Second-look Arthroscopy after Surgical Treatment for Osteochondral Lesion of Talus: Comparison of Mosaicplasty with Microfracture

Choi, Jin; Lee, Keun Bae; Cho, Seong Beom; Jung, Sung Taek; Park, Gi Heon

Abstract

PURPOSE: To evaluate the results of mosaicplasty and microfracture after surgical treatments for symptomatic osteochondral lesion of talus (OLT) by second-look arthroscopy.
MATERIALS AND METHODS
7 cases of mosaicplasty and 7 cases of microfracture were reviewed who undertook second-look arthroscopy at 6 months or one year after undertaking mosaicplasty or microfracture for OLT between December 2004 and October 2005. The mean age at first operation was 43.6 years (Range, 20-59) (Mosaicplasty; 43.9 years, Microfracture; 43.4 years). The mean size of cartilage defect was 15.0 x 7.7 mm in mosaicplasty and 7.1 x 6.6 mm in microfracture. Clinical outcomes were evaluated by Freiburg ankle score. Cartilage healing state was evaluated by Insall's classification for chondromalasia during second-look arthroscopy.
RESULTS
By the Freiburg ankle score, 9 ankles (6 in mosaicplasty, 3 in microfracture) had excellent and 5 (1 in mosaicplasty, 4 in microfracture) had good results at the times of second-look arthroscopy. By Insall's classification, consistency of the osteochondral grafts and congruity between grafts and native cartilage (Grade I) were shown in 9 (6 ankles in mosaicplasty, 3 ankles in microfracture), a fissuring (Grade II) in one ankle of mosaicplasty, a fasciculation (Grade III) in one ankle of microfracture, and partial exposure of subchondral bone (Grade IV) in 3 ankles of microfractures.
CONCLUSION
Mosaicplasty was more excellent in consistency and hardness of cartilage than microfracture. In some cases of microfracture, cartilage healing was incomplete at 6 months postoperatively, so second-look arthroscopy is necessary to identify. If incomplete cartilage healing was shown, additional procedure such as microfracture or mosaicplasty was needed.