Return to Play and Rehabilitation Protocols following Autologous Osteochondral Transplantation for Osteochondral Lesions of the Talus: A Systematic Review and Meta-Analysis

CATEGORY: Ankle, Sports INTRODUCTION/PURPOSE: Autologous osteochondral transplantation (AOT) has demonstrated favourable outcomes in the treatment of osteochondral lesions of the talus (OLT). Recent studies have reported high rates of return to play sports following AOT for OLT, however variable rates of return to play have been reported ranging from 50 to 95%. In addition, little information regarding optimal standardized rehabilitation protocols and return to play guidelines has been demonstrated. The purpose of this study is to determine the rate of return to play following AOT for OLT by systematic review and meta-analysis and report subsequent rehabilitation protocols. METHODS: The MEDLINE, EMBASE and The Cochrane Library databases was evaluated according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using specific inclusion/exclusion criteria. The quality of evidence was evaluated using the Modified Coleman Methodology Score (MCMS). Predetermined data was extracted on a datasheet with the return to play calculated as a percentage of patients that returned to sport. Rehabilitation protocols were recorded as the earliest time that range of motion, partial weightbearing and full weightbearing commenced was recorded. The quality of return to play guidelines in each study was evaluated based on the criteria by Zaman et al. Well defined return to play criteria was allocated a score of 4, poorly defined criteria allocated a score between 1 to 3 and no return to play criteria allocated 0. The meta-analysis of return to play was performed using previously published criteria. RESULTS: The search strategy yielded 8 studies evaluating 200 ankles with a mean follow-up of 44.3 ± 26.8 months (range, 16 to 84 months), mean age of 31.3 ± 6.92 years (range, 22.7 to 42 years) and mean OLT size of 119.2 ± 35.3 mm2 (range, 68.9 to 180 mm2). The mean time to return to play was 4.55 ± 2.19 months (range, 3 to 6.1 months). The reported rates of return to play ranged from 50% to 95.2%. The accumulative rate of return to play was 83.8% (140/167), with 77.4% (48/62) of athletes returning to pre-injury status. Based on the fixed-effect model, the rate of return to play was 81.5% (Figure 1). The quality of return to play criteria was poor in all. CONCLUSION: This systematic review indicates high rate of return to play following AOT in the athletic population. Rehabilitation protocols were largely inconsistent and were primarily based on individual surgeon protocols. The included studies were of low level and quality of evidence, therefore, further well-designed studies are warranted to sufficiently improve the reporting accuracy for rate of return to play.