SLR - January 2020 - Joseph B. Agyen
Reference: Nguyen A, Ramasamy A, Walsh M, McMenemy Louise, Calder J. Autologous Osteochondral Transplantation for Large Osteochondral Lesions of the Talus Is a Viable Option in an Athletic Population. The American Journal of Sports Medicine. 2019 Oct 31; Volume: 47 Issue: 14 Pages: 3429-3435Scientific Literature Review
Reviewed By: Joseph B. Agyen, DPM
Residency Program: AMITA Health, St. Joseph Hospital – Chicago, IL
Podiatric Relevance: Osteochondral lesion of the talus (OLT) is used to describe a spectrum of pathologies that included talar transchondral fractures, osteochondral fractures, flake fractures and talar osteochondritis. These injuries are very common and have a reported incidence of 28 percent to 69 percent after ankle fracture. Autologous osteochondral transplantation (AOT) has been purported to be a reliable and effective treatment option for lesions sized 150 to 400 mm2. The goal of this study was to determine whether AOT is an appropriate procedure that allows amateur and professional athletes to return to full sporting activity with lesions greater than 150 mm2.
Methods: A level IV case series study was performed on professional and amateur athletes with a talar osteochondral lesion size of 150 mm2 or greater. The surgical intervention was AOT with a donor site from the lateral femoral condyle. A total of 38 athletes (11 professional) were assessed. Clinical outcomes at a minimum of 24 months included return to sport, visual analog scale (VAS) for pain score, and Foot and Ankle Outcome Score (FAOS). Graft incorporation was evaluated by MRI using MOCART (magnetic resonance observation of cartilage repair tissue) scores at 12 months after surgery.
Results: Thirty-three patients returned to sport at their previous level, four returned at a lower level compared with preinjury, and one did not return to sport (mean return to play, 8.2 months). The VAS and FAOS improved significantly in all domains. There were no association between preoperative or lesion characteristics and ability to return to sport. The were no significant difference in age or duration of symptoms in the professional and amateur groups. A strong correlation between MOCART scores and ability to return to sport was found. There were no infections or wound healing issues requiring further surgery. An incidence of donor site morbidity in two of 38 patients occurred.
Conclusions: AOT can allow athletes with large osteochondral lesions to return to their pre-injury level of activity in a majority of cases. The limitations of this study are related to the case study design, with no control group available to provide comparison. Another limitation is that the specific contents of cBMA and PRGF were not measured. Further comparative studies would aid in defining the benefits of AOT in this high-demand population. Another limitation of this study is the retrospective nature.