeks earlier compared with those with coexisting lesions (19.7 ± 9.2 vs 23.8 ± 11.7 weeks). This time frame was shorter than the mean 6.3 months (range, 2-22 months) for return to activity reported by Ross et al 33 Lee et al 23 found significant improvements in the Foot and Ankle Ability Measure-Sports subscale (from 34.5 ± 26.0 to 65.2 ± 30.2; P < .001) and reported 100% return to sports; however, they also noted a significant decrease in level of sports activity as defined by impact, with a larger proportion of patients performing lower-impact activity postoperatively (from 12.5% preoperatively to 62.5% postoperatively; P ¼ .012). Future studies evaluating return-to-sports outcomes after OLTPs should incorporate details on the type of sports, the level of activity, patient satisfaction with activity level or performance, and timing.…”

“…Six studies 3,12,21,23,27,33 evaluating clinical or functional measures after treatment were included (Table 4). Three studies 3,12,27 utilized the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale; 2 studies, 21,33 the Foot and Ankle Outcome Score (FAOS); and 2 studies, 23,33 the 12-Item Short Form Health Survey (SF-12). The treatments varied.…”

“…Irwin et al 21 treated OLTs with bone marrow stimulation or autologous osteochondral transplantation and reported no difference in functional outcomes in those with coexisting tibial lesions. Lee et al 23 and Ross et al 33 primarily utilized arthroscopic microfracture/bone marrow stimulation techniques. Lee et al noted significantly improved visual analog scale for pain scores (from 8.3 ± 1.2 to 1.8 ± 1.2; P < .001) in addition to significantly improved Foot and Ankle Ability Measure and SF-12 scores; however, the effect of sports activity in this cohort decreased after treatment (P ¼ .012).…”

Relationship Between Tibiotalar Joint Space and Ankle Function Following Ankle Surgery

“…7 Previous studies have reported a mean FAAM ADL score of 82.4 to 84.3 and a mean FAAM Sports score of 63.4 to 89.3 at least 12 months following surgery for osteochondral lesions with microfracture surgery, autograft, or allograft. 1,2,5,15 At least 24 months following TAR, studies have reported a mean FAAM ADL score of 81.7 to 82.2 and a mean FAAM Sports score of 57.3 to 59.5. 18,22 Following AA, the FAAM ADL and the FAAM Sports scores were 71.3 to 74.9 and 43.4 to 53.5, respectively.…”