Preexisting and treated concomitant ankle instability does not compromise patient-reported outcomes of solitary osteochondral lesions of the talus treated with matrix-induced bone marrow stimulation in the first postoperative year: data from the German Cartilage Registry (KnorpelRegister DGOU)

Abstract

Purpose The purpose of this study was to compare the subjective ankle function within the irst year following matrixinduced bone marrow stimulation (M-BMS) of patients with a solitary osteochondral lesion of the talus (OCLT) with and without concomitant chronic ankle instability (CAI). Methods Data from the German Cartilage Registry (KnorpelRegister DGOU) for 78 patients with a solitary OCLT and a follow-up of at least 6 months were included. All patients received M-BMS for OCLT treatment. The cohort was subdivided into patients with OCLT without CAI treated with M-BMS alone (n = 40) and patients with OCLT and CAI treated with M-BMS and additional ankle stabilisation (n = 38). The Foot and Ankle Ability Measure (FAAM), the Foot and Ankle Outcome Score (FAOS), and the Numeric Rating Scale for Pain (NRS) were used to assess patient-reported outcomes (median (minimum-maximum)). Results From preoperatively to 12 months postoperatively, patients with OCLT without CAI treated with M-BMS alone had a signiicant improvement of all subscales in the FAAM [activity of daily living 64.3 (10-100) to 88.1 (39-100); sports 34.4 (0-100) to 65.6 (13-94), functional activities of daily life 50 (0-90) to 80 (30-100), functional sports 30 (0-100) to 70 (5-100)] and FAOS [pain 61.1 (8-94) to 86.1 (50-100), symptoms 60.7 (18-96) to 76.8 (29-100), activities of daily living 72.1 (24-100) to 91.9 (68-100), sport/recreational activities 30.0 (0-70) to 62.5 (0-95), quality of life 31.3 (6-50) to 46.9 (19-100)]. Within the irst year, patients with OCLT and CAI treated with M-BMS and ankle stabilisation also showed signiicant improvement in the FAAM [activity of daily living 68.8 (5-99) to 90.5 (45-100); sports 32.8 (0-87.5) to 64.1 (0-94), functional activities of daily life 62.5 (25-100) to 80 (60-90), functional sports 30 (0-100) to 67.5 (0.95)] and the FAOS [pain 66.7 (28-92) to 87.5 (47-100), symptoms 57.1 (29-96) to 78.6 (50-100), activities of daily living 80.1 (25-100) to 98.5 (59-100), sport/recreational activities 35.0 (0-100) to 70.0 (0-100), quality of life 25.0 (0-75) to 50.0 (19-94)]. The pain level decreased signiicantly in both groups. No signiicant diference was found between both groups regarding the subscales of FAAM, FAOS and the NRS 1 year postoperatively. Conclusion Improvements in subjective ankle function, daily life activities and sports activities were observed within the irst year following M-BMS. Our results suggest that preexisting and treated ankle instability did not compromise subjective outcome in patients treated with M-BMS in the irst postoperative year. Level of evidence Level IV.

Postoperative Management of Osteochondral Lesions of the Ankle: A Survey Among German-Speaking Foot and Ankle Surgeons

“…22 Despite this, the impact of ankle stabilization on the outcome of OCLA surgery remains unclear. 11,15 A recent comparative study showed similar clinical outcomes in patients treated for OLT with and without chronic ankle instability, but increased failure rates and inferior performance in sports and recreational activities were observed in patients with instability. 23 The postoperative management and rehabilitation process for an ankle cartilage injury requires a multidisciplinary and comprehensive approach.…”

“…12 The CTR working group of the DGOU published some observational studies based on data from the German Cartilage Registry (www.knorpelregister-dgou.de). 11,[13][14][15][16] As per one study, the surgical technique, postoperative care, and specific rehabilitation protocol might influence the outcome. The primary focus of rehabilitation after treating an OCLA should be returning to the pre-injury activity level.…”