Summary

52 skeletally immature patients with at least 2-years follow-up were analysed after treatment of their Osteochondral Lesions of the Talus (OLT)

Abstract

Background

Literature on treatment outcomes in skeletally immature patients with osteochondral lesions of the talus (OLT) is scarce. As the healing of an OLT may be fundamentally different in a skeletally immature patient, more evidence is required focusing on this specific patient group. The primary aim of this study is to assess the conversion to surgery rate after initial non-operative management in skeletally immature patients with an OLT. The secondary aims of the present study are to assess and compare the clinical outcomes, re-operations after both non-operative and surgical treatment strategies at a mid-to long-term follow-up.

Methods

All skeletally immature patients at the moment of initial treatment, treated for their primary or non-primary OLT with a minimum follow-up duration of 2 years, were included in this study. Patients were divided into groups based on the received treatment (non-operative, Bone Marrow Stimulation (BMS) and fixation of the OLT). The primary outcome was the conversion to surgery rate after initial non-operative management. Secondary outcomes consist of reoperations at mature and immature age, pain during weight-bearing, measured by the numeric rating scale (NRS), NRS of pain during rest, NRS during stairclimbing, Berndt and Harty outcome question, Foot and Ankle Outcome Score (FAOS) and Short Form-36 (SF-36) and the patient satisfaction rate regarding the received treatment.

Results

A total of 52 patients, 54% female, mean age 13.6 years, were included in this study. In total, 34 (65%) out of 52 patients required surgical treatment after initial non-operative management. A reoperation rate of 20% and 20% were found in the BMS and fixation groups, respectively. The median NRS of pain during weight-bearing was 1 (IQR 0-2), 1 (IQR 0-3) and 0 (IQR 0-0.5) in the (sustained) non-operative, BMS and fixation group, respectively (p<0.012). No significant differences in clinical outcomes between the different treatment groups could be observed.

Conclusion

The most important finding of this study is that 65% converted to surgery after initial non-operative treatment for OLTs in the skeletally immature population. Additionally, (sustained) non-operative treatment, as well as bone marrow stimulation (BMS) and fixation showed good mid- to long-term clinical results for treatment of skeletally immature patients. No significant differences in outcomes between these treatment options could be observed.