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

Abstract

Background: Osteochondral lesions of the talus (OLTs) are common injuries in young, active patients. Microfracture is an effective treatment for lesions less than 150 mm 2 in size. Most commonly employed postoperative protocols involve delaying weightbearing for 6 to 8 weeks (DWB), though one study suggests that early weightbearing (EWB) may not be detrimental to patient outcomes. The goal of this research is to compare outcomes following EWB and DWB protocols after microfracture for OLTs. Methods: We performed a prospective, randomized, multicenter clinical trial of subjects with unilateral, primary, unifocal OLTs treated with microfracture. Thirty-eight subjects were randomized into EWB (18 subjects) and DWB (20 subjects) at their first postsurgical visit. The EWB group began unrestricted WB at that time, whereas the DWB group were instructed to remain strictly nonweightbearing for an additional 4 weeks. Primary outcome measures were the American Academy of Orthopaedic Surgery (AAOS) Foot and Ankle score and numeric rating scale (NRS) pain score. Results: The EWB group demonstrated significant improvement in AAOS Foot and Ankle Questionnaire scores at the 6week follow-up appointment as compared to the DWB group (83.1 + 13.5 vs 68.7 + 15.8, P ¼ .017). Following this point, there were no significant differences in AAOS scores between groups. At no point were NRS pain scores significantly different between the groups. Conclusions: EWB after microfracture for OLTs was associated with improved AAOS scores in the short term. Thereafter and through 2 years' follow-up, no statistically significant differences were seen between EWB and DWB groups. Level of Evidence: Level II, prospective randomized trial.

Impact of Early Weightbearing After Ankle Arthroscopy and Bone Marrow Stimulation for Osteochondral Lesions of the Talus

“…Based on the underlying mechanism of repair, conservative postoperative protocols have traditionally been followed to protect the new fibrocartilage and promote further healing. 4 In cases in which microfracture sites have been revisited arthroscopically, there is evidence that the natural borders of the lesion confer a protective environment for the new cartilage from the loading forces of weightbearing and thus do not require restrictions. 9 Literature detailing earlier weightbearing protocols for OLT microfracture has reported successful outcomes, which is supported by the postoperative pain ratings and lack of increased complications found in this study.…”

“…The ability to allow EWB, specifically in the ankle, is based on the bony architecture, which confers a stability not seen in other joints and is less reliant on soft tissue constraints. 1 , 16 , 18 , 19 Specifically, regarding OLT microfractures, studies by Lee et al 11 and Deal et al 4 compared early mobilization at 2 weeks and late mobilization at 6 weeks, each showing comparable outcomes years after the procedures in both the VAS and the American Orthopedic Foot & Ankle Society scores. 4 , 11 One study that did examine immediate WBAT postoperatively in 58 patients showed a decrease in the VAS from 7.31 to 0.95 postoperatively, with just the use of a figure-of-8 brace, but did not have a weight restricted cohort to compare directly against.…”

“… 1 , 16 , 18 , 19 Specifically, regarding OLT microfractures, studies by Lee et al 11 and Deal et al 4 compared early mobilization at 2 weeks and late mobilization at 6 weeks, each showing comparable outcomes years after the procedures in both the VAS and the American Orthopedic Foot & Ankle Society scores. 4 , 11 One study that did examine immediate WBAT postoperatively in 58 patients showed a decrease in the VAS from 7.31 to 0.95 postoperatively, with just the use of a figure-of-8 brace, but did not have a weight restricted cohort to compare directly against. 12 The primary difference between our study and those in the literature is the inclusion of a direct comparison of NWB cohorts against which the outcomes measures can be directly compared.…”

Talus Osteokondral Lezyon Cerrahisi Sonrası Uygulanan Kısmi Ağırlık Aktarma Protokolünün Anlık Geri Bildirim ile Takibinin Erken Dönem Ağrı, Kinezyofobi ve Fonksiyon Üzerine Etkisi

“…Cerrahi sonrası kıkırdak dokuya uygun miktarlarda ağırlık aktarımı (kısmi ağırlık aktarma) ile mobilizasyon erken dönem rehabilitasyon yaklaşımlarının temel hedeflerinden biridir. Cerrah ve fizyoterapist tarafından belirlenen ağırlık aktarma miktarları dışındaki tüm yüklenmeler doku için anormal yüklenme olarak kabul edilir (Deal Jr, 2019). Cerrahi sonrası en başarılı sonuç, rehabilitasyon sürecinde anlık geri bildirim özelliği olan sistemlerin kullanımı, ameliyatı takiben kıkırdak doku üzerine belirlenen miktarda yüklenme oluşturulması ve yürüyüşün devamlılığını sağlayarak elde edilmiştir.…”