There Is No Difference in Clinical Outcomes Between Early or Late Weight-Bearing After Autologous Osteochondral Transplantation for Osteochondral Lesion of the Talus: A Systematic Review.

Abstract

Purpose: To provide a comprehensive systematic review to determine the impact of early weight-bearing compared with late weight-bearing on the clinical outcomes of patients who underwent osteochondral lesion of the talus (OLT) and were treated with autologous osteochondral transplantation (AOT) and to review the rate of return to sports and/or activities, patient satisfaction, and complications.

Methods: A systematic review of the PubMed, Embase, and The Cochrane Library databases was performed according to the Preferred Reporting Items for Systemic Reviews and Meta-Analyses guidelines. Publications were divided into group A, in which patients were allowed early weight-bearing within the first 6 weeks, whereas group B consisted of patients who were only allowed weight-bearing after 6 weeks. Unweighted estimates were calculated instead of quantitative random-effects meta-analysis due to the high heterogeneity and low level of evidence of the included studies.

Results: In total, 44 studies with 1,838 ankles were included. There were 25 studies in group A and 19 studies in group B. Both the American Orthopaedic Foot and Ankle Society and visual analog scale scores were not affected by early weight-bearing after AOT for OLT. There were similar rates of return to sports and/or activities (71.4%-100% vs 71.4%-100%) and patient satisfaction (71.4%-100% vs 65.7%-100%). Notably, late weight-bearers had lower rates of postoperative knee symptoms (0-30% vs 0-39.1%) despite more late weight-bearers presenting with complication rates >20% compared with early weight-bearers (20% vs 14.3%) respectively. Late weight-bearers also had greater rates of repeat surgery (0-26% vs 0-18.2%) compared with early weight-bearers, with the most common cause for repeat surgery being arthroscopic debridement for postoperative impingement pain.

Conclusions: Protocols allowing for early weight-bearing after AOT for OLT yielded similarly good outcomes in terms of American Orthopaedic Foot and Ankle Society, visual analog scale for pain score, return to sports and/or daily activities, and patient satisfaction when compared with late weight-bearing. Although the differences in ranges for postoperative complications were not exceedingly different, late weight-bearers have slightly lower rates of postoperative knee symptoms and marginally greater rates of repeat surgery, with the most common cause for repeat surgery being arthroscopic debridement for postoperative impingement pain, similar to the studies with a low level of evidence appraised. The strength of these conclusions is limited because of the high level of heterogeneity, low level of evidence and high risk of bias in the literature reviewed.

Level of evidence: Level IV, systematic review of Level I to Level IV studies with predominantly Level IV studies.