Effects of Early Weightbearing on Microfracture Treatment of Osteochondral Lesions of Talus with Subchondral Bone Defects

Abstract

When subchondral bone defects are present in osteochondral lesions of the talus (OCLT), it is inconclusive whether to allow early weightbearing after microfracture treatment because of the lack of effective support of the newly-formed fibrocartilage. After performing arthroscopic debridement and microfracture treatment on OCLT patients with subchondral bone defects, we allowed patients to have an early postoperative weightbearing exercise to observe their clinical outcome. Forty-two OCLT patients with subchondral bone defects were analyzed. Patients were randomly divided into two groups with 21 patients in each group. After arthroscopic debridement and microfracture treatment, group A was allowed to have early partial weightbearing while weightbearing was delayed in group B. Visual analogue scale (VAS) was used to evaluate joint pain before and after surgery. American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score was used to evaluate joint function. Tegner activity scale was used to assess patient’s exercise level. The AOFAS ankle-hindfoot score in group A increased from 54.4 to 87.6, and that in group B increased from 54.9 to 87.3. The VAS score in group A decreased from 6.5 to 2.2, and that in group B decreased from 6.4 to 2.3. The Tegner activity scale increased from 2.6 to 4.4 in group A, and that in group B increased from 2.6 to 3.9. There was significant difference in the Tegner activity scale between group A and group B (P<0.05). It was suggested that when performing microfracture treatment on OCLT patients with subchondral bone defects, early postoperative weightbearing may achieve similar clinical outcomes as delayed weightbearing, and patients may be better able to return to sports.

Keywords

osteochondral lesions of the talus / subchondral bone / arthroscopic microfracture / weightbearing time

References

[1] LoozeCA, CapoJ, RyanMK, et al.. Evaluation and Management of Osteochondral Lesions of the Talus. Cartilage, 2017, 8(1): 19-30

[2] NgA, BernhardA, BernhardK. Advances in Ankle Cartilage Repair. Clin Podiatr Med Surg, 2017, 34(4): 471-487

[3] VerhagenRA, StruijsPA, BossuytPM, et al.. Systematic review of treatment strategies for osteochondral defects of the talar dome. Foot Ankle Clin, 2003, 8(2): 233-242

[4] MeddaS, Al’KhafajiIM, ScottAT. Ankle Arthroscopy with Microfracture for Osteochondral Defects of the Talus. Arthrosc Tech, 2017, 6(1): e167-e174

[5] BuckwalterJA, MowVC, RatcliffeA. Restoration of injured or degenerated articular cartilage. J Am Acad Orthop Surg, 1994, 2(4): 192-201

[6] BecherC, DriessenA, HessT, et al.. Microfracture for chondral defects of the talus: maintenance of early results at midterm follow–up. Knee Surg Sports Traumatol Arthrosc, 2010, 18(5): 656-663

[7] PolatG, KarademirG, AkalanE, et al.. Patient compliance with touchdown weightbearing after microfracture treatment of talar osteochondral lesions. J Orthop Surg Res, 2017, 12(1): 46

[8] BerndtAL, HartyM. Transchondral fractures (osteochondritis dissecans) of the talus. J Bone Joint Surg Am, 2004, 86–A(6): 1336

[9] MintzDN, TashjianGS, ConnellDA, et al.. Osteochondral lesions of the talus: a new magnetic resonance grading system with arthroscopic correlation. Arthroscopy, 2003, 19(4): 353-359

[10] ChengJC, FerkelRD. The role of arthroscopy in ankle and subtalar degenerative joint disease. Clin Orthop Relat Res, 1998, 349(349): 65-72

[11] KitaokaH, AlexanderI, AdelaarR, et al.. Clinical rating system for the ankle–hindfoot, midfoot, hallux and lesser toes. Foot Ankle Int, 1994, 15(7): 349-353

[12] TegnerY, LysholmJ. Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res, 1985, 198(198): 43-49

[13] Savage–ElliottI, RossKA, SmythNA, et al.. Osteochondral lesions of the talus: a current concepts review and evidence–based treatment paradigm. Foot Ankle Spec, 2014, 7(5): 414-422

[14] ParkHW, LeeKB. Comparison of chondral versus osteochondral lesions of the talus after arthroscopic microfracture. Knee Surg Sports Traumatol Arthrosc, 2015, 23(3): 860-867

[15] PolatG, ErsenA, ErdilME, et al.. Long–term results of microfracture in the treatment of talus osteochondral lesions. Knee Surg Sports Traumatol Arthrosc, 2016, 24(4): 1299-1303

[16] ChoiJI, LeeKB. Comparison of clinical outcomes between arthroscopic subchondral drilling and microfracture for osteochondral lesions of the talus. Knee Surg Sports Traumatol Arthrosc, 2016, 24(7): 2140-2147

[17] GrambartST. Arthroscopic Management of Osteochondral Lesions of the Talus. Clin Pediatr Med Surg, 2016, 33(4): 521-530

[18] GuneyA, YurdakulE, KaramanI, et al.. Mediumterm outcomes of mosaicplasty versus arthroscopic microfracture with or without platelet–rich plasma in the treatment of osteochondral lesions of the talus. Knee Surg Sports Traumatol Arthrosc, 2016, 24(4): 1293-1298

[19] KokA D S, TuijthofGJ, et al.. Is technique performance a prognostic factor in bone marrow stimulation of the talus. J Foot Ankle Surg, 2012, 51(6): 777-782

[20] BecherC, DriessenA, HessT, et al.. Microfracture for chondral defects of the talus: maintenance of early results at midterm follow–up. Knee Surg Sports Traumatol Arthrosc, 2010, 18(5): 656-663

[21] FerkelRD, ZanottiRM, KomendaGA, et al.. Arthroscopic treatment of chronic osteochondral lesions of the talus: long–term results. Am J Sports Med, 2008, 36(9): 1750-1762

[22] LiS, LiH, LiuY, et al.. Clinical outcomes of early weight–bearing after arthroscopic microfracture during the treatment of osteochondral lesions of the talus. Chin Med J (Engl), 2014, 127(13): 2470-2474

[23] LeeDH, LeeKB, JungST, et al.. Comparison of early versus delayed weightbearing outcomes after microfracture for small to midsized osteochondral lesions of the talus. Am J Sports Med, 2012, 40(9): 2023-2028

[24] McCollumGA, MyersonMS, JonckJ. Managing the cystic osteochondral defect: allograft or autograft. Foot Ankle Clin, 2013, 18(1): 113-133