Autologous Osteochondral Transplantation for Osteochondral Lesions of the Talus: Does Gender Impact Outcomes?

CATEGORY: Ankle INTRODUCTION/PURPOSE: Autologous osteochondral transplantation (AOT) is commonly used in the treatment of osteochondral lesions (OCL) of the talus. There is limited data comparing gender differences in the incidence and presentation of talar OCLs and resultant outcomes following AOT. The purpose of this study is to compare these differences between male and female patients. METHODS: Eighty-seven consecutive patients who underwent AOT were retrospectively reviewed. Patients were divided into two groups based on gender. Demographic data and OCL defect characteristic data were recorded. Functional outcomes were assessed pre- and post-operatively using the Foot and Ankle Outcome Score (FAOS). The Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score was used to assess cartilage incorporation. RESULTS: Fifty-six (64%) males and 31 (36%) females with a mean clinical follow-up was 47.2 months were included in this study. OCL defect size was significantly larger in male patients (112.8mm(2)) when compared with female patients (88.7mm(2)) (p<0.0001). Male patients presented with a significantly longer duration of symptoms (p<0.001) and OCLs were more likely to be associated with a recognized trauma (p=0.0006) when compared with female patients who typically presented with associated chronic ankle instability. Mean FAOS improved pre- to postoperatively from 50 to 81(p< 0.001) with a statistically significant increase found in male patients (p<0.0001). The mean MOCART score was 82.1 in male and 86.7 female patients. (p<0.0001).No differences were found in knee donor site morbidity, complication rate, or revision surgery between male and female patients. CONCLUSION: Our study demonstrates that male patients typically present with talar OCLs that are larger in size, associated with a recognized trauma, and with longer symptom duration when compared with female patients. Talar OCLs in female patients typically were smaller in size and associated with chronic ankle instability. In addition, male patients had greater improvement in FAOS scores following AOT. Therefore, understanding these differences may influence the management and treatment of talar OCLs in male and female patients.