Results of arthroscopic microfracture treatment for traumatic and non-traumatic osteochondral lesions of the talus: a retrospective cohort study

Abstract

Background: This study is designed to assess the extent to which the outcomes of arthroscopic microfracture surgery for talus osteochondral lesions (OLTs)-whether of traumatic or atraumatic origin-are influenced by these underlying etiologic factors. Toward this end, it aims to optimise patient selection and treatment plans, thereby enabling the prediction of surgical prognosis.

Methods: This retrospective study included 70 ankles from 70 patients with OLTs, who were treated with microfracture procedures using anterior ankle arthroscopy by orthopaedic surgeons at two different medical centres. Of these cases, 38 were of a traumatic origin (Group 1) and 32 were of a non-traumatic origin (Group 2). The inclusion criteria were adult patients with unilateral, detached and/or displaced lesions located in the medial central region of the talus. Preoperative and final follow-up American Orthopaedic Foot and Ankle Society (AOFAS) and Visual Analogue Scale (VAS) pain scores were compared within and between groups. The rate of return to baseline activity levels was also compared between the various groups. The potential influence of body mass index (BMI) on both etiology and surgical outcome was examined.

Results: The median follow-up period, as the interquartile range, for all patients was 39 months, ranging from 26 to 54.25 months. Both groups of patients showed significant improvement in their AOFAS and VAS scores postoperatively compared with their preoperative assessment (p < 0.001). Nevertheless, no statistically significant difference was found in the median AOFAS and VAS scores between Group 1 and Group 2 (p > 0.05). After the operation, 66 patients, representing 94.3%, successfully resumed their previous lifestyle, with no difference observed between the two groups (p = 0.392). In addition, the mean BMI in Group 2 was significantly higher than in Group 1 (p = 0.0035).

Conclusion: Arthroscopic microfracture treatment provides similar clinical outcomes in the case of non-traumatic and traumatic OLTs. A high BMI, however, has been recognized as a significant risk factor for the development of non-traumatic OLTs.

Keywords: Microfracture; Osteochondral lesion; Talus.

Fig. 1

Study participants’ characteristics included in the study. AOFAS: American Orthopaedic Foot and Ankle Society

Fig. 2

Arthroscopic debridement along with the use of the microfracture technique in non-traumatic OLTs. a Preoperative preparation for arthroscopy, b Identification of the region of the OLTs using a probe. c Post-debridement appearance of the OLTs area, d Post-microfracture appearance of the OLTs area, e Pre-operative MRI related to the lesion, f Postoperative 36-months MRI showing the defect area filled with fibrocartilaginous tissue

Fig. 3

A comparison of the median (IQR) AOFAS (American Orthopaedic Foot and Ankle Society) scores before and after surgery, within and between groups. The yellow box represents Group 1 and the blue box represents Group 2. The p-values illustrate the differences seen in the median (IQR) AOFAS scores before surgery and at the end of the follow-up

Fig. 4

Pre- and post-operative medians (IQR) VAS (Visual analogue score) scores across the various groups. The blue represents Group 2, and the yellow represents Group 1. The p-values indicate the significance of the differences between the preoperative and postoperative medians of the VAS scores