STEOCHONDRAL DEFECTS OF THE TALUS: RESULTS OF REPEAT ARTHROSCOPIC DEBRIDEMENT

Abstract

Introduction: Arthroscopy to debride osteochondral lesions (OCL) of the talus is an accepted procedure with a good outcome in 70–80% of subjects. The minority of subjects that do not do well present a problem. Further arthroscopy and debridement procedures have been assumed to yield poor results and this has been used as justification for cartilage transplantation. The evidence for this is lacking.

Methods: In our unit the routine procedure for OCL is arthroscopic debridement. If this fails a further arthroscopic debridement is performed. We identified all subjects who had had a repeat procedure for failed arthroscopic debridement of an OCL by the senior author and reviewed them clinically. The outcome was scored using the AOFAS hind foot and ankle scoring system.

Results: Between 1993 and 2002 808 ankle arthroscopies were performed of which 215 were to treat OCLs. Of these 12 had repeat arthroscopies because of a poor outcome. AOFAS scores improved from a mean of 34.8 to 80.5 at a mean follow up of 5.9 years (range 18 months – 11 years). One subject had already undergone a cartilage transplantation procedure because of a poor outcome. The other 11 subjects scored themselves as fair or good and had returned to previous levels of activity, including two professional sportsmen. It was clear by 6 months in all subjects that their symptoms were significantly improved following the second procedure.

Conclusions: This is the first series specifically assessing subjects who have had repeat arthroscopic debridement of OCLs of the talus. Our results disprove the assumption that repeat arthroscopic debridement yield poor results. It provides benchmark results at medium term follow up for cartilage transplantation to be compared to.