Top

Archives of Orthopaedic and Trauma Surgery

Published in:

01-12-2012 | Arthroscopy and Sports Medicine

Clinical and MRI results after microfracture of osteochondral lesions of the talus

Authors: B. Kuni, H. Schmitt, D. Chloridis, K. Ludwig

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 12/2012

Abstract

Purpose

Arthroscopic microfracture (AM) of osteochondral lesions of the talus is used to induce intrinsic refilling of the defect and reduce pain. The aim of this retrospective study was to investigate the clinical state after AM and the MRI outcome.

Methods

A total of 22 patients [10 women, 12 men, 31 years old (mean, 13–68 range)] treated for osteochondral lesions of the talus by AM were examined 2 years (median) postoperatively and pre- and postoperative MRI results compared. Swelling/effusion, articular constriction, joint pain, and range of motion restriction were documented. Clinical state was evaluated using the AOFAS hindfoot score. MRI was used to assess the size of the defect, presence of bone marrow edema, cysts and effusion, thickness of repair tissue, and integrity of the cartilage.

Results

In all but six cases, the defect was located at the medial shoulder of the talus. The postoperative AOFAS score at follow-up was 87.5 points (median 36–100 points range). Seven patients were free of pain, 11 had “mild, occasional” pain, 1 “moderate daily”, and 3 “severe, almost always present” pain (AOFAS). The defect volume was significantly reduced from 377 mm³ preoperatively (median, interquartile distance: 417 mm³) to 249 mm³ postoperatively (median, IQD: 336 mm³, p = 0.019, Wilcoxon). In 7 cases, the defect was completely filled, in 11 partially and in 4 only slightly.

Conclusion

After AM of osteochondral lesions of the talus, 18 of 22 patients had no or mild, occasional pain at 2 years follow-up. On MRI, the lesion volume had been reduced and filling with repair tissue was found.

McGahan PJ, Pinney SJ (2010) Current concept review: osteochondral lesions of the talus. Foot Ankle Int 31(1):90–101. doi:10.3113/FAI.2010.0090 PubMedCrossRef

Kappis M (1922) Weitere Beiträge zur traumatisch-mechanischen Entstehung der spontanen Knorpelablösung (sogen. osteochondritis dissecans). Dtsch Z Chir 171:13–29CrossRef

Berndt AL, Harty M (1959) Transchondral fractures (osteochondritis dissecans) of the talus. J Bone Joint Surg Am 41(A):988–1020PubMed

Bruns J, Behrens P (1998) Osteochondrosis dissecans. Ätiologische und pathophysiologische Aspekte. Arthroskopie 11:166–176CrossRef

Steinhagen J, Niggemeyer O, Bruns J (2001) Etiology and pathogenesis of osteochondrosis dissecans tali. Orthopade 30(1):20–27PubMedCrossRef

Stroud CC, Marks RM (2000) Imaging of osteochondral lesions of the talus. Foot Ankle Clin 5(1):119–133PubMed

van Bergen CJ, de Leeuw PA, van Dijk CN (2008) Treatment of osteochondral defects of the talus. Rev Chir Orthop Reparatrice Appar Mot 94(8):398–408. doi:10.1016/j.rco.2008.09.003 PubMedCrossRef

Loomer R, Fisher C, Lloyd-Smith R, Sisler J, Cooney T (1993) Osteochondral lesions of the talus. Am J Sports Med 21(1):13–19PubMedCrossRef

Meftah M, Katchis SD, Scharf SC, Mintz DN, Klein DA, Weiner LS (2011) SPECT/CT in the management of osteochondral lesions of the talus. Foot Ankle Int 32(3):233–238. doi:10.3113/FAI.2011.0233 PubMedCrossRef

10.

Ferkel RD, Zanotti RM, Komenda GA, Sgaglione NA, Cheng MS, Applegate GR, Dopirak RM (2008) Arthroscopic treatment of chronic osteochondral lesions of the talus: long-term results. Am J Sports Med 36(9):1750–1762. doi:10.1177/0363546508316773 PubMedCrossRef

11.

Schuman L, Struijs PA, van Dijk CN (2002) Arthroscopic treatment for osteochondral defects of the talus. Results at follow-up at 2 to 11 years. J Bone Joint Surg Br 84(3):364–368PubMedCrossRef

12.

Steadman JR, Rodkey WG, Singleton SB, Briggs KK (1997) Microfracture technique for full-thickness chondral defects: technique and clinical results. Oper Techn Orthop 7:300–304CrossRef

13.

Niemeyer P, Salzmann G, Schmal H, Mayr H, Sudkamp NP (2011) Autologous chondrocyte implantation for the treatment of chondral and osteochondral defects of the talus: a meta-analysis of available evidence. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-011-1729-0 PubMed

14.

Giannini S, Battaglia M, Buda R, Cavallo M, Ruffilli A, Vannini F (2009) Surgical treatment of osteochondral lesions of the talus by open-field autologous chondrocyte implantation: a 10 year follow-up clinical and magnetic resonance imaging T2-mapping evaluation. Am J Sports Med 37(1):112S–118S. doi:10.1177/0363546509349928 PubMedCrossRef

15.

Wiewiorski M, Leumann A, Buettner O, Pagenstert G, Horisberger M, Valderrabano V (2011) Autologous matrix-induced chondrogenesis aided reconstruction of a large focal osteochondral lesion of the talus. Arch Orthop Trauma Surg 131(3):293–296. doi:10.1007/s00402-010-1048-9 PubMedCrossRef

16.

Baltzer AW, Arnold JP (2005) Bone-cartilage transplantation from the ipsilateral knee for chondral lesions of the talus. Arthroscopy 21(2):159–166. doi:10.1016/j.arthro.2004.10.021 PubMedCrossRef

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(10):1085–1092. doi:10.1016/j.arthro.2006.05.016 PubMedCrossRef

18.

Becher C, Thermann H (2005) Results of microfracture in the treatment of articular cartilage defects of the talus. Foot Ankle Int 26(8):583–589. doi:894977 PubMed

19.

Becher C, Driessen A, Thermann H (2008) Microfracture technique for the treatment of articular cartilage lesions of the talus. Orthopade 37(3):196, 198–203. doi:10.1007/s00132-008-1213-9

20.

Lee KB, Bai LB, Chung JY, Seon JK (2010) Arthroscopic microfracture for osteochondral lesions of the talus. Knee Surg Sports Traumatol Arthrosc 18(2):247–253. doi:10.1007/s00167-009-0914-x PubMedCrossRef

21.

Chuckpaiwong B, Berkson EM, Theodore GH (2008) Microfracture for osteochondral lesions of the ankle: outcome analysis and outcome predictors of 105 cases. Arthroscopy 24(1):106–112. doi:10.1016/j.arthro.2007.07.022 PubMedCrossRef

22.

Doral MN, Bilge O, Batmaz G, Donmez G, Turhan E, Demirel M, Atay OA, Uzumcugil A, Atesok K, Kaya D (2011) Treatment of osteochondral lesions of the talus with microfracture technique and postoperative hyaluronan injection. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-011-1856-7

23.

Becher C, Driessen A, Hess T, Longo UG, Maffulli N, Thermann H (2010) Microfracture for chondral defects of the talus: maintenance of early results at midterm follow-up. Knee Surg Sports Traumatol Arthrosc 18(5):656–663. doi:10.1007/s00167-009-1036-1 PubMedCrossRef

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(3):310–319. doi:10.1016/j.ejrad.2004.03.014 PubMedCrossRef

25.

Potter HG, Foo LF (2006) Magnetic resonance imaging of articular cartilage: trauma, degeneration, and repair. Am J Sports Med 34(4):661–677. doi:10.1177/0363546505281938 PubMedCrossRef

26.

Schneider T, Fink B, Jerosch J, Assheuer J, Ruther W (1998) The value of magnetic resonance imaging as postoperative control after arthroscopic treatment of osteochondritis dissecans. Arch Orthop Trauma Surg 117(4–5):235–239PubMedCrossRef

27.

Apprich S, Trattnig S, Welsch GH, Noebauer-Huhmann IM, Sokolwski M, Hirschfeld C, Stelzeneder D, Domayer S (2012) Assessment of articular cartilage repair tissue after matrix-associated autologous chondrocyte transplantation or the microfracture technique in the ankle joint using diffusion-weighted imaging at 3 Tesla. Osteoarthr Cartil. doi:10.1016/j.joca.2012.03.008

28.

Domayer SE, Apprich S, Stelzeneder D, Hirschfeld C, Sokolowski M, Kronnerwetter C, Chiari C, Windhager R, Trattnig S (2012) Cartilage repair of the ankle: first results of T2 mapping at 7.0 T after microfracture and matrix associated autologous cartilage transplantation. Osteoarthr Cartil. doi:10.1016/j.joca.2012.04.015

29.

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(11):1119–1125. doi:10.1016/j.joca.2006.05.003 PubMedCrossRef

30.

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(9):1911–1920. doi:10.2106/JBJS.D.02846 PubMedCrossRef

31.

Cuttica DJ, Shockley JA, Hyer CF, Berlet GC (2011) Correlation of MRI edema and clinical outcomes following microfracture of osteochondral lesions of the talus. Foot Ankle Spec 4(5):274–279. doi:10.1177/1938640011411082 PubMedCrossRef

32.

Guo QW, Hu YL, Jiao C, Yu CL, Ao YF (2010) Arthroscopic treatment for osteochondral lesions of the talus: analysis of outcome predictors. Chin Med J (Engl) 123(3):296–300

33.

Giannini S, Vannini F (2004) Operative treatment of osteochondral lesions of the talar dome: current concepts review. Foot Ankle Int 25(3):168–175. doi:594999 PubMed

34.

Lahm A, Erggelet C, Steinwachs M, Reichelt A (2000) Arthroscopic management of osteochondral lesions of the talus: results of drilling and usefulness of magnetic resonance imaging before and after treatment. Arthroscopy 16(3):299–304. doi:S0749806300535968 PubMedCrossRef

35.

Ettl V, Kenn W, Radke S, Kirschner S, Goerttler-Krauspe I, Vispo-Seara JL (2001) The role of MRI in therapy and follow-up after surgical treatment of osteochondrosis dissecans of the talus. Z Orthop Ihre Grenzgeb 139(2):157–162. doi:10.1055/s-2001-15049 PubMedCrossRef

36.

Jurgensen I, Bachmann G, Schleicher I, Haas H (2002) Arthroscopic versus conservative treatment of osteochondritis dissecans of the knee: value of magnetic resonance imaging in therapy planning and follow-up. Arthroscopy 18(4):378–386. doi:S0749806302445021 PubMedCrossRef

37.

Higashiyama I, Kumai T, Takakura Y, Tamail S (2000) Follow-up study of MRI for osteochondral lesion of the talus. Foot Ankle Int 21(2):127–133PubMed

Title: Clinical and MRI results after microfracture of osteochondral lesions of the talus
Authors: B. Kuni
H. Schmitt
D. Chloridis
K. Ludwig
Publication date: 01-12-2012
Publisher: Springer-Verlag
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 12/2012
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-012-1595-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Clinical and MRI results after microfracture of osteochondral lesions of the talus

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 12/2012

Predicting grip strength and key pinch using anthropometric data, DASH questionnaire and wrist range of motion

Operative treatment of scoliosis in proximal spinal muscular atrophy: results of 41 patients

Biochemical lung, liver and kidney markers and early death among elderly following hip fracture

The effect of labeling photo documents in wrist arthroscopies on intra- and interobserver reliability

Recombinant human bone morphogenetic protein-2 versus autogenous iliac crest bone graft for lumbar fusion: a meta-analysis of ten randomized controlled trials

Delayed detection of clinically significant posterior cruciate ligament injury after peri-articular fracture around the knee of 448 patients