SLR - April 2022 - Matthew E. Greenblatt
Reference: Ettinger S, Gottschalk O, Kostretzis L, Plaas C, Körner D, Walther M, Becher C. One-Year-Follow-Up Data from the German Cartilage Registry (Knorpelregister Dgou) in the Treatment of Chondral and Osteochondral Defects of the Talus. Arch Orthop Trauma Surg. 2022 Feb;142(2):205-210. doi: 10.1007/s00402-020-03631-z. Epub 2020 Oct 13. PMID: 33047231.Level of Evidence: Level III
Scientific Literature Review
Reviewed By: Matthew E. Greenblatt, DPM
Residency Program: Inova Fairfax Medical Campus – Fairfax, VA
Podiatric Relevance: Chondral and osteochondral lesions of the talus (OLTs) are common pathologies that are treated by foot and ankle surgeons. Typically, clinical evaluation involves significant pain, swelling, and restriction of range of motion at the ankle joint. Further workup often includes advanced imaging such as magnetic resonance imaging that allows for proper identification of the specific size and location of the lesion. Multiple surgical treatment options exist depending on the specific information gathered from advanced imaging. The purpose of this article was to analyze the outcomes of various procedures for treatment of OLTs with possible confounding variables that may influence the outcomes based on the registry data.
Methods: Researchers analyzed outcomes gathered from the German Cartilage Registry (KnorpelRegister DGOU) that is an observational, nationwide, longitudinal multicenter registry including entries of any kind of cartilage repair treatment for defects in the hip, knee, and ankle. In relation to this specific study, patients who underwent surgical treatment for an isolated OLT with a completed 1-year Foot and Ankle Outcomes Score (FAOS) score for subscale pain as the primary variable were included. Eighty-nine patients were included in the analysis and divided into the following four treatment groups: arthroscopic antegrade bone marrow stimulation (BMS), autologous chondrocyte implantation (ACI) with autologous cancellous bone grafting, matrix-augmented BMS (M-BMS), and M-BMS with autologous cancellous bone grafting.
Results: All four treatment groups showed statistically significant improvement of FAOS sores at one-year postoperatively compared with their preoperative scores (p<0.05). M-BMS with autologous cancellous bone grafting had significantly greater one-year follow-up results than M-BMS for FAOS subscale Symptoms (p = 0.041) while ACI with autologous cancellous bone grafting had significantly better one-year follow-up results than M-BMS for FAOS subscales Pain (p = 0.023), ADL (p = 0.020), and QoL (p = 0.007). Additionally, those patients who underwent concomitant stabilizing procedure for chronic ankle instability demonstrated greater improvement in one-year follow-up results for FAOS subscales Symptoms (p = 0.046) and ADL (p = 0.043). Furthermore, the FAOS pain subscale showed a greater improvement in patients with a stabilizing procedure than in patients without a stabilizing procedure, however this was not statistically significant (p > 0.05).
Conclusions: This study demonstrated that for treatment of OLTs multiple options are sufficient for improvement in a patient’s short term clinical result. In addition, in those with chronic ankle instability a stabilizing procedure appears to have a positive impact on outcomes. However, more data over a longer period of time is still necessary to determine possible differences with respect to influencing variables and group differences.