Arthroscopic treatment of symptomatic OLTs showed high function in young patients

The minimum 2-year follow-up revealed patients had minimal radiographic progression of OA after treatment.

Issue: February 2015

Young patients who underwent arthroscopic bone stimulation for symptomatic osteochondral lesions of the talus demonstrated high satisfaction and function, and minimal radiographic osteoarthritic progression at long-term follow-up, according to results of a recently presented study.

“Arthroscopic treatment of symptomatic osteochondral lesions in patients 18 [years] and younger with average 8-year follow-up demonstrated low pain and disability scores, high functional outcome scores, minimal osteoarthritic progression on X-ray and moderate MOCART scores,” Nicholas J. Larsen, MD, said during his presentation.

He added, “Previous literature on this population has been short-term follow-up with various open and closed treatments. As far as we know, this is the first long-term study to evaluate functional and radiographic outcomes on this population with arthroscopic bone marrow stimulating techniques.”

Arthroscopic treatment

In their database review, Larsen and his colleagues identified 22 patients who failed conservative care and were treated arthroscopically using marrow stimulation techniques. During surgery, standard anteromedial, anterolateral and posterolateral portals, and 2.7-mm cannulas were used. “Once within the joint, if the lesion was found to be stable, it was treated with trans-talar drilling, so not to violate the cartilage. If the lesion was found to be unstable, it was treated with excision and drilling, plus or minus microfracture.” Patients were splinted in a neutral position for 5 days to a week and then began early range of motion. They were non-weight-bearing for 6 weeks and full weight-bearing at 8 weeks. The patients had a minimum 2-year follow-up.

Twenty patients were satisfied with the results from surgery and would recommend it. The overall mean follow-up Visual Analog Scale (VAS) score for pain was a 2.2 on a 10-point scale and the overall mean AOFAS score was 86.6 points at follow-up. Postoperatively, patients had an overall mean Foot Function Index (FFI) score of 38.7 with a 17.1 for FFI pain, 16.5 for FFI disability and 4.7 for FFI activity. Patients also had a mean SF-36 physical component score of 50.7.

The mean dorsiflexion on operative ankles was 14.8° and 16.5° on the nonoperative contralateral ankles, while the mean plantar flexion on operative ankles was 36° and 35.5° on nonoperative ankles at follow-up.

Postoperative radiographs showed 56% of patients had an osteoarthritis (OA) grade of 0; 38% had grade I OA; 6% had grade II OA; and 0% had grade III OA. Results also revealed a mean MOCART score of 48. Postoperative MRI MOCART scores showed 77% of patients had greater than 50% complete filling of the defect.

Subgroup analyses

“In comparing the different dichotomous groups, we found that lateral lesions as compared to medial lesions had a significant increase in progression of osteoarthritis from pre- to post-op,” Larsen said.

The researchers also found skeletally immature patients had lower pain scores than skeletally mature patients.

“In comparing skeletally immature vs. skeletally mature [patients], small and large lesions as defined as 1 cm and stable and unstable lesions, we found no difference in satisfaction, [AOFAS and VAS scores], X-ray progression or cartilage healing on MRI,” Larsen said.

The investigators also discovered patients with less than 5 years follow-up had higher MOCART scores on postoperative MRI. – by Casey Tingle

References:

Larsen N. Paper #8.4. Presented at: American Orthopaedic Foot and Ankle Society Annual Meeting; Sept. 21-23, 2014; Chicago.

For more information:

Nicholas J. Larsen, MD, can be reached at Rim Rock Orthopedics and Sports Medicine, 652 S. Medical Center Dr., #120, St. George, Utah 84790; email: nlarsen@scoi.com.
Disclosure: Larsen has no relevant financial disclosures.