• Foot & Ankle Conditions
• Orthopaedics Clinical Trials

• Orthopaedics
• Foot & Ankle Conditions
• Orthopaedics Clinical Trials

Injury to the articular cartilage and subchondral bone of the talar dome rarely heals without treatment, and nonsurgical treatment is successful only 45% of the time [Verhagen RA et al. Foot Ankle Clin. 2003]. Neither approach is recommended for osteochondral lesions of the talus (OLTs), which are best treated by arthroscopic bone marrow stimulation with microfracture surgery, particularly for symptomatic OLTs < 15 mm in diameter. This procedure is technically simple and minimally invasive with low complication rates and postoperative pain [Ferkel RD et al. Am J Sports Med. 2008].

However, the quality and volume of repair tissue can be affected by postoperative loading, with excessive loads causing destruction of repaired tissue. For this reason, early non-weight bearing range-of-motion exercises for a minimum of 6 to 8 weeks, followed by progression to full weight bearing by 3 months, are widely recommended [Ferkel RD et al. Am J Sports Med. 2008]. Although a few investigators have reported successful outcomes after early weight bearing in patients treated with microfracture for chondral knee and ankle injuries with lesions < 15 mm in diameter [Li S et al. Chin Med J. 2014; Lee DH et al. Am J Sports Med. 2012], early and delayed (or non-weight bearing for 6 weeks) postoperative treatments after microfracture have not been compared in a randomized controlled trial.

Keun-Bae Lee, MD, PhD, Chonnam National University Hospital, Gwangju, Korea, reported that delayed and early weight-bearing postoperative regimens are equally beneficial for patients treated by microfracture for small to midsized OLTs.

Of 99 patients presenting with OLTs, 41 were randomized to delayed weight bearing and 40 to early weight bearing. For patients in the delayed weight-bearing arm, a posterior splint was applied during the first week. Active ankle range-of-motion and strength exercises were started in the second week. Non-weight bearing was maintained for 6 weeks. After 8 weeks, the posterior splint was removed. Patients in the early weight-bearing arm also received a posterior splint during the first week. Early in week 2, partial weight bearing in a walking boot was allowed, followed by early full weight bearing as tolerated. After 8 weeks, the walking boot was removed.

There were no significant demographic differences between the 2 arms. The mean age was 36 years; the majority were men; and the mean lesion size was 1.0 cm². There were no differences in American Orthopaedic Foot & Ankle Society scores preoperatively or during follow-up out to 24 months between the arms. There were also no differences in visual analogue scale or ankle activity score during postoperative follow-up out to 24 months.

No significant correlations were found between final American Orthopaedic Foot & Ankle Society scores based on sex, age, body mass index, duration of symptoms, or lesion size. Similar outcomes for delayed and early weight-bearing postoperative treatments suggest that either approach can be recommended for patients treated by microfracture for small to midsized OLTs.

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