Osteochondral lesions of the talus: randomized controlled trial comparing chondroplasty, microfracture, and osteochondral autograft transplantation.
OBJECTIVE
The purpose of this study was to compare outcomes of chondroplasty versus microfracture versus osteochondral autologous transplantation (OAT) in patients with osteochondral lesions of the talus (OLT).


METHODS
After prospective sample size analysis, patients with symptomatic, recalcitrant Ferkel class 2b, 3, and 4 OLT were randomized to chondroplasty, microfracture, or OAT treatment groups. Outcomes were measured with use of the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale (AHS), the Subjective Assessment Numeric Evaluation (SANE) rating, Numeric Pain Intensity (NPI), and magnetic resonance imaging (MRI).


RESULTS
Eleven patients had chondroplasty, 10 ankles (9 patients) had microfracture, and 12 patients had OAT. Mean time to follow-up was 53 months (range, 24 to 119 months). AHS scores showed no differences at 12 and 24 months, and SANE ratings showed no differences at final follow-up. NPI was significantly lower (P < .001) in chondroplasty and microfracture cases as compared with OAT at 24 hours postoperatively. Pearson's correlation analysis demonstrated an inverse relation between microfracture and OAT groups in that better outcome was associated with smaller lesions, compared with the chondroplasty group, which revealed mixed results with no particular trend. MRI revealed incomplete fill and edema after chondroplasty or microfracture and chondral gaps after OAT.


CONCLUSIONS
Our results demonstrate no difference between chondroplasty, microfracture, and OAT with regard to AHS and SANE ratings in patients with OLT. However, NPI at 24 hours postoperatively was significantly lower in patients who had chondroplasty and microfracture.


METHODS
Level I, Therapeutic study, high-quality randomized controlled trial with no statistically significant differences but narrow confidence interval.
Gobbi
Alberto
A
Orthopaedic Arthroscopic Surgery International, Milan, Italy. sportmd@tin.it
Francisco
Ramces A
RA
Lubowitz
James H
JH
Allegra
Francesco
F
Canata
Gianluigi
G
D000293:Adolescent; D000328:Adult; D016512:Ankle Injuries / Q000601:surgery*; D001182:Arthroscopy / Q000379:methods* / Q000706:statistics & numerical data; D002358:Cartilage, Articular / Q000293:injuries / Q000601:surgery / Q000637:transplantation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007103:Immobilization; D008279:Magnetic Resonance Imaging; D008297:Male; D008866:Microsurgery / Q000379:methods / Q000706:statistics & numerical data; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000706:statistics & numerical data; D010147:Pain Measurement; D011446:Prospective Studies; D020127:Recovery of Function; D012720:Severity of Illness Index; D013628:Talus / Q000293:injuries*; D014182:Transplantation, Autologous; D016896:Treatment Outcome