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Articular Talar Injuries in Athletes

Results of Microfracture and Autogenous Bone Graft

From the Department of Sports Medicine, Palo Alto Medical Foundation, Palo Alto, California

^* Address correspondence to Amol Saxena, DPM, Department of Sports Medicine, Palo Alto Medical Foundation, 795 El Camino Real, Palo Alto, CA 94301 (e-mail: HeySax{at}aol.com).

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.

Hypothesis: 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.

Study Design: 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.

Key Words: osteochondral defect • transchondral lesion • osteochondritis dissecans • talus • bone grafting • microfracture