Description
Non-weightbearing after Osteo(chondral) Grafts for Medial Osteochondral Defects of the Talus with Medial Malleolar Osteotomy: 5 vs 6 Weeks
Objectives
•When surgically treating osteochondral lesions of the talus (OLTs), a medial malleolar osteotomy may be needed to gain adequate access to the joint.
•Post-operatively, treatment protocols often exist out of a period of non-weightbearing and subsequently (partially) weightbearing.
•It is, however, unknown how many weeks patients should be immobilized.
•Therefore, it is the primary aim of the present study to compare the Numeric Rating Scale (NRS) of pain during Walking at 1-year follow-up after 5 or 6 weeks of immobilization after Talar OsteoPeriostic grafting from the Iliac Crest (TOPIC).
•The secondary goal is to assess other clinical outcomes and safety outcomes between both groups.
Methods
•This is a prospective case-control comparative cohort study
•Patients from the 5 weeks immobilization group were matched with the 6 weeks immobilization group in a ratio of 1:2, using factors that have been shown as being of prognostic value.
•All patients were prospectively followed, and the clinical outcomes were evaluated using the NRS of pain during walking, rest, and stairclimbing. Additionally, the Foot and Ankle Outcome Score (FAOS) and the AOFAS ankle-hindfoot score were assessed.
•Radiological characteristics such as lesion surface area, volume, morphology and location were determined on pre-op CT and osteotomy union and graft incorporation were assessed at 3 months and 1 year follow-up.
Results
•11 patients were included in the 5 weeks immobilization group and 22 in the 6 weeks group.
•No significant differences were found on baseline (Table 1).
•The NRS during walking in the 5 weeks group improved with 3.5 points and 4 points for the 6 weeks group (p=0.576, Figure 1). In addition, all other NRS scores, FAOS subscales and AOFAS scores improved (all n.s., Table 2).
•No significant differences in radiological outcomes were found, and also not in terms of complications and reoperations.
Conclusion
No significant differences were found in terms of clinical, radiological and safety outcomes between 5 weeks or 6 weeks of immobilization following a TOPIC procedure for a medial OLT. Therefore, we advise that the immobilization period can be decreased by one week and thereby the convenience of patients will improve.
