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

J Banks Deal Jr, Jeanne C Patzkowski, Adam T Groth, Paul M Ryan, Thomas C Dowd, Patrick M Osborn, Claude D Anderson, James R Ficke, Kevin L Kirk, J Banks Deal Jr, Jeanne C Patzkowski, Adam T Groth, Paul M Ryan, Thomas C Dowd, Patrick M Osborn, Claude D Anderson, James R Ficke, Kevin L Kirk

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 mm2 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 6-week follow-up appointment as compared to the DWB group (83.1 ± 13.5 vs 68.7 ± 15.8, P = .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.

Keywords: ankle arthroscopy; early weightbearing; osteochondral lesions of the talus; rehabilitation.

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: J. Banks Deal Jr, MD, Adam T. Groth, MD, Thomas C. Dowd, MD, and Kevin L. Kirk, DO, report this is part sponsored by a research grant from the American Orthopaedic Foot & Ankle Society. ICMJE forms for all authors are available online.

© The Author(s) 2019.

Figures

Figure 1.
Figure 1.
CONSORT flow diagram.
Figure 2.
Figure 2.
AAOS Foot and Ankle Questionnaire scores are displayed from preoperative values through 2 years of follow-up. AAOS, American Academy of Orthopaedic Surgery foot and ankle score.
Figure 3.
Figure 3.
Numeric rating scale pain scores are displayed from preoperative values through 2 years of follow-up.

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