Arthroscopic Debridement vs Bone Marrow Stimulation for Small Osteochondral Lesions of the Talus: A Retrospective Matched Study of Outcomes for Lesions <60 mm

Abstract

Background:

Osteochondral lesions of the talus (OLTs) are common ankle injuries, even small OLTs (≤100 mm²) cause pain, swelling, and reduced mobility if untreated, yet an optimal treatment standard remains elusive. This study aimed to compare the midterm outcomes of arthroscopic debridement (AD) and bone marrow stimulation (BMS) techniques for small-sized OLTs and to determine possible association between lesion size and clinical efficacy.

Methods:

Patients with small-sized OLTs who received AD or BMS were retrospectively analyzed, with a minimum follow-up of 36 months. A 1:1 propensity score matching was performed, and 32 pairs of patients were matched. Clinical outcomes were assessed using the visual analog scale (VAS), the Karlsson Score, Foot Ankle Outcome Score (FAOS), and the ankle activity score (AAS) scores. In addition, a general linear model analysis was performed between patient demographics and Karlsson scores in 2 groups separately to detect potential risk factors.

Results:

Finally, 28 patients in the AD group and 30 patients in the BMS group completed the follow-up and were enrolled with a mean follow-up period of 67.63 ± 17.01 months. No preoperative demographic differences were found between the 2 groups (all P > .050). Both AD and BMS groups showed significant improvements in all clinical scores postoperatively. No significant intergroup differences were found in all postoperative scores except FAOS ADL (P = .030). Correlation analysis showed a strong correlation between lesion area and the postoperative Karlsson score in the AD group (r = −0.673, P < .001), with lesions greater than 61.13 mm² associated with worse outcomes.

Conclusion:

Arthroscopic debridement and bone marrow stimulation showed similar improvements in clinical scores for small osteochondral lesions of the talus (<60 mm²). For larger lesions (>60 mm²), AD outcomes were worse; given the single-center, retrospective design and modest sample size, this data-derived cutoff is exploratory and requires external validation.