Autologous Osteochondral Transplantation for Osteochondral Lesions of the Talus: High Rate of Return to Play in the Athletic Population

SLR - December 2021 - Weldon G. Murry

Reference: Seow D, Shimozono Y, Gianakos AL, Chiarello E, Mercer N, Hurley ET, et al. Autologous Osteochondral Transplantation for Osteochondral Lesions of the Talus: High Rate of Return to Play in the Athletic Population. Knee Surg Sports Traumatol Arthrosc. 2021;29(5):1554–61.

Level of Evidence: Level IV

Scientific Literature Review

Reviewed By: Weldon G.  Murry, DPM
Residency Program: St. Vincent Hospital – Worcester, MA

Podiatric Relevance: Osteochondral lesions of the talus (OLT) are highly reported injuries throughout the literature. Autologous osteochondral transplantation (AOT) has been shown to be an excellent option in treating these lesions. However, there is a wide range of return to play in athletes reported in the literature. Also, there are no established return to play guidelines and consistent rehabilitation protocols following AOT for OLT. This systematic review aims to evaluate the rate of return to play and rehabilitation protocols following AOT for OLT.

Methods: A systemic review was performed and included nine studies that were published between 1997 and 2019. All studies included were of level of evidence IV and included (1) return to play following AOT for OLT, (2) clinical studies, (3) published in peer-reviewed journal, (4) written in English and (5) full-text studies. The rate of return to play was calculated as the percentage of patients that returned to sport. Rehabilitation protocols were evaluated using the earliest time point when patients were allowed range of motion, partial weight-bearing and full weight-bearing was recorded.

Results: There were a total of 205 ankles that underwent AOT for OLT that reported return to play. The mean follow-up was 44.4 months, the mean age was 30.6 years and the mean OLT size was 135 millimeters. The overall rate of return to play was 86.3 percent (177/205) with 81.8 percent (81/99) of athletes returning to pre-injury status. The mean time to return to play was 5.8 months. There was a significant correlation found between increase age and decrease rate of return to play and a significant non-correlation between OLT sizes and rate of return to play. Range of motion immediately following surgery was most commonly reported, followed by one week and then at two weeks. The most commonly reported time to allow partial weight-bearing was four weeks post-operatively, followed by six weeks, immediately, two weeks and then eight weeks.  

Conclusions: This systematic review concluded that AOT for OLTs in the athletic population results in high rates of return to competitive activity with a return to sport rate of 81.5 percent. This suggests that treating athletes with AOT for OLTs can be a sufficient treatment for this patient population. Another conclusion of this review redemonstrated the high variability in rehabilitation protocols. There should be further studies in order to standardize return to play guidelines and rehabilitation protocols following AOT for OLT.