Open Lift, Drill, Fill and Fix (LDFF) for Talar OCDs: 2 to 4 Year Results in 16 Patients

CATEGORY: Ankle INTRODUCTION/PURPOSE: The purpose of this study was to describe the mid to long-term clinical and radiological outcomes of an open fixation technique for large primary talar osteochondral defects (OCD): Lift, Drill, Fill and Fix (LDFF). METHODS: Nineteen patients underwent an open LDFF surgery. Mean follow-up was 35 months (SD 3.6). Pre-and postoperative clinical assessment included the Foot and Ankle Outcome Score (FAOS) and a numeric rating scale (NRS) on pain at rest and during weight-bearing. Remodeling and bone ingrowth were analyzed on CT at one year post-operatively. RESULTS: 15 out of 19 patients showed remodeling and bone ingrowth after the open LDFF procedure. Patients who did not show remodeling and bone ingrowth were treated by means of an OATS procedure. In the remaining 15 patients available at mid to long-term follow-up, LDFF led to a significant improvement of all FAOS subscales; FAOS-pain improved from 65 to 74 (p=0.014), FAOS-symptoms improved from 60 to 80 (p=0.005), FAOS-ADL improved from 80 to 85 (p=001), FAOS-sport improved from 38 to 61 (p=0.017) and FAOS-QoL improved from 38 to 64 (p=0.025). The NRS of pain at rest significantly improved from 3.2 to 1.2 (p=0.009), and pain during walking significantly improved from 6.5 to 1.6 (p<0.001). No complications occurred. CONCLUSION: Open LDFF of a talar OCDs show promising mid to long-term clinical and radiological results. A longer follow-up period with more study power is a subsequent necessary step in order to draw firmer conclusions about the longevity of this present procedure.