SLR - August 2016 - Eric Woolley

Clinical and MRI Outcomes After Surgical Treatment of Osteochondral Lesions of the Talus in Skeletally Immature Children

Reference: Jurina A, Dimnjaković D, Mustapić M, Smoljanović T, Bojanić I.  Clinical and MRI Outcomes After Surgical Treatment of Osteochondral Lesions of the Talus in Skeletally Immature Children.  J Pediatr Orthop. 2016 Mar 11.  

Scientific Literature Review

Reviewed By: Eric Woolley, DPM
Residency Program: Northern Colorado Medical Center

Podiatric Relevance: This article addresses the outcomes in young patients with talar osteochondral lesions treated with arthroscopic microfracture technique.  Limited data is currently available on this subject. Due to the high healing potential of children, it is important to understand the potential outcomes of a minimally invasive procedure in this patient population.  

Methods: The authors of this study evaluated thirteen skeletally immature patients who were treated by arthroscopic microfracture for osteochondral lesions of the talus. Patient satisfaction was measured using the Berndt and Harty outcome question, the Single Assessment Numeric Evaluation question and the Martin questionnaire. Each patient’s functional outcome was also evaluated pre- and postoperatively using the American Orthopedic Foot and Ankle Society (AOFAS) score.  The patient’s cartilage was also evaluated using MRI and scored postoperatively using a magnetic resonance observation of cartilage repair tissue (MOCART) scoring system for 11 ankles.

Results:
Utilizing the Berndt and Harty outcome question, 76.9 percent of patients evaluated reported good clinical results, and 23.1 percent reported fair results.  AOFAS scoring improved significantly. MRI evaluation (MOCART scoring) showed no association between score and clinical outcomes.  

Conclusions: The authors concluded that utilizing arthroscopic microfracture for the treatment of osteochondral lesions of the talus was effective in skeletally immature children.  

This article expanded my thoughts on possible treatment protocols for children with OCD lesions of the talus. Understanding that the microfracture technique results in varying levels of tissue quality per the MOCART score is important, but more clinically relevant is that patient outcomes were unrelated to the MOCART score and could avoid possible comorbidities and operative concerns associated with autograft harvesting and implantation.  

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