Journal List > J Korean Orthop Assoc > v.52(2) > 1013508

Kim, Lee, Seo, Song, Seo, and Ryu: Non-Operative Treatment for Symptomatic Osteochondral Lesion of the Talus

Abstract

Purpose

Although reports on operative treatment of osteochondral lesion of the talus (OLT) are increasing, to the best of our knowledge, there have been only a few reports on non-operative treatment of OLT. The purpose of this study is to report the prognosis of non-operative treatment for OLT patients.

Materials and Methods

This retrospective study included 104 patients (57 male, 47 female) with OLTs having a follow-up period of more than two years, between 2003 and 2013. The location, size, and stage of the OLT were confirmed by magnetic resonance imaging or computed tomography. At the final follow-up, simple radiographs confirmed the progression of osteoarthritis. We surveyed the limitations of sports activity, visual analogue scale (VAS), American Orthopedic Foot and Ankle Society (AOFAS) scale, and SF-36.

Results

There were no patients with progression of osteoarthritis at the final follow-up. Only two patients (2.4%) complained the limitation of desired sports activity. The mean VAS significantly decreased from 4.3 (range, 0–8) to 1.1 (range, 0–4) (p<0.001). The mean AOFAS scale significantly improved from 83.3 (range, 41–100) to 92.5 (range, 65–100). Moreover, the mean SF-36 also improved from 52.6 (range, 30.0–91.0) to 72.9 (range, 40.6–97.0) (p<0.001).

Conclusion

Sufficient non-operative treatment is initially recommended to OLT patients because pain, in general, improves in most cases despite the presence of symptoms. Moreover, it's worth noting that the progression to osteoarthritis is rare.

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Figure 1
Articular surface of talar dome is divided into nine areas.
jkoa-52-153f1.tif
Figure 2
Magnetic resonance imaging shows bone marrow edema and bone cyst of the talus.
jkoa-52-153f2.tif
Figure 3
An 18-year-old male. (A) Initial magnetic resonance imaging (MRI), (B) 10.4 years follow-up MRI. The size of the lesion decreased and American Orthopedic Foot and Ankle Society scale improved from 65 to 91.
jkoa-52-153f3.tif
Figure 4
A 71-year-old male. (A) Initial magnetic resonance imaging (MRI), (B) 2.5 years follow-up MRI. The size of the lesion increased. However, American Orthopedic Foot and Ankle Society scale improved from 65 to 88.
jkoa-52-153f4.tif
Table 1
Demographic Data of Participating Subjects
Variable Total (n=104)
Gender (male/female) 57/47
Age (yr) 46.7±15.7
Height (cm) 161.6±8.2
Weight (kg) 60.5±10.7
Body mass index (kg/m2) 22.8±3.0
Pain duration (mo) 21.0±33.0
Operation recommended hospital
Secondary, tertiary referral hospital 26
Primary hospital 52
Our hospital* 24
Military hospital 2
Mean follow-up period (yr) 3.5±1.7

Values are presented as number only or mean±standard deviation.

* Asan Medical Center.

Table 2
Location of Osteochondral Lesion of the Talus in Axial Plane
Location Medial Central Lateral
Anterior 2 (1.9) 0 0
Middle 58 (55.8) 0 7 (6.7)
Posterior 31 (29.8) 0 6 (5.8)
Total 91 (87.5) 0 13 (12.5)

Values are presented as number (%).

Table 3
Outcomes Questionnaire and Radiologic Results
Variable First visit Latest follow-up p-value
VAS 4.3±2.5 1.1±1.9 <0.001
AOFAS ankle-hindfoot scale 83.3±14.3 92.5±9.6 <0.001
SF-36 52.6±13.7 72.9±17.0 <0.001
Progression of sosteoarthritis - 0 -
Limitation of desired sports activity - 2 (2.4) -

Values are presented as mean±standard deviation, number only, or number (%).

Table 4
Correlation between Outcome Questionnaire and Predisposing Factors at Latest Follow-Up
VAS AOFAS ankle-hindfoot scale SF-36
Correlation coefficient p-value Correlation coefficient p-value Correlation coefficient p-value
Gender (female) 0.374 0.347 0.023
Age (elderly) -0.124 0.067 0.134 0.052 -0.345 0.002
Height 0.260 0.024 -0.147 0.133 0.122 0.179
Weight 0.145 0.127 -0.135 0.143 0.037 0.386
Body mass index -0.143 0.140 0.071 0.296 -0.170 0.099
Stage 0.183 0.032 -0.102 0.237 0.066 0.441
Bone marrow edema 0.177 0.083 0.651
Bone cyst 0.506 0.179 0.374
Location 0.134 0.097 -0.118 0.126 0.034 0.369
Size
Width -0.083 0.209 0.136 0.091 0.145 0.077
Length -0.078 0.224 0.084 0.209 -0.029 0.389
Depth 0.023 0.412 0.040 0.348 0.159 0.059
Total -0.020 0.421 0.058 0.283 0.041 0.345

All values were analyzed by Pearson correlation analysis except stage (by Spearman correlation coefficient), gender, bone marrow edema, and bone cyst (by t-test). VAS, visual analogue scale; AOFAS, American Orthopedic Foot and Ankle Society.

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