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Clinical and Radiographic Outcomes Following Concurrent Treatment of Osteochondral Lesions of the Talus and Symptomatic Os Trigonum

      Introduction

      Osteochondral lesions of the talus and symptomatic os trigonum represent two distinct lesions in the hindfoot and each are a well-recognized source of pain and disability. However, little is known about the outcomes of patients who are treated for both concurrently. Currently there are no case reports in the literature or case studies to guide surgeons in counseling patient expectations or treatment decisions when a symptomatic osteochondral lesion and painful os trigonum are both present. The purpose of this study is to address this deficiency in the literature.

      Methods

      We retrospectively identified 28 patients who had undergone arthroscopic treatment of OLT and Os Trigonum from 1997 to 2015. 19 patients met inclusion and exclusion criteria and were invited for participation in the study. The primary outcome measure was the FAOS and AOFAS ankle-hindfoot score. Secondary outcome measures were the Short-Form-36, resumption of work and sports, and a custom questionnaire. Preoperative and follow up progression of radiographic arthritis was reviewed.

      Results

      Twelve patients (6 male, 6 female, mean age 38) were available for participation in the study with a mean duration of follow up of 65 months (range 12-160) months. Most patients would have surgery again (78%) and were satisfied with their surgery (67%). Patients frequently were able to perform activities of daily living (FAOS 84) but performed modestly concerning sports and recreation (FAOS 61). The mean AOFAS score was 78. Two patients had radiographic progression of arthritis by a single grade.

      Conclusion

      The principle finding of this study was that patients have an overall fair outcome with combined treatment of osteochondral lesions of the talus and os Trigonum. The overall complication rate and radiographic progression of arthritis was low at final follow-up. We hypothesize that this combined injury occurs when a painful os trigonum impairs ankle stability leading to an osteochondral defect.