Revision surgery for osteochondral lesions of the talus: Are there predictive factors for successful surgery?

Abstract Purpose Osteochondral lesions of the talus (OLT) are common injuries of the ankle associated with persistent pain and functional impairment. Revision procedures are frequent. Currently, objective criteria to guide revision decision-making remain limited. This retrospective study is designed to identify factors associated with patient-reported outcome after surgery pathways and to enhance selection of patients who may benefit from revision surgery in OLT. Methods Between 2015 and 2018, 64 patients underwent surgical treatment for OLT (97 procedures in total). A symptomatic subgroup of 21 patients required additional procedures (33 revision operations). Outcomes at a mean follow-up of 3 years were assessed using the Visual Analog Scale (VAS), the American Orthopaedic Foot and Ankle Society (AOFAS) score, and the Foot and Ankle Outcome Score (FAOS). Primary outcome was a patient-level PROM-based classification (Success/ Partial relief/No relief) at follow-up. Analyses were performed per patient; procedure counts were reported descriptively. Results Of 64 patients, 43 (67%) achieved a successful outcome after a single procedure, whereas 21 (33%) required multiple procedures. In the multiple-surgery group, 9/21 (43%) were classified as Success at follow-up. PROM categories in follow up correlated significantly with AOFAS, VAS, and FAOS. A longer interval (> 24 months) between procedures might be associated with a higher likelihood of a habituation effect at follow-up. Conclusion PROM-based classification provides a patient-centered assessment of outcome after revision pathways for OLT. The FAOS score subdomains proved particularly valuable in identifying specific issues that could justify a revision. The waiting time between surgeries appears relevant and should be considered when planning revision surgery. Our data suggests that a longer interval between surgeries (exceeding 24 months) might be associated with habituation effects and adaptation processes, leading to a reduction in periarticular swelling and the continuation of physiotherapy. Despite moderate success rates, the treatment of OLT remains challenging, and preoperative factors such as age and activity level should be considered when evaluating the chances of success.