Descriptive analysis and short-term follow-up clinical results of osteochondral lesions of the distal tibia based on data of the German Cartilage Register (Knorpelregister® DGOU)

No influence of patient age on operative treatment outcome of osteochondral lesions of the talus: data from the German Cartilage Registry (GCR, KnorpelRegister DGOU)

INTRODUCTION

The influence of patient age on the clinical outcome of surgically treated osteochondral lesions of the talus (OCT) is controversial. Aim of this study was to evaluate the 24 months follow-up data of the German Cartilage Registry (KnorpelRegister DGOU, GCR) regarding the influence of patient age on clinical outcomes after surgical OCT treatment.

MATERIALS AND METHODS

303 patients met the inclusion criteria and were divided into patients < 40 years (27.1 ± 5.8 years, n = 177) and patients ≥ 40 years (50.8 ± 7.4 years, n = 126). Pre- and postoperative FAOS total scores, subscores and ΔFAOS for most frequent surgical techniques (bone marrow stimulation, matrix-augmented bone marrow stimulation, matrix-augmented bone marrow stimulation with additional bone grafting) and lesion size characteristics were evaluated for both groups. ANOVA analysis with post hoc Duncan test was applied for statistical analysis.

RESULTS

Both patients < 40 years and patients ≥ 40 years benefit from surgical treatment of OCT showing significant changes from pre- to postoperative FAOS total score (63.8 ± 20.3 to 81.5 ± 17.8 in patients < 40 years, p < 0.001; 57.3 ± 20.1 to 74.9 ± 21.6 in patients ≥ 40 years, p < 0.001) and subscores. Younger patient group tended to higher pre- and postoperative scores. ΔFAOS was not different between both groups. Older patient group had significantly higher lesion size area and volume; proportion of additional bone grafting was increased.

CONCLUSION

Results of surgical therapy of OCTs are independent from patient age. There is no superiority of a specific surgical technique depending on patient age.

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

OBJECTIVE

To assess the current treatment of osteochondral lesions of the ankle (OCLA) by German-speaking foot and ankle surgeons, focusing on the management of postoperative care and rehabilitation.

DESIGN

A questionnaire was created by a panel of 4 experienced foot and ankle surgeons on behalf of the "Clinical Tissue Regeneration" (CTR) working group of the German Society of Orthopaedics and Trauma Surgery (DGOU), and distributed electronically to members of the CTR, participants of the German Cartilage Registry (Knorpelregister DGOU©), and members of 6 German-speaking orthopedics or sports medicine societies. Results were classified depending on the consensus within the answers (agreement ≥75% "strong tendency," 50%-74% "tendency," 25%-49% "weak tendency," <25% "no tendency").

RESULTS

A total of 60 participants returned the questionnaire. The main results are as follows: regarding the frequency of surgical procedures for OCLA, refixation of the fragment, retrograde drilling, and bone marrow stimulation with or without using a matrix were performed by at least 75% of the surgeons and was considered a strong tendency. There was a strong tendency to stabilize the ankle (76.7%) and perform corrective osteotomies (51.7%). In total, 75.5% and 75% of the surgeons performed bone marrow stimulation with and without using a matrix, respectively. Corrective osteotomy and ankle stabilization were performed in 64.5% and 65.2% cases, respectively. Most participants included published recommendations on postoperative rehabilitation and the return to sports activities in their postoperative management. The main surgical procedures were considered the most critical factor in influencing the postoperative management by 81% of the participants (strong tendency). Adjunct surgical procedures such as corrective osteotomy and stabilization of the ankle were considered important by 67.8% of the respondents (tendency).

CONCLUSIONS

The management of OCLA varies among German-speaking foot and ankle surgeons. Therefore, guidelines remain essential to standardize the management of OCLA, to achieve improved and stable results. This survey will assist clinicians and patients with rehabilitation to return to sports after treating the ankle's cartilage injury.