SLR - January 2020 - Henry D. Spingola, III
Return to Sports after Surgical Treatment of Osteochondral Defects of the Talus A Systematic Review of 2347 CasesReference: Steman JAH, Dahmen J, Lambers KTA, Kerkhoffs GMMJ. Return to Sports after Surgical Treatment of Osteochondral Defects of the Talus: A Systematic Review of 2347 Cases. Orthop J Sports Med. 2019;7(10):2325967119876238. Published 2019 Oct 22. doi:10.1177/2325967119876238
Scientific Literature Review
Reviewed By: Henry D. Spingola, III, DPM
Residency Program: AMITA Health, St. Joseph Hospital – Chicago, IL
Podiatric Relevance: A high incidence of osteochondral defects of the talus have been reported due to injury whether it be ankle sprains, instability or fractures. Many of these injuries occur during athletic activities. There has been much debate in the podiatric literature regarding treatment of moderately sized OCL’s. As a result, procedure choice it can be difficult for a surgeon especially in an elite level athlete. Patients managed primarily with nonoperative treatment typically remain symptomatic and end up eventually requiring surgical intervention. Historically, microfracture has been the standard of care for lesions measuring less than 1.5 centimeters. Recent literature however, shows unfavorable long term results with microfracture. Retrograde drilling, grafting, osteochondral implantation, and cartilage transplantation are commonly utilized in lesions greater than 1.0-1.5 centimeters. The purpose of this study was to summarize return to sports after various surgical interventions for OCDs.
Methods: This article was a level IV retrospective review of the literature from 1996 to 2018 including 61 studies consisting of 2347 talar OCDs was conducted. These patients were divided into seven different surgical treatment groups. Treatment groups included bone marrow stimulation (BMS), retrograde drilling, osteochondral stimulation, autologous cartilage implantation, chrondrogenesis inducing therapies, metallic implantation and internal fixation. The return to sports (RTS) timeline was calculated along with the return to previous level of activity.
Results: Sixty-one studies involving 2347 OCDs were included in this RTS. The primary recording metrics were return to sports percentage as well as the Foot and Ankle Outcome score (FAOS). There were 23 studies consisting of 339 patients that underwent bone marrow stimulation. Lesions treated with BMS were primarily a Berndt and Hardy grade II or III. The return to sports score was 88 percent. In studies that evaluated level of play post BMS found that 79 percent of patients were able to participate at pre-injury level. Osteochondral autograft transplantation was performed in 194 patients. Seventy-nine percent of these patients had a grade III lesion or greater. The RTS rate was found to be 90 percent with 72 percent of patients returning to pre-injury level. Thirty-nine patients underwent autologous chondrocyte implantation with a RTS of 87 percent and a pre-injury level in 69 percent of patients. Finally, patients undergoing internal fixation had an RTS of 97 percent, but no pre-injury level data was pooled. There was no RTS data pooled in patients treated with chondrogenesis-inducing techniques and retrograde drilling as the FAOS was used in these studies.
Conclusions: The study concluded that all surgical treatment options yielded favoraded RTS rates. There was no correlation between RTS pre-injury level and procedure selection or grade of the lesion. Greater than 69 percent of patients that underwent BMS, autologous osteochondral transplantation and implantation returned to a pre-injury level. The present study had multiple limitations. The main limitation was the high number of low quality studies. Another main limitation was that a consistent validated scoring system was not used in all studies. Two alternating scoring systems (RTS and FAOS) were used. The present study can be utilized as a procedural guideline for RTS in patients with primary or secondary OCDs.