2015 ISAKOS Biennial Congress Paper #0

Sustained Clinical Success at 7 Years Follow-Up After Arthroscopic Lift-Drill-Fill-Fix (LDFF) Of Primary Osteochondral Lesions of the Talus

Quinten G.H. Rikken, BSc., Amsterdam NETHERLANDS
Nienke Altink, BSc, Amsterdam NETHERLANDS
Jari Dahmen, MD, BSc, Amsterdam NETHERLANDS
Kaj T.A. Lambers, MD, PhD, Amsterdan NETHERLANDS
Sjoerd A.S. Stufkens, MD, PhD, Amsterdam NETHERLANDS
Gino M. M. J. Kerkhoffs, MD, PhD, Prof., Amsterdam NETHERLANDS
Amsterdam UMC, Location AMC, Amsterdam, NETHERLANDS

FDA Status Not Applicable

Summary: Arthroscopic LDFF for fixable chronic primary OLTs results in excellent pain reduction and improved functional outcome, with sustained results at long-term follow-up. These results indicate surgeons may consider arthroscopic LDFF as treatment of choice for fragmentous OLT.

Abstract:

Introduction

The purpose of this study is to describe the long-term clinical results of arthroscopic fragment fixation for chronic primary osteochondral lesions of the talus (OLT), using the Lift-Drill-Fill-Fix (LDFF) technique.

Methods

18 Patients (20 ankles) underwent fixation for a primary OLT with an osteochondral fragment by means of arthroscopic LDFF and were evaluated at a mean final follow-up of 7 years. Pre- and postoperative clinical assessment was prospectively performed by measuring the Numeric Rating Scale (NRS) of pain at rest, during walking and when running. Additionally, the change in Foot and Ankle Outcome Score (FAOS) and the procedure survival (i.e., no reoperation for the OLT) at final follow-up and complications were assessed. A Wilcoxon signed-rank test was used to compare clinical outcomes preoperatively and postoperatively. A two-sided level of P< .05 was considered significant.

Results

The median NRS during walking significantly improved from 7 (IQR: 5 - 8) pre-operatively to 0 (IQR: 0 – 1.5) post-operatively (p = <0.001). The NRS during running significantly improved from 8 (IQR: 6 - 10) to 2 (IQR: 0 – 4.5) (p < 0.001) and the NRS in rest from 2.5 (IQR: 1 - 3) to 0 (IQR: 0 - 0) (p = <0.001). The median FAOS at final follow-up was 94 out of 100 for pain, 71 for other symptoms, 99 for activities of daily living, 80 for sport and 56 for quality of life. The FOAS remained significantly improved post-operatively on all subscales, except for the symptom’s subscale. The procedure survival rate is 87% at final follow-up. No complications were reported.

Conclusion

Arthroscopic LDFF for fixable chronic primary OLTs results in excellent pain reduction and improved functional outcome, with sustained results at long-term follow-up. These results indicate surgeons may consider arthroscopic LDFF as treatment of choice for fragmentous OLT.