Summary

Patients with retained arthroscopic BMS for OLT reported satisfactory clinical outcomes at average 15-years follow-up. Patients with non-primary OLT may benefit less from the procedure due to inferior pain scores. Two in three patients report participating in sports at long-term follow-up. The present study shows that arthroscopic BMS remains a viable treatment option for OLT as clinical results a

Abstract

Purpose

Long-term clinical outcomes of arthroscopic bone marrow stimulation (BMS) for the treatment of osteochondral lesions of the talus (OLT) are rarely reported in the literature, even though the procedure remains the most common treatment for OLT. Understanding of long-term clinical outcomes in patients with retained (i.e., non-failed) BMS can inform clinicians on the sustainability of BMS and may justify its continued practice. It was therefore the aim of this study to assess the patient-reported outcome measures (PROMs) of patients with a minimum follow-up of 10-years after arthroscopic BMS for OLT who did not undergo revision surgery. The secondary aim of this study was to assess the influence of baseline demographic and lesion characteristics on PROMs.

Methods

All consecutive patients who underwent arthroscopic BMS with retained results (i.e., no revision surgery for OLT after index surgery) were cross-sectionally contacted and included. PROMs were collected using the online CASTOR portal. The primary outcome was the numeric rating scale (NRS) for pain during walking. Additionally, the NRS during rest, stair climbing, and running, as well as the foot and ankle outcome score (FAOS) were collected. Participation in sports at follow-up and desired level of sports were also collected. A two-sample T-test was used to compare the primary outcome in sub-groups for prognostic factors; primary vs. non-primary lesions (i.e., failed prior surgical treatment), lesion size (> 150mm2 vs. < 150mm2), presence of cystic lesion, and sex. P<0.05 was considered significant.

Results

At final follow-up of mean 15.1 ± 4.7 years 102 patients were included. Patients were a mean 34.4 ± 10.8 years old at index surgery. 85 (83%) patients presented at baseline with a primary OLT. The average pre-operative lesion area was 279 ± 189 mm2, and 75% of patients presented with a cystic lesion. The primary outcome, the NRS during walking was 1.8 ± 2.4 out of 10 at final follow-up. Patients with a non-primary OLT reported a significantly higher NRS for pain during walking compared to primary OLT patients (2.9 ± 2.8 vs. 1.5 ± 2.3 out of 10, P= 0.04). Contrastingly, no significant differences were observed in the primary outcome when considering lesion size (P= 0.12), cystic lesions (P= 0.68), or sex (P= 0.56). The NRS during rest, stair climbing, and running was 0.8 ± 1.8, 1.5 ± 2.5, and 2.2 ± 3.0 out of 10, respectively. The following FAOS sub-scales were reported; symptoms: 69.8 ± 19.6, pain: 82.8 ±: 19.7, ADL: 99.2 ± 1.4, sport: 67.1 ± 28.3, QoL: 62.6 ± 27.5. At final follow-up, 66 (65%) patients participated in sports. Of these, 61% reported participating in sports at their desired level, while 33% reported other reasons for not reaching their desired level of sports, and 6% of patients reported being restricted in their desired level of sports due to their ankle complaints.

Conclusion

Patients with retained arthroscopic BMS for OLT reported satisfactory clinical outcomes at an average 15-years follow-up. Patients with non-primary OLT may benefit less from the procedure due to inferior pain scores. Two in three patients report participating in sports at long-term follow-up. The present study shows that arthroscopic BMS remains a viable treatment option for OLT as clinical results are maintained over time in the majority of patients.