SLR - July 2021 - Samantha A. Miner

Lesion Size May Predict Return to Play in Young Elite Athletes Undergoing Microfracture for Osteochondral Lesions of the Talus

Reference: Lee KT, Song SY, Hyuk J, Kim SJ. Lesion Size May Predict Return to Play in Young Elite Athletes Undergoing Microfracture for Osteochondral Lesions of the Talus. Arthroscopy. 2021 May; 37(5):1612-1619.

Level of Evidence: Level IV, Retrospective case series

Scientific Literature Review 

Reviewed By: Samantha A. Miner, DPM
Residency Program: Mount Auburn Hospital – Cambridge, MA

Podiatric Relevance: Ankle sprains are a common injury sustained by athletes. Osteochondral lesions of the talus (OLT) are found in approximately 50 percent of ankle sprains. Arthroscopic debridement and microfracture (MFx) for bone marrow stimulation is often the first-line surgical treatment for OLT. Prior studies have demonstrated that MFx produces adequate clinical outcomes and high rates of return-to-sports activity in athletes. However, these studies were often small case series with ambiguous definitions of return-to-sports activity. Further, prior studies have tried to determine maximum lesion size for predicting positive outcomes after MFx treatment, however none of these focused specifically on the elite athlete population. Therefore, it was the purpose of this study to evaluate clinical and sports-related outcomes of MFx treatment of OLT in elite athletes. 

Methods: Elite-level athletes who underwent arthroscopic MFx treatment for OLT at a single institution between January 2011 and September 2015 were included. Patients with less than two years of follow-up were excluded. Clinical outcomes were evaluated with the Foot and Ankle Outcome Score (FAOS), the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score, and visual analog scale (VAS) pain score. Sports-related outcomes were evaluated with time and rate of return-to-competition (RTC) and return-to-play (RTP). RTC was defined as return to an official match for at least one minute after treatment, and RTP was defined as participation in at least two entire seasons after treatment. Preoperative MRI was used to evaluate the size and location of OLT. Statistical analysis was performed comparing patients who were able to RTP to those who were not, including a receiver operating characteristic (ROC) curve analysis to find the predictive cut-off value of the lesion size for RTP. 

Results: This study included 41 patients (34 males, 7 females) with a mean age of 19.34 ± 3.76 years and a mean follow up of 54.9 ± 13.72 months. The most common type of sports participation was soccer in 51.2 percent of patients (n=21). The average OLT size was 80.62 ± 45.96 square millimeters. In 36 cases (87.8 percent), the OLT was located on the medial side of the talus. Improvements were seen in all clinical outcome scales (FOAS, AOFAS hindfoot, and VAS) postoperatively, with the AOFAS hindfoot score improving from 74.46 ± 8.10 preoperatively to 91.62 ± 2.99 (P < .001) at final follow-up. All patients were able to RTC after a mean of 5.45 months postoperatively, and 74.4 percent were able to RTP. Those who were unable to RTP had significantly larger lesions than those who were able to RTP (107.00 ± 45.28 vs 71.52 ± 43.29 square millimeters, P = 0.009). 

Conclusions: All patients were able to RTC after MFx, however only 74.4 percent were able to continue as an elite athlete for at least two years after treatment. Lesion size was the only statistically significant difference between the RTP and no-RTP groups. In conclusion, this study demonstrated that elite athletes with symptomatic OLTs less than 84 square millimeters size may be successfully treated with MFx with predictable RTP. 

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