ISAKOS Congress 2021

2021 ISAKOS Biennial Congress Paper

 

Predictors Of Outcomes Of Microfracture For Osteochondral Lesions Of The Talus

Yoshiharu Shimozono, MD, Kyoto City, Kyoto JAPAN
John F Dankert, MD, PhD, New York, NY UNITED STATES
Timothy W. Deyer, MD, New York, NY UNITED STATES
Nathaniel P Mercer, MS, New York, NY UNITED STATES
John G. Kennedy, MD, FRCS, New York, NY UNITED STATES

New York University Langone Health, New York City, New York, UNITED STATES

FDA Status Cleared

Summary

This study sought to define the outcome predictors of microfracture for osteochondral lesions of the talus and identified lesion uncontainment and the existence of cysts as independent predictors of poor clinical outcomes following arthroscopic microfracture for smaller sized osteochondral lesions of the talus (<100mm2).

Abstract

Introduction

Microfracture has been widely published as a treatment modality for osteochondral lesions of the talus (OLT). However, little is known about the outcome predictors following microfracture for smaller sized OLT (<100mm2). This study sought to define the predictors of both clinical and magnetic resonance imaging (MRI) outcomes for small OLT treated with microfracture.

Methods

A retrospective cohort study investigating patients who received arthroscopic microfracture for OLT (<10mm or 100mm2) between 2008 and 2017 were evaluated. Multivariate regression models were used to evaluate factors affecting post-operative Foot and Ankle Outcome Scores (FAOS) and Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) scores. Kaplan-Meier survival curves with log rank test were constructed and endpoint was defined as the requirement of revision surgery.

Results

Eighty-seven patients were included in the study. The mean follow-up time was 41.4±28.7 months. The mean FAOS pain score significantly improved from 60.4±14.8 preoperatively to 79.3±12.8 at final follow-up (p<0.001). Patients with uncontained-type OLT had an approximately 9-point worse FAOS pain score compared to contained-type OLT (p=0.036). Patients with cystic OLT also had an approximately 9-point worse pain FAOS compared to non-cystic OLT (p=0.026). Patients with larger lesion size had worse postoperative MOCART scores (p=0.012). Both Uncontained-Cyst and Uncontained-Noncyst groups had significantly worse FAOS pain than the Contained-Noncyst group (p<0.001, p=0.026). Survival rates in uncontained and contained lesions were 51.5% and 84.4%, respectively (p=0.616).

Conclusions

Lesion uncontainment and the existence of cysts are independent predictors of poor clinical outcome following arthroscopic microfracture for smaller sized OLT (<100mm2).

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