Resurfacing Shows Promise in Treating Talar OCDs

Osteochondral defects in young active patients who previously underwent ankle surgery can be effectively treated with a metal resurfacing inlay implant fixed to the talar dome with titanium screws, according to research presented at the European Society of Sports Traumatology, Knee Surgery and Arthroscopy Congress.

Christiaan J.A. van Bergen, M.D., reported that no patients have needed a revision to date despite degenerative changes that independent observers saw on radiographs of the ankles of four of 22 patients.

“Metal resurfacing inlay implant is a promising procedure for talar [osteochondral defects] OCDs after previous surgery,” van Bergen said.

To be included in the study, which involved treatment with the HemiCap implant (Arthrosurface; Franklin, Mass.) patients needed a large osteochondral defect of the talar dome with persistent complaints of pain for up to one year after previous surgery.

Forty-two patients have been treated with the implant to date and van Bergen reported on 22 of the patients (seven men and 15 women) who had reached two years or more of follow-up. The preoperative mean size of the patients’ medial defect in the anteroposterior view measured on computed tomography was 16 mm with a range of 12 mm to 20 mm.

Investigators used the one to 10 point Numeric Rating Scale (NRS) for pain, where one is no pain and 10 is the maximum pain level. Pain measured with the NRS was significantly reduced postoperatively at rest, walking, running and stair climbing.

“Although patients still had some pain, it was significantly reduced as compared to preoperatively according to a repeated measures ANOVA (analysis of variance),” van Bergen said.

All patients who worked could return to work at a median of eight weeks after the procedure. Thirteen patients participated in sports prior to the procedure, and 12 patients could resume sports after a median of 17 weeks postoperatively, he said.