Treatment of osteochondral lesion of the talus with microfracture

does the size of the lesion matter?

Abstract

Introduction: Microfracture of talus osteochondral lesions has proven to be a very efficient treatment for lesion size under 20 milimeters. The purpose of this study is to evaluate the results of microfracture of this lesion despite the size. Methods: Retrospective analysis was performed of patients with talar dome osteochondral lesion, treated with arthroscopic microfracture between august 2007 and January 2016. Visual analog scale (VAS), patient satisfaction and lesion size was evaluated, dividing it in 2 groups, lesion size smaller than 20mm and lesion size equal or bigger than 20mm. Results: Thirty-nine of 48 patients treated could be followed up at one year postop, the mean follow up time was 17,6 months (12-38). The VAS preop in the 28 (71%) patients with lesion smaller than 20mm was 7,8 (4 to 9) and postop 1,6 (0 to 4), 2 (7%) patients needed new microfracture. 11 (28%) patients had lesion equal or bigger than 20mm, preop VAS was 8,2 (6 to 9) and postop 2,6 (1 to 6). 3 (27%) needed a new procedure, 1 (9%) microfracture and 2 (18%) mosaicplasty. Conclusion: In our study we found that an important number of patients with talar osteochondral lesions equal or bigger than 20 milimeters can benefit from microfracture, avoiding more aggressive treatments and its complications, so microfracture is our first treatment option for this lesions, despite the lesion size.