Postoperative Management of Osteochondral Lesions of the Ankle: A Survey Among German-Speaking Foot and Ankle Surgeons

Aurich Matthias; Christoph Becher; Sarah Ettinger; Oliver Gottschalk; Daniel Guenther; Kajetan Klos; Marc-Daniel Ahrend; Daniel Körner; Christian Plaass; Markus Walther

doi:10.1177/19476035231213184

Postoperative Management of Osteochondral Lesions of the Ankle: A Survey Among German-Speaking Foot and Ankle Surgeons

Cartilage. 2023 Dec 3:19476035231213184. doi: 10.1177/19476035231213184. Online ahead of print.

Authors

Aurich Matthias^{1

2}, Christoph Becher³, Sarah Ettinger⁴, Oliver Gottschalk^{5

6}, Daniel Guenther⁷, Kajetan Klos^{8

9}, Marc-Daniel Ahrend¹⁰, Daniel Körner¹⁰, Christian Plaass¹¹, Markus Walther^{12

13

14

15}

Affiliations

¹ DOUW, Section of Trauma- and Reconstructive Surgery, University Hospital Halle (Saale), Halle, Germany.
² BG Trauma Center Bergmannstrost Halle, Department of Trauma- and Reconstructive Surgery, Halle, Germany.
³ Department of Orthopaedic Surgery, Hannover Medical School, Diakovere Annastift, Hannover, Germany.
⁴ University Hospital for Orthopedic Surgery, Pius Hospital Oldenburg, Oldenburg, Germany.
⁵ Hospital München Harlaching, Department of Foot and Ankle Surgery, München, Germany.
⁶ Department of Orthopaedics and Trauma Surgery, Muskuloskelettal University Center Munich (MUM), Hospital of the University Munich, LMU Munich, Germany.
⁷ Department of Orthopaedic Surgery, Trauma Surgery, and Sports Medicine, Cologne Merheim Medical Center, Cologne, Germany.
⁸ Joint Center Rhein-Main, Hochheim am Main, Germany.
⁹ Department of Trauma, Hand and Reconstructive Surgery, University Hospital Jena, Jena, Germany.
¹⁰ BG Trauma Center Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany.
¹¹ DIAKOVERE Annastift, Hannover, Germany.
¹² Schön Hospital München Harlaching-FIFA Medical Centre of Excellence, Munich, Germany.
¹³ Ludwig Maximilian University Munich, Department of Orthopaedics and Trauma Surgery, Muskuloskelletal University Center Munich (MUM), Munich, Germany.
¹⁴ Justus Maximilian University Wuerzburg, König-Ludwig-Haus, Würzburg, Germany.
¹⁵ Paracelsus Medical Private Universität, Salzburg, Austria.

PMID: 38044500
DOI: 10.1177/19476035231213184

Abstract

Objective: To assess the current treatment of osteochondral lesions of the ankle (OCLA) by German-speaking foot and ankle surgeons, focusing on the management of postoperative care and rehabilitation.

Design: A questionnaire was created by a panel of 4 experienced foot and ankle surgeons on behalf of the "Clinical Tissue Regeneration" (CTR) working group of the German Society of Orthopaedics and Trauma Surgery (DGOU), and distributed electronically to members of the CTR, participants of the German Cartilage Registry (Knorpelregister DGOU©), and members of 6 German-speaking orthopedics or sports medicine societies. Results were classified depending on the consensus within the answers (agreement ≥75% "strong tendency," 50%-74% "tendency," 25%-49% "weak tendency," <25% "no tendency").

Results: A total of 60 participants returned the questionnaire. The main results are as follows: regarding the frequency of surgical procedures for OCLA, refixation of the fragment, retrograde drilling, and bone marrow stimulation with or without using a matrix were performed by at least 75% of the surgeons and was considered a strong tendency. There was a strong tendency to stabilize the ankle (76.7%) and perform corrective osteotomies (51.7%). In total, 75.5% and 75% of the surgeons performed bone marrow stimulation with and without using a matrix, respectively. Corrective osteotomy and ankle stabilization were performed in 64.5% and 65.2% cases, respectively. Most participants included published recommendations on postoperative rehabilitation and the return to sports activities in their postoperative management. The main surgical procedures were considered the most critical factor in influencing the postoperative management by 81% of the participants (strong tendency). Adjunct surgical procedures such as corrective osteotomy and stabilization of the ankle were considered important by 67.8% of the respondents (tendency).

Conclusions: The management of OCLA varies among German-speaking foot and ankle surgeons. Therefore, guidelines remain essential to standardize the management of OCLA, to achieve improved and stable results. This survey will assist clinicians and patients with rehabilitation to return to sports after treating the ankle's cartilage injury.

Keywords: ankle; cartilage; lesion; survey.