Summary

Analysis of the radiological change of non-operatively treated Osteochondral lesions of the Talus at 1 and 2 years follow-up showed that only 1 in 7 lesions deteriorates over this period.

Abstract

Background

Osteochondral lesions of the talus (OLTs) should be initially treated using a non-operative protocol. Recent findings have shown that good clinical results can be obtained and surgery can often be avoided with non-operative treatment. However, patients may worry about deterioration of the lesions when treated non-operatively. The primary aim of the present study is therefore to analyse the radiological progression of all OLTs treated non-operatively at 1 and 2-years follow-up. The secondary aim is to assess the relation between baseline patient and lesion characteristics and these radiological outcomes.

Methods

All patients who underwent non-operative treatment for a primary OLT that did not convert to surgery for at least 12 months were included in this study. Baseline patient and lesion characteristics were obtained. CT-scans were obtained at baseline, 12-months and 24 months. The primary outcome is the radiological change, assessed by subjective scoring of the lesions being either radiologically stable, improved or worsened compared to their previous CT scan based on either an increase in lesion size or an increase in cysts within the same area . Secondary outcomes include the change in size (AP, ML and depth). Sub-analysis using the t-test and Chi-square test were performed to assess the influence of BMI, age, lesion morphology and lesion location on the primary outcome (worsened versus improvement/stable). All radiological outcomes were measured independently by two researchers and cross-verified.

Results

After application of the in- and exclusion criteria, 63 patients with 66 ankles were included in the present study. There were 28 males (42%) and the median age at the start of treatment was 28.4 years . Of these patients, 59 CTs were available at the 12 months timepoint (89% of total) and 28 CTs at 24 months follow-up (42% of total). The intraclass correlation (ICC) for lesion deterioration was considered ‘substantial’ and the ICC for lesion size was considered ‘excellent’. At 1-year, 68% (40 out of 59) of the lesions remained stable while 11 (19%) improved and 8 (14%) lesions deteriorated. At 2-year follow-up, 21 of the 28 lesions (75%) were stable, and 4 improved (14%) while 3 lesions deteriorated (11%). Median lesion size did not change significantly over time. Lesion morphology and location, BMI, and patient age did not show any significant relation to lesion deterioration.

Conclusion

Of the OLT patients that were treated non-operatively for at least a year, 2 out of 3 lesions remained stable over time and only 1 in 7 lesions deteriorated. No significant relation was found between lesion deterioration and lesion morphology, location, BMI or patient age.