Arthroscopic lift, drill, fill and fix (LDFF) is an effective treatment option for primary talar osteochondral defects

Kaj T. A. Lambers, Jari Dahmen, Mikel L. Reilingh, Christiaan J. A. van Bergen, Sjoerd A. S. Stufkens, Gino M. M. J. Kerkhoffs

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Purpose: The purpose of this study was to describe the mid-term clinical and radiological results of a novel arthroscopic fixation technique for primary osteochondral defects (OCD) of the talus, named the lift, drill, fill and fix (LDFF) technique. Methods: Twenty-seven ankles (25 patients) underwent an arthroscopic LDFF procedure for primary fixable talar OCDs. The mean follow-up was 27 months (SD 5). Pre- and post-operative clinical assessments were prospectively performed by measuring the Numeric Rating Scale (NRS) of pain in/at rest, walking and when running. Additionally, the Foot and Ankle Outcome Score (FAOS) and the Short Form-36 (SF-36) were used to assess clinical outcome. The patients were radiologically assessed by means of computed tomography (CT) scans pre-operatively and 1 year post-operatively. Results: The mean NRS during running significantly improved from 7.8 pre-operatively to 2.9 post-operatively (p = 0.006), the NRS during walking from 5.7 to 2.0 (p < 0.001) and the NRS in rest from 2.3 to 1.2 (p = 0.015). The median FAOS at final follow-up was 86 for pain, 63 for other symptoms, 95 for activities of daily living, 70 for sport and 53 for quality of life. A pre- and post-operative score comparison was available for 16 patients, and improved significantly in most subscores. The SF-36 physical component scale significantly improved from 42.9 to 50.1. Of the CT scans at 1 year after surgery, 81% showed a flush subchondral bone plate and 92% of OCDs showed union. Conclusion: Arthroscopic LDFF of a fixable primary talar OCD results in excellent improvement of clinical outcomes. The radiological follow-up confirms that fusion of the fragment is feasible in 92%. This technique could be regarded as the new gold standard for the orthopedic surgeon comfortable with arthroscopic procedures. Level of evidence: Prospective case series, therapeutic level IV.
Original languageEnglish
Pages (from-to)141-147
Number of pages7
JournalKnee Surgery, Sports Traumatology, Arthroscopy
Volume28
Issue number1
Early online date2019
DOIs
Publication statusPublished - 1 Jan 2020

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