Summary

We analysed the clinical and radiological outcomes for 40 patients who underwent non-operative management for their Osteochondral Lesion of the Talus

Abstract

Background

Osteochondral lesions of the talus (OLTs) are preferably treated initially non-operative before invasive surgical strategies are indicated for at least 6 months. However, the current evidence to support this initial non-operative management is limited. The primary aim of this study is to assess the effect of the non-operative management for OLT on clinical outcomes over the course of one year. The secondary aims were to assess the influence of baseline factors on clinical outcomes, radiological outcomes, and conversion to surgery rate.

Methods

Patients allocated for primarily non-operative management were screened for eligibility. After the inclusion process, clinical outcome measures were obtained at baseline, 6 months and 12 months. Clinical outcome measures consisted of Patient Reported Outcome Measures (PROMS). Radiological outcomes consist of change in volume (cm3) and surface (cm2) of the lesion over the course of one year. The primary outcome of this study is the change of the NRS during walking over the course of 1 year, measured at baseline, 6 months and 12 months. The secondary outcomes consist of change in NRS during rest, NRS during running, NRS during stair climbing, FAOS subscales, change in lesion volume and surface area (as measured per CT), and conversion to surgery rate.

Results

In total, 40 patients and 42 ankles with a primary symptomatic OLT were included in this study. The primary outcome, NRS during weightbearing, improved significantly after 6 and remained stable up to 12 months, compared to baseline. NRS during running and stair climbing showed significant improvement both between 0-6 months and 0-12 months. Only NRS during rest remains stable over time. FAOS subscales symptoms, pain, sports and quality of life improved all statistically significant between 0-6 months but remain stable between 0-12 months. Lesion sizes remains stable over the course of one year. Only 3 out of 40 patients converted to surgery within one year.

Conclusion

Outcomes of this study confirm that non-operative treatment must be the first treatment in line before surgical treatment is considered. Non-operative treatment yields significant improvements regarding pain during weightbearing, as well as most functional secondary outcomes. These improvements were retained at 12 months follow-up. Outcomes improve minimally in terms of clinical relevance, however, the improvements made were stable over time. A stable lesion size at 12 months follow-up was observed.