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Defect size shown as prognostic factor in arthroscopic surgery

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DENVER — A new study presented at the American Orthopaedic Foot and Ankle Society (AOFAS) 24th Annual Summer Meeting, here, associates larger osteochondral defects with poorer clinical outcomes after arthroscopic treatment, and suggests that using preoperative MRI to determine defect size may aid in surgical decision-making.

To determine the prognostic influence of defect size on clinical outcomes, Woo Jin Choi, MD, and colleagues studied 117 patients (120 ankles) who had arthroscopic treatment for osteochondral lesions of the talus. The study included 64 microfractured ankles and 56 ankles that underwent chondroplasty. The patients had a mean follow-up of 44.5 months.

The investigators used preoperative MRI images to measure the defect size and defined failure as a postoperative AOFAS score of less than 80 or an osteochondral transfer after the arthroscopic procedure.

The investigators discovered a significantly higher rate of poor clinical outcome in patients with defects greater than 150 mm². A Pearson correlation coefficient analysis also revealed an inverse relationship between AOFAS scores and defect size (P<.001), according to the study abstract.

Although the investigators discovered that defect size >150 mm² had a significant influence on the clinical outcome, they found no association between AOFAS score and other potential prognostic factors, including trauma, patient age, duration of symptoms and associated lesions.

“Defect size showed a significant influence on the clinical outcome,” Choi said during his presentation. “Defect size is readily available by MRI and may therefore be useful preoperatively for surgical decisions. Other prognostic factors did not show a significant influence on the clinical outcome.”

He added, “Determining defect size is an important prognostic factor in osteochondral lesion of the talus, and arthroscopic treatment should be used for lesions less than 150 mm². It is reasonable to consider osteochondral transplantation as a primary treatment modality for larger lesions.”

For more information:

• Choi WJ, Lee JW, Kim BS, et al. Correlation of defect size and clinical outcome in osteochondral lesion of the talus. Presented at the American Orthopaedic Foot and Ankle Society 24th Annual Summer Meeting. June 26-28, 2008. Denver.