Articular talar injuries in athletes: results of microfracture and autogenous bone graft.
BACKGROUND
The treatment options of talar osteochondral lesions are numerous. Although studies show these treatments have been used with varying success, the ability to return to activity (RTA), including sports after treatment of talar dome injuries, have not been well documented.


OBJECTIVE
A treatment plan that uses microfracture for Hepple stage 2 through 4 lesions and autogenous bone grafting for Hepple stage 5 lesions for athletes with articular lesions of the talus will produce a high rate of return to athletic activity.


METHODS
Case series; Level of evidence, 4.


METHODS
Preoperative and postoperative American Orthopaedic Foot and Ankle Society (AOFAS) scores and RTA were assessed prospectively 2 to 8 years after surgery in high-demand (athletic) patients with articular injuries to the talar dome treated according to the above protocol over a 6-year period.


RESULTS
There were 26 microfracture procedures and 20 bone grafts to the talus. The AOFAS scores for both microfracture (pre-operative, 54.6; postoperative, 94.4) and bone graft (preoperative, 46.1; postoperative, 93.4) patients improved significantly. The RTA for the entire group was 17.0 +/- 5.3 weeks; for those undergoing microfracture, RTA was 15.1 +/- 4.0 weeks; and for bone grafting, it was 19.6 +/- 5.9 weeks. The RTA for the bone graft group was significantly slower than that of the microfracture group. Anterolateral lesions had significantly faster RTA and higher postoperative scores compared with other lesion locations. Arthroscopically treated lesions had similar postoperative AOFAS scores to those who had arthrotomy and did not have significantly faster RTA. Forty-four (96%) "excellent/good" AOFAS scores were achieved overall for talar lesions, with the same percentage of return to sport.


CONCLUSIONS
Talar bone grafting required a longer time to return to activity than microfracture in high-demand patients, but both groups had similar postoperative AOFAS scores. When applied to appropriate lesions, both techniques allow athletic patients to return to sports.
Department of Sports Medicine, Palo Alto Medical Foundation, 795 El Camino Real, Palo Alto, CA 94301, USA. HeySax@aol.com
Amol
A
Saxena
Colin
C
Eakin
D000328:Adult; D016512:Ankle Injuries / Q000601:surgery*; D001265:Athletic Injuries / Q000601:surgery*; D016025:Bone Transplantation / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D019637:Orthopedic Procedures / Q000379:methods*; D011446:Prospective Studies; D020127:Recovery of Function; D013628:Talus / Q000293:injuries* / Q000601:surgery*; D016896:Treatment Outcome