Arthroscopic bone marrow stimulation techniques for osteochondral lesions of the talus: prognostic factors for small lesions.
BACKGROUND
The defect size of an osteochondral lesion of the talus is one of the most important prognostic factors for deciding clinical outcomes. However, the prognostic factors for small osteochondral lesions of the talus are unknown.


OBJECTIVE
To investigate the significant prognostic factors for small osteochondral lesions of the talus using arthroscopic bone marrow stimulation techniques.


METHODS
Case series; Level of evidence, 4.


METHODS
Fifty ankles in 50 patients treated with arthroscopic bone marrow stimulation techniques for an osteochondral lesion of the talus (<150 mm(2)) were evaluated for prognostic factors. The patients were 22 men and 28 women (mean age, 35.0 years). Outcomes were measured using the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale, Berndt and Harty scale, and Saxena criteria.


RESULTS
The mean lesion size was 62 mm(2) (range, 7-119 mm(2)). The mean AOFAS score improved from 74 (range, 18-90) preoperatively to 90 (range, 67-100) postoperatively. The Saxena criteria results were excellent, good, fair, and poor in 36 (72%), 8 (16%), 5 (10%), and 1 (2%) patients, respectively. The Berndt and Harty scale results were good in 34 (68%), fair in 6 (12%), and poor in 10 (20%) patients. Linear regression analyses showed prognostic significance for lesion depth and outcome. Medial lesions had a significantly higher incidence of poor outcomes than lateral lesions (P < .05). Among the medial lesions, lesions uncovered with the medial malleolus had inferior outcomes compared with covered lesions (P < .0001). There was no association between clinical outcome and lesion size or body mass index. In older patients (≥40 years), there was a significant trend toward inferior clinical outcomes (P < .05).


CONCLUSIONS
Arthroscopic bone marrow stimulation techniques provided satisfactory clinical outcomes. However, older patients, deep lesions, and medial lesions uncovered with the medial malleolus were associated with inferior clinical outcomes.
Department of Orthopaedic Surgery, Faculty of Medicine, Fukuoka University, Fukuoka 814-0180, Japan. ichiroy813@gmail.com
Ichiro
I
Yoshimura
Kazuki
K
Kanazawa
Akinori
A
Takeyama
Chayanin
C
Angthong
Takahiro
T
Ida
Tomonobu
T
Hagio
Hirofumi
H
Hanada
Masatoshi
M
Naito
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D054544:Arthroplasty, Subchondral; D001182:Arthroscopy; D002358:Cartilage, Articular / Q000293:injuries / Q000601:surgery*; D002648:Child; D003475:Curettage; D005260:Female; D006801:Humans; D008023:Ligaments, Articular / Q000293:injuries / Q000601:surgery; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D013628:Talus / Q000293:injuries / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult