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Autologous Microfractured and Purified Adipose Tissue for Arthroscopic Management of Osteochondral Lesions of the Talus
Published on: January 23, 2018
Treatment of osteochondral defects of the talus in children
M L Reilingh1, G M M J Kerkhoffs, C J A Telkamp
1Orthopaedic Research Center Amsterdam, Department of Orthopaedic Surgery, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD, Amsterdam, The Netherlands.
Insights
Conservative treatment for pediatric osteochondral talar defects often fails. Surgical options like fragment fixation or bone marrow stimulation offer good outcomes for these rare injuries in children.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Sports medicine
Background:
- Osteochondral talar defects are uncommon in children.
- Limited data exists on treatment and outcomes for pediatric cases.
Purpose of the Study:
- To evaluate clinical and radiographic outcomes of conservative and surgical treatments for osteochondral talar defects in skeletally immature children.
Main Methods:
- Retrospective case series (Level IV evidence) of 37 patients.
- Clinical assessment using multiple validated outcome scores and SF-36.
- Radiographic comparison for ankle osteoarthritis.
Main Results:
- 92% of initially conservatively treated children required surgery.
- Fragment fixation yielded good/fair outcomes in 100% of cases.
- Debridement with bone marrow stimulation resulted in good/fair/poor outcomes in 100% of cases.
- No degenerative changes observed post-operatively in either group.
Conclusions:
- Both fragment fixation and debridement with bone marrow stimulation are effective surgical treatments for pediatric osteochondral talar defects.
- Surgery is often necessary after failed conservative management.
Purpose:
Osteochondral talar defects are infrequent in children, and little is known about the treatment and clinical outcome of these defects. The purpose of this study was to evaluate the clinical and radiographic outcomes of conservative and primary surgically treated osteochondral talar defects in skeletally immature children.
Methods:
Thirty-six (97%) of 37 eligible patients with a symptomatic primary osteochondral talar defect were evaluated after a median follow-up of 4 years (range 1-12 years). Clinical assessment included the Berndt and Harty outcome question, Ogilvie-Harris score, Visual Analog Scale pain score (at rest, during walking and during running), the American Orthopaedic Foot and Ankle Society (AOFAS) score, and the SF-36. Weight-bearing radiographs were compared with preoperative radiographs with the use of an ankle osteoarthritis classification system.
Results:
Ninety-two per cent of the initially conservatively treated children [mean age 13 years (SD 2)] were eventually scheduled to undergo surgery. After fixation of the fragment, seven cases (78%) reported a good Berndt and Harty outcome, and two cases (22%) a fair outcome; the median AOFAS score was 95.0 (range 77-100). After debridement and bone marrow stimulation, 13 cases (62%) reported a good Berndt and Harty outcome, three cases (14%) a fair outcome, and five cases (24%) a poor outcome; the median AOFAS score was 95.0 (range 45-100). No signs of degenerative changes were seen in both groups at follow-up.
Conclusions:
Fixation and debridement and bone marrow stimulation of an osteochondral talar defect are both good surgical options after failed conservative treatment.
Level Of Evidence:
Retrospective case series, Therapeutic, Level IV.
