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Arthroscopic Treatment of Chronic Osteochondral Lesions of the Talus

Long-term Results

Richard D. Ferkel, MD^,*, Robert M. Zanotti, MD, Gregory A. Komenda, MD, Nicholas A. Sgaglione, MD^||, Margaret S. Cheng, MD^¶, Gregory R. Applegate, MD^# and Ryan M. Dopirak, MD^**

From the Southern California Orthopedic Institute, Van Nuys, California, Department of Orthopedic Surgery, University of California at Los Angeles, Center for Orthopedics, Sheffield Village, Ohio, NW Orthopaedic Physicians, Bellevue, Washington, ^|| Department of Orthopaedics, Division of Sports Medicine, North Shore University Hospital, Great Neck, New York, ^¶ Kaiser Permanente, San Jose, California, ^# San Fernando Valley MRI, Van Nuys, California, and ^** Lakeshore Orthopedics, Manitowoc, Wisconsin

^* Address correspondence to Richard D. Ferkel, MD, Southern California Orthopedic Institute, 6815 Noble Avenue, Van Nuys, CA 91405 (e-mail: rferkel{at}scoi.com).

Background: Osteochondral lesions of the talus are relatively uncommon but may be a cause of significant pain and disability in symptomatic patients.

Hypothesis: Arthroscopic treatment of osteochondral lesions of the talus will result in good long-term clinical outcomes in the majority of patients.

Study Design: Case series; Level of evidence, 4.

Methods: Fifty patients with chronic osteochondral lesions of the talus underwent arthroscopic treatment. Average age was 32 years (range, 12–72 years). Average follow-up was 71 months (range, 24–152 months). Treatment consisted of either drilling of the osteochondral lesions of the talus in situ (n = 4), excision of the osteochondral lesions of the talus and abrasion arthroplasty (n = 6), or excision of the osteochondral lesions of the talus and drilling (n = 40). Preoperative and intraoperative staging of the osteochondral lesions of the talus was performed. Follow-up evaluation included 3 clinical rating systems: Alexander, modified Weber, and American Orthopaedic Foot and Ankle Society Ankle/Hindfoot scores.

Results: There were 72% excellent/good, 20% fair, and 8% poor results on the Alexander scale. According to the modified Weber scale, there were 64% excellent/good, 30% fair, and 6% poor results. The average American Orthopaedic Foot and Ankle Society Ankle/Hindfoot score was 84 (range, 34–100). We found no correlation between plain radiographs, computed tomography, or magnetic resonance imaging staging and clinical results. However, there was significant correlation between arthroscopic stage and clinical outcome. Seventeen patients had been seen 5 years previously and evaluated using the same criteria; 35% demonstrated a deterioration in their result over time.

Conclusion: Arthroscopic treatment of chronic symptomatic osteochondral lesions of the talus results in good clinical outcomes in the majority of patients. However, pain and functional limitation may persist in some patients, especially those noted to have unstable osteochondral defects at the time of arthroscopy.

Key Words: OLT • arthroscopic • osteochondral • talus