In the JournalsPerspective

Osteochondral lesions of the talus may have incomplete healing after arthroscopic microfracture

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.

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.

    Perspective
    Lew C. Schon

    Lew C. Schon

    Microfracture is a popular procedure for the treatment of osteochondral lesion of the talus. However, its outcome, especially in the long term, can be unpredictable. The fact that the procedure produces fibrocartilage, which is inferior to articular cartilage in mechanical strength, may contribute to some disappointing results. Much is needed to learn about this procedure, including what are the factors or conditions that influence its outcome. In their recent paper, Hong-Yeol Yang, MD, and Keun-Bae Lee MD, PhD, both experienced foot and ankle surgeons, have made a contribution to our understanding.

    They followed up 25 patients with osteochondral lesions in the talus and treated with arthroscopic microfracture. The clinical outcome was recorded with ankle function scores, and MRI imaging and second-look arthroscopy were performed. Correlations among those data would hint that potential MRI or arthroscopic signs would correlate with the long-term outcome of microfracture. The authors found that second-look arthroscopy is a practical and reliable method for evaluation the cartilage repair of microfracture. In the future, MRI could play a more prominent role in assessing cartilage repair because it is non-invasive, and provides in-depth, sectional images and biochemical properties of cartilage.

    • Lew C. Schon, MD, FACS, FAAOS
    • Director of orthopedic innovation
      Institute of Foot and Ankle Reconstruction
      Mercy Medical Center
      Baltimore

    Disclosures: Schon reports he is a co-inventor of the Zimmer Trabecular Metal Total Ankle and receives royalties from Zimmer Biomet.