Arthroscopic Treatment of Large and Massive Osteochondral Lesions of the Talus: A Prospective Cohort Study
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Published:
Jun 27, 2025
Keywords:
Osteochondral lesion, lesión, talus, debridement, microfracture, arthroscopy
Main Article Content
Abstract
Introduction: The treatment of talar osteochondral lesions remains challenging, particularly in cases of large or massive defects, due to the limited intrinsic capacity of articular hyaline cartilage for repair or regeneration.
Objective: To evaluate clinical outcomes and physical activity levels two years after surgery in patients with large or massive talar osteochondral lesions treated arthroscopically with debridement and microfracture of the subchondral bone.
Materials and Methods: A short-term prospective descriptive cohort study was conducted, including 14 symptomatic patients with large or massive osteochondral lesions of the talus. All patients underwent anterior ankle arthroscopy involving debridement of devitalized cartilage and microfracture of the subchondral bone. At the two-year follow-up, clinical outcomes were assessed using the Foot and Ankle Ability Measure (FAAM), patient satisfaction, and the ability to perform physical activity.
Results: The mean FAAM score for activities of daily living was 89% (range: 50–100%), and for sports activities, 78.8% (range: 43.7–100%). Thirteen patients reported being satisfied with the surgical outcome. No statistically significant association was found between FAAM scores and lesion size, volume, or location within the talus.
Conclusions: Arthroscopic treatment of large and massive talar osteochondral lesions using debridement and microfracture of the subchondral bone yields high patient satisfaction and favorable clinical outcomes, with low complication rates at two years postoperatively.
Objective: To evaluate clinical outcomes and physical activity levels two years after surgery in patients with large or massive talar osteochondral lesions treated arthroscopically with debridement and microfracture of the subchondral bone.
Materials and Methods: A short-term prospective descriptive cohort study was conducted, including 14 symptomatic patients with large or massive osteochondral lesions of the talus. All patients underwent anterior ankle arthroscopy involving debridement of devitalized cartilage and microfracture of the subchondral bone. At the two-year follow-up, clinical outcomes were assessed using the Foot and Ankle Ability Measure (FAAM), patient satisfaction, and the ability to perform physical activity.
Results: The mean FAAM score for activities of daily living was 89% (range: 50–100%), and for sports activities, 78.8% (range: 43.7–100%). Thirteen patients reported being satisfied with the surgical outcome. No statistically significant association was found between FAAM scores and lesion size, volume, or location within the talus.
Conclusions: Arthroscopic treatment of large and massive talar osteochondral lesions using debridement and microfracture of the subchondral bone yields high patient satisfaction and favorable clinical outcomes, with low complication rates at two years postoperatively.
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How to Cite
Raimondi, N., Yañez Arauz, J. M., Eksarho, A. E., Pérez Lloveras, G. O., Colombato, F., & Casserá, F. (2025). Arthroscopic Treatment of Large and Massive Osteochondral Lesions of the Talus: A Prospective Cohort Study. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 90(3), 219-234. https://doi.org/10.15417/issn.1852-7434.2025.90.3.2105
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Clinical Research
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References
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12. Kuni B, Schmitt H, Chloridis D, Ludwig K. Clinical and MRI results after microfracture of osteochondral lesions of the talus. Arch Orthop Trauma Surg 2012;132(12):1765-71. https://doi.org/10.1007/s00402-012-1595-3
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18. Goyal D, Keyhani S, Lee EH, Hui JH. Evidence-based status of microfracture technique: a systematic review of level I and II studies. Arthroscopy 2013;29(9):1579-88. https://doi.org/10.1016/j.arthro.2013.05.027
19. Solheim E, Hegna J, Inderhaug E, Øyen J, Harlem T, Strand T. Results at 10-14 years after microfracture treatment of articular cartilage defects in the knee. Knee Surg Sports Traumatol Arthrosc 2016;24(5):1587-93. https://doi.org/10.1007/s00167-014-3443-1
20. Becher C, Driessen A, Hess T, Longo UG, Maffulli N, Thermann H. Microfracture for chondral defects of the talus: maintenance of early results at midterm follow-up. Knee Surg Sports Traumatol Arthrosc 2010;18(5):656-63. https://doi.org/10.1007/s00167-009-1036-1
21. Guney A, Akar M, Karaman I, Oner M, Guney B. Clinical outcomes of platelet rich plasma (PRP) as an adjunct to microfracture surgery in osteochondral lesions of the talus. Knee Surg Sports Traumatol Arthrosc 2015;23(8):2384-9. https://doi.org/10.1007/s00167-013-2784-5
22. Hannon CP, Ross KA, Murawski CD, Deyer TW, Smyth NA, Hogan MV, et al. Arthroscopic bone marrow
stimulation and concentrated bone marrow aspirate for osteochondral lesions of the talus: a case-control study of functional and magnetic resonance observation of cartilage repair tissue outcomes. Arthroscopy 2016;32(2):339-47. https://doi.org/10.1016/j.arthro.2015.07.012
23. Karnovsky SC, DeSandis B, Haleem AM, Sofka CM, O’Malley M, Drakos MC. Comparison of juvenile
allogenous articular cartilage and bone marrow aspirate concentrate versus microfracture with and without bone marrow aspirate concentrate in arthroscopic treatment of talar osteochondral lesions.
Foot Ankle Int 2018;39(4):393-405. https://doi.org/10.1177/1071100717746627
24. Görmeli G, Karakaplan M, Görmeli CA, Sarıkaya B, Elmalı N, Ersoy Y. Clinical effects of platelet-rich plasma and hyaluronic acid as an additional therapy for talar osteochondral lesions treated with microfracture surgery: a prospective randomized clinical trial. Foot Ankle Int 2015;36(8):891-900.
https://doi.org/10.1177/1071100715578435
25. Dombrowski ME, Yasui Y, Murawski CD, Fortier LA, Giza E, Haleem AM, et al. Conservative management and biological treatment strategies: Proceedings of the International Consensus Meeting
on Cartilage Repair of the Ankle. Foot Ankle Int 2018;39(1_suppl):9S-15S. https://doi.org/10.1177/1071100718779390
26. Ferkel RD, Zanotti RM, Komenda GA, Sgaglione NA, Cheng MS, Applegate GR, et al. Arthroscopic
treatment of chronic osteochondral lesions of the talus: long-term results. Am J Sports Med 2008;36(9):1750-62. https://doi.org/10.1177/0363546508316773
2. Berndt AL, Harty M. Transchondral fractures (osteochondritis dissecans) of the talus. J Bone Joint Surg Am 1959;41(A):988-1020. PMID: 13849029
3. Scranton Jr PE, McDermott JE. Treatment of type V osteochondral lesions of the talus with ipsilateral knee osteochondral autografts. Foot Ankle Int 2001;22(5):380-4. https://doi.org/10.1177/107110070102200504
4. Chuckpaiwong B, Berkson EM, Theodore GH. Microfracture for osteochondral lesions of the ankle: outcome analysis and outcome predictors of 105 cases. Arthroscopy 2008;24(1):106-12.
https://doi.org/10.1016/j.arthro.2007.07.022
5. Raikin SM. Stage VI: massive osteochondral defects of the talus. Foot Ankle Clin 2004;9(4):737-44, vi.
https://doi.org/10.1016/j.fcl.2004.06.003
6. Raikin SM, Elias I, Zoga AC, Morrison WB, Besser MP, Schweitzer ME. Osteochondral lesions of the talus:
Localization and morphologic data from 424 patients using a novel anatomical grid scheme. Foot Ankle Int 2007;28(2):154-61. https://doi.org/10.3113/FAI.2007.0154
7. Tasto JP, Ostrander R, Bugbee W, Brage M. The diagnosis and management of osteochondral lesions of the talus: osteochondral allograft update. Arthroscopy 2003;19(Suppl 1):138-41. https://doi.org/10.1016/j.arthro.2003.09.052
8. Brittberg M, Winalski CS. Evaluation of cartilage injuries and repair. J Bone Joint Surg Am
2003;85-A(Suppl 2):58-69. https://doi.org/10.2106/00004623-200300002-00008
9. Browne JE, Branch TP. Surgical alternatives for treatment of articular cartilage lesions. J Am Acad Orthop Surg 2000;8(3):180-9. https://doi.org/10.5435/00124635-200005000-00005
10. Ramponi L, Yasui Y, Murawski CD, Ferkel RD, DiGiovanni CW, Kerkhoffs GMMJ, et al. Lesion size is a predictor of clinical outcomes after bone marrow stimulation for osteochondral lesions of the talus: A systematic review. Am J Sports Med 2017;45(7):1698-705. https://doi.org/10.1177/0363546516668292
11. van Bergen CJ, Kox LS, Maas M, Sierevelt IN, Kerkhoffs GM, van Dijk CN. Arthroscopic treatment of osteochondral defects of the talus: outcomes at eight to twenty years of follow-up. J Bone Joint Surg Am 2013;95(6):519-25. https://doi.org/10.2106/JBJS.L.00675
12. Kuni B, Schmitt H, Chloridis D, Ludwig K. Clinical and MRI results after microfracture of osteochondral lesions of the talus. Arch Orthop Trauma Surg 2012;132(12):1765-71. https://doi.org/10.1007/s00402-012-1595-3
13. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP; STROBE Initiative. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines
for reporting observational studies. BMJ 2007;335(7624):806-8. https://doi.org/10.1136/bmj.39335.541782.AD
14. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap) – A metadata-driven methodology and workflow process for providing translational research
informatics support. J Biomed Inform 2009;42(2):377-81. https://doi.org/10.1016/j.jbi.2008.08.010
15. Yañez Arauz JM, Del Vecchio JJ, Bilbao F, Raimondi N. Osteochondral lesions of the talus treatment with fresh frozen allograft. Foot Ankle Surg 2017;23(4):296-301. https://doi.org/10.1016/j.fas.2016.09.002
16. Steadman JR, Rodkey WG, Briggs KK. Microfracture to treat full-thickness chondral defects: surgical technique, rehabilitation, and outcomes. J Knee Surg 2002;15(3):170-6. PMID: 12152979
17. Steadman JR, Rodkey WG, Rodrigo JJ. Microfracture: surgical technique and rehabilitation to treat chondral defects. Clin Orthop Relat Res 2001;391(Suppl):S362-9. https://doi.org/10.1097/00003086-200110001-00033
18. Goyal D, Keyhani S, Lee EH, Hui JH. Evidence-based status of microfracture technique: a systematic review of level I and II studies. Arthroscopy 2013;29(9):1579-88. https://doi.org/10.1016/j.arthro.2013.05.027
19. Solheim E, Hegna J, Inderhaug E, Øyen J, Harlem T, Strand T. Results at 10-14 years after microfracture treatment of articular cartilage defects in the knee. Knee Surg Sports Traumatol Arthrosc 2016;24(5):1587-93. https://doi.org/10.1007/s00167-014-3443-1
20. Becher C, Driessen A, Hess T, Longo UG, Maffulli N, Thermann H. Microfracture for chondral defects of the talus: maintenance of early results at midterm follow-up. Knee Surg Sports Traumatol Arthrosc 2010;18(5):656-63. https://doi.org/10.1007/s00167-009-1036-1
21. Guney A, Akar M, Karaman I, Oner M, Guney B. Clinical outcomes of platelet rich plasma (PRP) as an adjunct to microfracture surgery in osteochondral lesions of the talus. Knee Surg Sports Traumatol Arthrosc 2015;23(8):2384-9. https://doi.org/10.1007/s00167-013-2784-5
22. Hannon CP, Ross KA, Murawski CD, Deyer TW, Smyth NA, Hogan MV, et al. Arthroscopic bone marrow
stimulation and concentrated bone marrow aspirate for osteochondral lesions of the talus: a case-control study of functional and magnetic resonance observation of cartilage repair tissue outcomes. Arthroscopy 2016;32(2):339-47. https://doi.org/10.1016/j.arthro.2015.07.012
23. Karnovsky SC, DeSandis B, Haleem AM, Sofka CM, O’Malley M, Drakos MC. Comparison of juvenile
allogenous articular cartilage and bone marrow aspirate concentrate versus microfracture with and without bone marrow aspirate concentrate in arthroscopic treatment of talar osteochondral lesions.
Foot Ankle Int 2018;39(4):393-405. https://doi.org/10.1177/1071100717746627
24. Görmeli G, Karakaplan M, Görmeli CA, Sarıkaya B, Elmalı N, Ersoy Y. Clinical effects of platelet-rich plasma and hyaluronic acid as an additional therapy for talar osteochondral lesions treated with microfracture surgery: a prospective randomized clinical trial. Foot Ankle Int 2015;36(8):891-900.
https://doi.org/10.1177/1071100715578435
25. Dombrowski ME, Yasui Y, Murawski CD, Fortier LA, Giza E, Haleem AM, et al. Conservative management and biological treatment strategies: Proceedings of the International Consensus Meeting
on Cartilage Repair of the Ankle. Foot Ankle Int 2018;39(1_suppl):9S-15S. https://doi.org/10.1177/1071100718779390
26. Ferkel RD, Zanotti RM, Komenda GA, Sgaglione NA, Cheng MS, Applegate GR, et al. Arthroscopic
treatment of chronic osteochondral lesions of the talus: long-term results. Am J Sports Med 2008;36(9):1750-62. https://doi.org/10.1177/0363546508316773