Talar OsteoPeriostic Grafting from the Iliac Crest (TOPIC): 2-year Results of a Novel Press-fit Surgical Treatment for Large Talar Osteochondral Lesions

Category: Ankle; Sports Introduction/Purpose: The purpose of this study was to present the surgical technique and to evaluate the clinical and radiological outcomes of a new press-fit transplantation technique for large talar osteochondral lesions of the talus (OLTs), Talar OsteoPeriostic grafting from the Iliac Crest (TOPIC). Methods: 60 patients, mean age 38 years, underwent a press-fit TOPIC procedure. Clinical assessment at 12- and 24-months follow-up included the American Orthopaedic Foot and Ankle Society (AOFAS) score, the Short-Form 36 (SF-36) Mental Component Scale (MCS) and Physical Component Scale (PCS), the Numeric Rating Scales (NRS) of pain at rest, during walking and stairclimbing, and the Foot and Ankle Outcome Score (FAOS). Remodeling of the contour of the talus, bone ingrowth and consolidation of the implanted graft were assessed on computed tomography (CT) one year post-operatively. Results: All patients were available for two-year follow-up. The AOFAS improved from 48 to 90 (p< 0.05). All NRS scores improved: during rest from 3 to 0 (p< 0.05), during walking from 5 to 1 p< 0.05), and stairclimbing from 5 to 1 (p< 0.05). Both SF-36 components improved. The PCS from 34 to 47 (p< 0.05) and the MCS from 37 to 66 (p< 0.05). All FAOS subscales significantly improved. All patients showed remodeling of the talus and all grafts showed bone ingrowth on the CT scans. Conclusion: The TOPIC procedure for large osteochondral lesions of the medial talar dome is an effective technique resulting in significant improvement in pain, as well as other outcomes, with 100% consolidation of the grafts.