SLR - August 2014 - Jackie Pyle

Clinical Characteristic of Early-Stage Osteonecrosis of the Ankle and Treatment Outcomes.

Reference: Issa K, Nazari Q, Kapadia BH, Lamm BM, Jones LC, Mont MA. Clinical Characteristics of Early-Stage Osteonecrosis of the Ankle and Treatment Outcomes. J Bone and Joint Surgery. 2014; 96: e 3(1-8).

Scientific Literature Review

Reviewed By: Jackie Pyle, DPM
Residency Program: Southern Arizona VA Health Care System

Podiatric Relevance: With the increasing prevalence of ankle osteonecrosis in younger patients, it is important to attempt joint-preserving procedures in patients with early-stage osteonecrosis of distal tibia and talus.
 
Methods: One hundred and one ankles in 73 patients (mean age 41) with radiographic diagnosis of symptomatic early-stage osteonecrosis of the distal tibia and/or talus were treated surgically with percutaneous drilling. All had previous failed conservative treatment of at least three months. Eighty one ankles had no previous surgical treatment. Twenty ankles had previous failed core decompression. Percutaneous drilling was performed using 1.8-mm Steinmann pins percutaneously under fluoroscopy. Patients were partial weight bearing for four weeks then weight bearing as tolerated allowing high impact activity at 10 months. Bilateral patients were allowed full weight bearing at five-six weeks. Average follow up was five months. Follow up data was collected using AOFAS ankle-hindfoot scores (clinical outcomes), Short-Form 36 physical and mental component score, UCLA activity scores, and Visual Analog Scale (VAS) to assess pain.

Results: At latest follow up, eighty-four ankles (83 percent) showed no further progression of osteonecrosis. Seventeen ankles had showed progression, four of these to the point of joint collapse. There were significant improvements in AOFAS, VAS, and UCLA activity scores post operatively.
 
Conclusions: Though osteonecrosis involving the distal tibia and talus is relatively rare, early diagnosis and treatment are important. This study shows that percutaneous drilling is a minimally invasive, joint-sparing procedure that is effective for early-stage ankle osteonecrosis.

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