SLR - October 2012 - Gabriel Van Gompel
Reference: Dong-Hyun Lee, MD, Keun-Bae Lee, MD, PhD, Sung-Taek Jung, MD, PhD, Jong-Keun Seon, MD, PhD, Myung-Sun Kim, MD, PhD, and Il-Hoon Sung, MD, PhD. Am J Sports Med. Aug 9, 2012. Epub ahead of print
Scientific Literature Review
Reviewed by: Gabriel Van Gompel, DPM
Residency Program: Kaiser South Bay Consortium
Podiatric Relevance:
The post-operative treatment for microfracture of osteochondral lesions of the talus has traditionally been non-weightbearing for 6-8 weeks. A few investigators have, however, reported successful outcomes after early weightbearing in patients treated with this procedure. No prospective studies have compared the results of early versus delayed weightbearing for microfracture treatment of osteochondral lesions of the talus.
Methods:
Eighty-one ankles in 81 patients with a single osteochondral lesion of the talus treated by arthroscopic microfracture were included in the study cohort. This was divided into two groups: the delayed weightbearing (DWB) group (41 ankles) and the early weightbearing (EWB) group (40 ankles). These two groups were comparable with regard to preoperative data. Postoperatively, patients in the DWB group maintained non-weightbearing for six weeks, but the EWB group was allowed weightbearing at two weeks. The AOFAS ankle-hindfoot score, visual analog scale (VAS) score for pain, and ankle activity score (AAS) were used to evaluate clinical outcomes. The overall mean duration of follow-up was 37 months.
Results:
Mean AOFAS ankle-hindfoot scores were 64.9 points in the DWB group and 66.5 points in the EWB group preoperatively, and these improved to 89.5 and 89.3 at the final follow-up visits. Mean VAS scores were 7.3 points in the DWB group and 7.4 points in the EWB group preoperatively and 1.9 and 1.8 at final follow-up. Mean AAS in the DWB and EWB groups improved from 3.0 and 3.0 preoperatively to 6.0 and 6.0 at final follow-up. No significant differences were found between the two groups in terms of the AOFAS score, VAS score and AAS.
Conclusion:
The two postoperative treatments after arthroscopic microfracture for small to midsized osteochondral lesions of the talus showed good clinical results and similar outcomes in terms of the AOFAS score, VAS score and AAS. This study shows that early weightbearing protocol can be used successfully in the postoperative treatment of microfracture of small to midsized osteochondral lesions of the talus.