SLR - July 2019 - Jonathan Pajouh

Early vs Delayed Weightbearing After Microfracture of Osteochondral Lesions of the Talus: A Prospective Randomized Trial

Reference: Deal, J. Banks, Jeanne C. Patzkowski, Adam T. Groth, Paul M. Ryan, Thomas C. Dowd, Patrick M. Osborn, Claude D. Anderson, James R. Ficke, and Kevin L. Kirk. Early vs Delayed Weightbearing After Microfracture of Osteochondral Lesions of the Talus: A Prospective Randomized Trial. Foot & Ankle Orthopaedics, April 2019. doi:10.1177/2473011419838832.

Scientific Literature Review

Reviewed By: Jonathan Pajouh, DPM 
Residency Program: Hunt Regional Medical Center – Greenville, TX

Podiatric Relevance: Osteochondral lesions of the talus (OLTs) are common injuries which are seen in traumatic incidents including but not limited to ankle sprains and ankle fractures. For less severe injuries (Berndt and Hardy stage I and II lesions) non operative management typically results in about half of patient obtaining satisfactory results. For the patients that do not recover with non operative treatments with lesions less than 150 mm, arthroscopic microfracture has been shown to be an effective treatment. No established post-operative time to weightbearing has been reported and most are six to eight weeks of strict non weightbearing to allow for the development of mature fibrocartilage. Studies have shown that early weightbearing in femoral condyles have resulted in good results following microfracture in the knee. This study reviewed the difference in early weightbearing at two weeks and a delayed weightbearing group at six weeks in thirty-eight patients. The goal of this study was to compare clinical outcomes following early weightbearing and delayed weightbearing and showed no differences between the clinical outcome of early weightbearing vs delayed weightbearing.

Methods: This was a Level II prospective, randomized multicenter trial that was performed on thirty-eight OLTs treated with microfracture. Subjects underwent ankle arthroscopy with standard anterolateral and anteromedial portals. Thirty-eight subjects were randomized with eighteen early weightbearing and twenty delayed weightbearing at their first postsurgical visit. Patients were followed for two years after surgery. The average age of the patients was 34.1 (range, 21-50) years. Eighty-six percent of subjects were male. The mechanisms of injury were as follows: six falls, six traumas, sixteen twisting injuries, and nine unknown. Randomization was achieved through use of a computerized random number generator. Envelopes with the randomization assignment were prepared by a nonclinical research coordinator, then sealed until at the time of first follow-up. Eighteen early weightbearing group began unrestricted weight bearing at that time, whereas the delayed weightbearing group were instructed to remain strictly non weightbearing for an additional four weeks. Primary outcome measures were the American Academy of Orthopedic Surgery (AAOS) Foot and Ankle score and numeric rating scale (NRS) pain score.

Results: Significant improvement in AAOS Foot and Ankle Questionnaire scores were noted at the six week follow up in the early weightbearing group when compared to the delayed weightbearing group (83.1 + 13.5 vs 68.7 + 15.8, P 1⁄4 .017). It was also noted that there were no significant differences in AAOS scores between groups. At no point were NRS pain scores significantly different between the groups.

Conclusions: This study provides information on the clinical results of early vs delayed weightbearing following microfracture for OLT. Patients who were in the early weightbearing group demonstrated greater improvement in patient outcome score at six weeks after surgery then the delayed weightbearing group. Quicker times to rehab have shown good results in knees which was also shown in this study. This provides some guidance to physician’s post-operative rehabilitation course and in treatment of OLTs and shows that early weightbearing can result in better clinical outcome. 

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