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.