Arthroscopic Treatment of Osteochondral Lesions of the Talus: Microfracture and Drilling Versus Debridement

Operative treatment of osteochondral lesions of the talus (OLTs) is frequently based on lesion size, stability, and surgeon preference. The purpose of this study was to determine if one arthroscopic treatment is superior to another for improving pain in patients with OLTs. Sixty-two patients treated by a single surgeon from 1999 to 2009 had sufficient medical records to be reviewed. Demographics, mechanism of injury, type of operation, lesion characteristics, and pain scores were analyzed. Thirty-one males and 31 females (mean age 32) were included; 54.1% of the lesions were on the medial talar dome and 72.3% were posttraumatic. Seventeen patients underwent arthroscopic debridement and 45 underwent arthroscopic drilling or microfracture. Visual analog scale pain scores were documented in 33 patients, demonstrating a statistically significant decrease at 6 months for debridement (p D .006) and drilling and microfracture (p D .0003) procedures. Neither procedure was superior to the other in pain reduction. No demographic variables were identified that influenced these postoperative pain scores. These results support that most OLTs are posttraumatic lesions caused by inversion or twisting and often occur on the medial talus. Arthroscopic interventions were effective for decreasing pain in both surgical groups. (Journal of Surgical Orthopaedic Advances 21(4):218–222, 2012)