Elevated Body Mass Index Does Not Adversely Influence the Outcomes of Arthroscopic Treatment for Osteochondral Lesions of the Talus

Abstract

Category: Ankle; Arthroscopy; Hindfoot; Trauma Introduction/Purpose: Osteochondral lesion of the talus (OLTs) is a common condition found in patients with chronic ankle pain after previous ankle sprains. Conservative measures such as analgesics, activity modification and immobilisation of the affected ankle are usually applied as first line treatments. Surgical management are indicated after conservative management have failed. This study evaluates the influence of body mass index (BMI) on the early clinical outcomes of arthroscopic debridement and microfracture of OLTs. Methods: An IRB approved study was conducted between 2007 and 2017. A total of 252 patients with symptomatic OLTs who failed conservative management underwent arthroscopic debridement and microfracture of OLTs over the affected ankle. Postoperatively, all patients underwent a standardised postoperative rehabilitation protocol. Patients who underwent previous fractures, previous infections or associated ligamentous injury of the affected ankle were excluded from this study. Patients from this cohort were divided into two groups based on BMI. The normal BMI group (NB-Group) (BMI 18.5-25.0kg/m 2 ) and raised BMI group (RB-Group) (BMI >=25kg/m 2 ). Visual Analogue Score (VAS), American Orthopaedic Foot & Ankle Society (AOFAS) Hindfoot Score as well as the Physical and Mental Components of the Short-Form 36 Questionnaire (PCS and MCS respectively) were prospectively collected from these cohort during their standard postoperative outpatient follow up. Results: A total of 252 patients were reviewed. Patients from either group were otherwise well matched demographically (Table 1). The operative duration was significantly shorter for NB-Group compared to RB-Group. Patients from both groups had significant improvement VAS, AOFAS and PCS scores postoperatively at 6 months and 24 months after surgery (Table 2).Between both groups, patients had comparable VAS, AOFAS as well as PCS scores at preoperative, 6 months postoperative and 24 months postoperatively (p > 0.05). However, MCS in the RB-Group showed a gradual deterioration over 24 months postoperatively and was significantly poorer compared to the NB-Group at 24 months (p = 0.036) (Figure 1). Conclusion: Arthroscopic debridement and microfracture is a reliable procedure, providing significant improvement in pain relief and functional improvement in patients. A raised BMI did not adversely affect pain and functional outcomes. However, patients with raised BMI required a longer duration of procedure and had significantly poorer MCS scores at 24 months after surgery.