J Korean Foot Ankle Soc.  2021 Dec;25(4):149-156. 10.14193/jkfas.2021.25.4.149.

Current Trends in the Treatment of Osteochondral Lesion of the Talus: Analysis of the Korean Foot and Ankle Society (KFAS) Member Survey

• Cho BK
• Cho J
• Young KW
• Lee DY
• Bae SY
• The Academic Committee of Korean Foot and Ankle Society, 2021

• KMID: 2523295
• DOI: http://doi.org/10.14193/jkfas.2021.25.4.149

Abstract

Purpose
Given the lack of definite evidence-based guidelines in clinical practice, there may be a wide variation in treatment protocols for osteochondral lesions of the talus (OLT). Based on the Korean Foot and Ankle Society (KFAS) member survey, this study aimed to report the current trends in the management of OLT.
Materials and Methods
A web-based questionnaire containing 30 questions was sent to all KFAS members in September 2021. The questions were mainly related to clinical experience and preferences in diagnosis, conservative, and surgical treatments for patients with OLT. Answers with a prevalence of ≥50% of respondents were considered a tendency.
Results
Sixty-two (11.3%) of the 550 surgeons queried responded to the survey. The responses to 9 (30.0%) of the total of 30 questions established a tendency. Answers exhibiting a tendency were as follows; additional diagnostic tools except for plain radiograph (magnetic resonance imaging), most common conservative treatment method (oral medication, rest), most important radiological factor in decision making for surgical treatment and method (size of the lesion, ankle instability, loose bodies), most important patient factors in decision making for surgical treatment and method (age, activity or occupation), infrequently requiring posterior arthroscopy (less than 3%), most common revision surgery for failed bone marrow stimulation procedure (osteochondral autograft transplantation [OAT]), not requiring additional procedure for donor site in OAT, the main reason for unsatisfactory result after OAT (persistent pain without radiological abnormality), no generalization of autologous chondrocyte implantation or chondrogenesis using stem cells.
Conclusion
This study presents updated information on current trends in the management of OLT in Korea. Both consensus and variations in the approach to patients with OLT were revealed through this survey. Since recent biologic efforts to regenerate cartilage have been unsuccessful, further studies to identify clinical evidence would be needed.

Keyword

Talus; Osteochondral lesion; Trend; Survey; Korean Foot and Ankle Society

Figure

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  Figure. 1 The most common symptom in patients with osteochondral lesions of the talus.

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  Figure. 2 The most preferred method in conservative treatment for osteochondral lesions of the talus.

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  Figure. 3 Degree of significance of the radiological factors in decision making for surgical treatment and method. OLT: osteochondral lesions of the talus.

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  Figure. 4 Degree of significance of the patient-specific factors in decision making for surgical treatment and method. BMI: body mass index.

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  Figure. 5 Frequency to treat concomitant pathologies during surgical treatment for osteochondral lesions of the talus.

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  Figure. 6 Postoperative rehabilitation protocol to permit range of motion exercise. OAT: osteochondral autograft transplantation, ACI: autologous chondrocyte implantation, AMIC: autologous matrix-induced chondrogenesis, MAST: matrix-associated stem cell transplantation.

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  Figure. 7 Postoperative rehabilitation protocol to permit weight-bearing ambulation. OAT: osteochondral autograft transplantation, ACI: autologous chondrocyte implantation, AMIC: autologous matrix-induced chondrogenesis, MAST: matrix-associated stem cell transplantation.

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