Abstract
Purpose
The objectives of this study were to compare the clinical outcomes of the two common bone marrow stimulation techniques such as subchondral drilling and microfracture for symptomatic osteochondral lesions of the talus and to evaluate prognostic factors affecting the outcomes.
Methods
Ninety patients (90 ankles) who underwent arthroscopic bone marrow stimulation for small- to mid-sized osteochondral lesions of the talus constituted the study cohort. The 90 ankles were divided into two groups: a drilling group (40 ankles) and a microfracture group (50 ankles). Each group was matched for age and gender, and both groups had characteristics similar to those obtained from pre-operative demographic data. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and the ankle activity score (AAS) were used to compare clinical outcomes, during a mean follow-up period of 43 months.
Results
The median AOFAS scores were 66.0 points (51–80) in drilling group and 66.5 points (45–81) in microfracture group pre-operatively, and these improved to 89.4 points (77–100) and 90.1 points (69–100) at the final follow-up, respectively. The median VAS scores improved at the final follow-up compared with the pre-operative condition. The median AAS for the drilling group improved from 4.5 (1–6) pre-operatively to 6.0 (1–8) at the final follow-up, while those for the microfracture group improved from 3.0 (2–8) to 6.0 (3–9). No significant differences were observed between the two groups in terms of the AOFAS scores, VAS, and AAS.
Conclusions
The arthroscopic subchondral drilling and microfracture techniques that were used to stimulate bone marrow showed similar clinical outcomes. The results of this study suggest that both techniques are effective and reliable in treating small- to mid-sized osteochondral lesions of the talus, regardless of which of the two techniques is used.
Level of evidence
Level III, retrospective comparative study.
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References
Anderson IF, Crichton KJ, Grattan-Smith T, Cooper RA, Brazier D (1989) Osteochondral fractures of the dome of the talus. J Bone Joint Surg Am 71:1143–1152
Angermann P, Jensen P (1989) Osteochondritis dissecans of the talus long-term results of surgical treatment. Foot Ankle Int 10:161–163
Baums MH, Heidrich G, Schultz W, Steckel H, Kahl E, Klinger HM (2006) Autologous chondrocyte transplantation for treating cartilage defects of the talus. J Bone Joint Surg Am 88:303–308
Becher C, Thermann H (2005) Results of microfracture in the treatment of articular cartilage defects of the talus. Foot Ankle Int 26:583–585
Berndt AL, Harty M (1959) Transchondral fractures (osteochondritisdissecans) of the talus. J Bone Joint Surg Am 41:988–1020
Brittberg M, Tallheden T, Sjogren-Jansson B, Lindahl A, Peterson L (2001) Autologous chondrocytes used for articular cartilage repair: an update. Clin Orthop Relat Res 391(Suppl):S337–S348
Buckwalter JA, Mankin HJ (1998) Articular cartilage: degeneration and osteoarthritis, repair, regeneration, and transplantation. Instr Course Lect 47:487–504
Choi WJ, Kim BS, Lee JW (2012) Osteochondral lesion of the talus: could age be an indication for arthroscopic treatment? Am J Sports Med 40(2):419–424
Chen H, Sun J, Hoemann CD, Lascau-Coman V, Ouyang W, McKee MD, Shive MS, Buschmann MD (2009) Drilling and microfracture lead to different bone structure and necrosis during bone-marrow stimulation for cartilage repair. J Orthop Res 27(11):1432–1438
Chuckpaiwong B, Berkson EM, Theodore GH (2008) Microfracture for osteochondral lesions of the ankle: outcome analysis and outcome predictors of 105 cases. Arthroscopy 24:106–112
Ferkel RD, Cheng JC (1999) Ankle and subtalar arthroscopy. In: Kelikian A (ed) Operative Treatment of the Foot and Ankle, 1st edn. Appleton-Croft, New York, pp 321–350
Ferkel RD, Zanotti RM, Komenda GA, Sgaglione NA, Cheng MS, Applegate GR, Dopirak RM (2008) Arthroscopic treatment of chronic osteochondral lesions of the talus: long-term results. Am J Sports Med 36:1750–1762
Giannini S, Vannini F (2004) Operative treatment of osteochondral lesions of the talar dome: current concepts review. Foot Ankle Int 25:168–175
Gobbi A, Francisco RA, Lubowitz JH, Allegra F, Canata G (2006) Osteochondral lesions of the talus: randomized controlled trial comparing chondroplasty, microfracture, and osteochondral autograft transplantation. Arthroscopy 22:1085–1092
Gobbi A, Nunag P, Malinowski K (2005) Treatment of full thickness chondral lesions of the knee with microfracture in a group of athletes. Knee Surg Sports Traumatol Arthrosc 13:213–221
Halasi T, Kynsburg A, Tallay A, Berkes I (2004) Development of a new activity score for the evaluation of ankle instability. Am J Sports Med 32:899–908
Han SH, Lee JW, Lee DY, Kang ES (2006) Radiographic changes and clinical results of osteochondral defects of the talus with and without subchondral cysts. Foot Ankle Int 27:1109–1114
Hunt SA, Sherman O (2003) Arthroscopic treatment of osteochondral lesions of the talus with correlation of outcome scoring systems. Arthroscopy 19(4):360–367
Kerkhoffs GM, Reilingh ML, Gerards RM, de Leeuw PA (2014) Lift, drill, fill and fix (LDFF): a new arthroscopic treatment for talar osteochondral defects. Knee Surg Sports Traumatol Arthrosc May 20 [Epub ahead of print]
Kim YS, Lee HJ, Choi YJ, Kim YI, Koh YG (2014) Does an injection of a stromal vascular fraction containing adipose-derived mesenchymal stem cells influence the outcomes of marrow stimulation in osteochondral lesions of the talus? A clinical and magnetic resonance imaging study. Am J Sports Med 42(10):2424–2434
Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M (1994) Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int 15:349–353
Kok AC, Sd Dunnen, Tuijthof GJ, van Dijk CN, Kerkhoffs GM (2012) Is technique performance a prognostic factor in bone marrow stimulation of the talus? J Foot Ankle Surg 51:777–782
Kumai T, Takakura Y, Higashiyama I, Tamai S (1999) Arthroscopic drilling for the treatment of osteochondral lesions of the talus. J Bone Joint Surg Am 81:1229–1235
Lahm A, Erggelet C, Steinwachs M, Reichelt A (2006) Arthroscopic management of osteochondral lesion of the talus: results of drilling and usefulness of the magnetic resonance imaging before and after treatment. Arthroscopy 16:299–304
Lee KB, Bai LB, Chung JY, Seon JK (2010) Arthroscopic microfracture for osteochondral lesions of the talus. Knee Surg Sports Traumatol Arthrosc 18:247–253
Lee KB, Bai LB, Yoon TR, Jung ST, Seon JK (2009) Second-look arthroscopic findings and clinical outcomes after microfracture for osteochondral lesions of the talus. Am J Sports Med 37(Suppl 1):S63–S70
Nehrer S, Spector M, Minas T (1999) Histologic analysis of tissue after failed cartilage repair procedures. Clin Orthop Relat Res 365:149–162
Pritsch M, Horoshovski H, Farine I (1986) Arthroscopic treatment of osteochondral lesions of the talus. J Bone Joint Surg Am 68:862–865
Robinson DE, Winson IG, Harries WJ, Kelly AJ (2003) Arthroscopic treatment of osteochondral lesions of the talus. J Bone Joint Surg Br 85:989–993
Sammarco GJ, Makwana NK (2002) Treatment of talarosteochondral lesions using local osteochondral graft. Foot Ankle Int 23:693–698
Schuman L, Struijs PA, van Dijk CN (2002) Arthroscopic treatment for osteochondral defects of the talus. results at follow up at 2 to 11 years. J Bone Joint Surg Br 84:364–368
Steadman JR, Rodkey WG, Singleton SB, Briggs KK (1997) Microfracture technique for full-thickness chondral defects: technique and clinical results. Oper Tech Orthop 7:300–304
Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 198:43–49
Thermann H, Driessen A, Becher C (2008) Autologous chondrocyte transplantation in the treatment of articular cartilage lesions of the talus. Orthopade 37:232–239
Tol JL, Struijs PA, Bossuyt PM, Verhagen RA, van Dijk CN (2000) Treatment strategies in osteochondral defects of the talar dome: a systematic review. Foot Ankle Int 21:119–126
van Bergen CJ, de Leeuw PA, van Dijk CN (2009) Potential pitfall in the microfracturing technique during the arthroscopic treatment of an osteochondral lesion. Knee Surg Sports Traumatol Arthrosc 17:184–187
vanDijk CN, Scholte D (1997) Arthroscopy of the ankle joint. Arthroscopy 13:90–96
Verhagen RA, Struijs PA, Bossuyt PM, van Dijk CN (2003) Systematic review of treatment strategies for osteochondral defects of the talar dome. Foot Ankle Clin 8(233–242):391 Suppl: S233–S242
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Choi, JI., Lee, KB. Comparison of clinical outcomes between arthroscopic subchondral drilling and microfracture for osteochondral lesions of the talus. Knee Surg Sports Traumatol Arthrosc 24, 2140–2147 (2016). https://doi.org/10.1007/s00167-015-3511-1
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DOI: https://doi.org/10.1007/s00167-015-3511-1