January 27, 2020
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Osteochondral lesions of the talus may have incomplete healing after arthroscopic microfracture

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Despite functional improvements with arthroscopic microfracture, published results showed incomplete healing and inferior quality of repair tissue in nearly half of osteochondral lesions of the talus.

Of 110 patients with symptomatic osteochondral lesions of the talus who underwent arthroscopic microfracture, researchers assessed second-look arthroscopic findings in 25 patients according to the system of the International Cartilage Repair Society. Researchers evaluated MRI postoperatively with the magnetic resonance observation of cartilage repair tissue (MOCART) score and determined clinical outcomes with the foot and ankle outcome score, the American Orthopaedic Foot & Ankle Society ankle-hindfoot scale and SF-36 score.

Results showed 36% of ankles had abnormal findings on second-look arthroscopy according to the ICRS overall repair grades and 24% of patients had a mismatch between the MRI and second-look arthroscopic findings. Researchers found patients had an average postoperative MOCART score of 67.8 with good association with functional outcome. Between the preoperative and latest follow-up evaluations, patients had significant improvements in all functional outcome categories, according to results. Researchers noted a significant correlation between foot and ankle outcome scores and ICRS grades, with mean foot and ankle outcome scores of 86.8 for ICRS repair grades I and II and of 75.6 for ICRS repair grades III and IV.

“Our results provide evidence for the utility of second-look arthroscopy in accurately assessing the status of the cartilage repair tissue beyond use of MOCART and functional outcomes,” the authors wrote. “However, using arthroscopic microfracture alone is limited by the inherent disadvantage that it results in the production of fibrocartilage, which has mechanical and biologic properties that are inferior to those of native hyaline cartilage. Therefore, further improvements in treatment, including the use of biologic adjuncts, should be evaluated.” – by Casey Tingle

Disclosures: The authors report no relevant financial disclosures.