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Fixation of the osteochondral talar fragment yields good results regardless of lesion size or chronicity

  • Ankle
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Osteochondral talar lesions, regardless of their size and/or chronicity, are, at our hospital, now treated by fixation of the fragment if the talar dome cartilage is judged to be healthy. The retrospective study described herein was conducted to assess clinical outcomes of this treatment strategy.

Methods

The study group comprised 44 patients (18 men and 26 women) with 45 such talar lesions. In all cases, the osteochondral fragment was reduced and fixed with bone harvested from the osteotomy site and shaped into peg(s) (one to four pegs per lesion). Median follow-up was 2.1 years (1–9 years). The lesion area was measured on computed tomography arthrographs, and the Japanese Society for Surgery of the Foot (JSSF) ankle/hindfoot scale was used to evaluate postoperative outcomes. Clinical failure was defined as a JSSF score < 80 points.

Results

The mean JSSF score improved significantly from 63.5 points preoperatively to 93.0 postoperatively (p < 0.001). Treatment failure occurred in only one ankle (0.02%). The mean lesion area was 51.2 mm2 (range 5–147 mm2). Correlation between lesion areas and the postoperative JSSF scores was weak (r = − 0.133). Correlation between the time of the trauma to the time of fixation surgery and the postoperative JSSF scores was also weak (r = 0.042). Radiographic outcomes were good for 28 ankles, fair for 10, and poor for 7.

Conclusion

Fixation of the lesion fragment, regardless of size and/or chronicity, appears to be appropriate in cases of an osteochondral talar lesion.

Level of evidence

IV.

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References

  1. Badekas T, Takvorian M, Souras N (2013) Treatment principles for osteochondral lesions in foot and ankle. Int Orthop 37:1697–1706

    Article  Google Scholar 

  2. Berndt AL, Harty M (1959) Transchondral fractures (osteochondritis dissecans) of the talus. J Bone Jt Surg Am 41:988–1020

    Article  Google Scholar 

  3. Choi WJ, Park KK, Kim BS, Lee JW (2004) Osteochondral lesion of the talus: is there a critical defect size for poor outcome? Am J Sports Med 32:389–395

    Article  Google Scholar 

  4. Dahmen J, Lambers KTA, Reilingh ML, van Bergen CJA, Stufkens SAS, Kerkhoffs GMMJ (2017) No superior treatment for primary osteochondral defects of the talus. Knee Surg Sports Traumatol Arthrosc 26:2142–2157

    Article  Google Scholar 

  5. DeLee JC (1991) Fractures and dislocations of the foot. In: Mann RA, Coughlin MJ (eds) Surgery of the foot and ankle, 6th edn. Mosby, St. Louis, pp 1465–1518

    Google Scholar 

  6. Elias I, Zoga AC, Morrison WB, Besser MP, Schweitzer ME, Raikin SM (2007) Osteochondral lesions of the talus: localization and morphologic data from 424 patients using a novel anatomical grid scheme. Foot Ankle Int 28:154–161

    Article  Google Scholar 

  7. 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

    Article  Google Scholar 

  8. Furukawa T, Eyre DR, Koide S, Glimcher MJ (1980) Biochemical studies on repair cartilage resurfacing experimental defects in the rabbit knee. J Bone Jt Surg Am 62:79–89

    Article  CAS  Google Scholar 

  9. Hannon CP, Bayer S, Murawski CD, Canata GL, Clanton TO, Haverkamp D, Lee JW, O’Malley MJ, Yinghui H, Stone JW, International Consensus Group on Cartilage Repair of the Ankle (2018) Debridement, curettage, and bone marrow stimulation: proceedings of the international consensus meeting on cartilage repair of the ankle. Foot Ankle Int 39(1_suppl):16S–22S

    Article  Google Scholar 

  10. Hunt SA, Sherman O (2003) Arthroscopic treatment of osteochondral lesions of the talus with correlation of outcome scoring systems. Arthroscopy 19:360–367

    Article  Google Scholar 

  11. Kerkhoffs GM, Reilingh ML, Gerards RM, de Leeuw PA (2016) Lift, drill, fill and fix (LDFF): a new arthroscopic treatment for talar osteochondral defects. Knee Surg Sports Traumatol Arthrosc 24:1265–1271

    Article  CAS  Google Scholar 

  12. 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

    Article  CAS  Google Scholar 

  13. Kraeutler MJ, Chahla J, Dean CS, Mitchell JJ, Santini-Araujo MG, Pinney SJ, Pascual-Garrido C (2017) Current concepts review update: osteochondral lesions of the talus. Foot Ankle Int 38:331–342

    Article  Google Scholar 

  14. Kumai T, Takakura Y, Higashiyama I, Tamai S (1999) Arthroscopic drilling for the treatment of osteochondral lesions of the talus. J Bone Jt Surg Am 81:1229–1235

    Article  CAS  Google Scholar 

  15. Kumai T, Takakura Y, Kitada C, Tanaka Y, Hayashi K (2002) Fixation of osteochondral lesions of the talus using cortical bone pegs. J Bone Jt Surg Br 84:369–374

    Article  CAS  Google Scholar 

  16. 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):63S–70S

    Article  Google Scholar 

  17. Loveday D, Clifton R, Robinson A (2010) Interventions for treating osteochondral defects of the talus in adults. Cochrane Database Syst Rev 4(8):CD008104

    Google Scholar 

  18. Murawski CD, Foo LF, Kennedy JG (2010) A review of arthroscopic bone marrow stimulation techniques of the talus: the good, the bad, and the causes for concern. Cartilage 1:137–144

    Article  Google Scholar 

  19. Murawski CD, Kennedy JG (2013) Operative treatment of osteochondral lesions of the talus. J Bone Jt Surg Am 95:1045–1054

    Article  Google Scholar 

  20. Nehrer S, Spector M, Minas T (1999) Histologic analysis of tissue after failed cartilage repair procedures. Clin Orthop Relat Res 365:149–162

    Article  Google Scholar 

  21. Niki H, Aoki H, Inokuchi S, Ozeki S, Kinoshita M, Kura H, Tanaka Y, Noguchi M, Nomura S, Hatori M, Tatsunami S (2005) Development and reliability of a standard rating system for outcome measurement of foot and ankle disorders. II: interclinician and intraclinician reliability and validity of the newly established standard rating scales and Japanese Orthopaedic Association rating scale. J Orthop Sci 10:466–474

    Article  Google Scholar 

  22. Niki H, Aoki H, Inokuchi S, Ozeki S, Kinoshita M, Kura H, Tanaka Y, Noguchi M, Nomura S, Hatori M, Tatsunami S (2005) Development and reliability of a standard rating system for outcome measurement of foot and ankle disorders. I: development of standard rating system. J Orthop Sci 10:457–465

    Article  Google Scholar 

  23. Nikolopoulos CE, Tsirikos AI, Sourmelis S, Papachristou G (2004) The accessory anteroinferior tibiofibular ligament as a cause of talar impingement: a cadaveric study. Am J Sports Med 32:389–395

    Article  Google Scholar 

  24. Pettine KA, Morrey BF (1987) Osteochondral fractures of the talus. A long-term follow-up. J Bone Jt Surg Br 69:89–92

    Article  CAS  Google Scholar 

  25. Reilingh ML, Lambers KTA, Dahmen J, Opdam KTM, Kerkhoffs GMMJ (2018) The subchondral bone healing after fixation of an osteochondral talar defect is superior in comparison with microfracture. Knee Surg Sports Traumatol Arthrosc 26:2177–2182

    Article  Google Scholar 

  26. Reilingh ML, Murawski CD, DiGiovanni CW, Dahmen J, Ferrao PNF, Lambers KTA, Ling JS, Tanaka Y, Kerkhoffs GMMJ, International Consensus Group on Cartilage Repair of the Ankle (2018) Fixation techniques: proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle. Foot Ankle Int 39(1_suppl):23S–27S

    Article  Google Scholar 

  27. Saxena A, Eakin C (2007) Articular talar injuries in athletes: results of microfracture and autogenous bone graft. Am J Sports Med 35:1680–1687

    Article  Google Scholar 

  28. 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 Jt Surg Br 84:364–368

    Article  CAS  Google Scholar 

  29. Stone JW (1996) Osteochondral lesions of the talar dome. J Am Acad Orthop Surg 4:63–73

    Article  CAS  Google Scholar 

  30. Tochigi Y, Amendola A, Muir D, Saltzman C (2002) Surgical approach for centrolateral talar osteochondral lesions with an anterolateral osteotomy. Foot Ankle Int 23:1038–1039

    Article  Google Scholar 

  31. Wang Yuze, Wei Lei, Zeng Lingyuan, He Dongdong, Wei Xiaochun (2013) Nutrition and degeneration of articular cartilage. Knee Surg Sports Traumatol Arthrosc 21:1751–1762

    Article  Google Scholar 

  32. van Bergen CJA, Kox LS, Maas M, Sierevelt IN, Kerkhoffs GMMJ, van Dijk CN (2013) Arthroscopic treatment of osteochondral defects of the talus: outcomes at eight to twenty years of follow-up. J Bone Jt Surg Am 95:519–525

    Article  Google Scholar 

  33. van Dijk PAD, Murawski CD, Hunt KJ, Andrews CL, Longo UG, McCollum G, Simpson H, Sofka CM, Yoshimura I, Karlsson J, International Consensus Group on Cartilage Repair of the Ankle (2018) Post-treatment follow-up, imaging, and outcome scores: proceedings of the international consensus meeting on cartilage repair of the ankle. Foot Ankle Int 39(1_suppl):68S–73S

    Article  Google Scholar 

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Funding

No external source of funding was used.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, St. Marianna University Yokohama Seibu Hospital, 1197-1 Yasashicho, Asahi-ku, Yokohama, Kanagawa, 241-0811, Japan

    Naoki Haraguchi & Takaki Shiratsuchi

  2. Department of Orthopaedic Surgery, Tokyo Metropolitan Police Hospital, 4-22-1 Nakano, Nakano-ku, Tokyo, 164-8541, Japan

    Koki Ota, Takuma Ozeki & Masaki Gibu

  3. Department of Orthopaedic Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan

    Hisateru Niki

Authors
  1. Naoki Haraguchi
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  2. Takaki Shiratsuchi
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  4. Takuma Ozeki
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Corresponding author

Correspondence to Naoki Haraguchi.

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Conflict of interest

Naoki Haraguchi, Takaki Shiratsuchi, Koki Ota, Takuma Ozeki, Masaki Gibu, and Hisateru Niki declare that they have no conflict of interest.

Ethical approval

This study was approved by the review board of our hospital. All procedures performed were in accordance with the ethical standards of the institutional research committee (Institutional Review Board of Tokyo Metropolitan Police Hospital, Approval no. 19-A02) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Haraguchi, N., Shiratsuchi, T., Ota, K. et al. Fixation of the osteochondral talar fragment yields good results regardless of lesion size or chronicity. Knee Surg Sports Traumatol Arthrosc 28, 291–297 (2020). https://doi.org/10.1007/s00167-019-05716-8

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