Saturday, June 22, 2024

Impact of Medial Malleolar Osteotomies on Osteochondral Lesions of the Talus

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Surgeons have long debated the role of medial malleolar osteotomies (MMO) in enhancing the treatment of osteochondral lesions of the talus (OCLT). While MMO can improve access to the talus, the procedure carries potential risks and there is limited research on its prevalence and outcomes. This study delves into data from the German Cartilage Register to shed light on the impact of MMO on patient-reported outcomes and surgical success.

Study Design and Methodology

The investigation drew upon retrospective data from the German Cartilage Register, covering the period from 2015 to December 2020. The analysis focused on patient-reported outcome measures (PROMs) following OCLT surgeries, assessing the impact of MMO. Subgroups were meticulously matched using a propensity score to ensure comparability between patients who had OCLT with and without MMO. Criteria for matching included age, sex, weight, lesion location, ICRS grading, surgical procedures, and preoperative symptoms measured by Foot and Ankle Ability Measure (FAAM) and Activities of Daily Living Subscale (ADL).

Key Findings

The study found that MMO was utilized in 15.9% of OCLT surgeries, predominantly for medial talar dome lesions (76.8%) and severe cases (ICRS grades III and IV). More than half of these procedures (55.6%) occurred during revision surgeries. A matched pair analysis of 44 patients revealed no significant differences in PROMs—measured by FAAM-ADL and FAOS—between those who underwent arthrotomy with MMO and those who had arthrotomy alone at six, twelve, and twenty-four months post-surgery.

Concrete Inferences for Clinical Practice

  • MMO is primarily indicated for severe OCL lesions and revision surgeries.
  • Patient-reported outcomes do not significantly differ between MMO and non-MMO procedures.
  • Surgeons may consider MMO without expecting major differences in functional recovery.
  • MMO is most frequently applied to medial talar dome lesions.

In conclusion, while MMO is a common adjunct in severe and revision cases of OCLT, it does not significantly impact patient-reported outcomes compared to arthrotomy alone. This insight can guide surgeons in making informed decisions about the use of MMO in treating OCLT.

Original Article: BMC Musculoskelet Disord. 2024 Jun 1;25(1):427. doi: 10.1186/s12891-024-07541-8.

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