Summary

No predictive factors could be identified using univariate linear regression for patients undergoing osteoperiosteal autografting for a medial OLT.

Abstract

Background

Osteochondral lesions of the talus (OLTs) can be treated using osteochondral or osteoperiosteal autograft transplantation. Success rates of 77% have been reported. The prospective two-year outcomes of Talar OsteoPeriostic grafting from the Iliac Crest (TOPIC) also show that the upper quartile of patients still have a Numeric Rating Scale (NRS) of pain during walking ranging from 5 to 9. It is, however, up to date unknown which patients predispose to an inferior outcome. Therefore, it is the primary aim of the present study to determine predictive factors for the NRS during walking of pain at 1- and 2-year follow-up after the TOPIC procedure for a medial OLT. Secondarily, it was aimed to identify predictive factors for other clinical outcomes.

Methods

The present prospective cohort study was performed in a tertiary referral academic hospital that is accredited as expert center for cartilage damage of the foot and ankle. All patients that underwent a press-fit TOPIC procedure for a medial OLT with more than 1-year of follow-up were eligible for inclusion. The primary dependent outcome is the change from baseline of the NRS of pain during walking at 1- and 2-year post-operatively. The secondary dependent outcomes consisted out of the NRS of pain during rest, NRS of pain during stair climbing, FAOS subscales and the AOFAS ankle-hindfoot score. Univariate linear regression was performed for possible prognostic factors, including patient gender, age at surgery, BMI, smoking status, lesion nature, lesion surface area, lesion volume, lesion morphology and ankle OA score. Multiple-comparison correction was performed using the Bonferroni correction.

Results

A total of 86 patients were included in the present study. Of these patients, 77 patients could be analyzed at 1-year follow-up and 66 patients at 2-year follow-up. Both groups consisted of 60% non-primary lesions. The 1-year NRS of pain during walking changed from 6 [4-8] to 2 [1-5]. No significant factors were identified. The 2-year NRS of pain during walking changed from 6 [4-8] at baseline to 2.5 [1-5] at 2-year follow-up. None of the predictors were found to be significant. For the secondary outcomes, none of the predictors was found to be significant.

Conclusion

No predictive factors could be identified using univariate linear regression for patients undergoing osteoperiosteal autografting for a medial OLT. This indicates that a possible relationship between these variables and the post-operative outcome could be more complex. Further research should use more advanced statistical techniques involving a larger dataset.