Sustained Improvement in Pain with Talar OsteoPeriostic Grafting from the Iliac Crest (TOPIC) for Medial Osteochondral Lesions of the Talus

Talar OsteoPeriostic grafting from the Iliac Crest (TOPIC) for large osteochondral lesions of the medial talar dome was shown to be effective at 2 years of follow-up. In this prospective cohort study, our aim was to evaluate the clinical and radiographic outcomes at 5 years of follow-up. The primary outcome was the Numeric Rating Scale (NRS) score for pain during walking. Secondary outcomes included NRS scores for pain during rest and during stair-climbing as well as scores on the Foot and Ankle Outcome Score (FAOS) subscales, Short Form (SF)-36 Physical Component Summary and Mental Component Summary scores, and the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score. Computed tomography (CT) scans were evaluated. Thirty-seven patients were included. Two patients died and 2 underwent ankle arthrodesis before 5 years and thus were not included in the 5-year statistical analysis of outcomes. The median NRS score for pain during walking improved from 7 (interquartile range [IQR], 5 to 8) preoperatively to 2 (IQR, 1 to 4) at 5 years (p < 0.001), surpassing the minimal clinically important difference. All secondary clinical outcomes improved significantly. All grafts showed incorporation, and 87% of the patients with a CT scan at 5 years demonstrated evidence of cyst formation. Osteoperiosteal autografting using the TOPIC technique is an effective treatment option for large medial osteochondral lesions of the talus, with durable results at 5 years of follow-up. Level of Evidence: Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.