Until now there has been little information on the success rates of autologous osteochondral transplantation for large osteochondral lesions of the talus in athletes.
Outcome Data for Autologous Osteochondral Transplantation
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A recent study, “Autologous Osteochondral Transplantation for Large Osteochondral Lesions of the Talus Is a Viable Option in an Athletic Population,” published in the October, 2019 issue of The American Journal of Sports Medicine offers evidence that is may be an effective treatment option.
The researchers collected data on 38 athletes, 11 of which were professional athletes. The mean lesion size was 249 mm2 and the mean follow-up was 45 months. Of the 38 athletes, 33 were able to return to sport at their pre-injury level and one did not return to sport at all.
The researchers found that the Visual Analog Scale (VAS) improved from 4.53 preoperatively to 0.63 postoperatively (p = .002) and Foot and Ankle Outcome Scores (FAOS) also improved (p < .001). There was also a strong association between MOCART (magnetic resonance observation of cartilage repair tissue) scores at 12 months after surgery and ability to return to sport.
According to the report, “The area under receiver operating characteristics of the MOCART score and return to play was 0.891 (p = .005), with a MOCART score of 52.50 representing a sensitivity of 0.85 and specificity of 0.80 in determining ability to return to one’s previous level of activity.”
In addition, two patients who experienced knee donor site pain each had three osteochondral plugs harvested.
The researchers wrote, “The ability to return to sport is predicated upon good graft incorporation, and further research to optimize this technique.”
“Our data suggest that patients should be aware of the increased risk of developing knee donor site pain when 3 osteochondral plugs are harvested.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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