Open Lift, Drill, Fill, and Fix (LDFF) for Chronic Osteochondral Lesions of the Talus: Favorable 2-Year Clinical Outcomes.

BACKGROUND

In the presence of an osteochondral fragment with sufficient subchondral bone thickness, fixation is considered to be an effective treatment method for osteochondral lesions of the talus (OLT). One such fixation technique is the lift-drill-fill-fix (LDFF) procedure, which has shown reliable long-term results in an arthroscopic approach; however, the outcomes in cases treated through an open approach are unknown.

PURPOSE: To assess the 2-year outcomes after open LDFF for chronic OLT.

STUDY

DESIGN

Case series; Level of evidence, 4.

METHODS

A total of 34 patients who underwent an open LDFF procedure for chronic (>6 weeks) OLT were prospectively followed for 2 years. The primary outcome concerned the comparison in numeric rating scale of pain (0 = no pain; 10 = most severe pain) during walking between the preoperative score to the 2-year postoperative follow-up score. The association of baseline factors with the change in the primary outcome between baseline and 2-year follow-up was assessed. Secondary patient-reported outcome measures (PROMs) were the Foot and Ankle Outcome Score and 36-Item Short Form Health Survey (SF-36). The fragment union rate on 1-year follow-up computed tomography scans and the influence of possible baseline factors on union were assessed. Adverse events, including revision surgery and complications, were assessed and documented.

RESULTS

The primary outcome significantly improved from a median of 6 (IQR, 4-7) out of 10 preoperatively to 1 (IQR, 0-3) out of 10 at final follow-up, P < .01. There was no association between baseline factors (sex, age, body mass index (BMI), smoking status, lesion size, and location) and change in primary outcome between baseline and 2-year follow-up. All other PROMs significantly improved, except for the SF-36 Mental Component Summary. The fragment union rate was 91% [95% CI, 76-98]. BMI of ≥30 kg/m2 was significantly associated with fragment nonunion (odds ratio, 1.39; 95% CI, 1.04-1.84; P = .02). Three patients underwent revision surgery, while 2 complications (1 case of delayed superficial wound healing and 1 case of complex regional pain syndrome) were observed.

CONCLUSION

Open LDFF resulted in favorable PROs for chronic OLT up to 2-year follow-up. The procedure achieved a 91% fragment union rate, while patients with obesity showed a higher risk of fragment nonunion.