Higher preoperative range of motion is predictive of good mid-term results in the surgical management of osteochondral lesions of the talus: a prospective multicentric study

Abstract

Introduction Osteochondral lesions of the talus (OLT) are a frequent cause of pain in young patients and a new CT arthrographic classiication system of OLT was recently proposed to help guide the choices of and standardize the indications for surgical treatment. The primary hypothesis was that this algorithm would result in a postoperative AOFAS score of ≥ 80/100. The secondary hypothesis was to identify the preoperative factors of successful surgery. Methods This was a prospective observational multicenter study. Eighty-six patients who underwent surgery for OLT after at least 6 months of unsuccessful conservative management were included for a mean follow-up of 15 months (12-36). Fortynine patients with stage 1 OLT underwent microperforation, 2 patients with stage 2 OLT underwent a lift, drill, ill, and ix graft procedure with screw ixation, and 35 patients with stage 3 OLT were treated with mosaicplasty. Results After a follow-up of at least 1 year, 56 patients (65%) had an AOFAS score > 80 and the mean AOFAS score was 82 (16-100). A lower BMI (p = 0.038), a higher preoperative range of motion in the ankle (p = 0.033), higher preoperative AOFAS and FAOS scores (p = 0.001 and p = 0.011), and the presence of a preoperative bone bruise on MRI (p = 0.020) were good prognostic factors on univariate analysis. The presence of grade 1 osteoarthritis on the Van Dijk classiication was predictive of a poor prognosis (p = 0.044). Multivariate analysis showed that a good preoperative range of motion (OR = 1.080 [1.020-1.150] p = 0.01) was predictive of a positive outcome, while grade 1 osteoarthritis was predictive of a poor outcome (OR = 0.147 [0.036-0.603] p = 0.008). The postoperative AOFAS decreased in six patients and 17 patients had at least one complication: six dysthesias of the supericial ibular nerve, two of the sural nerve, and nine stage 1 complex regional pain syndromes. ConclusionThe new algorithm for OLT resulted in a postoperative AOFAS score of ≥ 80/100 in 65% of cases. The positive predictive factors of a successful postoperative outcome were the presence of a good preoperative range of motion and the absence of preoperative osteoarthritis. Level of evidence Level II.

Surgical management of concurrent lateral ankle instability and osteochondral lesions of the talus increases dynamic sagittal ankle range of motion

“…The procedure did not cause a substantial change in static ankle ROM postoperatively. The effects of arthroscopic MBP and microfracture on static ankle ROM are not evident [3, 18]. The decreased static ankle ROM and OLT can be attributed to bony constraint, which cannot be managed intraoperatively with arthroscopic MBP and microfracture [26].…”

“…However, patients with concurrent LAI and OLT have inferior postoperative outcomes compared with solitary OLT or LAI [15, 20]. Decreased preoperative ankle sagittal ROM is a risk factor for failure after the procedure [3].…”

“…In contrast to patients with solitary LAI, patients with concurrent LAI and OLT have decreased sagittal ankle ROM [3]. LAI and OLT are inversely related, indicating that bony constraint may explain why patients with concurrent LAI and OLT have decreased ankle ROM [18, 25, 26].…”

Radiographic and Clinical Outcomes After Arthroscopic Microfracture for Osteochondral Lesions of the Talus: 5-Year Results in 355 Consecutive Ankles

“…Many prognostic factors including age, 8 body mass index (BMI), 13 preoperative joint range of motion, 2 cystic OLT, 17 and weightbearing timing have been investigated extensively by previous studies. 45 Previous outcomes of arthroscopic microfracture for OLT have been reported based on retrospective data with a small to medium sample sizes (<200 patients).…”