Return to Play after Arthroscopic Microfracture for Osteochondral Lesions of the Talus in Young Elite Athletes

CATEGORY: Ankle; Arthroscopy INTRODUCTION/PURPOSE: The current scientific evidence for the clinical and sports-related outcomes of the surgical treatment of osteochondral lesions of the talus (OLTs) with arthroscopic microfracture (MF) in elite athletes is scarce. The purpose of curretn study is to evaluate the clinical outcomes and return to sports activity after arthroscopic MF for OLTs in elite athletes. METHODS: The files of 41 elite athletes (mean age 19.34 +- 3.76 years) who had undergone arthroscopic MF for OLTs at our institution between January 2011 and September 2015 were retrospectively reviewed. The Foot and Ankle Outcome Score (FAOS), American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot and visual analog pain (VAS) score, time and rate of ‘return-to-competition’ (RTC, defined as return to an official match for at least one minute after treatment), and rate of ‘return- to-play’ (RTP, defined as participation in at least two entire seasons after treatment) were used to evaluate the outcomes. We compared athletes who were able to RTP (RTP-group) with those who were not (No-RTP group). RESULTS: The mean follow-up was 54.9 +- 13.72 months. All five subscales of preoperative FAOS were significantly improved at the final follow-up. The mean preoperative AOFAS hindfoot score of 74.46 +- 8.10 improved to 91.62 +- 2.99 (P < 0.001) at the final follow-up. The mean preoperative VAS score of 5.44 +- 1.57 improved to 2.66 +- 1.04 (P < 0.001). All patients achieved RTC (100%) at mean time of 5.45 +- 3.18 months, and 74.4% of patients were able to RTP. The RTP-group showed significantly smaller lesions compared to the No-RTP group (71.52 +- 43.29 vs. 107.00 +- 45.28 mm2, P = 0.009). The cut-off OLT size for predicting RTP was 84.0 mm2, with a sensitivity of 90.0% and specificity of 75.9%. CONCLUSION: All athletes were able to RTC at average of 5.45 months after MF for OLTs, and 74.4% were able to RTP. The only prognostic variable for RTP was lesion size, and its predictive cut-off was 84 mm2.