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Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 1/2020

Open Access 01-01-2020 | Computed Tomography | ANKLE

Arthroscopic lift, drill, fill and fix (LDFF) is an effective treatment option for primary talar osteochondral defects

Authors: Kaj T. A. Lambers, Jari Dahmen, Mikel L. Reilingh, Christiaan J. A. van Bergen, Sjoerd A. S. Stufkens, Gino M. M. J. Kerkhoffs

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 1/2020

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Abstract

Purpose

The purpose of this study was to describe the mid-term clinical and radiological results of a novel arthroscopic fixation technique for primary osteochondral defects (OCD) of the talus, named the lift, drill, fill and fix (LDFF) technique.

Methods

Twenty-seven ankles (25 patients) underwent an arthroscopic LDFF procedure for primary fixable talar OCDs. The mean follow-up was 27 months (SD 5). Pre- and post-operative clinical assessments were prospectively performed by measuring the Numeric Rating Scale (NRS) of pain in/at rest, walking and when running. Additionally, the Foot and Ankle Outcome Score (FAOS) and the Short Form-36 (SF-36) were used to assess clinical outcome. The patients were radiologically assessed by means of computed tomography (CT) scans pre-operatively and 1 year post-operatively.

Results

The mean NRS during running significantly improved from 7.8 pre-operatively to 2.9 post-operatively (p = 0.006), the NRS during walking from 5.7 to 2.0 (p < 0.001) and the NRS in rest from 2.3 to 1.2 (p = 0.015). The median FAOS at final follow-up was 86 for pain, 63 for other symptoms, 95 for activities of daily living, 70 for sport and 53 for quality of life. A pre- and post-operative score comparison was available for 16 patients, and improved significantly in most subscores. The SF-36 physical component scale significantly improved from 42.9 to 50.1. Of the CT scans at 1 year after surgery, 81% showed a flush subchondral bone plate and 92% of OCDs showed union.

Conclusion

Arthroscopic LDFF of a fixable primary talar OCD results in excellent improvement of clinical outcomes. The radiological follow-up confirms that fusion of the fragment is feasible in 92%. This technique could be regarded as the new gold standard for the orthopedic surgeon comfortable with arthroscopic procedures.

Level of evidence

Prospective case series, therapeutic level IV.
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Metadata
Title
Arthroscopic lift, drill, fill and fix (LDFF) is an effective treatment option for primary talar osteochondral defects
Authors
Kaj T. A. Lambers
Jari Dahmen
Mikel L. Reilingh
Christiaan J. A. van Bergen
Sjoerd A. S. Stufkens
Gino M. M. J. Kerkhoffs
Publication date
01-01-2020
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 1/2020
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-019-05687-w

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