Skip to main content
SpringerLink
Log in

Autologous osteochondral transplantation for osteochondral lesions of the talus: high rate of return to play in the athletic population

  • ANKLE
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

(1) To determine the rate of return to play following autologous osteochondral transplantation (AOT) for osteochondral lesions of the talus (OLT) and (2) report subsequent rehabilitation protocols.

Methods

A systematic review of the PubMed, Embase, and The Cochrane Library databases was performed according to the PRISMA guidelines based on specific eligibility criteria. Return to play data was meta-analysed and subsequent rehabilitation protocols were summarised. Level of evidence and quality of evidence (Zaman’s criteria) were also evaluated.

Results

Nine studies that totalled 205 ankles were included for review. The mean follow-up was 44.4 ± 25.0 (range 16–84) months. The mean OLT size was 135.4 ± 56.4 mm2. The mean time to return to play was 5.8 ± 2.6 months. The mean rate of return to play was 86.3% (range 50–95.2%), with 81.8% of athletes returning to pre-injury status. Based on the fixed-effect model, the rate of return to play was 84.07%. Significant correlation was found between increase age and decrease rate of return to play (R2 = 0.362, p = 0.00056). There was no correlation between OLT sizes and rate of return to play (R2 = 0.140, p = 0.023). The most common time to ankle motion post-surgery was immediately and the most common time to full weight-bearing was 12 weeks.

Conclusions

This systematic review indicated a high rate of return to play following AOT in the athletic population. Size of OLT was not found to be a predictor of return to play, whereas advancing age was a predictor. Rehabilitation protocols were largely inconsistent and were primarily based on individual surgeon protocols. However, the included studies were of low level and quality of evidence.

Level of evidence

Level IV.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Fong DT, Hong Y, Chan LK, Yung PS, Chan KM (2007) A systematic review on ankle injury and ankle sprain in sports. Sports Med 37:73–94

    Article  Google Scholar 

  2. Fraser EJ, Harris MC, Prado MP, Kennedy JG (2016) Autologous osteochondral transplantation for osteochondral lesions of the talus in an athletic population. Knee Surg Sports Traumatol Arthrosc 24:1272–1279

    Article  Google Scholar 

  3. Fraser EJ, Savage-Elliott I, Yasui Y, Ackermann J, Watson G, Ross KA, Deyer T, Kennedy JG (2016) Clinical and MRI donor site outcomes following autologous osteochondral transplantation for talar osteochondral lesions. Foot Ankle Int 37:968–976

    Article  Google Scholar 

  4. Gautier E, Kolker D, Jakob RP (2002) Treatment of cartilage defects of the talus by autologous osteochondral grafts. J Bone Joint Surg Br 84:237–244

    Article  CAS  Google Scholar 

  5. Gianakos AL, Hannon CP, Ross KA, Newman H, Egan CJ, Deyer TW, Kennedy JG (2015) Anterolateral tibial osteotomy for accessing osteochondral lesions of the talus in autologous osteochondral transplantation: functional and t2 MRI analysis. Foot Ankle Int 36:531–538

    Article  Google Scholar 

  6. Haasper C, Zelle BA, Knobloch K, Jagodzinski M, Citak M, Lotz J, Krettek C, Zeichen J (2008) No mid-term difference in mosaicplasty in previously treated versus previously untreated patients with osteochondral lesions of the talus. Arch Orthop Trauma Surg 128:499–504

    Article  Google Scholar 

  7. Haleem AM, Ross KA, Smyth NA, Duke GL, Deyer TW, Do HT, Kennedy JG (2014) Double-plug autologous osteochondral transplantation shows equal functional outcomes compared with single-plug procedures in lesions of the talar dome: a minimum 5-year clinical follow-up. Am J Sports Med 42:1888–1895

    Article  Google Scholar 

  8. Hangody L, Kish G, Kárpáti Z, Szerb I, Eberhardt R (1997) Treatment of osteochondritis dissecans of the talus: use of the mosaicplasty technique–a preliminary report. Foot Ankle Int 18:628–634

    Article  CAS  Google Scholar 

  9. Harris JD, Brophy RH, Siston RA, Flanigan DC (2010) Treatment of chondral defects in the athlete’s knee. Arthroscopy 26:841–852

    Article  Google Scholar 

  10. Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560

    Article  Google Scholar 

  11. Imhoff AB, Paul J, Ottinger B, Wörtler K, Lämmle L, Spang J, Hinterwimmer S (2011) Osteochondral transplantation of the talus: long-term clinical and magnetic resonance imaging evaluation. Am J Sports Med 39:1487–1493

    Article  Google Scholar 

  12. Kennedy JG, Murawski CD (2011) The treatment of osteochondral lesions of the talus with autologous osteochondral transplantation and bone marrow aspirate concentrate: surgical technique. Cartilage 2:327–336

    Article  Google Scholar 

  13. Lamb J, Murawski CD, Deyer TW, Kennedy JG (2013) Chevron-type medial malleolar osteotomy: a functional, radiographic and quantitative T2-mapping MRI analysis. Knee Surg Sports Traumatol Arthrosc 21:1283–1288

    Article  Google Scholar 

  14. Lee CH, Chao KH, Huang GS, Wu SS (2003) Osteochondral autografts for osteochondritis dessicans of the talus. Foot Ankle Int 24:815–822

    Article  Google Scholar 

  15. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JPA, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Ann Intern Med 51:W-65–W-94

  16. Marx RG, Wilson SM, Swiontkowski MF (2015) Updating the assignment of levels of evidence. J Bone Joint Surg Am 97:1–2

    Article  Google Scholar 

  17. Murawski CD, Kennedy JG (2013) Operative treatment of osteochondral lesions of the talus. J Bone Joint Surg Am 95:1045–1054

    Article  Google Scholar 

  18. Neyeloff JL, Fuchs SC, Moreira LB (2012) Meta-analyses and Forest plots using a Microsoft excel spreadsheet: step-by-step guide focusing on descriptive data analysis. BMC Res Notes 5:52

    Article  Google Scholar 

  19. Nguyen A, Ramasamy A, Walsh M, McMenemy L, Calder JDF (2019) Autologous osteochondral transplantation for large osteochondral lesions of the talus is a viable option in an athletic population. Am J Sports Med 47:3429–3435

    Article  Google Scholar 

  20. Nosewicz TL, Reilingh ML, Wolny M, van Dijk CN, Duda GN, Schell H (2014) Influence of basal support and early loading on bone cartilage healing in press-fitted osteochondral autografts. Knee Surg Sports Traumatol Arthrosc 22:1445–1451

    PubMed  Google Scholar 

  21. Paul J, Sagstetter A, Kriner M, Imhoff AB, Spang J, Hinterwimmer S (2009) Donor-site morbidity after osteochondral autologous transplantation for lesions of the talus. J Bone Joint Surg Am 91:1683–1688

    Article  CAS  Google Scholar 

  22. Pinski JM, Boakye LA, Murawski CD, Hannon CP, Ross KA, Kennedy JG (2016) Low level of evidence and methodologic quality of clinical outcome studies on cartilage repair of the ankle. Arthroscopy 32:214–222

    Article  Google Scholar 

  23. Potter HG, le Chong R (2009) Magnetic resonance imaging assessment of chondral lesions and repair. J Bone Joint Surg Am 91(Suppl 1):126–131

    Article  Google Scholar 

  24. Ramponi L, Yasui Y, Murawski CD, Ferkel RD, DiGiovanni CW, Kerkhoffs GMMJ, Calder JDF, Takao M, Vannini F, Choi WJ, Lee JW, Stone J, Kennedy JG (2017) Lesion size is a predictor of clinical outcomes after bone marrow stimulation for osteochondral lesions of the talus: a systematic review. Am J Sports Med 45:1698–1705

    Article  Google Scholar 

  25. Ross AW, Murawski CD, Fraser EJ, Ross KA, Do HT, Deyer TW, Kennedy JG (2016) Autologous osteochondral transplantation for osteochondral lesions of the talus: does previous bone marrow stimulation negatively affect clinical outcome? Arthroscopy 32:1377–1383

    Article  Google Scholar 

  26. Saxena A, Eakin C (2007) Articular talar injuries in athletes: results of microfracture and autogenous bone graft. Am J Sports Med 35:1680–1687

    Article  Google Scholar 

  27. Scranton PE Jr, Frey CC, Feder KS (2006) Outcome of osteochondral autograft transplantation for type-V cystic osteochondral lesions of the talus. J Bone Joint Surg Br 88:614–619

    Article  Google Scholar 

  28. Shimozono Y, Brown AJ, Batista JP et al (2018) Subchondral pathology: proceedings of the international consensus meeting on cartilage repair of the ankle. Foot Ankle Int 39(1_suppl):48S‐53S

  29. Shimozono Y, Hurley ET, Myerson CL, Kennedy JG (2018) Good clinical and functional outcomes at mid-term following autologous osteochondral transplantation for osteochondral lesions of the talus. Knee Surg Sports Traumatol Arthrosc 26:3055–3062

    Article  Google Scholar 

  30. Shimozono Y, Seow D, Yasui Y, Fields K, Kennedy JG (2019) Knee-to-talus donor-site morbidity following autologous osteochondral transplantation: a meta-analysis with best-case and worst-case analysis. Clin Orthop Relat Res 477:1915–1931

    Article  Google Scholar 

  31. Trattnig S, Millington SA, Szomolanyi P, Marlovits S (2007) MR imaging of osteochondral grafts and autologous chondrocyte implantation. Eur Radiol 17:103–118

    Article  CAS  Google Scholar 

  32. Valderrabano V, Leumann A, Rasch H, Egelhof T, Hintermann B, Pagenstert G (2009) Knee-to-ankle mosaicplasty for the treatment of osteochondral lesions of the ankle joint. Am J Sports Med 37(Suppl 1):105S–111S

    Article  Google Scholar 

  33. Yoon HS, Park YJ, Lee M, Choi WJ, Lee JW (2014) Osteochondral autologous transplantation is superior to repeat arthroscopy for the treatment of osteochondral lesions of the talus after failed primary arthroscopic treatment. Am J Sports Med 42:1896–1903

    Article  Google Scholar 

  34. Zaman S, White A, Shi WJ, Freedman KB, Dodson CC (2018) Return-to-play guidelines after medial patellofemoral ligament surgery for recurrent patellar instability. A systematic review. Am J Sports Med 46:2530–2539

    Article  Google Scholar 

  35. Zengerink M, Struijs PA, Tol JL, van Dijk CN (2010) Treatment of osteochondral lesions of the talus: a systematic review. Knee Surg Sports Traumatol Arthrosc 18:238–246

    Article  Google Scholar 

Download references

Funding

No funding has been received for this study.

Author information

Authors and Affiliations

  1. NYU Langone Health, NYU Langone Orthopedic Hospital, 171 Delancey Street, New York, NY, 10002, USA

    Dexter Seow, Yoshiharu Shimozono, Nathaniel Mercer, Eoghan T. Hurley & John G. Kennedy

  2. Jersey City Medical Center – RWJ Barnabas Health, Jersey City, NJ, USA

    Arianna L. Gianakos

  3. ULSS3 Serenissima, Ospedale dell’Angelo, Orthopaedics and Traumatology, Venice, Italy

    Eugenio Chiarello

Authors
  1. Dexter Seow
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yoshiharu Shimozono
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Arianna L. Gianakos
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Eugenio Chiarello
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Nathaniel Mercer
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Eoghan T. Hurley
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. John G. Kennedy
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to John G. Kennedy.

Ethics declarations

Conflict of interest

The authors report the following potential conflicts of interest or sources of funding: J.G.K. receives support from Ohnell Family Foundation and Mr. and Mrs. Michael J. Levitt.

Ethical approval

This manuscript is a systematic review and meta-analysis, and does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Not applicable.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Seow, D., Shimozono, Y., Gianakos, A.L. et al. Autologous osteochondral transplantation for osteochondral lesions of the talus: high rate of return to play in the athletic population. Knee Surg Sports Traumatol Arthrosc 29, 1554–1561 (2021). https://doi.org/10.1007/s00167-020-06216-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-020-06216-w

Keywords

Search

Navigation