SLR - June 2021 - Karan Malani

Internal Fixation of Osteochondral Lesion of the Talus Involving a Large Bone Fragment 

Reference: Rak Choi, Young et al. “Internal Fixation of Osteochondral Lesion of the Talus Involving a Large Bone Fragment.” The American journal of sports medicine vol. 49,4 (2021): 1031-1039.

Scientific Literature Review

Level of Evidence: 4

Reviewed By: Karan Malani, DPM
Residency Program: Cambridge Health Alliance

Podiatric Relevance: Common surgical interventions utilized for large (> 10.2 millimeters) osteochondral lesions of the talus (OLT) currently include autologous osteochondral transplantation (AOT) or osteochondral allografting. Even though these procedures demonstrate excellent clinical outcomes, they are not without inherent risks and complications. The present study aims to provide clinical and radiologic outcomes following internal fixation of OLT. The dearth of literature regarding surgical treatment and fixation of large osteochondral lesions of the talus lends to the relevancy of this article to the podiatric surgeon.

Methods: The authors retrospectively reviewed the data of 26 patients with OLT treated from August 2014-December 2017. The indications of the procedure included a large OLT with a bone fragment of at least 10 millimeters in diameter and 3 millimeters in depth on a CT scan that failed to attain radiological union after four months of conservative care. Exclusion criteria consisted of cases with osteoarthritis, infection, damaged cartilage and fragmentation of the bone fragment. Preoperatively, the authors obtained radiographs, MRI and CT scans to determine the size, location and morphology of the lesion. The authors measured clinical outcomes based on visual analog (VAS) and Foot Function Index (FFI) preoperatively, and at six months, one year and every subsequent year postoperatively. The primary radiological outcome was observation of osseous union at six months postoperatively on a CT scan.

Results: The mean follow-up duration was 27.7 months. The mean 100 millimeters VAS score improved from 30.5 ± 8.5 preoperatively to 13.4 ±9.7 postoperatively. The mean FFI improved from 30.5 ± 6.7 preoperatively to 13.7 ± 9.8 postoperatively. Following conclusion of the study, 76.9 percent (n=20) achieved a radiological osseous union. No significant differences were noted in outcomes between patients with skeletally mature and immature ankles. Additionally, a malleolar osteotomy was not required for 88 percent of the patients. 

Conclusions: The primary finding of this study was that internal fixation of OLT involving a large bone fragment resulted in satisfactory clinical and radiological outcomes. Essentially, this study is able to provide an alternative method for management of OLT with large bone fragments in addition to the current accepted treatment methods such as microfracture technique or even autologous osteochondral transplantation and allografting. This study did have several limitations including its retrospective nature, small sample size and lack of a control group. Additional research is required with a larger sample size and a more comparative design to further confirm the findings noted in this paper. 

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