Microfracture for chondral defects of the talus: maintenance of early results at midterm follow-up

  • Christoph Becher
  • Arne Driessen
  • Thomas Hess
  • Umile Giuseppe Longo
  • Nicola Maffulli
  • Hajo ThermannEmail author


We determined whether the early improvement in symptoms and function after microfracture in the management of articular cartilage defects of the talus is maintained at mid term follow-up. Factors influencing outcome and postoperative magnetic resonance imaging were also evaluated. We performed data collection prospectively using the Hannover Scoring System for the ankle (HSS) and a Visual Analog Scale (VAS) for pain and function preoperatively, at 1 ± 0.1 year (45 ankles), 2 ± 0.4 years (45 ankles), and at an average of 5.8 ± 2.0 years (39 ankles) postoperatively. MRI was used to assess cartilage repair tissue based on the following variables: degree of defect repair and filling of the defect, integration to border zone, surface of the repair tissue, structure of the repair tissue and subchondral bone alterations. Comparing the outcome scores of the last follow-up to the previous follow-up points, the HSS and the VAS (pain, function and satisfaction) showed no deterioration. Four ankles, however, underwent further surgery to address the chondral defect and were regarded as failures. A body mass index greater than 25 kg/m2 and having severe post-traumatic cartilage damage appeared to be negative prognostic factors. Results for patients older than 50 years were not inferior to those in younger patients. Microfracture arthroplasty induces repair of localized articular cartilage defects of the talus maintaining the encouraging early results at mid term follow-up.


Cartilage defect Microfracture Ankle Talus MRI 


  1. 1.
    Alexander AH, Lichtman DM (1980) Surgical treatment of transchondral talar-dome fractures (osteochondritis dissecans). Long-term follow-up. J Bone Joint Surg Am 62:646–652PubMedGoogle Scholar
  2. 2.
    Alparslan L, Winalski CS, Boutin RD, Minas T (2001) Postoperative magnetic resonance imaging of articular cartilage repair. Semin Musculoskelet Radiol 5:345–363CrossRefPubMedGoogle Scholar
  3. 3.
    Asik M, Ciftci F, Sen C, Erdil M, Atalar A (2008) The microfracture technique for the treatment of full-thickness articular cartilage lesions of the knee: midterm results. Arthroscopy 24:1214–1220PubMedCrossRefGoogle Scholar
  4. 4.
    Assenmacher JA, Kelikian AS, Gottlob C, Kodros S (2001) Arthroscopically assisted autologous osteochondral transplantation for osteochondral lesions of the talar dome: an MRI and clinical follow-up study. Foot Ankle Int 22:544–551PubMedGoogle Scholar
  5. 5.
    Bae DK, Yoon KH, Song SJ (2006) Cartilage healing after microfracture in osteoarthritic knees. Arthroscopy 22:367–374PubMedGoogle Scholar
  6. 6.
    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 88:303–308CrossRefPubMedGoogle Scholar
  7. 7.
    Becher C, Driessen A, Thermann H (2008) Microfracture technique for the treatment of articular cartilage lesions of the talus. Orthopade 37(196):198–203 (in German)Google Scholar
  8. 8.
    Becher C, Thermann H (2005) Results of microfracture in the treatment of articular cartilage defects of the talus. Foot Ankle Int 26:583–589PubMedGoogle Scholar
  9. 9.
    Berndt AL, Harty M (1959) Transchondral fractures (osteochondritis dissecans) of the talus. J Bone Joint Surg Am 41:97–102Google Scholar
  10. 10.
    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–S348CrossRefPubMedGoogle Scholar
  11. 11.
    Buckwalter JA, Mankin HJ (1998) Articular cartilage: degeneration and osteoarthritis, repair, regeneration, and transplantation. Instr Course Lect 47:487–504PubMedGoogle Scholar
  12. 12.
    Carlson CS, Meuten DJ, Richardson DC (1991) Ischemic necrosis of cartilage in spontaneous and experimental lesions of osteochondrosis. J Orthop Res 9:317–329CrossRefPubMedGoogle Scholar
  13. 13.
    Chuckpaiwong B, Berkson EM, Theodore GH (2008) Microfracture for osteochondral lesions of the ankle: outcome analysis and outcome predictors of 105 cases. Arthroscopy 24:106–112PubMedCrossRefGoogle Scholar
  14. 14.
    Franceschi F, Longo UG, Ruzzini L, Marinozzi A, Maffulli N, Denaro V (2008) Simultaneous arthroscopic implantation of autologous chondrocytes and high tibial osteotomy for tibial chondral defects in the varus knee. Knee 15:309–313CrossRefPubMedGoogle Scholar
  15. 15.
    Gautier E, Kolker D, Jakob RP (2002) Treatment of cartilage defects of the talus by autologous osteochondral grafts. J Bone Joint Surg Br 84:237–244CrossRefPubMedGoogle Scholar
  16. 16.
    Giannini S, Vannini F (2004) Operative treatment of osteochondral lesions of the talar dome: current concepts review. Foot Ankle Int 25:168–175PubMedGoogle Scholar
  17. 17.
    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 22:1085–1092PubMedCrossRefGoogle Scholar
  18. 18.
    Hangody L, Kish G, Modis L, Szerb I, Gaspar L, Dioszegi Z, Kendik Z (2001) Mosaicplasty for the treatment of osteochondritis dissecans of the talus: two to seven year results in 36 patients. Foot Ankle Int 22:552–558PubMedGoogle Scholar
  19. 19.
    Hintermann B, Boss A, Schafer D (2002) Arthroscopic findings in patients with chronic ankle instability. Am J Sports Med 30:402–409PubMedGoogle Scholar
  20. 20.
    Knutsen G, Engebretsen L, Ludvigsen TC, Drogset JO, Grontvedt T, Solheim E, Strand T, Roberts S, Isaksen V, Johansen O (2004) Autologous chondrocyte implantation compared with microfracture in the knee. A randomized trial. J Bone Joint Surg 86:A455–A464Google Scholar
  21. 21.
    Kreuz PC, Erggelet C, Steinwachs MR, Krause SJ, Lahm A, Niemeyer P, Ghanem N, Uhl M, Sudkamp N (2006) Is microfracture of chondral defects in the knee associated with different results in patients aged 40 years or younger? Arthroscopy 22:1180–1186PubMedCrossRefGoogle Scholar
  22. 22.
    Kreuz PC, Steinwachs MR, Erggelet C, Krause SJ, Konrad G, Uhl M, Sudkamp N (2006) Results after microfracture of full-thickness chondral defects in different compartments in the knee. Osteoarthr Cartil 14:1119–1125CrossRefPubMedGoogle Scholar
  23. 23.
    Longo UG, Franceschi F, Ruzzini L, Rabitti C, Maffulli N, Denaro V (2009) Foreign-body giant-cell reaction at the donor site after autologous osteochondral transplant for cartilaginous lesion. A case report. J Bone Joint Surg Am 91:945–949CrossRefPubMedGoogle Scholar
  24. 24.
    Marlovits S, Striessnig G, Resinger CT, Aldrian SM, Vecsei V, Imhof H, Trattnig S (2004) Definition of pertinent parameters for the evaluation of articular cartilage repair tissue with high-resolution magnetic resonance imaging. Eur J Radiol 52:310–319CrossRefPubMedGoogle Scholar
  25. 25.
    Miller BS, Steadman JR, Briggs KK, Rodrigo JJ, Rodkey WG (2004) Patient satisfaction and outcome after microfracture of the degenerative knee. J Knee Surg 17:13–17PubMedGoogle Scholar
  26. 26.
    Millett PJ, Huffard BH, Horan MP, Hawkins RJ, Steadman JR (2009) Outcomes of full-thickness articular cartilage injuries of the shoulder treated with microfracture. Arthroscopy 25:856–863PubMedCrossRefGoogle Scholar
  27. 27.
    Mithoefer K, Williams RJ 3rd, Warren RF, Potter HG, Spock CR, Jones EC, Wickiewicz TL, Marx RG (2005) The microfracture technique for the treatment of articular cartilage lesions in the knee. A prospective cohort study. J Bone Joint Surg Am 87:1911–1920CrossRefPubMedGoogle Scholar
  28. 28.
    Mithoefer K, Williams RJ III, Warren RF, Wickiewicz TL, Marx RG (2006) High-impact athletics after knee articular cartilage repair: a prospective evaluation of the microfracture technique. Am J Sports Med 34:1413–1418CrossRefPubMedGoogle Scholar
  29. 29.
    Outerbridge RE (1961) The etiology of chondromalacia patellae. J Bone Joint Surg Br 43:752–767PubMedGoogle Scholar
  30. 30.
    Potter HG, Foo LF (2006) Magnetic resonance imaging of articular cartilage: trauma, degeneration, and repair. Am J Sports Med 34:661–677CrossRefPubMedGoogle Scholar
  31. 31.
    Pritsch M, Horoshovski H, Farine I (1986) Arthroscopic treatment of osteochondral lesions of the talus. J Bone Joint Surg Am 68:862–865PubMedGoogle Scholar
  32. 32.
    Recht MP, Piraino DW, Paletta GA et al (1996) Accuracy of three-dimensional spoiled gradient-echo FLASH MR imaging in the detection of patellofemoral articular cartilage abnormalities. Radiology 198:209–212PubMedGoogle Scholar
  33. 33.
    Sammarco G, Makwana N (2002) Treatment of talar osteochondral lesions using local osteochondral graft. Foot Ankle Int 23:693–698PubMedGoogle Scholar
  34. 34.
    Saxena A, Eakin C (2007) Articular talar injuries in athletes: results of microfracture and autogenous bone graft. Am J Sports Med 35:1680–1687CrossRefPubMedGoogle Scholar
  35. 35.
    Schafer D, Boss A, Hintermann B (2003) Accuracy of arthroscopic assessment of anterior ankle cartilage lesions. Foot Ankle Int 24:317–320PubMedGoogle Scholar
  36. 36.
    Steadman JR (1997) Microfracture technique for full-thickness chondral defects: technique and clinical results. Oper Tech Orthop 7:300–304CrossRefGoogle Scholar
  37. 37.
    Steadman JR, Briggs KK, Rodrigo JJ, Kocher MS, Gill TJ, Rodkey WG (2003) Outcomes of microfracture for traumatic chondral defects of the knee: average 11-year follow-up. Arthroscopy 19:477–484PubMedGoogle Scholar
  38. 38.
    Steadman JR, Ramappa AJ, Maxwell RB, Briggs KK (2007) An arthroscopic treatment regimen for osteoarthritis of the knee. Arthroscopy 23:948–955PubMedCrossRefGoogle Scholar
  39. 39.
    Stougaard J (1964) Familial occurrence of osteochondritis dissecans. J Bone Joint Surg Br 46:542–543PubMedGoogle Scholar
  40. 40.
    Taga I, Shino K, Inoue M, Nakata K, Maeda A (1993) Articular cartilage lesions in ankles with lateral ligament injury. An arthroscopic study. Am J Sports Med 21:120–126CrossRefPubMedGoogle Scholar
  41. 41.
    Taranow WS, Bisignani GA, Towers JD, Conti SF (1999) Retrograde drilling of osteochondral lesions of the medial talar dome. Foot Ankle Int 20:474–480PubMedGoogle Scholar
  42. 42.
    Thermann H (1994) Treatment of osteochondritis dissecans of the talus: a long-term follow-up. Sports Med Arthrosc 2:284–288Google Scholar
  43. 43.
    Thermann H, Driessen A, Becher C (2008) Autologous chondrocyte transplantation in the treatment of articular cartilage lesions of the talus. Orthopade 37:232–239CrossRefPubMedGoogle Scholar
  44. 44.
    WHO (1995) Physical status: the use and interpretation of anthropometry. Report of a WHO expert consultation. In: WHO technical report series number 854. World Health Organization, GenevaGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Christoph Becher
    • 1
  • Arne Driessen
    • 2
  • Thomas Hess
    • 3
  • Umile Giuseppe Longo
    • 4
  • Nicola Maffulli
    • 5
  • Hajo Thermann
    • 2
    Email author
  1. 1.Department of OrthopaedicsHannover Medical SchoolHannoverGermany
  2. 2.Centre for Knee and Foot Surgery/Sports TraumaATOS-Clinic CentreHeidelbergGermany
  3. 3.Department of RadiologySt. Vincenz KrankenhausLimburgGermany
  4. 4.Department of OrthopaedicsCampus BiomedicoRomeItaly
  5. 5.Centre for Sports and Exercise MedicineBarts and The London School of Medicine and Dentistry, Mile End HospitalLondonUK

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