Open AccessTreatment of post‐traumatic osteochondral lesions of the talus: a four‐step approach
Author(s) -
Ventura Alberto,
Terzaghi Clara,
Legnani Claudio,
Borgo Enrico
Publication year - 2013
Publication title -
knee surgery, sports traumatology, arthroscopy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.806
H-Index - 125
eISSN - 1433-7347
pISSN - 0942-2056
DOI - 10.1007/s00167-012-2028-0
Subject(s) - medicine , ankle , surgery , synovectomy , lesion , debridement (dental) , retrospective cohort study , rheumatoid arthritis
Purpose The purpose of this retrospective study was to assess the treatment of post‐traumatic osteochondral lesions (OCLs) of the ankle with a four‐step protocol. Methods Thirty‐eight patients with at least one MRI‐documented OCL of the ankle were treated from 2004 to 2010. Median age at surgery was 39 years (range: 18–52). Mean lesion size was 1.0 cm 2 (SD: 0.2). All patients underwent a four‐step surgical procedure including synovectomy, debridement and microfractures of the OCL, capsular shrinkage, and bracing and non‐weightbearing for 21 days. Clinical assessment included objective examination, the AOFAS ankle and hindfoot scoring system, Karlsson‐Peterson score, Tegner activity level, and Sefton articular stability scale. MRI scans were taken 18 months after surgery in all patients. Results Follow‐up examination at an average of 4 years (SD: 1.1) after surgery showed significant improvement of all variables compared to pre‐operative values ( P < 0.05). Most patients rated their outcome as good/excellent. MRI scans taken 18 months after surgery documented completely repaired lesion in 27 ankles, slight bone marrow oedema with partially repaired defect in 9 patients, and visible defect in 2 ankles. Conclusion Based on the present results, we propose a comprehensive four‐step protocol as a safe and clinically effective treatment option in patients with post‐traumatic OCLs of the ankle. Level of evidence Retrospective case series, Level IV.