Buck Tristan M F, Steman Jason A H, Dahmen Jari, Rikken Quinten G H, Sierevelt Inger N, Stufkens Sjoerd A S, Kerkhoffs Gino M M J
Amsterdam UMC location University of Amsterdam, Department of Orthopedic Surgery and Sports Medicine, Amsterdam, the Netherlands.
Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, the Netherlands.
Foot Ankle Int. 2025 Jul;46(7):699-706. doi: 10.1177/10711007251330881. Epub 2025 Apr 22.
Often, the preferred initial treatment for osteochondral lesions of the talus (OLTs) is nonoperative for at least 6 months before considering more invasive surgical strategies. The primary aim of this study was to evaluate the clinical effectiveness of nonoperative management for OLTs on prospective clinical outcomes over a 1-year period. Secondary aims included assessing the radiologic outcomes, the rate of conversion to surgery, and the influence of baseline factors on return to a higher level of activity.
Patients who underwent nonoperative management for primary OLTs were prospectively included. Clinical outcome measures were assessed at baseline, 6 months, and 12 months. The primary outcome of this prospective cohort study is the change in the numeric rating scale (NRS) for pain score during walking between baseline and 12 months. Secondary outcomes included changes in NRS during rest, NRS during running, NRS during stair climbing, Foot and Ankle Outcome Scale (FAOS) subscales, changes in lesion volume and surface area, and conversion to surgery rate.
A total of 40 patients (42 ankles) mean age 31.6 years with a primary symptomatic OLT were included. The primary outcome, NRS during walking, significantly improved between 0 and 12 months (4.8 to 3.3; = .0003). However, the mean decrease did not exceed the minimal clinically important difference (MCID), with only 38% of the patients exceeding the MCID at 12-month follow-up. NRS scores during running and stair climbing showed improvements from baseline to 6 months ( = .0004 and = .002) and from baseline to 12 months ( = .0001 and = .0002). None of these average NRS change scores at 12-month follow-up exceeded the MCID. FAOS sports and quality of life subscales improved significantly from baseline to 6 months ( = .003 and = .011) and remained stable from 6 to 12 months. The FAOS pain subscale showed significant improvement only after 12 months. Lesion sizes remained stable throughout the one-year period.
Nonoperative treatment resulted in statistically significant improvements in pain during walking after 1 year, with clinically relevant improvement observed in 38% of patients. These findings suggest that nonoperative treatment held the potential for meaningfully improving symptoms in the minority of our patients, with no appreciable change in OLTT size. We think it should be considered as a preferred approach for the first line of treatment.
通常，距骨骨软骨损伤（OLTs）的首选初始治疗方法是在考虑更具侵入性的手术策略之前至少进行6个月的非手术治疗。本研究的主要目的是评估OLTs非手术治疗对1年期间前瞻性临床结果的临床有效性。次要目的包括评估放射学结果、手术转化率以及基线因素对恢复到更高活动水平的影响。
前瞻性纳入接受原发性OLTs非手术治疗的患者。在基线、6个月和12个月时评估临床结局指标。这项前瞻性队列研究的主要结局是基线至12个月期间步行时疼痛评分的数字评定量表（NRS）变化。次要结局包括休息时NRS变化、跑步时NRS变化、爬楼梯时NRS变化、足踝结局量表（FAOS）子量表、病变体积和表面积变化以及手术转化率。
共纳入40例患者（42个踝关节），平均年龄31.6岁，患有原发性症状性OLTs。主要结局，即步行时的NRS，在0至12个月期间显著改善（从4.8降至3.3；P = 0.0003）。然而，平均下降幅度未超过最小临床重要差异（MCID），在12个月随访时只有38%的患者超过MCID。跑步和爬楼梯时的NRS评分从基线到6个月（P = 0.0004和P = 0.002）以及从基线到12个月（P = 0.0001和P = 0.0002）均有改善。12个月随访时这些平均NRS变化评分均未超过MCID。FAOS运动和生活质量子量表从基线到6个月显著改善（P = 0.003和P = 0.011），从6个月到12个月保持稳定。FAOS疼痛子量表仅在12个月后显示出显著改善。病变大小在整个一年期间保持稳定。
非手术治疗在1年后步行时疼痛方面有统计学显著改善，38%的患者有临床相关改善。这些发现表明非手术治疗有可能在少数患者中显著改善症状，而OLTT大小无明显变化。我们认为它应被视为一线治疗的首选方法。
