Arthroscopic debridement and drilling of osteochondral lesions of the talus

Background: Use of marrow-stimulating techniques to treat osteochondral lesions of the talus (OLTs) in National Basketball Association (NBA) players is controversial. Hypothesis: NBA players will be able to return to preinjury playing status after treatment of OLTs by arthroscopic debridement alone without marrow-stimulating techniques. Study Design: Cohort study; Level of evidence, 3. Methods: Between the 2000 and 2015 seasons, 10 NBA players were treated with arthroscopic debridement of an OLT. The following performance outcomes were compared pre- and postoperatively: seasons played, games played, games started, minutes per game, points per game, field goals, 3-point shots, rebounds, assists, double doubles, triple doubles, steals, blocks, turnovers, personal fouls, assists per turnovers, steals per turnovers, NBA rating, scoring efficiency, and shooting efficiency. In addition, the players were compared with a matched control group using mixed effects regression and Fisher least significant difference modeling. Results: All 10 players returned to play in the NBA after arthroscopic debridement without microfracture or drilling of an OLT. When compared with preoperative performance, postoperative mean points scored, assists made, and steals made increased by 2.86 ( P = .042), 0.61 ( P = .049), and 0.15 ( P = .027), respectively. Only field goal percentage decreased postoperatively when compared with matched controls; however, this normalized by the end of the second season after surgery. There was no statistically significant change in any of the other performance factors when compared with matched controls. All patients returned to basketball during the same season (n = 1) or the following season (n = 9) if the operation was performed off-season. The mean length of career after surgery was 4.1 years, with 5 players still playing in the league at the time of this study. Conclusion: After arthroscopic debridement of an OLT without drilling or microfracture, there was a high rate of return to the NBA, with improved points scored, assists, and steals made after surgery when compared with preoperative performance. There was no statistically significant change in any performance factors when compared with uninjured matched controls. Lesion size did not affect player career length. These data should be used to manage patients’ and teams’ expectations regarding players’ ability to return to elite levels of athletic performance after surgery of an OLT.

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Nontraumatic Osteochondral Lesion of the Talar Head: A Case Report and Description of Operative Technique for Arthroscopic Debridement

Journal of Foot and Ankle Surgery Asia Pacific ◽

10.5005/jp-journals-10040-1008 ◽

2014 ◽

Vol 1 (1) ◽

pp. 34-37

Author(s):

A Patel ◽

J Mangwani ◽

W Al-Jundi ◽

A Askari ◽

D Moore

Keyword(s):

Case Report ◽

Operative Technique ◽

Osteochondral Lesion ◽

Asia Pacific ◽

Osteochondral Lesions ◽

Arthroscopic Debridement ◽

Talar Dome ◽

Bone Marrow Stimulation ◽

Talar Head

ABSTRACT Osteochondral lesions of the talar dome are well described. To our knowledge, there are no published reports of osteochondral lesion of the talar head. We report the case of a 16-year-old girl who presented with a nontraumatic osteochondral lesion of talar head, which was treated with arthroscopic debridement and bone marrow stimulation. At 6-month follow-up, the patient was symptom free and the radiograph showed signs of healing of the lesion. How to cite this article Mangwani J, Patel A, Al-Jundi W, Askari A, Moore D. Nontraumatic Osteochondral Lesion of the Talar Head: A Case Report and Description of Operative Technique for Arthroscopic Debridement. J Foot Ankle Surg (Asia-Pacific) 2014;1(1):34-37.

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Osteochondral Lesions of the Talus: Results of Repeat Arthroscopic Debridement

Yearbook of Orthopedics ◽

10.1016/s0276-1092(08)79215-0 ◽

2008 ◽

Vol 2008 ◽

pp. 171

Author(s):

B.F. Morrey

Keyword(s):

Osteochondral Lesions ◽

Arthroscopic Debridement

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Osteochondral Lesions of the Talus: Results of Repeat Arthroscopic Debridement

Foot & Ankle International ◽

10.3113/fai.2007.0669 ◽

2007 ◽

Vol 28 (6) ◽

pp. 669-673 ◽

Cited By ~ 68

Author(s):

Nicholas Savva ◽

Majid Jabur ◽

Mark Davies ◽

Terry Saxby

Keyword(s):

Osteochondral Lesion ◽

Professional Sports ◽

Senior Author ◽

Osteochondral Lesions ◽

Arthroscopic Debridement ◽

Foot And Ankle ◽

Medium Term ◽

Cartilage Transplantation ◽

American Orthopaedic ◽

Second Procedure

Background: Repeat arthroscopic debridement of osteochondral lesions of the talus has a poor reputation despite a paucity of evidence in the literature. Methods: We reviewed all patients who had repeat arthroscopic debridement of an osteochondral lesion performed by the senior author. They were scored using the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale, and lesions were graded using the system described by Berndt and Harty. Results: Between 1993 and 2002, 808 consecutive ankle arthroscopies were performed by the senior author, of which 215 were to treat osteochondral lesions of the talus. Of these, 12 had repeat arthroscopies because of unresolved symptoms. AOFAS scores improved from a mean of 34.8 prior to arthroscopy to 80.5 after repeat arthroscopy at a mean followup of 5.9 years (18 months to 11 years). Two patients returned to professional sports after the second procedure. Six patients returned to their preinjury levels of sporting activity and three returned to the same sports but played to a lesser standard or less frequently. One patient had already had a cartilage transplantation procedure. Conclusions: This is the first series specifically assessing patients who have had repeat arthroscopic debridement of osteochondral lesions of the talus, using the same debridement technique by a single surgeon. Our results question the assumption that repeat arthroscopic debridement yields poor results. They also provide a baseline for the newer chondral and osteochondral transplantation techniques to compare to at the medium term.

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