Short-Term Outcome Comparison of Arthroscopic Chondroplasty and Microfracture for Treatment of Small and Medium-Sized Osteochondral Defects of the Ankle

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Abstract
Background: To compare short-term outcomes of patients diagnosed with small and medium-sized osteochondral ankle defects who were treated with chondroplasty and microfracture. Materials and Methods: A retrospective multicentre ankle and foot arthroscopy registry was queried for patients from December 2017 to December 2022 who were diagnosed with a small or medium-sized osteochondral ankle defect and treated with an arthroscopic chondroplasty or microfracture. Demographic and intraoperative variables were collected. Foot and Ankle Ability Measure Sports Subscale (FAAM-S), Visual Analogue Scale (VAS), VR-12 Mental, VR-12 Physical and Foot Function Index (FFI) PROMs were completed by patients preoperatively and at a minimum of one year postoperatively. Data were compared between patients who were treated with chondroplasty and those treated with microfracture. The differences in continuous variables were assessed via paired-sample t-tests. χ 2 analysis was performed on all categorical variables. Results: Thirteen patients were treated with chondroplasty, and 22 patients were treated with microfracture. There were no demographic differences between groups (P = 0.30, P = 0.68, P = 0.18). Microfracture patients had significantly deeper chondral defects than chondroplasty patients (P = 0.002), and their lesions had significantly higher International Cartilage Repair Society (ICRS) grades (P = 0.003). There were no differences in length, width or location of defect between groups (P = 0.50, P = 0.73, P = 0.12). Both cohorts saw significant improvement in FAAM-S, VAS, VR-12 Physical and FFI PROMs at a minimum of one year postoperatively (P = 0.00004, P = 0.008, P = 0.010, P = 0.0007; P < 0.00001, P = 0.0001, P = 0.00007, P = 0.0001). There were no differences in any PROM score between groups preoperatively or postoperatively (P = 0.93, P = 0.96, P = 0.57, P = 0.61, P = 0.12; P = 0.79, P = 0.52, P = 0.26, P = 0.46, P = 0.83). Conclusion: There were no significant outcome differences in patients treated with chondroplasty and microfracture for small to medium-sized chondral ankle defects. Patients in both groups saw significant improvements in PROMs at a minimum of one year postoperatively. In small and medium-sized chondral lesions, microfracture may be recommended over chondroplasty for lesions with greater depth or ICRS grade. Level of Evidence: III, retrospective cohort study.

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