TY - JOUR
T1 - Open Lift, Drill, Fill, and Fix (LDFF) for Chronic Osteochondral Lesions of the Talus
T2 - Favorable 2-Year Clinical Outcomes
AU - Rikken, Q. G. H.
AU - Dahmen, Jari
AU - Lambers, Kaj T. A.
AU - Emanuel, Kaj S.
AU - Stufkens, Sjoerd A. S.
AU - Kerkhoffs, Gino M. M. J.
AU - Altink, J. Nienke
AU - van Bergen, Christiaan J. A.
AU - de Leeuw, Peter A. J.
AU - Krips, Rover
AU - Amsterdam Ankle Cartilage Team
AU - Reilingh, Mikel L.
N1 - Publisher Copyright:
© The Author(s) 2023. This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
PY - 2025/8/1
Y1 - 2025/8/1
N2 - Background: In the presence of an osteochondral fragment with sufficient subchondral bone thickness, fixation is considered to be an effective treatment method for osteochondral lesions of the talus (OLT). One such fixation technique is the lift-drill-fill-fix (LDFF) procedure, which has shown reliable long-term results in an arthroscopic approach; however, the outcomes in cases treated through an open approach are unknown. Purpose: To assess the 2-year outcomes after open LDFF for chronic OLT. Study Design: Case series; Level of evidence, 4. Methods: A total of 34 patients who underwent an open LDFF procedure for chronic (>6 weeks) OLT were prospectively followed for 2 years. The primary outcome concerned the comparison in numeric rating scale of pain (0 = no pain; 10 = most severe pain) during walking between the preoperative score to the 2-year postoperative follow-up score. The association of baseline factors with the change in the primary outcome between baseline and 2-year follow-up was assessed. Secondary patient-reported outcome measures (PROMs) were the Foot and Ankle Outcome Score and 36-Item Short Form Health Survey (SF-36). The fragment union rate on 1-year follow-up computed tomography scans and the influence of possible baseline factors on union were assessed. Adverse events, including revision surgery and complications, were assessed and documented. Results: The primary outcome significantly improved from a median of 6 (IQR, 4-7) out of 10 preoperatively to 1 (IQR, 0-3) out of 10 at final follow-up, P < .01. There was no association between baseline factors (sex, age, body mass index (BMI), smoking status, lesion size, and location) and change in primary outcome between baseline and 2-year follow-up. All other PROMs significantly improved, except for the SF-36 Mental Component Summary. The fragment union rate was 91% [95% CI, 76-98]. BMI of ≥30 kg/m2was significantly associated with fragment nonunion (odds ratio, 1.39; 95% CI, 1.04-1.84; P = .02). Three patients underwent revision surgery, while 2 complications (1 case of delayed superficial wound healing and 1 case of complex regional pain syndrome) were observed. Conclusion: Open LDFF resulted in favorable PROs for chronic OLT up to 2-year follow-up. The procedure achieved a 91% fragment union rate, while patients with obesity showed a higher risk of fragment nonunion.
AB - Background: In the presence of an osteochondral fragment with sufficient subchondral bone thickness, fixation is considered to be an effective treatment method for osteochondral lesions of the talus (OLT). One such fixation technique is the lift-drill-fill-fix (LDFF) procedure, which has shown reliable long-term results in an arthroscopic approach; however, the outcomes in cases treated through an open approach are unknown. Purpose: To assess the 2-year outcomes after open LDFF for chronic OLT. Study Design: Case series; Level of evidence, 4. Methods: A total of 34 patients who underwent an open LDFF procedure for chronic (>6 weeks) OLT were prospectively followed for 2 years. The primary outcome concerned the comparison in numeric rating scale of pain (0 = no pain; 10 = most severe pain) during walking between the preoperative score to the 2-year postoperative follow-up score. The association of baseline factors with the change in the primary outcome between baseline and 2-year follow-up was assessed. Secondary patient-reported outcome measures (PROMs) were the Foot and Ankle Outcome Score and 36-Item Short Form Health Survey (SF-36). The fragment union rate on 1-year follow-up computed tomography scans and the influence of possible baseline factors on union were assessed. Adverse events, including revision surgery and complications, were assessed and documented. Results: The primary outcome significantly improved from a median of 6 (IQR, 4-7) out of 10 preoperatively to 1 (IQR, 0-3) out of 10 at final follow-up, P < .01. There was no association between baseline factors (sex, age, body mass index (BMI), smoking status, lesion size, and location) and change in primary outcome between baseline and 2-year follow-up. All other PROMs significantly improved, except for the SF-36 Mental Component Summary. The fragment union rate was 91% [95% CI, 76-98]. BMI of ≥30 kg/m2was significantly associated with fragment nonunion (odds ratio, 1.39; 95% CI, 1.04-1.84; P = .02). Three patients underwent revision surgery, while 2 complications (1 case of delayed superficial wound healing and 1 case of complex regional pain syndrome) were observed. Conclusion: Open LDFF resulted in favorable PROs for chronic OLT up to 2-year follow-up. The procedure achieved a 91% fragment union rate, while patients with obesity showed a higher risk of fragment nonunion.
KW - LDFF
KW - drill
KW - fill and fix
KW - internal fixation
KW - lift
KW - osteochondral lesion of the talus (OLT)
UR - https://www.scopus.com/pages/publications/105013597846
U2 - 10.1177/23259671251356700
DO - 10.1177/23259671251356700
M3 - Article
C2 - 40786919
SN - 2325-9671
VL - 13
JO - Orthopaedic journal of sports medicine
JF - Orthopaedic journal of sports medicine
IS - 8
M1 - 23259671251356700
ER -
