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Lift, drill, fill and fix (LDFF): a new arthroscopic treatment for talar osteochondral defects

  • Ankle
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this study was to describe the short-term clinical outcome of a new arthroscopic fixation technique for primary osteochondral talar defects: lift, drill, fill and fix (LDFF).

Methods

Seven patients underwent an arthroscopic LDFF surgery for osteochondral talar defects, the mean follow-up was 12 months (SD 0.6). Pre- and postoperative clinical assessment included the American Orthopaedic Foot and Ankle Society Score (AOFAS) and the numeric rating scales (NRS) of pain at rest and during walking. Remodelling and bone ingrowth after LDFF were analysed on weight-bearing radiographs during follow-up.

Results

In all patients, LDFF led to an improvement of the AOFAS and NRS of pain. The AOFAS significantly improved from 63 to 99 (p < 0.001). The NRS of pain at rest significantly improved from 2.9 to 0.1 (p = 0.004), and pain with walking significantly improved from 7.6 to 0.1 (p < 0.001). On the final radiographs, five of seven patients showed remodelling and bone ingrowth after LDFF.

Conclusions

The LDFF of an osteochondral talar defect appears to be a promising arthroscopic treatment option for primary talar osteochondral defects. Although the clinical and radiological results of 1-year follow-up are encouraging, more patients and longer follow-up are needed to draw any firm conclusions and determine whether the results stand the test of time.

Level of evidence

Prospective case series. Therapeutic, Level IV.

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References

  1. Baums MH, Heidrich G, Schultz W, Steckel H, Kahl E, Klinger HM (2006) Autologous chondrocyte transplantation for treating cartilage defects of the talus. J Bone Joint Surg Am 88:303–308

    Article  CAS  PubMed  Google Scholar 

  2. Berndt AL, Harty M (1959) Transchondral fractures (osteochondritis dissecans) of the talus. J Bone Joint Surg Am 41-A:988–1020

    CAS  PubMed  Google Scholar 

  3. Choi WJ, Park KK, Kim BS, Lee JW (2009) Osteochondral lesion of the talus: is there a critical defect size for poor outcome? Am J Sports Med 37:1974–1980

    Article  PubMed  Google Scholar 

  4. Chuckpaiwong B, Berkson EM, Theodore GH (2008) Microfracture for osteochondral lesions of the ankle: outcome analysis and outcome predictors of 105 cases. Arthroscopy 24:106–112

    Article  PubMed  Google Scholar 

  5. El Rashidy H, Villacis D, Omar I, Kelikian AS (2011) Fresh osteochondral allograft for the treatment of cartilage defects of the talus: a retrospective review. J Bone Joint Surg Am 93:1634–1640

    PubMed  Google Scholar 

  6. Fansa AM, Murawski CD, Imhauser CW, Nguyen JT, Kennedy JG (2011) Autologous osteochondral transplantation of the talus partially restores contact mechanics of the ankle joint. Am J Sports Med 39:2457–2465

    Article  PubMed  Google Scholar 

  7. Ferkel RD, Zanotti RM, Komenda GA, Sgaglione NA, Cheng MS, Applegate GR et al (2008) Arthroscopic treatment of chronic osteochondral lesions of the talus: long-term results. Am J Sports Med 36:1750–1762

    Article  PubMed  Google Scholar 

  8. Furukawa T, Eyre DR, Koide S, Glimcher MJ (1980) Biochemical studies on repair cartilage resurfacing experimental defects in the rabbit knee. J Bone Joint Surg Am 62:79–89

    CAS  PubMed  Google Scholar 

  9. Giannini S, Buda R, Vannini F, Cavallo M, Grigolo B (2009) One-step bone marrow-derived cell transplantation in talar osteochondral lesions. Clin Orthop Relat Res 467:3307–3320

    Article  PubMed  PubMed Central  Google Scholar 

  10. Han SH, Lee JW, Lee DY, Kang ES (2006) Radiographic changes and clinical results of osteochondral defects of the talus with and without subchondral cysts. Foot Ankle Int 27:1109–1114

    PubMed  Google Scholar 

  11. Ibrahim T, Beiri A, Azzabi M, Best AJ, Taylor GJ, Menon DK (2007) Reliability and validity of the subjective component of the American Orthopaedic Foot and Ankle Society clinical rating scales. J Foot Ankle Surg 46:65–74

    Article  PubMed  Google Scholar 

  12. Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M (1994) Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int 15:349–353

    Article  CAS  PubMed  Google Scholar 

  13. Kumai T, Takakura Y, Kitada C, Tanaka Y, Hayashi K (2002) Fixation of osteochondral lesions of the talus using cortical bone pegs. J Bone Joint Surg Br 84:369–374

    Article  CAS  PubMed  Google Scholar 

  14. Lee KB, Bai LB, Yoon TR, Jung ST, Seon JK (2009) Second-look arthroscopic findings and clinical outcomes after microfracture for osteochondral lesions of the talus. Am J Sports Med 37:63–70

    Article  Google Scholar 

  15. Niemeyer P, Salzmann G, Schmal H, Mayr H, Sudkamp NP (2012) Autologous chondrocyte implantation for the treatment of chondral and osteochondral defects of the talus: a meta-analysis of available evidence. Knee Surg Sports Traumatol Arthrosc 20:1696–1703

    Article  PubMed  Google Scholar 

  16. Qiu YS, Shahgaldi BF, Revell WJ, Heatley FW (2003) Observations of subchondral plate advancement during osteochondral repair: a histomorphometric and mechanical study in the rabbit femoral condyle. Osteoarthr Cartil 11:810–820

    Article  PubMed  Google Scholar 

  17. Reilingh ML, Blankevoort L, van Eekeren IC, van Dijk CN (2013) Morphological analysis of subchondral talar cysts on microCT. Knee Surg Sports Traumatol Arthrosc 21:1409–1417

    Article  CAS  PubMed  Google Scholar 

  18. Reilingh ML, Kerkhoffs GM, Telkamp CJ, Struijs PA, van Dijk CN (2013) Treatment of osteochondral defects of the talus in children. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-013-2685-7

    Google Scholar 

  19. Salaffi F, Stancati A, Silvestri CA, Ciapetti A, Grassi W (2007) Minimal clinically important changes in chronic musculoskeletal pain intensity measured on a numerical rating scale. Eur J Pain 8:283–291

    Article  Google Scholar 

  20. Saxena A, Eakin C (2007) Articular talar injuries in athletes: results of microfracture and autogenous bone graft. Am J Sports Med 35:1680–1687

    Article  PubMed  Google Scholar 

  21. Schuh A, Salminen S, Zeiler G, Schraml A (2004) Results of fixation of osteochondral lesions of the talus using K-wires. Zentralbl Chir 129:470–475

    Article  CAS  PubMed  Google Scholar 

  22. Scranton PE Jr, McDermott JE (2001) Treatment of type V osteochondral lesions of the talus with ipsilateral knee osteochondral autografts. Foot Ankle Int 22:380–384

    PubMed  Google Scholar 

  23. Valderrabano V, Leumann A, Rasch H, Egelhof T, Hintermann B, Pagenstert G (2009) Knee-to-ankle mosaicplasty for the treatment of osteochondral lesions of the ankle joint. Am J Sports Med 37:105–111

    Article  Google Scholar 

  24. van Bergen CJ, Kox LS, Maas M, Sierevelt IN, Kerkhoffs GM, van Dijk CN (2013) Arthroscopic treatment of osteochondral defects of the talus: outcomes at eight to twenty years of follow-up. J Bone Joint Surg Am 95:519–525

    Article  PubMed  Google Scholar 

  25. van Bergen CJ, Tuijthof GJ, Blankevoort L, Maas M, Kerkhoffs GM, van Dijk CN (2012) Computed tomography of the ankle in full plantar flexion: a reliable method for preoperative planning of arthroscopic access to osteochondral defects of the talus. Arthroscopy 28:985–992

    Article  PubMed  Google Scholar 

  26. van Dijk CN, Reilingh ML, Zengerink M, van Bergen CJ (2010) Osteochondral defects in the ankle: why painful? Knee Surg Sports Traumatol Arthrosc 18:570–580

    Article  PubMed  PubMed Central  Google Scholar 

  27. van Dijk CN, Scholte D (1997) Arthroscopy of the ankle joint. Arthroscopy 13:90–96

    Article  PubMed  Google Scholar 

  28. van Dijk CN, van Bergen CJ (2008) Advancements in ankle arthroscopy. J Am Acad Orthop Surg 16:635–646

    Article  PubMed  Google Scholar 

  29. Zengerink M, Struijs PA, Tol JL, van Dijk CN (2010) Treatment of osteochondral lesions of the talus: a systematic review. Knee Surg Sports Traumatol Arthrosc 18:238–246

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Orthopaedic Research Center Amsterdam, Department of Orthopaedic Surgery, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD, Amsterdam, The Netherlands

    G. M. M. J. Kerkhoffs, M. L. Reilingh, R. M. Gerards & P. A. J. de Leeuw

Authors
  1. G. M. M. J. Kerkhoffs
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  2. M. L. Reilingh
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  3. R. M. Gerards
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  4. P. A. J. de Leeuw
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Corresponding authors

Correspondence to G. M. M. J. Kerkhoffs or M. L. Reilingh.

Additional information

G. M. M. J. Kerkhoffs and M. L. Reilingh contributed equally to this work and thus share first authorship.

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Kerkhoffs, G.M.M.J., Reilingh, M.L., Gerards, R.M. et al. Lift, drill, fill and fix (LDFF): a new arthroscopic treatment for talar osteochondral defects. Knee Surg Sports Traumatol Arthrosc 24, 1265–1271 (2016). https://doi.org/10.1007/s00167-014-3057-7

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  • DOI: https://doi.org/10.1007/s00167-014-3057-7

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