Introduction: The aim of current study was to: 1) analyse the impact of intrinsic factors on preoperative status of patients with osteochondral lesion of talus (OLT); 2) compare preoperative status of patients scheduled for surgical treatment of seven common ankle disorders; 3) evaluate the outcome after various operative interventions for OLT and identify predicting factors for the patients’ subjective outcome.
Methods: Hospital records of 610 patients that were admitted for surgical intervention on the ankle joint between 2009 and 2018 were reviewed. Patients’ general and ankle-related subjective status, quality of life, and activity levels were recorded at the admission by standard questionnaires (PROMs): FAOS (Foot and Ankle Outcome Score), EQ-5D (European Quality of Life in 5 Dimensions) and TAS (Tegner activity scale). 1) First, all the patients who were admitted for OLT surgery of any kind were selected. Their demographics, medical history, and the index ankle joint status were tested as possible predictors for patients’ subjective status by a linear regression model. 2) Secondly, all the patients who were treated operatively for an isolated ankle pathology were identified: 19 primary OLT (P-OLT), 18 recurrent OLT (R-OLT), 22 osteoarthritis (OA), 15 lateral instability, 20 anterior, 13 posterior, and 16 combined ankle impingement. Across these seven groups, preoperative active range of motion, subjective ankle status, quality of life, and patients’ activity levels were compared. 3) The patients from the first cohort (OLT of any kind) were cross-sectionally re-evaluated after the operation by using the same PROMs. Preoperative to postoperative values of PROMs were compared with a paired Student t-test. Possible predicting factors (patients’ demographics, ankle characteristics, surgical technique) for the treatment improvement (postoperative to preoperative PROMs differences) were tested via a linear regression model. A Cox proportional hazard model was used fort the graft survival analysis.
Results: 1) Linear regression model revealed that gender, body mass index (BMI), and Kellgren-Lawrence (KL) osteoarthritis score were correlated with the preoperative FAOS and TAS. 2) All evaluated ankle disorders induced significant preoperative subjective joint dysfunction, decreased quality of life, and activity level. The most profound impairments were reported by patients treated for OA and recurrent OLT. 3) All FAOS and EQ-5Q values increased from preoperative to the final follow-up values. There was no correlation between age, gender, BMI, aetiology, symptoms duration, lesion characteristics, additional procedures, OA toward the postoperative improvement of PROMs values. Graft survival rates were 100% at 1 year and 77% (males)/47% (females) at 5 years. A Cox proportional hazard model revealed 1,6-times higher risk of graft failure for females.
Conclusions: Female gender, higher BMI, and higher grade of ankle OA were negative predictors for the preoperative status of patients with OLT. 2) Patients amenable for surgical treatment of the common ankle pathology reported considerable functional decline in comparison to the general population. The worst subjective ankle status was reported equally by OA and R-OLT patients, while patients with other five disorders reported comparable values. 3) Various operative interventions for OLT significantly improved patients’ ankle status, and quality of life. Patients’ characteristics and surgical technique had no influence on the treatment outcome. High graft survival rates were demonstrated over first two years, but notable decline was confirmed thereafter, especially in females.
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