Summary

Talar OsteoPeriostic grafting from the Iliac Crest (TOPIC) for lateral OLTs provides promising results in the first 8 prospectively followed patients.

Abstract

Background

Osteochondral lesions of the talus (OLTs) are initially treated non-operatively. In case of failure, operative treatment may be indicated. Larger (non-)primary lesions often are treated using osteochondral or osteoperiosteal autograft transplantation therapies. Talar OsteoPeriostic grafting from the Iliac Crest (TOPIC) is a novel technique that uses a press-fit autograft from the ipsilateral iliac crest. For medially located lesions, good to excellent outcomes have been observed. However, 1 out of 4 OLTs is located on the lateral talar dome and have a substantial different technique as there is no osteotomy needed and the ATFL should be released from the fibular footprint. This might introduce other safety concerns and result in different outcomes. Therefore it is the primary aim of the present prospective study to assess the Numeric Rating Scale (NRS) of pain during walking at two-year follow-up after the TOPIC procedure for lateral OLTs. Secondarily, the aim is to assess other clinical, radiological and safety outcomes at both one- and two-year follow-up.

Methods

The present is a single-center, non-randomized prospective cohort study in which all patients that underwent a press-fit TOPIC procedure for a (non-)primary OLT of the lateral talar dome were eligible for inclusion. The primary outcome is the NRS of pain during walking. Secondary clinical outcomes included the NRS of pain during rest and during stair climbing. Additionally, the Foot and Ankle Outcome Score (FAOS), the AOFAS ankle-hindfoot score and the Mental Component Summary (MCS) and Physical Component Summary (PCS) of the Short Form-36 (SF-36 were recorded. All clinical outcomes were assessed pre-operatively and after 6 months, 1 year and 2 years follow-up. Radiological follow-up was performed using computed tomography (CT) scans both pre-operatively and post-operatively after 12 weeks, 1 year and 2 years to assess graft incorporation and cyst development in or around the graft. All complications were recorded.

Results

After application of the in- and exclusion criteria, 8 patients were included with 100% clinical follow-up. One patient was not available for radiological follow-up. The median age at time of surgery was 29.5 years. The OLTs had a median surface area of 130 mm2. The NRS of pain during walking improved from 6 [4-7] pre-operatively to 1 [0-1] at 2-years of follow-up (p=0.008). All FAOS subscales improved significantly, except the FAOS Symptoms subscale. Graft consolidation was observed in 100% of the patients and cysts were present in 6 out of 7 patients. No complications occurred and 0% of the patients complained of donor-site morbidity. No reoperations were performed.

Conclusion

In the first 8 prospectively followed patients who underwent the TOPIC procedure for large osteochondral lesions of the lateral talar dome, an improvement of the NRS of pain during walking from median 6 pre-operatively to 1 at 2-year follow-up was observed. Additionally, all grafts showed incorporation, and no reoperations and complications were recorded. However, cysts developed in up to 6 out of 7 patients. Further research should include a higher number of patients and report long-term outcomes.