Autogenous bone grafting for the treatment of talar dome lesions

Abstract

This study evaluated a surgical bone grafting technique, which restores the talar dome weightbearing articular surface for the repair of a transchondral lesion. An autogenous bone graft combined with viable cartilage is used to recreate a normal talar articular surface. In a retrospective analysis of talar dome lesions, 14 patients surgically treated with bone grafts were compared to 17 patients treated with curettage and subchondral drilling. Post surgical follow-up was collected at 71.5 +/- 21.1 months (mean +/- SD). Age, lesion stage, and gender did not differ between the groups, but the mean fracture area was selectively smaller in the curettage and drilling group (85.2 +/- 58.7 mm2 vs. 156.4 +/- 69.4 mm2). Clinical evaluation consisted of an 8-point scale which took into account range of motion, the presence of pain and crepitus, and radiographic assessment. Significantly better overall clinical scores were observed for the bone graft group (graft, 6.9 +/- 1.6, curettage plus drilling, 4.5 +/- 1.9; p = .001), due to better results for range of motion (1.6 degrees +/- 0.5 degrees; 1.1 degrees +/- 0.4 degrees), less pain (2.7 +/- 0.50; 2.0 +/- 0.7), and presence of subchondral bone on x-ray (0.9 +/- 0.4; 0.2 +/- 0.4). Patients were also asked their perception of their own surgical outcome (considering pain frequency and ability to participate in sporting activities or walk at a similar level compared to before the surgery), and if they would have the surgery again. No differences in the patients' preoperative symptoms or their subjective assessment post surgery were detected between the groups. While curettage plus drilling is the most common surgical procedure for chronic symptomatic talar dome lesion, our results suggest that bone grafting of the lesion yields better long-term clinical results.