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PURPOSE. To assess outcome of 6 juvenile patients with osteochondritis dissecans (OCD) of the ankle treated conservatively.
METHODS. Records of 4 males and one female aged 10.8 to 14.1 (mean, 12.3) years who underwent cast immobilisation and/or restriction of physical activities for OCD of the talus (4 on the left and 2 on the right) were reviewed. OCD lesions were graded using the Berndt and Harty classification. Functional outcome was assessed using the ankle-hindfoot score of the American Orthopaedic Foot and Ankle Society. Clinical and radiographic outcomes were assessed according to the Higuera classification.
RESULTS. The mean follow-up period was 30.5 (range, 11-63) months. The mean ankle-hindfoot score was 90 (range, 86-100). Radiological resolution of OCD was noted in 2 ankles, although all ankles showed some degree of healing. All patients had resolution of pain after a mean of 7 (range, 3-12) months. According to the Higuera classification, clinical outcome was excellent in one and good in 5 ankles, whereas radiological outcome was excellent in 2, good in 2, and fair in 2 ankles. In one patient, the OCD of the right posteromedial talar dome resolved spontaneously.
CONCLUSION. Almost all patients achieved good functional outcome after conservative management, regardless of the presence of radiological evidence of healing. Surgery should only be performed if the OCD is unstable.
Background: We hypothesized that patients undergoing nonoperative treatment for asymptomatic or minimally symptomatic osteochondral lesions of the talus (OLTs) would not deteriorate clinically or radiologically over time.
Methods: Forty-eight patients (mean age = 48 years; range, 13-78 years) with an OLT confirmed by magnetic resonance imaging (MRI) who had not undergone ankle joint surgery were retrospectively reviewed. All patients were evaluated after a minimum follow-up of 2 years (mean = 52 months; range, 27-124 months). All patients filled out an individual questionnaire and underwent a physical and radiographic assessment (radiograph and hindfoot MRI).
Results: At final follow-up, 43 ankles (86%) in 41 patients were pain-free (visual analogue scale [VAS] 0, n = 12) or less painful (VAS 1-3, n = 31). Radiographically, osteoarthritis was absent in 47%, and grade 1 and 2 osteoarthritis each were found in 27% (van Dijk classification). Magnetic resonance imaging revealed no substantial progression in staging or lesion size. Pain at time of follow-up correlated with the depth of the lesion at initial MRI (P < .05) and with subchondral cyst formation and presence or change of bone marrow edema at follow-up MRI (P < .05).
Conclusion: Minimally symptomatic OLTs did not appear to progress or worsen over time when treated nonoperatively.
Arthroscopic treatment of osteochondritis dissecans (OCD) of the talus has resulted in outcomes as good as, or better than, those after arthrotomy. We noted a lack of prospective studies investigating the outcomes of arthroscopic treatment. As such, we conducted a prospective study investigating the functional outcomes, pain scores, patient satisfaction, and expectation scores of patients undergoing arthroscopic treatment of OCD of the talus, hypothesizing that these patients would have good outcomes and satisfaction. A total of 61 patients underwent arthroscopic chondroplasty, removal of loose bodies, and microfracture for OCD of the talus and completed ≥1 year of follow-up. We evaluated patients pre- and postoperatively at 6 and 12 months using the Ankle-Hindfoot score, visual analog scale for pain, and Medical Outcomes Study short-form 36 questionnaires. We also evaluated the patients’ expectations and satisfaction. The mean Ankle-Hindfoot score improved significantly from 53.0 ± 14.3 points preoperatively to 77.8 ± 19.1 at 6 months and 83.1 ± 18.3 at 12 months after arthroscopic treatment (p < .001). The overall scores at the final follow-up visit were excellent for 30 (49%), good for 6 (10%), fair for 18 (30%), and poor for 7 (11%). The patients also experienced significant improvement in the visual analog scale score and physical component score of the short-form 36 questionnaire (p < .001). Of the 61 patients, 67% had their expectations fulfilled and 74% were satisfied with their surgery at 12 months of follow-up. Arthroscopic treatment of OCD of the talus continues to be a successful procedure to alleviate pain and loss of function. It is also associated with improvements to quality of life and good patient satisfaction.
INTRODUCTION: Recently, mesenchymal stem cells (MSCs) are expected to biologically augment the
treatment of osteochondral lesion of the talus (OLT). The aim of this study was to compare the clinical
and magnetic resonance imaging (MRI) outcomes between MSC injection with marrow stimulation and
marrow stimulation alone in patients with OLT.
METHODS: A total of 49 patients (50 ankles) with OLT underwent follow-up MRI after arthroscopic
treatment. Among these 50 ankles, 26 underwent marrow stimulation alone (conventional group) and
24 underwent marrow stimulation with injection of MSC (MSC group). Clinical outcomes were evaluated
according to a visual analog scale (VAS) for pain, American Orthopaedic Foot and Ankle Society (AOFAS)
Ankle-Hindfoot Scale, and Tegner activity scale. Magnetic Resonance Observation of Cartilage Repair
Tissue (MOCART) score was used for MRI evaluation of repaired lesions.
RESULTS: Mean VAS score, AOFAS score, and Tegner activity scale in each group improved from 7.1 ±
1.2, 68.5 ± 5.6, and 3.4 ± 0.6 to 3.9 ± 0.8, 78.3 ± 4.9, and 3.5 ± 0.8, respectively in the conventional group
and from 7.1 ± 0.8, 67.7 ± 4.7, and 3.4 ± 0.5 to 3.2 ± 0.8, 83.3 ± 7.0, and 3.9 ± 0.7, respectively in the
MSC group. All clinical outcomes, including VAS, AOFAS, and Tegner activity scores, improved
significantly in the MSC group compared with the conventional group (P = .003, .009, and .041,
respectively). There was a significant difference (P = .037) in the mean MOCART score between the
conventional and MSC groups (49.4 ± 16.6 vs. 62.1 ± 21.8), and significant correlations of MOCART score
with clinical outcomes were found in both groups (P < .05). Patient age (≥ 46.1 years), large lesion size (≥
151.2 mm2), and presence of subchondral cyst were associated with a worse MOCART score in the
conventional group (P = .015, .004, and .013, respectively), but not in the MSC group.
DISCUSSION AND CONCLUSION: Clinical and MRI outcomes of injection of MSCs with marrow
stimulation were encouraging, compared with marrow stimulation alone, for the treatment of OLT.
Therefore, injection of MSCs with marrow stimulation should be considered as a treatment for OLT,
even when poor prognostic factors, including older age, large-sized lesion, or presence of subchondral