Objective: to investigate the long-term clinical and radiological outcome of talar avascular necrosis after treatment by a patellar-tendon bearing brace (PTB), and if parameters predictive for a positive or negative outcome could be identified.

Patients and methods: 21 patients were reviewed retrospectively, 10 had a non-traumatic origin and 11 a traumatic one (groups comparable to gender and age). Mean follow-up was 5,5 and 6,3 years, respectively; mean use of the PTB was 17,2 and 14,8 months. Clinical outcome was assessed by the Mazur scale and the Kitaoka score for function, and a VAS for pain and subjective satisfaction; radiological outcome by the Ficat & Arlet classification and by the Kellgren scale. Clinical parameters were analysed for their positive or negative predictive value on outcome.

Results: A very early pain control was achieved in both groups (2.1 versus 1.9 weeks). On both the Mazur scale and the Kitaoka score the non-traumatic group scored lower as the posttraumatic group (66,3 versus 77,6 and 76.1 versus 78.1). Both VAS were similar in both groups: 3,1 and 3,6 for pain and 6,8 and 7,1 for satisfaction. The need for analgesic medication was slightly higher in the non-traumatic group: 4 versus 3 patients. Radiologically both groups showed a similar outcome with both evaluation systems. Older age, delay in treatment, corticosteroids, alcohol, hyperlipidaemia and female gender were identified as negative predictive parameters.

Conclusions: A PTB is an efficient treatment for talar avascular necrosis of both non-traumatic and traumatic origin. Clinical outcome is better in the posttraumatic group, although radiological outcome is comparable. Only negative predictive parameters could be identified.