Autologous osteochondral transplantation for osteochondral lesions of the talus: high rate of return to play in the athl
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Autologous osteochondral transplantation for osteochondral lesions of the talus: high rate of return to play in the athletic population Dexter Seow1 · Yoshiharu Shimozono1 · Arianna L. Gianakos2 · Eugenio Chiarello3 · Nathaniel Mercer1 · Eoghan T. Hurley1 · John G. Kennedy1 Received: 22 March 2020 / Accepted: 6 August 2020 © European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2020
Abstract Purpose (1) To determine the rate of return to play following autologous osteochondral transplantation (AOT) for osteochondral lesions of the talus (OLT) and (2) report subsequent rehabilitation protocols. Methods A systematic review of the PubMed, Embase, and The Cochrane Library databases was performed according to the PRISMA guidelines based on specific eligibility criteria. Return to play data was meta-analysed and subsequent rehabilitation protocols were summarised. Level of evidence and quality of evidence (Zaman’s criteria) were also evaluated. Results Nine studies that totalled 205 ankles were included for review. The mean follow-up was 44.4 ± 25.0 (range 16–84) months. The mean OLT size was 135.4 ± 56.4 mm2. The mean time to return to play was 5.8 ± 2.6 months. The mean rate of return to play was 86.3% (range 50–95.2%), with 81.8% of athletes returning to pre-injury status. Based on the fixed-effect model, the rate of return to play was 84.07%. Significant correlation was found between increase age and decrease rate of return to play (R2 = 0.362, p = 0.00056). There was no correlation between OLT sizes and rate of return to play (R2 = 0.140, p = 0.023). The most common time to ankle motion post-surgery was immediately and the most common time to full weightbearing was 12 weeks. Conclusions This systematic review indicated a high rate of return to play following AOT in the athletic population. Size of OLT was not found to be a predictor of return to play, whereas advancing age was a predictor. Rehabilitation protocols were largely inconsistent and were primarily based on individual surgeon protocols. However, the included studies were of low level and quality of evidence. Level of evidence Level IV. Keywords Osteochondral lesion · Talus · Autograft · Rehabilitation protocol · Return to sport
Introduction Osteochondral lesions of the talus (OLT) are common injuries amongst the sporting population. They can occur in upwards of 50% of patients with chronic ankle instability and 70% of patients with concurrent ankle fractures [17]. Symptomatic OLT have often required operative intervention * John G. Kennedy [email protected] 1
NYU Langone Health, NYU Langone Orthopedic Hospital, 171 Delancey Street, New York, NY 10002, USA
2
Jersey City Medical Center – RWJ Barnabas Health, Jersey City, NJ, USA
3
ULSS3 Serenissima, Ospedale dell’Angelo, Orthopaedics and Traumatology, Venice, Italy
[35]. Autologous osteochondral transplantation (AOT) is an operative option that replaces the osteochondral defect with autologous viable cartilage and subchondral bone by transplantati
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