Osteochondral lesion of the talus: Is There a critical defect size for poor outcome?

Woo Jin Choi, Kwan Kyu Park, Bom Soo Kim, Jin Woo Lee

Research output: Contribution to journalArticle

211 Citations (Scopus)

Abstract

Background: Identifying factors associated with favorable or unfavorable outcomes would provide patients with accurate expectations of the arthroscopic marrow stimulation techniques. Purpose: To investigate the prognostic significance and optimal measures of defect size in osteochondral lesion of the talus as treated with arthroscopy. Hypothesis: A critical, or threshold, defect size may exist at which clinical outcomes become poor in the treatment of osteochondral lesion of the talus. Study Design: Cohort study; Level of evidence, 3. Methods: In sum, 120 ankles underwent arthroscopic marrow stimulation treatment for osteochondral lesion of the talus and were evaluated for prognostic factors. Clinical failure was defined as patients' having osteochondral transplantation or an American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale score less than 80. Linear regression analysis and the Kaplan-Meier method were used to identify optimal cutoff values of defect size. Results: Eight ankles (6.7%) required osteochondral transplantation, and 22 ankles (18.4%) were considered failures because of AOFAS scores less than 80, which indicated fair or poor results. Linear regression analysis showed a high prognostic significance of defect area and suggested a cutoff defect size of 150 mm2 for the optimum identification of poor clinical outcomes (P <.001). Only 10 of 95 ankles (10.5%) with a defect area<150 mm2 showed clinical failure, whereas in patients with an area ≥150 mm 2, the clinical failure rate was significantly higher (80%, 20/25). There was no association between outcome and the patient's age, duration of symptoms, trauma, associated lesions, and location of lesions (P >.05). Conclusion: Initial defect size is an important and easily obtainable prognostic factor in osteochondral lesions of the talus and so may serve as a basis for preoperative surgical decisions. A cutoff point exists regarding the risk of clinical failure at a defect area of approximately 150 mm2 as calculated from magnetic resonance imaging.

Original languageEnglish
Pages (from-to)1974-1980
Number of pages7
JournalAmerican Journal of Sports Medicine
Volume37
Issue number10
DOIs
Publication statusPublished - 2009 Dec 2

Fingerprint

Talus
Ankle
Orthopedics
Foot
Linear Models
Transplantation
Bone Marrow
Regression Analysis
Arthroscopy
Cohort Studies
Magnetic Resonance Imaging
Therapeutics

All Science Journal Classification (ASJC) codes

  • Orthopedics and Sports Medicine
  • Physical Therapy, Sports Therapy and Rehabilitation

Cite this

Choi, Woo Jin ; Park, Kwan Kyu ; Kim, Bom Soo ; Lee, Jin Woo. / Osteochondral lesion of the talus : Is There a critical defect size for poor outcome?. In: American Journal of Sports Medicine. 2009 ; Vol. 37, No. 10. pp. 1974-1980.
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abstract = "Background: Identifying factors associated with favorable or unfavorable outcomes would provide patients with accurate expectations of the arthroscopic marrow stimulation techniques. Purpose: To investigate the prognostic significance and optimal measures of defect size in osteochondral lesion of the talus as treated with arthroscopy. Hypothesis: A critical, or threshold, defect size may exist at which clinical outcomes become poor in the treatment of osteochondral lesion of the talus. Study Design: Cohort study; Level of evidence, 3. Methods: In sum, 120 ankles underwent arthroscopic marrow stimulation treatment for osteochondral lesion of the talus and were evaluated for prognostic factors. Clinical failure was defined as patients' having osteochondral transplantation or an American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale score less than 80. Linear regression analysis and the Kaplan-Meier method were used to identify optimal cutoff values of defect size. Results: Eight ankles (6.7{\%}) required osteochondral transplantation, and 22 ankles (18.4{\%}) were considered failures because of AOFAS scores less than 80, which indicated fair or poor results. Linear regression analysis showed a high prognostic significance of defect area and suggested a cutoff defect size of 150 mm2 for the optimum identification of poor clinical outcomes (P <.001). Only 10 of 95 ankles (10.5{\%}) with a defect area<150 mm2 showed clinical failure, whereas in patients with an area ≥150 mm 2, the clinical failure rate was significantly higher (80{\%}, 20/25). There was no association between outcome and the patient's age, duration of symptoms, trauma, associated lesions, and location of lesions (P >.05). Conclusion: Initial defect size is an important and easily obtainable prognostic factor in osteochondral lesions of the talus and so may serve as a basis for preoperative surgical decisions. A cutoff point exists regarding the risk of clinical failure at a defect area of approximately 150 mm2 as calculated from magnetic resonance imaging.",
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Osteochondral lesion of the talus : Is There a critical defect size for poor outcome? / Choi, Woo Jin; Park, Kwan Kyu; Kim, Bom Soo; Lee, Jin Woo.

In: American Journal of Sports Medicine, Vol. 37, No. 10, 02.12.2009, p. 1974-1980.

Research output: Contribution to journalArticle

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N2 - Background: Identifying factors associated with favorable or unfavorable outcomes would provide patients with accurate expectations of the arthroscopic marrow stimulation techniques. Purpose: To investigate the prognostic significance and optimal measures of defect size in osteochondral lesion of the talus as treated with arthroscopy. Hypothesis: A critical, or threshold, defect size may exist at which clinical outcomes become poor in the treatment of osteochondral lesion of the talus. Study Design: Cohort study; Level of evidence, 3. Methods: In sum, 120 ankles underwent arthroscopic marrow stimulation treatment for osteochondral lesion of the talus and were evaluated for prognostic factors. Clinical failure was defined as patients' having osteochondral transplantation or an American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale score less than 80. Linear regression analysis and the Kaplan-Meier method were used to identify optimal cutoff values of defect size. Results: Eight ankles (6.7%) required osteochondral transplantation, and 22 ankles (18.4%) were considered failures because of AOFAS scores less than 80, which indicated fair or poor results. Linear regression analysis showed a high prognostic significance of defect area and suggested a cutoff defect size of 150 mm2 for the optimum identification of poor clinical outcomes (P <.001). Only 10 of 95 ankles (10.5%) with a defect area<150 mm2 showed clinical failure, whereas in patients with an area ≥150 mm 2, the clinical failure rate was significantly higher (80%, 20/25). There was no association between outcome and the patient's age, duration of symptoms, trauma, associated lesions, and location of lesions (P >.05). Conclusion: Initial defect size is an important and easily obtainable prognostic factor in osteochondral lesions of the talus and so may serve as a basis for preoperative surgical decisions. A cutoff point exists regarding the risk of clinical failure at a defect area of approximately 150 mm2 as calculated from magnetic resonance imaging.

AB - Background: Identifying factors associated with favorable or unfavorable outcomes would provide patients with accurate expectations of the arthroscopic marrow stimulation techniques. Purpose: To investigate the prognostic significance and optimal measures of defect size in osteochondral lesion of the talus as treated with arthroscopy. Hypothesis: A critical, or threshold, defect size may exist at which clinical outcomes become poor in the treatment of osteochondral lesion of the talus. Study Design: Cohort study; Level of evidence, 3. Methods: In sum, 120 ankles underwent arthroscopic marrow stimulation treatment for osteochondral lesion of the talus and were evaluated for prognostic factors. Clinical failure was defined as patients' having osteochondral transplantation or an American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale score less than 80. Linear regression analysis and the Kaplan-Meier method were used to identify optimal cutoff values of defect size. Results: Eight ankles (6.7%) required osteochondral transplantation, and 22 ankles (18.4%) were considered failures because of AOFAS scores less than 80, which indicated fair or poor results. Linear regression analysis showed a high prognostic significance of defect area and suggested a cutoff defect size of 150 mm2 for the optimum identification of poor clinical outcomes (P <.001). Only 10 of 95 ankles (10.5%) with a defect area<150 mm2 showed clinical failure, whereas in patients with an area ≥150 mm 2, the clinical failure rate was significantly higher (80%, 20/25). There was no association between outcome and the patient's age, duration of symptoms, trauma, associated lesions, and location of lesions (P >.05). Conclusion: Initial defect size is an important and easily obtainable prognostic factor in osteochondral lesions of the talus and so may serve as a basis for preoperative surgical decisions. A cutoff point exists regarding the risk of clinical failure at a defect area of approximately 150 mm2 as calculated from magnetic resonance imaging.

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