Abstract
PurposeAlthough bone marrow stimulation (BMS) as a treatment for osteochondral lesions of the talus (OCLT) shows high rates of sport resumption at short-term follow-up, it is unclear whether the sports activity is still possible at longer follow-up. The purpose of this study was, therefore, to evaluate sports activity after arthroscopic BMS at long-term follow-up.MethodsSixty patients included in a previously published randomized-controlled trial were analyzed in the present study. All patients had undergone arthroscopic debridement and BMS for OCLT. Return to sports, level, and type were assessed in the first year post-operative and at final follow-up. Secondary outcome measures were assessed by standardized questionnaires with use of numeric rating scales for pain and satisfaction and the Foot and Ankle Outcome Score (FAOS).ResultsThe mean follow-up was 6.4 years (SD ± 1.1 years). The mean level of activity measured with the AAS was 6.2 pre-injury and 3.4 post-injury. It increased to 5.2 at 1 year after surgery and was 5.8 at final follow-up. At final follow-up, 54 patients (90%) participated in 16 different sports. Thirty-three patients (53%) indicated they returned to play sport at their pre-injury level. Twenty patients (33%) were not able to obtain their pre-injury level of sport because of ankle problems and eight other patients (13%) because of other reasons. Mean NRS for pain during rest was 2.7 pre-operative, 1.1 at 1 year, and 1.0 at final follow-up. Mean NRS during activity changed from 7.9 to 3.7 to 4.4, respectively. The FAOS scores improved at 1 year follow-up, but all subscores significantly decreased at final follow-up.ConclusionAt long-term follow-up (mean 6.4 years) after BMS for OCLT, 90% of patients still participate in sports activities, of whom 53% at pre-injury level. The AAS of the patients participating in sports remains similar pre-injury and post-operatively at final follow-up. A decrease over time in clinical outcomes was, however, seen when the follow-up scores at 1 year post-operatively were compared with the final follow-up.Level of evidenceLevel II.
Highlights
Materials and methodsOsteochondral lesions of the talus (OCLT) are lesions to the subchondral bone and the overlying cartilage layer
These numbers are much higher than the return to sport (RTS) to pre-injury level which we found being 53% at final follow-up
Arthroscopic bone marrow stimulation (BMS) in OCLT results in 90% of return to sports/physical activity with 53% being able to return to their pre-injury level of sport at a mean follow-up of 6.4 years
Summary
Osteochondral lesions of the talus (OCLT) are lesions to the subchondral bone and the overlying cartilage layer. The authors showed that the activity level seemed to decrease at long-term follow-up [28] In most studies, it is often unclear whether authors reported on return to pre-injury level or return to any associated level of sports. The sport outcomes, the AAS, the NRS scales (at rest and when running), the FAOS, and return to work had been assessed in the previous study by Reilingh et al [19] both pre-operatively and 1 year post-operatively which, facilitated a formal comparison in changes over time. Differences in FAOS scores, NRS of pain, and AAS at final follow-up were assessed between patients in the two different original treatment groups (PEMF and Placebo) by means of an independent samples t-test. The comparisons with p < 0.05 were considered to be statistically significant
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