10-Year Survival Rate of 82% Following 262 Cases of Arthroscopic Bone Marrow Stimulation for Osteochondral Lesions of the Talus

Category: Arthroscopy; Ankle Introduction/Purpose: The long-term sustainability of arthroscopic bone marrow stimulation (BMS) for osteochondral lesions of the talus (OLT) remains a matter of debate. The primary aim of the present study is to assess the 10-year survival following arthroscopic BMS for OLT. The secondary aim is to evaluate the influence of baseline patient- and lesion characteristics on survival. Methods: Patients who underwent arthroscopic BMS for a symptomatic OLT with a minimum follow-up of 10-years were included to assess procedure survival. The primary outcome, the 10-year cumulative survival rate, was analysed with a Kaplan-Meier survival analysis. Secondary outcomes concerned the median time to survival and the effect of baseline factors (i.e., lesion size, primary or non-primary lesion type, preoperative cysts, and obesity (body mass index ≥30 kg/m²) on survival and was analysed with a cox-regression model and reported with hazard ratios (HR). Results: From the 262 patients included at a mean 15.3 ± 4.8 years follow-up, the 10-year cumulative survival rate of arthroscopic BMS was 82% [95%-CI: 77% - 87%]. At 15-years follow-up the cumulative survival rate was 82% [95%-CI: 76% - 86%]. The median time to revision was 2.4 (interquartile range: 1.3 – 5.1) years. Of the baseline factors, obesity (HR: 3.0 [95%-CI: 1.44 – 6.43], p= < 0.01) was associated with decreased survival. Lesion size (HR: 0.9 [95%-CI: 0.5– 1.8] p= 0.8), non-primary lesion type (HR: 1.8 [95%-CI: 0.9 – 3.4] p= 0.1), and the presence of preoperative cysts (HR: 1.0 [95%-CI: 0.6 – 1.9] p= 0.9) were not significantly associated with survival. Conclusion: At a minimum follow-up of 10-years, the survival rate of arthroscopic BMS for OLT was 82%. At 15- and 20-years follow-up survival seems to remain stable. Obesity (BMI ≥30 kg/m 2 ) was associated with a higher likelihood of revision surgery. This risk factor should be incorporated into the treatment algorithm for OLT when counselling patients for surgery.