Outcome of Arthroscopic Bone Marrow Stimulation in Osteochondritis Dissecans of the Talus in a Tertiary Care Hospital

Abstract

Introduction: Osteochondritis dissecans of the talus is a rare condition that can create challenges for both the patient and the treating surgeon. Arthroscopic bone marrow stimulation (i.e. microfracture, drilling) is a well-accepted and proven technique to allow fibrocartilage differentiation and thereby provide infill at the site of a cartilage defect in several joints, including the ankle. The aim of our study was to examine the role of arthroscopic bone marrow stimulation techniques as a means of treatment for osteochondral lesions of the talus. Material and methods: Thirty two ankles were identified between January 2012 and January 2020 with talus OCD that underwent arthroscopic bone marrow stimulation. Each lesion was classified according to the Berndt and Harty classification. Study patients were evaluated at 6 weeks, 3 months, 6 months, 12 months, and annually after surgery. Assessments via a visual analogue scale (VAS) for pain during daily activities and sport activity and the American Orthopaedic Foot & Ankle Society (AOFAS) scoring system were obtained at each visit. Result: There were 25 men and 4 women of average age 35 years (range 17–50) and mean body mass index (BMI) 22 kg/ m2 (range 20–34) at the time of surgery. Quantitative MRI measurements on 3D FSPGR Sequence showed that mean area of the lesions were 0.801 ± 0.505 cm2. Mean AOFAS scores improved from 66 points (range 53–77) preoperatively to 90 points (range 83–100) at final follow-up (p<0.05) and mean Visual Analogue Scale (VAS) scores from 6 points (range 5–8) to 2 points (range 0–5) with p value <0.05 which is statistically significant. Conclusion: Arthroscopic management of osteochondral lesions of the talus has the advantages of better cosmetic results, less pain, and less surgical trauma. This technique is technically demanding and should be reserved for the experienced foot and ankle arthroscopist.