2025 ISAKOS Congress in Munich, Germany

2025 ISAKOS Biennial Congress Paper


Open Lift, Drill, Fill and Fix (LDFF) for Chronic Osteochondral Lesions of the Talus: Excellent Two-year Prospective Clinical Outcomes

Quinten G.H. Rikken, MD, Amsterdam NETHERLANDS
Jari Dahmen, MD, BSc, Amsterdam NETHERLANDS
Kaj T.A. Lambers, MD, PhD, Amsterdan NETHERLANDS
Kaj Emanuel, MD, PhD, Amsterdam NETHERLANDS
Sjoerd A.S. Stufkens, MD, PhD, Amsterdam NETHERLANDS
Gino M. M. J. Kerkhoffs, MD, PhD, Prof., Amsterdam NETHERLANDS

Amsterdam UMC, Amsterdam, NETHERLANDS

FDA Status Not Applicable

Summary

Open LDFF results in an excellent pain reduction and good clinical outcomes, with a 91% fragment union rate. Patients with obesity may be at a higher risk for a fragment non-union and should be counseled accordingly.

Abstract

Introduction

In the presence of an osteochondral fragment with sufficient subchondral bone thickness fixation is considered to be an effective treatment method for osteochondral lesions of the talus (OLT). One such a fixation technique is the Lift-Drill-Fill-Fix (LDFF) procedure, which has shown reliable long-term results in the arthroscopic setting, however, the outcomes in cases treated through an open approach are unknown. It was therefore the primary aim of the study to assess the 2-year outcomes following open LDFF for chronic OLTs.

Methods

34 patients who underwent an open LDFF procedure for chronic OLT were prospectively followed for 2-years. The primary outcome concerned the comparison in numeric rating scale (NRS) (0 no pain – 10 most severe pain) of pain during walking between the preoperative score to the 2-years postoperative follow-up score. The association of baseline factors with the change in the primary outcome between baseline and 2-year follow-up was assessed. Secondary patient-reported outcome measures (PROMs) were the Foot and Ankle Outcome Score (FAOS) and Short-Form (SF)-36. The fragment union rate on 1-year follow-up computed tomography (CT) scans and the influence of possible baseline factors on union was assessed. Adverse events, including revision surgery and complications were assessed.

Results

The primary outcome significantly improved from a median of 6 (IQR: 4 – 7) out of 10 preoperatively to 1 (IQR: 0 – 3) out of 10 at final follow up, P= <0.01. There was no association between baseline factors (sex, age, body mass index (BMI), smoking status, lesion size, and location) and change in primary outcome between baseline and 2-years follow-up. All other PROMs significantly improved, except for the SF-36 mental component scale. The fragment union rate was 91% [95%-CI: 76 – 98]. BMI was significantly associated with fragment non-union (OR: 1.39 [95%-CI: 1.04 – 1.84], P=0.02). Three patients underwent revision surgery while 2 complications were observed.

Conclusions

Open LDFF results in an excellent pain reduction and good clinical outcomes, with a 91% fragment union rate. Patients with obesity may be at a higher risk for a fragment non-union and should be counseled accordingly.