Osteochondral lesion of the talus: could age be an indication for arthroscopic treatment?

BACKGROUND

Several studies have addressed the issue of the feasibility of arthroscopic surgery in older patients, usually by choosing an arbitrary age limit.

HYPOTHESIS

Patient age is not associated with poor clinical outcome after arthroscopic surgery for osteochondral lesion of the talus (OLT), and other patient variables are the major determinants of clinical success/failure.

STUDY DESIGN

Cohort study; Level of evidence, 3.

METHODS

Between 2001 and 2008, 173 ankles underwent arthroscopic marrow stimulation treatment for OLT and were stratified into 6 age groups (<20, 20-29, 30-39, 40-49, 50-59, and ≥60 years). Bivariate and multivariate analyses were performed to determine the effect of age on clinical outcome.

RESULTS

There were no significant differences among the 6 age groups in the preoperative and postoperative visual analog scale (VAS) for pain or the American Orthopaedic Foot and Ankle Society (AOFAS) score. There was a significant increase in the duration of symptoms (P < .001) and a significant decrease in the incidence of trauma (P = .01) in the older group. Both the size of the osteochondral defect and the number of associated intra-articular lesions independently predicted a poor clinical outcome (P < .001).

CONCLUSION

In contrast to some of the previous studies on this topic, we found that increased age was not an independent risk factor for poor clinical outcome after arthroscopic treatment for OLT. We did find that older patients were less likely to have a history of trauma and had a longer duration of symptoms, had smaller osteochondral defects, and had more associated intra-articular lesions.