2015 ISAKOS Biennial Congress Paper #0

Talar Osteoperiostic Grafting From The Iliac Crest (Topic): 2-Year Results Of A Novel Press-Fit Surgical Treatment For Large Talar Osteochondral Lesions

Jari Dahmen, MD, BSc, Amsterdam NETHERLANDS
Sjoerd A.S. Stufkens, MD, PhD, Amsterdam NETHERLANDS
Gino M. M. J. Kerkhoffs, MD, PhD, Prof., Amsterdam NETHERLANDS
Amsterdam UMC, Amsterdam, Noord-Holland  NH, NETHERLANDS

FDA Status Not Applicable

Summary: The Talar OsteoPeriostic grafting from the Iliac Crest (TOPIC) procedure for large OLTs results in clinically effective outcomes with 100% ingrowth of all the grafts with no non-unions.

Abstract:

Purpose

The purpose of this study was to present the surgical technique and to evaluate the clinical and radiological outcomes of a new press-fit OATS technique for large primary and secondary talar osteochondral defects of the talus, Talar OsteoPeriostic grafting from the Iliac Crest (TOPIC).

Methods

60 patients underwent a press-fit TOPIC procedure. Mean age was 38 years (SD 4.6). Pre- and postoperative clinical assessment at 12- and 24-months follow-up included the American Orthopaedic Foot and Ankle Society (AOFAS) score, the Short-Form 36 (SF-36) Mental Component Scale (MCS) and Physical Component Scale (PCS), the Numeric Rating Scales (NRS) of pain at rest, during walking and stairclimbing, and the Foot and Ankle Outcome Score (FAOS). Return to work was assessed in time and rate. Remodeling of the contour of the talus, bone ingrowth and consolidation of the implanted graft were assessed on computed tomography (CT) one year post-operatively.

Results

All patients were available for the two-year follow-up. The AOFAS improved from 48 to 90 (p<0.05). All NRS scores improved: the NRS during rest from 3 to 0 (p<0.05), the NRS during walking from 5 to 1 p<0.05), and the NRS during stairclimbing from 5 to 1 (p<0.05). Both components of the SF-36 improved. The PCS improved from 34 to 47 (p<0.05) and the MCS from 37 to 66 (p<0.05). All FAOS subscales significantly improved. 72% returned to sport at pre-injury sports level and mean time to return to sports was 9 months (SD 2.4). All patients showed remodeling of the talus and all grafts showed consolidation as well as bone ingrowth on the CT scans. All patients returned to work, at a mean time of 4 months post-operatively (SD 4.4). One patient had a temporary loss of n. saphenous sensibility.

Conclusions

The TOPIC procedure for large OLTs results in clinically effective outcomes with 100% ingrowth of all the grafts with no non-unions. There is a 100% return to work rate and a 72% return to pre-injury of sports rate. Long-term results are necessary to evaluate whether the TOPIC procedure stands the test of time and can be considered the treatment of choice for large OLTs at long-term follow-up.