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Return to Sports After Osteochondral Autologous Transplantation of the Ankle

Posted on: 05/17/2012
In this study, surgeons measured the frequency, intensity, and sports choices of recreational sports athletes following bone grafting for an ankle injury. In all cases, the athletes had sprained their ankles with an associated bone lesion.

Ankle sprain with an osteochondral lesion refers to a sprain severe enough to cause a piece of cartilage and bone to detach. In these patients, the talus ankle bone was the area of specific injury.

Treatment was with a bone graft from the ipsilateral knee to the talus bone of the ankle. Ipsilateral means the bone graft was harvested from the knee on the same side as the injured ankle. The donor bone is carefully shaped to fit the defect or hole in the talus bone.

Patients were selected for this treatment technique with the following risk factors in mind. Previous studies have shown that people who are morbidly obese experience significant knee pain from the harvest site. Significant ankle deformity or poor alignment of the ankle axis for rotation or other movements is another risk factor that can result in poor outcomes.

Patients with ankle osteoarthritis or ligamentous instability of the ankle are not good candidates for this procedure either. And anyone young enough to have open growth plates should also not be treated with osteochondral autologous transplantation (OAT).

In this study, 131 young, active adults engaged in recreational activities and sports were included. After the osteochondral autologous transplantation (OAT procedure), everyone was followed for a minimum of two years (some were followed for as long as 12 years). The primary area of interest was the ability to return-to-sports. Pain, activity levels in general, and patient satisfaction were also measured.

They found a significant change in activity type and level from before to after surgery. Patient satisfaction was not high, possibly due to the fact that these athletes expected more after this type of surgery. Many of them altered their activity level and started avoiding high-impact activities such as jumping and contact sports.

It's likely (but not confirmed) that the athletes were afraid of injuring or reinjuring the ankle. By limiting the amount of time they played and the intensity of play, they may have believed that they could further prevent deterioration of the ankle joint.

The authors did not test out this hypothesis but just offered their theories on the athletes' behaviors. The decreased patient satisfaction may be the result of athletes who were disappointed that they could no longer train or play at the high level they participated in sports before the injury and subsequent ankle surgery. Pain at the bone donor site (knee) may also adversely affect activity and sports play as well as attitude and level of satisfaction.

As a result of these findings, the authors suggest surgeons advise young, active patients having osteochondral transplantation of the talus what to expect after surgery. There may be a risk that the outcomes won't be as expected. The patient may have to reduce activity level and possibly change type of sports participation. Surgeons should select patients carefully for this procedure keeping risk factors (especially obesity) in mind.

Jochen Paul, MD, et al. Sports Activity After Osteochondral Transplantation of the Talus. In The American Journal of Sports Medicine. April 2012. Vol. 40. No. 4. Pp. 870-874.

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